African-Americans and Asians more pessimistic about the health systems ability to cope with a bioterrorist event

Aug 30 2004

While nearly three-quarters of Americans believe that the public health system would respond fairly in a bioterrorist event, African-Americans and Asians adhere to this view in smaller proportions, perhaps because of past discriminatory policies put in place by health officials, according to a new UCLA study.

The findings will be published in late September in Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. The article is also available online at the journal's Web site, http://www.biosecurityjournal.com/PDFs/v2n304/520402.pdf.

The multivariate study, based on a random-digit, population-based telephone survey of Los Angeles County residents, found that 72 percent of respondents overall believe that the public health system would respond fairly in a bioterrorist event.

Breaking the results down by ethnicity, however, revealed that only 63 percent of African Americans and 68 percent of Asians/Pacific Islanders--groups often discriminated against by the system-- believe that the public health system would respond fairly. By contrast, 73 percent of Latinos and 77 percent of whites thought the system's response would be fair.

Public health officials would be wise to improve their relationships with minority communities, which would help ensure an effective response both to a bioterrorist attack and disease outbreaks, according to the paper's authors

"The public's trust and cooperation will determine the success of our public health response to a large bioterror attack," said Dr. David Eisenman, assistant professor of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. "These agencies must better integrate minority communities into their terrorism response planning."

Previous reports indicate that African Americans and other groups felt betrayed by the response of the United States Postal Service, public health authorities in the District of Columbia, and the Centers for Disease Control and Prevention, to the 2001 anthrax scare, the study says. And there is a history of discriminatory public health policies against minorities in the United States, according to the paper.

At the turn of the last century, for example, public health officials quarantined San Francisco's Chinatown in response to a cluster of plague cases--a move that a federal court in 1900 ruled as unfair, saying that the quarantine was based on ethnic bias.

Health officials also unfairly distributed resources during the 1918 Spanish flu pandemic, and in Baltimore, Jim Crow segregation laws barred African Americans from hospitals, contributing to the city's high mortality rates and poor public health, the study notes.

In 1994, California voters passed Proposition 187, which would have prohibited undocumented immigrants from receiving publicly funded health care and required physicians to report these patients to immigration authorities. The law was ultimately struck down as unconstitutional.

Finally, the 1996 Personal Responsibility and Work Opportunity Reconciliation Act aims to restrict immigrants' access to public health services. While generally not followed by state and local health authorities, the act requires the reporting of undocumented immigrants who seek medical assistance.

The UCLA study was based on interviews with 8,167 participants who answered 120 core questions. A random sample of 1,041 participants answered 12 additional questions about terrorism.

According to the paper, public health officials can alleviate this perceived unfairness to minority groups by including their representatives in bioterrorism-response planning, and urging community participation during the response. It may also be necessary to address provisions of welfare and immigration laws in order to design and implement an effective response to a bioterrorist attack, the study says.

"Improving perceptions that public health agencies will respond fairly to bioterrorism events will additionally enhance their capacity to deal with emerging natural disease outbreaks," the study says.

In addition to Eisenman, co-authors included Cheryl Wold, Ben Lee, and Anna Long of the Los Angeles County Department of Health Services; Claude Setodji and Scot Hickey of the RAND Corp.; Bradley D. Stein of both the RAND Corp. and the University of Southern California.