Assistant Professor in Applied Psychology at UIC, Dr Thomas Huggins, gripped the attention of many participants during his online talk, which was organised by the Division of Science and Technology (DST) on 1 April. The talk was titled ‘The Inverse Response Paradox in Public Health Emergencies’.

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Dr Huggins explained that the inverse care law explains that the public health of vulnerable populations is often the least cost-effective to address, leading to a paradox where people with more needs receive a lower standard of care. This concept of public health inequalities has also been applied to case studies of emergency management in Mexico, New Zealand, Puerto Rico, USA, and the UK.

Before coming to UIC, Dr Huggins was employed for more than a decade at Massey University, in New Zealand. This included almost eight years working for the Joint Centre for Disaster Research, which is a collaboration between the School of Psychology and New Zealand's Geological and Nuclear Science Institute.

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Dr Thomas Huggins

To begin the talk, Dr Huggins explained in-depth that the cost and other difficulties of managing hazards faced by vulnerable populations in a range of settings have meant that socio-economic and other disadvantages have only worsened over time. For the purposes of emergency management, this dynamic is called the inverse response law. However, the specificity of this term does not mean that public health is excluded from emergency management scenarios.

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He gave an example of the 2015 eruption of the Volcán de Fuego in Colima, Mexico, which created a public health emergency among a few hundred rural households, within 15 kilometres of the volcano’s crater. Responding agencies struggled to assist residents affected by approximately 40 millimetres of ashfall. The hazards faced by thousands of urban households, located more than 30 kilometres from the crater, were much more efficiently managed. The latter was achieved without any substantial costs to emergency management or public health agencies.

Dr Huggins mentioned how comparable dynamics can also be observed in some responses to the COVID-19 pandemic. Initial responses in some national and sub-national settings appear to have focused on the economic advantages of simply letting the virus take its course. This kind of approach is bolstered where the needs of populations that are most vulnerable to the pandemic, such as the elderly, are arguably less cost-effective to address.  

To finish off the talk, Dr Huggins concluded that opaque approaches to cost-effectiveness in public health emergencies can suffer from the Inverse Response paradox. He stressed that this tends to compound vulnerabilities, rather than addressing them. According to Dr Huggins, it is crucial that the values driving pandemic management are being articulated to put any over-dependence on cost-effectiveness in context.

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During the Q&A session, the audience was eager to know more and asked whether Dr Huggins supports cost-effective pandemic responses or a more values-driven approach. In response, he reiterated that values surrounding the cost-effectiveness of public health emergency management planning must be explicitly declared. Dr Huggins said that implicit beliefs about the survival of the fittest individuals are particularly fallible and need to be exposed.

Reporter: Samuel Burgess
Editors: Deen He, Lauren Richardson
(from MPRO)