Public health – listen to the community


Sir, – The lessons of history must loom large in our management of Covid-19. We know from our response to HIV/Aids that the infection-prevention message needs to come to the community from within the community. Lessons from ebola outbreaks in east, central and west Africa have also shown that public health recommendations are most effective when community members are mobilised to shape local solutions that strengthen health protection efforts. This is particularly true in disadvantaged communities.

Italian officials have reported that at least half of the deaths from Covid-19 in the region of Puglia have been among people from lower socioeconomic groups with up to three chronic diseases, including high blood pressure, obesity, diabetes, heart and/or respiratory disease. In Chicago, with a population that is 30 per cent black, black Americans account for 70 per cent of all coronavirus cases and more than half of the deaths. In Ireland, as elsewhere, the burden of chronic disease is concentrated in poor and vulnerable populations, which suggests that many of the Covid-19 related deaths will be clustered among disadvantaged communities.

While recent government support for the “Community Call” is a welcome first step towards a much-needed “bottom-up” response that complements the “top-down” or high-level response, it is not nearly enough. A walk through any disadvantaged area of Dublin will reveal pockets of resistance to social distancing and young people continuing to congregate in defiance of public health guidance. Behind the disregard for infection prevention measures lies deeper causes of mistrust between local communities and government agencies.

The retrospective joint report by Harvard University and the London School of Hygiene and Tropical Medicine in the wake of the ebola outbreak in west Africa found that poor understanding of the importance of community engagement was a primary weakness in national and international outbreak management approaches.

So while we can all agree that the National Public Health Emergency Team has done a stellar job, we need to act now to ensure that Ireland’s retrospective analysis of the Covid-19 response will not highlight weaknesses in efforts to protect our poorest and most vulnerable citizens. – Yours, etc,


Assistant Professor

in Global Health,

Trinity Centre

for Global Health,

Trinity College Dublin,

Dublin 2.