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Employer Preparedness for Pandemic Influenza: Shifting the Conversation from Insurance to Investment


Pandemic influenza is currently one of the most visible public health threats of concern to the general public, and private businesses are an important part of pandemic preparedness. The health of communities is affected by the local economy, which is driven by the businesses in that economy. To date, public health authorities' efforts to engage businesses in pandemic influenza preparedness efforts have justified preparedness based on potential losses due to future, uncertain threats. However, this approach has not successfully engaged businesses on a broad scale. This dissertation proposes that a more effective way to engage the private sector may be to shift the conversation away from justifying preparedness only as a long-term insurance strategy and toward justifying it as an investment strategy with short-term benefits such as improved employee health during interpandemic cold and influenza seasons. The viability and acceptability of this new approach are explored here via three distinct but complementary studies using both quantitative and qualitative methods.

The first study, a prospective observational cohort study, examined the individual characteristics and situations that predicted changes in hand and respiratory hygiene and social distancing behaviors among university students during an interpandemic cold and influenza season. This analysis reveals that individuals have higher adherence to behaviors in situations such as when they are ill. Additionally, some individual characteristics predict higher behavior adherence. In particular, individuals who perceive peer expectations concerning adherence to hygiene behaviors tend to have better adherence to those behaviors over the course of a cold and influenza season.

The second study, a cost-effectiveness analysis of a hand and respiratory hygiene intervention among university students, assessed whether an intervention could be cost-effective in reducing influenza-like illness and associated time lost from productive activities during an interpandemic cold and influenza season. This analysis finds that hand and respiratory hygiene interventions can be cost-effective and may even become cost-saving during a severe cold and influenza season, especially using group-level interventions that may create peer expectations to influence behaviors.

Finally, the third study, an exploratory analysis based on key informant interviews with private sector business continuity managers, consultants, and public sector planners, examined private sector preparedness for pandemic influenza. This analysis assessed the key components of employer pandemic influenza preparedness plans, including whether short-term benefits are a consideration in business planning. The results indicate that the most important components of private sector pandemic influenza plans before and during the 2009 H1N1 influenza pandemic included communications and employee education around hygiene behaviors. Participants further identified that implementation of these initiatives during interpandemic cold and influenza seasons is of interest to organizations due to potential short-term and long-term benefits.

These results together provide evidence that education and provision of materials for hygiene behaviors at a group level can be cost-effective in reducing influenza-like illnesses during interpandemic cold and influenza seasons and are an acceptable strategy to the private sector. This provides a basis for the hypothesis that employer preparedness for public health events such as pandemic influenza can be justified as a short-term business investment strategy rather than only as a long-term insurance strategy.

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