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April 25, 2017
For Immediate Release

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Waterloo – Thanks to a €250,000 grant from the scientific philanthropy arm of the AXA Group, a French multinational insurance company, Wilfrid Laurier University researcher Karen Grépin is examining why people do not seek medical care at certain times and what it means for health care systems around the world.

When the Ebola virus broke out in West Africa in 2014, a lot of people stopped going to doctors and clinics. Women gave birth at home, children went unvaccinated, and malaria and other non-Ebola ailments went untreated. Grépin, an associate professor of Health Sciences who is also affiliated with the School of International Policy and Governance, started research to find out why.

“It wasn’t just that health clinics were closed or that there was fear of the outbreak,” said Grépin, who argues that the outbreak was mismanaged on a global scale. “People’s lack of trust in the government influenced whether they sought care or not.”

Grépin soon found it wasn’t just Ebola that kept people from clinics and hospitals worldwide. Other shocks, such as terrorism, natural disasters, economic downturns and even elections, can also have similar effects, she said.

“We have this view that everyone knows health services will make them better and therefore everyone should want them. I think that’s a very naïve view of the world.”

People can have rational reasons for avoiding or postponing medical care. They may be scared to leave their homes during a disaster or terrorist incident. They may be afraid of being exposed to a disease like Ebola. A neighbourhood clinic may be closed during an election. The local hospital might not have air conditioning – or even reliable electricity.

In some situations, staying home may be the best choice, at least in the short term, but not seeking medical care when it’s needed can result in terrible consequences. Diseases can worsen or spread and people can die of preventable causes. That’s why it’s crucial to understand why people might not seek medical care and to mitigate those causes, Grépin said.

“A lot of things can quickly disrupt people’s decision-making processes and there are more of these happening. Climate change has the potential to bring on more environmental shocks. The political situation around the world right now is very unstable. Also, news spreads a lot faster than it used to and small events can escalate very quickly. We don’t fully understand those dynamics.”

With a background in health policy and economics, Grépin is examining a variety of secondary data sources to look for times when health service utilization decreased or increased rapidly, possible reasons why, and the cumulative effect.

The project started in the summer of 2016, though the grant was formally announced April 25, 2017. It will be funded until 2019, so there is still a great deal of work to be done. However, Grépin hopes her research will lead to concrete changes.

There may be governance implications. For instance, though governments often respond to low health service utilization by deploying more outreach workers, community residents may not trust these government workers. It may therefore be more effective to work on trust issues, she said.

Infrastructure issues must also be considered. Where power cuts are frequent, people may be afraid of ending up on an operating room table during a blackout. Ensuring hospitals have working generators may help address that fear, said Grépin. Also, putting in air conditioners may encourage people to visit hospitals and clinics, especially during heat waves.

Security is important too – reducing terrorism, crime and election-related violence may be effective in increasing health service utilization, said Grépin.

Grépin’s research may have implications for the insurance industry, which is interested in calculating risks. Still, she was surprised to receive the AXA Research Fund grant. She didn’t apply for it; she was nominated.

“It has been wonderful way to build a new research program here at Laurier,” said Grépin, who became a Laurier faculty member in August 2016. “It’s made things a lot easier, especially adjusting to a new university.”

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Media Contacts:

Karen Grépin, Associate Professor, Health Sciences

T: 519.884.0710 x3655

Kevin Crowley, Director, Communications and Public Affairs

T: 519.884.0710 x3070


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