We Cannot Have It All

This chapter discusses health gaps by giving an example of a campaign for flu vaccination. To improve the town’s flu vaccination rate, the mayor tasks the health commissioner to develop a strategy that communicates, primarily through doctors’ offices, the importance of flu vaccinations. The strategy works; the flu vaccination rate increased from 45% to 65%. This success is not as complete as it looks, however. At the level of what the mayor intended—that more residents would be vaccinated—the campaign worked. However, the health gaps in town between the rich and the poor residents also increased—substantially. Health inequities like these are the result of systematic injustice—in this case, the injustice of unequal access to health care settings where vaccine marketing and delivery take place, and the broader socioeconomic inequality this reflects. These inequities matter. After all, if a pocket of the town’s population remains unvaccinated, it puts the whole area at risk, even if vaccination rates go up among the rich. Public health must recognize that a healthy society is one where health is accessible to all—not some, or even most, but all.

Creative Destruction

Although the tenth anniversary of the crisis pictured Love Canal as a thing of the past, the area still inspired dreams of development in the future. That became clear in September 1988, when Health Commissioner David Axelrod returned to Niagara Falls to announce that the state would back Love Canal resettlement. The longtime mayor of Niagara Falls, Michael O’Loughlin, beamed at the news. This was the first “positive statement about Love Canal” in years, he said. Axelrod’s resettlement recommendation was the result of a five-year, $14 million study. Using massive amounts of test data, the study drilled down into Love Canal’s new nature to see if the monumental remediation plan had worked. The study determined that parts of the ten-block Emergency Declaration Area (EDA) had acceptable chemical levels and only slightly higher contamination risks than comparison areas hard by landfills, steel plants, and old manufacturing facilities in the American Rust Belt. While no one could certify the neighborhood’s absolute safety, Axelrod proposed that people might soon move into sections of the nearly empty subdivision. Former residents again fumed at Axelrod. Joann Hale called Axelrod’s decision “piece meal,” at best, and dangerous at worst. Anything but a “black and white” answer about the safety of resettlement was wrong. The ETF’s Roger Cook said that resettlement posed “unacceptable risks” to future residents. Janet Ecker, a former resident not known for screaming and shouting, told a reporter that Axelrod’s announcement was “very sad.” “I don’t agree it is a safe place. The chemicals don’t know that they’re supposed to stop” at certain places. The mere mention of Love Canal brought back unhappy memories to Ecker, who left in 1980 for Florida and was still “glad to be as far away as I can get from that place.” Lois Gibbs went even further: it was morally wrong for the state to resettle the area. As these divergent perspectives on Axelrod’s announcement indicated, Love Canal remained a hotly contested environment well after final evacuation had occurred.

Successful Strategies for Recruitment of Emergency Medical Volunteers

ObjectivesA robust medical volunteer program is critical to ensuring a successful response to public health and medical emergencies. The New York City (NYC) Department of Health and Mental Hygiene created the NYC Medical Reserve Corps in 2003 to build a multidisciplinary team of health professionals who wish to assist NYC with response during large-scale health emergencies. This article reports on the search to determine which recruitment activities have been most successful to date, with the goal of modeling future activities upon those that worked best.MethodsA retrospective review of effectiveness of recruitment strategies to identify and register new NYC Medical Reserve Corps volunteers was undertaken.ResultsA broad range of recruitment activities have been implemented since the program's inception, with varying degrees of success. Various recruitment modalities were tried, including direct invitations to licensed professionals by the NYC Health Commissioner and announcements through professional organization partners. The direct invitation by the NYC Health Commissioner to health professionals licensed in 1 of the 5 boroughs of NYC has proved to be the most successful recruitment tool to date.ConclusionsThe local health commissioner or other trusted community figure is an excellent messenger for recruiting emergency volunteers. It is also critical that recruitment messages reach as many potential volunteers as possible to ensure that the requisite number of volunteers and mix of professional disciplines are identified. (Disaster Med Public Health Preparedness. 2013;7:266-271)