School of Public Health & Community Medicine, Faculty of Medicine, The University of New South Wales, Sydney, NSW 2052, Australia.
School of Political & Social Inquiry, Faculty of Arts, Monash University, VIC 3800, Australia.
Soc Sci Med. 2014 Feb;102:10-7. doi: 10.1016/j.socscimed.2013.11.031. Epub 2013 Nov 21.
Analysis of public health's growing interest in "vulnerability" has largely focused on health policy, with little interrogation of how vulnerability is being actively appropriated, countered, ignored or reworked by the publics whose health such policy is designed to protect. Once the assemblage of public health is understood as comprised of different forms of expertise and actors, including publics, addressing this gap matters. We examine the use of vulnerability in the specific context of pandemic influenza preparedness. Pandemic preparedness raises some familiar dilemmas for public health governance: how to engage with publics without fuelling social divisions and disruption; and whether to invoke publics as passive recipients of public health advice or to recognise publics as collective agents responding to the threat of pandemic influenza. Thus, we ask how the mobilisation of vulnerability connects with these dilemmas. To examine vulnerability in pandemic preparedness, two forms of qualitative data are analysed: 1) interviews and focus groups with "vulnerable" and "healthy" people (conducted 2011-12) discussing seasonal and pandemic influenza and; 2) international, Australian national and state level pandemic plans (1999-2013). Vulnerability is variously used in plans as a way to identify groups at particular risk of infection because of pre-existing clinical conditions, and as a free-floating social category that could apply to a broad range of people potentially involved in the social disruption a pandemic might entail. Our interview and focus group data indicate that healthy people rework the free-floating extension of vulnerability, and that people designated vulnerable encounter an absence of any collective responsibility for the threat of pandemic influenza. Our analysis suggests that vulnerability's mobilisation in pandemic preparedness limits the connection between public health governance and its publics: here, the openness and unpredictability of people's collective agency is something to be tightly controlled by a government concerned with protecting people from themselves.
公共卫生对“脆弱性”日益增长的兴趣分析主要集中在卫生政策上，很少有人质疑脆弱性是如何被旨在保护其健康的公众积极利用、抵制、忽视或重新构建的。一旦将公共卫生组合理解为包括不同形式的专业知识和行为者，包括公众，解决这一差距就很重要。我们在大流行性流感防备的具体背景下考察了脆弱性的使用。大流行性流感防备给公共卫生治理带来了一些熟悉的困境：如何在不加剧社会分裂和混乱的情况下与公众接触；以及是否将公众作为公共卫生建议的被动接受者来援引，还是承认公众是应对大流行性流感威胁的集体行动者。因此，我们询问脆弱性的调动与这些困境有何联系。为了研究大流行性流感防备中的脆弱性，我们分析了两种形式的定性数据：1）与“脆弱”和“健康”人群（2011-12 年进行）进行的访谈和焦点小组讨论，讨论季节性和大流行性流感；2）国际、澳大利亚国家和州一级的大流行性流感计划（1999-2013 年）。脆弱性在计划中被各种方式使用，以确定由于先前存在的临床条件而特别容易感染的群体，以及作为一个自由浮动的社会类别，可能适用于可能涉及大流行可能带来的社会混乱的广泛人群。我们的访谈和焦点小组数据表明，健康人群重新构建了脆弱性的自由浮动扩展，而被指定为脆弱的人群则遇到了对大流行性流感威胁没有任何集体责任的情况。我们的分析表明，脆弱性在大流行性流感防备中的调动限制了公共卫生治理与其公众之间的联系：在这里，政府关注的是保护人民免受自身伤害，因此人民的集体机构的开放性和不可预测性是需要严格控制的。
