Initial behavioural and attitudinal responses to influenza A, H1N1 ('swine flu').

As the media interest in H1N1 Influenza A (‘swine flu’) ebbs and wanes, it is important to prepare ourselves for the societaldnot just the medicaldimplications of this outbreak. While practitioners may, rightly, anticipate a desire for physical intervention (eg, face masks), psychologists also point to the societal ‘out-grouping’ that can follow an epidemic. Often, when populations face a seemingly uncontrollable threat, they draw on existing stereotypes to reassure themselves. Already there are reports of the negative treatment and stereotyping of Mexicans following the outbreak in that country. In our own recent data, collected in Malaysia from community members and students (n1⁄4180) and in Europe via an internet questionnaire (n1⁄4148) five groups of people were seen as at high risk of infection: the immune compromised (mentioned by 87% respondents), pig farmers (70%), older people (57%), prostitutes/highly sexually active and homeless (both 53%). In addition, in Malaysia, 32% thought homosexuals also to be a high risk group (8% in Europe), primarily because they associate homosexuality with HIV infection, and thus weakened immunity. This tendency to focus on particular ‘out-groups’ at risk can have important consequences. First, such associations with risk can lead to increased prejudice towards those already marginalised by societies. During times of widespread threat, and possible shortages, it is hard to imagine that will not lead to the rationing of vital supplies (eg, anti-viral drugs). Second, by limiting our attention to particular groups, we can become far too optimistic about our own mortality. This can then lead to both patients and practitioners failing to take appropriate behavioural precautions. Never, therefore, has there been a more prescient time for physicians to ‘know thyself ’. No social group, however well trained, is free from bias, and this applies to medical professionals too. Pandemic threats, such as that posed by the current H1N1 outbreak, have the rare ability to affect everyone, even the ‘health young’ often relatively unaffected by seasonal flu. Engrained models of the vulnerable die hard, but if there was ever a time to challenge these, it is now.