White Coat Underground

According to a Pew survey, 61% of Americans are getting health information online. The internet is now the third leading resource for health information after doctors and family/friends. At a recent session hosted by USC Annenberg School for Communication and Journalism, I learned this and many other things while chatting with journalists and other bloggers. It turns out (and I don’t have the data in my hands yet) that some of the “sub-trends” are pretty interesting. For example, moms and other women seem to prefer facebook to other social networking sites. I’ve noticed this anecdotally as I’ve been fielding dozens of flu questions on my own facebook page, most from moms in my community.

And in some of these interactions, I’ve found an interesting phenomenon. If you’re not familiar with the Detroit area, you still may have heard of 8 Mile Road. This is the northern border of Detroit, and has for years also served as a racial and economic border. While Detroit does have a relatively vibrant downtown area, it isn’t like similar size cities; there isn’t the huge influx of commuters to the city center and back every day. There is a terrific venue for the Detroit Symphony Orchestra, one of the countries best baseball stadiums, Ford Field, where the Lions lose, and Joe Louis Arena, where the Red Wings win. There are also just under a million people ringing this reasonably attractive downtown in a geographical area that was, a few decades ago, home to almost 2 million people. Today, Detroiters, with their unemployment rate of nearly 30%, bravely try to hold a community together in a place where abandoned homes and reclaimed urban prairies seem more common than jobs.

And the 8 Mile divide has become even firmer. As people with jobs—at first mostly white, and now black as well–have fled Detroit, poverty has concentrated below 8 Mile, and fear and suspicion cross the border more often than people. This makes what I’ve learned on facebook so surprising.

Distribution of swine flu shots has been a disaster in the U.S. There seems to be little attempt to get the so-far scarce vaccines into the highest-risk populations first. Encouraging though has been the fact that demand is high, despite anti-vaccine propaganda. In the mostly white, affluent suburbs of Detroit. it has been nearly impossible to get flu shots for high-risk people. County-wide clinics have been held in stadiums and other large venues, with people waiting in the cold for hours. There has been, as far as I can tell, no real attempt to reach those at highest risk first. Hospitals and clinics have struggled to get enough vaccine to cover their front-line staff.

But apparently, there’s some vaccine south of 8 Mile. On facebook I learned that some public health clinics in Detroit have 20-30 minute waits and are open daily, instead of the 4 hour waits waits in the suburbs at venues announced sometimes a day or two ahead of time. Normally fearful suburbanites are crossing 8 Mile and waiting in line with local residents for their shots, and are coming back north happy and immunized.

I don’t know what this means. Is our public health system reaching Detroit residents? Are suburbanites competing for a scarce local resource, or simply taking advantage of surplus? Will this have any lasting effect on the willingness of people to go to the city?

I don’t know the answer, but to anyone familiar with Detroit, this is a pretty remarkable phenomenon. For decades, mostly white suburbanites have fought to avoid regionalization of services such as transit and schools. But what about public health? Is this an foot in the door to start to bring Detroiters and suburbanites back together? Or is it just another example of the relatively privileged robbing the poor of scarce resources?

Comments

#1 MFA Mama
November 10, 2009

I don’t live in Detroit, but here? I live in an affluent school district have three extremely high-risk children and spent hours pleading with various specialists so that they could get three of the twenty doses of vaccine their pediatrician’s office (which is in a nice area of town) got…then had to go down to the local Dept. of Social Services on business and was all but tackled to the ground by volunteers staffing an H1N1 information kiosk who happily vaccinated me even though I’m low-risk (since I’m the sole caregiver to three medically compromised children I let them). Then I went to Philly to visit a friend who has donor organs (kidney and pancrease). His transplant surgeon and nephrologist said they had no clue where to get the vaccine but advised him to try so I took him to an inner-city vaccine distribution site in the basement of a run-down elementary school where we stood in line for three hours surrounded by a mix of the “huddled masses” and some very scared-looking yuppies so he could get the shot. I don’t know what to make of this, but it seems like if you live in or are willing to venture into a scary area you stand a better chance at finding a dose of the vaccine than if you live in the suburbs and just need it for medical reasons.
#2 amindell
November 10, 2009

why Detroiters aren’t using their own vacs? maybe lack of transportation; lack of outreach/education; lack of trust in the system; or, maybe the deciders cynically knew Detroit parents would not get shots but wanted to avoid the appearance of neglect and favoritism. Which could be why non-Wayne County residents are given those Detroit clinic shots but in Oakland we were told you must be an OC resident to get one.
That said, boroughs of NY are suffering same lack of enthusiasm for shots (see link I posted earlier).
I bet all told, however, there will be far fewer total doses given to poor areas than the wealthier ones.
Yes, we stood in lines for hours in Oakland County, it was clearly not the best logistic plan, but perhaps there is some psychological aspect they’ve considered? Like, it’s harder to get thus more attractive thus will motivate competitive OC parents to push through anti-vac dissemination to get the shot?
#3 Shay
November 11, 2009

Distribution of swine flu shots has been a disaster in the U.S.

Well…our county health dept* did everything right, applied for a grant to help fund community vaccination clinics, ordered the appropriate amount of vaccine correctly and on time, and has been working with the biggest local employers as well as the two county hospitals, the Red Cross and the school districts to get information and vaccines out to the public. In addition to three mass clinics we have held specialty clinics for EMTs, medical professionals, and child-care providers. We have two more clinics scheduled; Thursday’s clinic will be for county residents between the ages of 6 months and 18 years, and Sunday’s clinic is for students at the local university.

Yes, there have been waits up to three hours in a couple of the mass clinics, and no, we don’t have enough vaccine yet–but we’ve been able to push what we have gotten so far to almost 8K residents in the highest-risk groups (out of a county population of 170k). Our target for Thursday is 2500 kids and we hope to do the same number of students on Sunday.

We are surrounded by counties who are not doing nearly so well, and anecdotal evidence indicates it’s because they filed the paperwork late, or incorrectly, or in the case of one neighboring county, not at all.

So is it remotely possible that the vaccine situation in Detroit is favorable because the Wayne County Health Department knows it’s job?

(*I feel I can brag about us because I’m a recent hire at the health dept and can’t take any of the credit).
#4 BB
November 11, 2009

No H1N1 vaccine here yet. Daughter in college now has flu, because vaccines were never given. Thankfully, she started Tamiflu at first symptoms. Seriously, what are folk supposed to do if they need the vaccine and it’s not available?
#5 Rebecca
November 11, 2009

I’ve observed the same phenomenon in the Washington, D.C. metropolitan area. The suburbs have had a few mass vaccination clinics with lines that are hours long, but waits in the city have been quite reasonable.
#6 PalMD
November 11, 2009

I do wonder whether urban public health departments are doing it right compared to suburban ones, or whether urban residents just aren’t lining up.
#7 katydid13
November 11, 2009

In DC you are not getting an H1N1 shot unless you are in a high risk group. Otherwise you are out of luck. From what I understand based on co-workers who have spent the whole day standing in line in suburban areas anyone can get vacinated.

Quite frankly the suburban residents feel more entitled. DC residents are used to crazy bureaucracy and aren’t going to take the day off to stand in line when they’ve been told IF YOU AREN”T HIGH RISK YOU AREN’T GETTING A SHOT.

Several of the large academic medical centers are also backing that up. My primary care physican is part of the George Washington University Medical Schools faculty practice and it’s the same thing. They have also made it clear that shouldn’t bother calling for tamiflu either unless you are high risk.

Lots of federal employees can get shots at work, through Federal Occupational Health. Right now they are vaccinating pregnant women. People with underlying medical conditions will be next. If the general population gets it will be late Dec at the earliest.

I’m very frustrated that no one in the suburbs is following the rules. It’s not that there is no demand in DC it’s that they are allocating the vaccine by the establish priorities.
#8 Mu
November 11, 2009

Here in NM the vaccine is nearly impossible to come by, especially for children. We’ve been to three “clinics”, no luck, and we call our pediatrician three times a week, no dice.
As for the availability in “disadvantaged urban areas”, three hypotheses, one politics, one bureaucracy, one social. First, someone is afraid of “discrimination”; can you imagine the Rev. Jesse Jackson if shots be made available in suburbia and not in the inner city? Second, as you pointed out, there used to be a lot more people in Detroit, and distribution list might still reflect that. And third, the inner city health centers cover usually a much larger number of people than the outlying areas, so their allotment is higher but the number of people showing up is lower.
#9 Denice Walter
November 11, 2009

I live a few miles west of NYC and I’ve been trying to locate an H1N1 vaccine for my SO, who has asthma.Calling the NJ Dept. of Health yesterday,I was informed that vaccines weren’t yet available for his level of risk *and* nothing in my county.On Friday(from the Record,a newspaper),700 vaccines were released in a small town 30+ miles west of here and promptly utilized.The people pictured in the article were not “locals”,but from my area or 30 miles north of that town: I guess at least some people are traveling.
#10 dr. luba
November 11, 2009

Out here in (rich) Oakland county there have been mass immunization clinics, with no apparent criteria for immunization. The people who need the vaccine most–obstetric patients and sick elderly–are the least likely to be able to stand outside in the cold for hours.

My hospital finally got enough does that we’ve begun immunizing all staff and our OB patients. Most of our OB/GYNs aren’t MICR compliant, so it was deemed best just to have them send their patients to us for the shots.
#11 Rocketscientista
November 11, 2009

My guess would be they’re just not getting enough information in Detroit to realize the importance. How does word about it all go out and is it nearly as effective as the advertising in, say, Oakland county, plus word of mouth, and all those facebooking worried upper-class moms?

I guess it might be somewhat encouraging that at least those folks are willing to cross the border for something. It’s not a hard and fast wall like it often appears to be…
#12 Aime
November 11, 2009

Re katydid13′s comments: I can tell you for a fact that there are people in the DC suburbs who are following the rules. Just take a look at the county websites to see how they set up the priorities for the clinics. In Virginia, H1N1 vaccinations through the clinics have only been available to priority groups, although the groups covered have varied some from county to county. From what I was reading on county health department websites a couple of weeks ago, when there didn’t seem to be any vaccine available in NoVA at all, that was true of clinics in the MD suburbs as well.

Even the pediatricians’ offices are working with priority groups (actually calling parents of at-risk kids instead of announcing availability on their websites or holding the regular vaccination clinics) because they don’t have enough to get to every kid. I don’t know about other doc’s offices or the major health systems.

As for the relative lack of interest in the city’s immunization clinics, it does seem that mistrust and misinformation may be factors. The Washington Post started covering it weeks ago: http://1wjn.sl.pt.
#13 katydid13
November 12, 2009

Aime — I know a number of people who went with their kids in the VA and MD suburbs and managed to get shots for themselves even though they weren’t in priority groups. I don’t know anyone who has managed to pull that off in DC.