The recent flu outbreak caused a wave of panic that subsided almost as quickly as it arose. Outside of Mexico the scattered deaths were but a handful compared to all those who die from regular flu outbreaks every year.  And yet there were lasting impacts, lasting lessons to be learned.  

Internationally, the coordinated efforts of research scientists put together the genetic history of how the new strain evolved from a recombination of human, avian and swine flu strains within a matter of days, tracing events from Thanksgiving 2005 in Sheboygan, Wisconsin all the way to April 2009 in La Gloria, Mexico. The specifics they learned also carried a broader lesson, as indicated in an article in Newsweek magazine ("The Path of a Pandemic," May 18, 2009) by Laurie Garrett. senior fellow for global health at the Council on Foreign Relations, and author of The Coming Plague: Newly Emerging Diseases in a World Out of Balance and Betrayal of Trust: The Collapse of Global Public Health.

"Fingers are now pointing, either at the entire pig species Sus domestica, or at the nation of Mexico," Garret wrote.  But the reality that researchers quickly traced pointed elsewhere, she wrote: "We live in a globalized world, filled with shared microbial threats that arise in one place, are amplified somewhere else through human activities that aid and abet the germs, and then traverse vast geographic terrains in days, even hours-again, thanks to human activities and movements. If there is blame to be meted out, it should be directed at the species Homo sapiens and the manifest ways in which we are reshaping the world ecology, offering germs like the influenza virus extraordinary new opportunities to evolve, mutate and spread."

In contrast, the lessons were mostly fine-tuning at the immediate community level, where emergency preparedness planning and drills have become routine-and also reflect a highly interconnected world.  "We've been in planning for a flu pandemic for four and a half, five years," said Christopher Riccardi, Disaster Preparedness Coordinator for Providence Hospital, Little Company of Mary, Torrance and San Pedro. "Because of that our hospitals have put a lot of resources into place for what just happened.  This was really not a surprise."

In a addition to flu-specific planning, the hospitals participate in disaster preparedness drills at the state and local levels. "We do two live drills every year," Riccardi explained. "The statewide drill though based on terrorist attack is applicable to a flu pandemic."  Such drills involve extensive coordination with emergency responders-fire and police departments-as well the County Health Department.

The contingencies they've trained for are far more severe than anything seen anywhere in America during the recent H1N1 virus outbreak.  "We have a decontamination trailer that can handle 40-60 patients per hour, to render them safe to be treated," Riccardi said. "We can set up external treatment areas.  We have plans that trigger different types of response, according to how many people we have to treat."  And it's not just plans. "We train at least once every quarter," he added.

With all this planning and training, the modest upsurge in patients with flu symptoms did not hold any major surprises, or lessons at the hospital level.  But for society at large, it's a different matter, since the threat of a deadly pandemic vividly reminds us that health care is not merely a matter of individual health care coverage, even as healthcare debates take center stage in DC.  There are all sorts of other factors involved in what's commonly referred to as the field of public health, and it's advances in public health-beginning with water sanitation systems in the 19th Century-which have been responsible for the majority of advances in improving health and extending average lifespans several decades longer than they once were.

Yet, writing in Huffington Post ("H1N1 'Swine' Flu: A Global Wake-Up Call", May 12, 2009), Rear Admiral Susan Blumenthal, M.D. (ret.) pointed out, "[D]espite the documented power of public health interventions to prevent and control disease outbreaks, only 1-3 % of US health expenditures are spent on prevention, a percentage that is unchanged since the 1930s. Additionally, the 47 million Americans who lack health insurance experience difficulty accessing and receiving care. This results in missed opportunities for early diagnosis and treatment of infectious illnesses such as the flu, which can lead to poorer health outcomes and the inadvertent spread of disease."

Beyond commonly identified public health expenditures, there is an entire range of social and environmental factors that public health researchers have identified as impacting community health-factors such as our own exposure to port pollution, which causes hundreds of premature deaths each year.  Fifty such factors were systematically evaluated in a yearlong study, by Community Health Councils  (CHC), the results of which were published last December in the South LA Health Equity Scorecard report.  Findings from South LA were compared to West LA, where resources are abundant, and to LA County as a whole.  

"There is a growing body of research and data that suggests that having a health insurance card does not equate to a long and happy life," CHC executive director Lark Galloway-Gilliam told Random Lengths "Science has shown that there are environmental risk factors," and more recently, "science has moved beyond just the physical environment to what they call the social determinants of health-a lot of it from the international health community, particularly the World Health Organization-beginning to make the correlation between income level, education, and health, and then drill down to things like access to healthy and nutritional food, access to safe and hazard-free exercise and be active."

Examples cited in the report's press release include:

• South LA has roughly  11 pediatricians for every 100,000 children, compared to 193 pediatricians in West LA, and 57 in LA County overall.
  
• In South LA, 30 percent of adults are uninsured, compared to 12 percent in West LA.  
  
• In South LA there were only 34 mammograms per 1,000 uninsured women, compared to 169 in West LA and 41 county wide.
  
• South LA has 8.5 liquor stores per square mile compared to 1.97 stores in West LA.
  
• In South LA, 37 percent of households are overcrowded compared to fewer than 8 percent in West LA.
  
• In South LA, 64 percent of schools are classified as insufficiently staffed, resourced, and without a clean, safe, and functional learning environment, compared to just 8 percent in West LA..

Just as underserved populations can pose a general health risk in times of epidemic, as Blumenthal highlights, there are profound society-wide costs that result from entire communities being underserved.  Those who live shorter, sicker, less productive lives contribute far less to society as a whole than they otherwise would. In today's highly interconnected world, John Dunne's words ring truer than ever: "No man is an island unto himself," and emergency threats, like flu epidemics, only serve to starkly illuminate otherwise forgotten truths we live with every day.

"What frightens me is that when we have this kind of widespread public heath risk, the first thing I think is where do they go, if there's a full-scale outbreak?" Galloway-Gilliam asks.  "Do they have a doctor? Is there a hospital they can go to? What would have happened in communities like this? Because people just had nowhere to go.  The few resources we do have, would they have had the capacity to deal with it?  And I know the answer to that: It's no."