Academic journal article International Public Health Journal

The Martha's Vineyard Public Health System Responds to 2009 H1N1

Academic journal article International Public Health Journal

The Martha's Vineyard Public Health System Responds to 2009 H1N1

Article excerpt


The Institute of Medicine defined the public health system as the "complex network of individuals and organizations that have the potential to play critical roles in creating the conditions for health" (1). For public health emergency preparedness (PHEP), this system includes not only federal, state and local health departments, but also hospitals and healthcare providers, fire departments, schools, the media, and many other public and private organizations (2). The 2009 H1N1 pandemic required a concerted effort from the entire US PHEP system, from the federal government down to local areas. Given the isolation of the community, residents of Martha's Vineyard (Islanders) were pressed to use existing community resources to address the H1N1 outbreak on the Vineyard, and the response involved several public health agencies, health care providers, and other components of local public health emergency preparedness systems.

This case study examines the community response in an island community. Limited resources, such as school nurses, were shared across the six diverse towns to enhance the community's capacity when responding to the outbreak. The school system came together with the hospital, town local public health entities, and organizations such as the Visiting Nurses Association to protect the health of Vineyard residents. These practical solutions that the Islanders on their own demonstrate the community resilience that is necessary to respond effectively to public health emergencies.

We present our analysis in three sections. First, to set the stage and provide context, we describe the Vineyard community and public health system that serves it. Next, we describe the system's response to the H1N1 pandemic, primarily in the Fall of 2009. We conclude the results section with an "after action analysis" of the response on the Vineyard. The discussion section that follows identifies five lessons that are potentially generalizable to other similar communities.


This case study is based on a review of local newspapers and interviews with key stakeholders. First, we reviewed the two local newspapers, Hie Martha 's Vineyard Gazette and the Martha 's Vineyard Times, between May and December, 2009. We also reviewed The Boston Globe for H1N1 related material involving Massachusetts, Cape Cod, or Martha's Vineyard. We also draw on the Massachusetts H1N1 After Action Report/ Improvement Plan, which the authors helped to prepare.

We also interviewed key stakeholders on the Island in May 2010 and June 2011. The majority of the Martha's Vineyard (MV) local health agents were interviewed in a group, including the health agents from the towns of Tisbury, Edgartown, and Chilmark. We also interviewed the Chief Executive Officer, the Chief Nurse Executive, the lead Pharmacist, and the Employee Health and Infectious Disease Nurse from Martha's Vineyard Hospital. Finally, the MV School Superintendent was interviewed, as the schools had a large role in the island's vaccination program.


The Martha 's vineyard public health system

Martha's Vineyard is a 90 square mile island in Massachusetts with a year-round population of approximately 16,000. As one can see from Exhibit 1, the island is composed of six towns that, together with the town of Gosnold (population 75) on a separate group of islands, make up the entirety of Duke's County, Massachusetts.

While the Vineyard has a reputation based on its wealthy summer visitors, the year round population is comprised of mostly agricultural and service workers, with relatively low income and education in comparison to the rest of the state. A substantial number of the year-round residents are Brazilian and speak Portuguese as their primary language, and there is also a Native American community on the island known as the Wampanoag Tribe of Gay Head, located predominately in Aquinnah, the island's smallest and most rural town. …

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