"SWINE CONFLUSION"

http://www.gwu.edu/~cih/journal/JHClink/v14n5_editorial.pdf

SWINE CONFLUSION
Journal of Health Communication: International Perspectives
Volume 14, Issue 5

Like a Hollywood thriller movie, the 2009 flu outbreak developed in real time, complete with phases of pandemic alert issued by the World Health Organization (WHO) as if they were DEFCON warnings, the defense readiness condition that gauges activation and readiness of the United States Armed Forces.
While the DEFCON describes progressive levels from peacetime (DEFCON 5) to imminent attack (DEFCON 1), the WHO alert is a technical description designed for incorporation into member states (aka 192 governments) national preparedness and response plans. The WHO Phase 5 warning means a virus has spread into at least two countries and is causing
large outbreaks. The highest phase, Phase 6, means outbreaks have been detected in two or more regions of the world and a pandemic is under way. These do not relate nor communicate imminence of deaths or protective actions by individuals.

We are understandably confused and concerned. Information is pouring in 24/7 through media coverage, social media, blogs and conversations. We have seen frightening images, hear that hundreds of schools have closed, and heard that our President is worried. There is no clear consensus on what to call it - is it swine flu, A/H1N1, Mexican flu, North American flu, novel flu or just seasonal flu? Some leaders in the US and Europe suggested we limit or cancel travel...or not.

This is not just a case of communicable chaos, but a real test of our ability to appropriately reach and inform citizens with understandable,
reliable, and actionable news (information) they can use.

It’s about health literacy. What do I need to know and do today to protect my health and that of my family? Where do I find information that I can understand and trust? It is confusing...do I “stay home” if I am sick
and avoid exposing others, or “seek medical attention” if I am sick and wonder if I have this flu? And Tamiflu and Relenza...should I get
some just in case? How can I get it? Does it really expire exactly on the date like the label says, or can I save it and use it later? How do
I figure out and do the best things for my family’s health?
People should know if they are at risk and what they can do. We need a widely known, accessible repository of trustworthy, actionable
health information that everyone knows how to find and use. Health literacy - people having the ability to obtain, process and understand
basic health information and services to make appropriate health decisions - is a global challenge. In the US, it is estimated that nearly
half of the adult population does not have the ideal level.

Ironically, I write from Beijing where I am participating in a United Nations ministerial meeting on “Promoting Health Literacy.” This
includes the World Health Organization, the Chinese Government with the Health Minister, leaders from the Asian Pacific and other
experts. There has been considerable discussion on the swine flu.

Given the Chinese experience in handling avian flu and subsequently SARS, the general consensus from China is that the flu will be
“defeated.”Nonetheless, the front page of the May 1st China Daily, cites the Chinese Health Minister stating he had pork for lunch the day
before. The article also mentions the Minister referencing a cartoon published in China Daily during the bird flu outbreaks, that “depicts
the best way to fight the disease - cooking chicken with star aniseed, the main ingredient in Tamiflu, which kills the virus.
“I suggest people cook pork with star aniseed as a good prevention method.” “

In this case, we are relying on the media to effect behavior change - multiple sources encourage us to wash our hands frequently, practice
good hygiene by covering our mouths when we cough and sneeze, and seek medical care if we have flu-like symptoms, including fever.
This epidemic will run its course - just as the mad cow crisis (never a human epidemic, with 150 deaths over 10 years due to the linked
nv-CJD), avian flu panic in 2005 (257 deaths due to H5N1) and SARS panic in 2002-3 with 774 deaths. did. Yet, it also underscores our need
to know where to find and how to use reliable health information for action. We should hope that the mediademic will curtail and leave
behind a basic health literacy.

It also may heed a warning that future opportunities at the global, regional, federal and state levels to “promote health literacy” needs to
be a priority. Our history documents that an informed activated public is of utmost most importance in protecting the health of the
public. Likewise, an informed and activated leadership that employs health diplomacy to advance a “health literate” population is
foundational for health and well-being. It is incumbent upon all of us to contribute to such a goal.

~Scott Ratzan, Beijing, 1 May 2009

Scott C. Ratzan MD, MPA, Vice President, Global Health, Johnson & Johnson,
and Editor-In-Chief of the Journal of Health Communication: International Perspectives.

For more information on Journal of Health Communication, visit www.tandf.co.uk/journals/UHCM