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Politics, Pushback, and Pandemics: Challenges to Public Health Orders in the 1918 Influenza Pandemic
Abstract
During the first wave of the COVID-19 pandemic in the United States, many state governors faced an increasing number of acts of defiance as well as political and legal challenges to their public health emergency orders. Less well studied are the similar acts of protest that occurred during the 1918–1919 influenza pandemic, when residents, business owners, clergy, and even local politicians grew increasingly restless by the ongoing public health measures, defied public health edicts, and agitated to have them rescinded. We explore several of the themes that emerged during the late fall of 1918 and conclude that, although the nation seems to be following the same path as it did in 1918, the motivations for pushback to the 2020 pandemic are decidedly more political than they were a century ago. (Am J Public Health. Published online ahead of print January 21, 2021: e1–e7. https://doi.org/10.2105/AJPH.2020.305958 )
... or otherwise prefer disability --and Hurley 2002, Whitaker 2002. This time period was the Progressive Era, when scientific expertise and social change were both valued (Navarro and Markel 2021). Some science was questionable or outright racist, -Caucasian races (Gould 1996, Turner andHurley 2002). ...
... Catching the flu was often a death sentence, with medical personnel and science researchers helpless as people became sick and died (C. Brown 2018, Hammond 2020. The flu disproportionately affected people (including college students and soldiers) from disadvantaged and poor households (Navarro and Markel 2021), and Indigenous communities were hit especially hard (C. Brown 2018, Hammond 2020. ...
... President Woodrow Wilson remained silent about influenza, even as officials tried to link masks and other compliance campaigns to patriotic wartime duty (Navarro and Markel 2021). Nevertheless, people frequently protested against such policies or fought to have them rescinded, with some people even resorting to violence (Navarro and Markel 2021). ...
... Singapore, among other nations such as Taiwan and New Zealand, had been touted globally as a nation effective in its management of the pandemic. Singapore's success had been credited to early response, extensive testing, contact tracing, citizen's knowledge and awareness of the virus, and social distancing measures, against the backdrop of sociopolitical success [16][17][18][19][20]. Adoption of many COVID-19 safety measures does not come easily without sociopolitical success. ...
... Singapore's success had been credited to early response, extensive testing, contact tracing, citizen's knowledge and awareness of the virus, and social distancing measures, against the backdrop of sociopolitical success [16][17][18][19][20]. Adoption of many COVID-19 safety measures does not come easily without sociopolitical success. Drastic measures such as a national lockdown, and even less drastic measures such as mandatory mask-wearing, have been subjected to scrutiny and pushback [18]. Resistance between the government and its citizens can result in delayed widespread adoption of these safety measures [21], a delay which might make the difference when it comes to infectious disease containment. ...
Background
Distrust, and more broadly, public perception of government’s handling of a crisis, has been a widely studied topic within health crisis research and suggests that these perceptions are significantly associated with the behavior of its citizens.
Purpose
To understand which aspects of the public’s perception of government handling of the COVID-19 pandemic predicted engagement of protective behaviors among older adults, who are the most vulnerable to COVID-19.
Methods
Participants were recruited from an ongoing biopsychosocial study on aging amongst community-dwelling older adults. There were two rounds of data collection, during the national lockdown and post-lockdown. The average length of follow-up was 5.88 months. N = 421 completed the first round of data collection and N = 318 subsequently completed the second round of questionnaires.
Results
During the lockdown, perceptions that pandemic-related measures in place were sufficient, effective, timely, provided a sense of safety, important information was easily accessible, and government handling of the pandemic could be trusted, were found to significantly predict engagement in protective behaviors. During post-lockdown, only perceptions that measures in place were sufficient, provided a sense of safety, and important information was easily accessible, remained significant predictors. The perception that COVID-19 measures were clear and easy to understand now became a significant predictor.
Conclusions
Public perceptions of government handling of the pandemic predicted engagement in protective behaviors but were less important during post-lockdown. To effectively engage older adults in protective behavior, our findings suggest for pandemic-related information to be accessible, introducing timely safety measures, and having easy-to-understand instructions for nuanced measures.
... The mistrust of French population has begun to increase as a result of ethical questions or scientific debates about effectiveness of medicines (i.e., hydroxychloroquine, Zinc) as many contradictory studies (not randomized controlled trials) have not given a strong strategy for treating patients [7]. The pandemic has broken the barrier between medical and policy as expressed in recent studies [8]. ...
... An anti-vax community has developed with influential health professionals in their ranks. Thus, each publication on vaccine side effect or policy decisions to stop the use of some vaccines (e.g., AstraZeneca) feeds suspicion, even among health professional [8,10]. This is probably one of the reasons why, although vaccination may be thought to play a fundamental role in the prognosis of the population, and even if it is strongly recommended, it is not mandatory. ...
... A century later, COVID-19 was known to be a respiratory pathogen, and masks were again recommended by public health authorities and resisted by many citizens. Both the 1918 influenza and COVID-19 pandemics saw citizen resistance to public health mandates, although in the case of COVID-19, some of the resistance was political (16). Even the development of safe and effective vaccines found resistance, and in the United States alone, vaccine hesitancy cost over 200,000 lives (17). ...
... 15 The broader political context was important, as it is in all epidemics, in determining the extent to which covid-19 related interventions were introduced. 16 Anti-vaccine and anti-government sentiment, fuelled by misinformation in mass and social media, stoked distrust in community mitigation measures and health officials. Political alliances between "health freedom" groups and some conservative politicians helped translate this sentiment into policy decisions and platforms for politicians. ...
... Management approach is also affected by event duration. For example, in long-duration responses, because there is time for the public to learn about and understand the government's response, there may be more opportunities for pushback and conflict regarding management approach (Navarro and Markel 2021). There is more time for information to travel further, especially given current technologies. ...
Disaster researchers have long sought to classify hazard events using various characteristics. Despite varying perspectives on how hazard events differ, the most commonly used classification in disaster scholarship categorizes hazard events as either emergencies, disasters, or catastrophes, which generally are described as being distinguished based on impacts, needs, stakeholder involvement, and management approach. Although this hazard event classification is useful, disaster scholars have noted it needs further refinement and development. In an effort to address these calls from disaster scholars and create a more robust hazard event classification, the traditional classification is revisited and expanded. Specifically, this article proposes the addition of a second dimension, response duration, to the existing hazard event type classification, which to this point has largely been defined by scale of impacts, needs, stakeholder involvement, and management approach. This paper argues short and long-duration emergencies, disasters, and catastrophes are categorically different and therefore require different management approaches, and can be used to categorize and distinguish between events such as COVID-19 and Hurricane Katrina and the Levee Failure. The proposed change would have important implications for emergency management practice and policy and would encourage a re-evaluation of the kinds of hazard events considered to be part of the academic purview of emergency management.
... This section will provide extracts from the dataset, which will be discussed in accordance with relevant literature to demonstrate how the outbreak of SARS CoV-2 influenced informal caregivers of PwP. [33][34][35][36][37][38][39][40][41][42][43] Vulnerabilities to COVID-19 ...
Informal caregivers can experience various demands when providing care and support for People with Parkinson’s disease (PwP) in their own homes. The outbreak of SARS-CoV-2 and public health strategies employed to mitigate the spread of COVID-19 have presented challenges to the general populace on a global basis. The present study used a qualitative research design to explore how the COVID-19 pandemic has impacted informal caregivers in their role of providing care for PwP in their own homes. A series of 1:1 semi-structured interviews were conducted with 11 informal caregivers of PwP ( M age = 72.64 years, SD = 8.94 years). A thematic analysis indicated that 1) vulnerabilities to COVID-19, 2) home maintenance & activities of daily living and 3) engagement with healthcare services were 3 themes that provided indications on how the COVID-19 pandemic impacted informal caregivers of PwP. The present study provides illustrations of how being an informal caregiver of PwP and being identified as high risk to COVID-19 can present challenges to the process of caring for loved ones who are also vulnerable to SARS-CoV-2. The results of the present study highlights the necessity to develop strategies to ensure that informal caregivers have the necessary resources to provide care for PwP in their homes and also maintain their own well-being in the post COVID-19 era.
... Nowadays, environmental pollution, disease epidemics, and other emergencies pose great challenges to human health and sustainable development, and a public health system is an important tool in addressing these challenges [1][2][3][4]. Especially after the COVID-19 pandemic, public health systems worldwide are undergoing a major shock [5][6][7]. As a result, it has become a growing concern for researchers and policymakers how to build an effective public health system. ...
This paper focus on the quantitative measurement of public health systems and its mismatch with socio-economic development. Based on systematic theory, we divide the public health system into four sub-systems: resource inputs, planning in decision-making, operations, and service outputs. We also provide a method to analyse the ability to match between the public health system and social-economic development by using the grey correlation and coupling method. Then we introduce data from China as a case of empirical research. The main findings are as follows: (1) China’s public health system has progressed from 2012 to 2019, and the development of China’s public health system is typically “input-driven”. Second, the level of public health management in China lacks sustainability. (2) The main reason for this problem is the mismatch between the central and local governments in China in terms of public health management authority. (3) Third, the coupling between China’s public health system and socio-economics development has shown a decreasing trend, which indicates an increasingly significant mismatch problem between public health and economic growth, urbanization, and population aging. Our study will enrich the understanding of the relationship between the public health system and socio-economics development.
... Put another way, wearing a mask is a visible commitment to reduce the extent of the body and, with it, the capacity to touch others. This dual medical and symbolic function has been studied in relation to the masking of past pandemics (Lynteris 2018), however, the widespread politicization of refusal is new (Navarro and Markel 2021). Writing about how social contact is administered through individuals' regulation of their own breath, Mary Louise Pratt explains that 'Civic responsibility boils down to not breathing on others […] physical separation becomes the primal expression of civic solidarity' (2020). ...
This essay develops the concept of the ‘coronasphere’ to grapple with how breath shifts the perceptible extent of the body during a pandemic, and the implications of such a radically altered sense of proximity for the choreography of public movement. Coming into being through an act of perception that is entangled with responsibility to others, the coronasphere is offered as a sensory alternative to fixed-distance models of social distancing approaches to risk, one that overrides the false dichotomy between the seeming stasis of shelter-in-place on the one side, versus ‘freedom’ of movement on the other. Redefining the extent of bodies relationally by the range of their breath has implications for understanding the uneven impacts of COVID-19 in terms of tactile entanglements and the vulnerability to uninvited touch that may violate bodies as individual and impermeable, in particular when the capacity for movement is limited. Ultimately turning to the coherence of such expanded bodies in terms of individual versus communal mobilization through a series of protests, the essay shows how the pandemic can not only reify but challenge the conflation of freedom and mobility, and the sensory ramifications of this in terms of finding new ways to rebuild public life.
This study compares pandemic experiences of Missouri’s 115 counties based on rurality and sociodemographic characteristics during the 1918–20 influenza and 2020–21 COVID-19 pandemics. The state’s counties and overall population distribution have remained relatively stable over the last century, which enables identification of long-lasting pandemic attributes. Sociodemographic data available at the county level for both time periods were taken from U.S. census data and used to create clusters of similar counties. Counties were also grouped by rural status (RSU), including fully (100%) rural, semirural (1–49% living in urban areas), and urban (>50% of the population living in urban areas). Deaths from 1918 through 1920 were collated from the Missouri Digital Heritage database and COVID-19 cases and deaths were downloaded from the Missouri COVID-19 dashboard. Results from sociodemographic analyses indicate that, during both time periods, average farm value, proportion White, and literacy were the most important determinants of sociodemographic clusters. Furthermore, the Urban/Central and Southeastern regions experienced higher mortality during both pandemics than did the North and South. Analyses comparing county groups by rurality indicated that throughout the 1918–20 influenza pandemic, urban counties had the highest and rural had the lowest mortality rates. Early in the 2020–21 COVID-19 pandemic, urban counties saw the most extensive epidemic spread and highest mortality, but as the epidemic progressed, cumulative mortality became highest in semirural counties. Additional results highlight the greater effects both pandemics had on county groups with lower rates of education and a lower proportion of Whites in the population. This was especially true for the far southeastern counties of Missouri (“the Bootheel”) during the COVID-19 pandemic. These results indicate that rural-urban and socioeconomic differences in health outcomes are long-standing problems that continue to be of significant importance, even though the overall quality of health care is substantially better in the 21st century.
During the First World War, the term “essential business” was used initially in military procurement, and then in disease control when pandemic influenza struck. Essential businesses were exempt from restrictions imposed in the interest of national defense or public health, so debates about essential business concerned the necessity of various goods and services to the consumer. Ultimately, the concept of essential business depended on a shared understanding of the American consumer’s rights and duties as a citizen. On the one hand, consumers furthered the state’s interests by complying with, interpreting, implementing, and enforcing public-health restrictions. On the other, what contemporaries called “the American standard of living” entitled citizens to maintain relatively large expenditures. This relationship between citizenship and consumption explains the economy’s surprising stability in 1918. The flu did not cause a depression because social norms authorized most consumer expenditures as legitimate and appropriate, even during the wartime epidemic. “Essential” work is theorized using the Marxist concept of socially necessary labor, which relates productivity and purchasing power to norms of consumption.
Public Health: Local and Global Perspectives presents a comprehensive introduction to public health issues and concepts in the Australian and international contexts. It provides students with fundamental knowledge of the public health field, including frameworks, theories, key organisations and contemporary issues. The third edition features a new chapter on the public health workforce and the importance of advocacy in the profession and a thorough update that includes current research and case studies. Discussion of the COVID-19 pandemic and other contemporary public health issues offers students the opportunity to apply theory to familiar examples. Each chapter contextualises key concepts with spotlights and vignettes, reflective questions, tutorial exercises and suggestions for further reading. Written by an expert team of public health professionals, Public Health is an essential resource for public health students.
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