Critical Systems Challenges for Chronic Diseases

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Critical Systems Challenges for Chronic Diseases
Public Health Response in Disasters
2006 National Health Policy Conference Adjunct
Meeting Feb. 8, 2006

• George A. Mensah, M.D.
• Associate Director for Medical Affairs
• National Center for Chronic Disease Prevention
  and Health Promotion

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Disclosure Statements

• No conflicts of interest

• Statements made in this presentation do not
  necessarily represent the views of the CDC, DHHS,
  or the US Government

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CDC Foundation
Kaiser Permanente
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(No Transcript)
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www.who.int
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Katrina and Other Natural Disasters

• Panel 1 Lessons Learned
• Impact on public health systems
• Deployment of mobile hospitals
• System evacuation issues
• Mental health transformations
• Panel 2 Critical System Challenges
• Surge Capacity Issues
• Legal Issues
• Chronic Disease Issues

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Chronic Disease Issues in Natural Disasters - The
Outline

• Triumphs and Successes
• Tradition of Neglect
• Critical Challenges
• Opportunities and Hope

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Triumphs and Successes

• ? Civil society response
• ? International collaboration
• ? Attention to provision of shelter, food and
  water for evacuees
• ? Fatality from malnutrition
• Control of infectious outbreaks

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Mokdad, Mensah, Posner, Reed, Simoes, Engelgau,
and the Chronic Diseases and Vulnerable
Populations in Natural Disasters Working Group.
Prev Chronic Dis 2005 Novhttp//www.cdc.gov/pcd/i
ssues/2005/nov/05_0201.htm
These triumphs and the current focus of
preparations are important and necessary, but
they are not enough
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Persons at Risk from Disasters 1

• Persons with underlying chronic diseases mental
  illness
• Persons without health insurance
• Persons with low income, SES, and educational
  attainment
• Homeless persons

Mokdad, Mensah, Posner, et al. Prev Chronic Dis
2005 Novhttp//www.cdc.gov/pcd/issues/2005/nov/05
_0201.htm
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Persons at Risk from Disasters 2Other
Vulnerable Populations

• The elderly
• Pregnant women and infants
• Children and adolescents
• Mentally impaired
• People living with disabilities
• Prisoners and other institutionalized persons

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Chronic Diseases and Vulnerable Population Issues

• Lack of access to routine health care and
  medications
• Significant interruption in life-supporting
  treatments
• home oxygen use
• renal dialysis
• insulin injections

Mokdad, Mensah, Posner, et al. Prev Chronic Dis
2005 Novhttp//www.cdc.gov/pcd/issues/2005/nov/05
_0201.htm
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Selected Observations from Surveys of Hurricane
Evacuees

• Most health care visits were for chronic health
  conditions
• Up to 41 had at least one major chronic health
  condition.
• Non-traumatic deaths often result from existing
  chronic conditions.

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Needs Assessment in Persons Staying in Evacuation
Centers

• Leading the list of top 10 conditions were
• Hypertension
• Cardiovascular diseases
• Diabetes
• Psychiatric disorders

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Chronic Disease Issues in Natural Disasters - The
Outline

• Triumphs and Successes
• Tradition of Neglect
• Critical Challenges
• Opportunities and Hope

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Chronic Disease Management During Disasters and
Emergencies

• No generally accepted guidance on the management
  of chronic diseases during disasters has
  previously been established.

Humanitarian Charter and Minimum Standards p 294
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Priority Chronic Conditions During Disasters or
Complex Emergencies

• Conditions for which an acute cessation of
  therapy was likely to result in death, including
• Dialysis-dependent chronic kidney failure
• Insulin-dependent diabetes
• Certain childhood cancers

Humanitarian Charter and Minimum Standards p 294
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http//www.dhs.gov/interweb/assetlibrary/NRP_FullT
ext.pdf
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Frequency of Selected Terms inThe National
Response Plan
TERM FREQUENCY
Outbreak 62
Infection/infectious disease 18
Cancer 1
Heart disease 0
Diabetes 0
Pregnant/pregnancy 0
Mental Illness 0
http//www.dhs.gov/interweb/assetlibrary/NRP_FullT
ext.pdf
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Chronic Disease Issues in Natural Disasters - The
Outline

• Triumphs and Successes
• Tradition of Neglect
• Critical Challenges
• Opportunities and Hope

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Data to Guide Chronic Disease Disaster
Preparedness

1. Pre-disaster burden data
2. Estimates of immediate needs
3. Surge capacity of local and neighboring health
   care systems
4. Ability to rebuild infrastructure needed to
   support care

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Surveillance Needs Before, During, and After a
Disaster

1. Size, functional status, and needs prior to the
   disaster
2. Ability to assess the needs and levels of actual
   response during the disaster
3. Ability to monitor the long-term effects of the
   disaster.

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Chronic Disease Issues in Natural Disasters - The
Outline

• Triumphs and Successes
• Tradition of Neglect
• Critical Challenges
• Opportunities and Hope

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Humanitarian Charter and MinimumStandards in
Disaster Response
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Standard 2 Reproductive Health Guidance Note

1. Minimum Initial Service Package
2. Gender-based violence (GBV)
3. Emergency obstetric care
4. Comprehensive reproductive health services

Humanitarian Charter and Minimum Standards p 290
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Standard 4 Chronic DiseasesControl of
Non-Communicable Diseases
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Essential Drugs and Supplies

• Life-threatening conditions
• Acute heart attack stroke care
• Oxygen in severe lung disease
• Insulin in type 1 diabetics
• Dialysis in kidney failure
• Obstetric complications
• Acute care in certain cancers
• Medications for routine care

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Chronic Disease and Vulnerable Populations
Research Issues

• Direct morbidity mechanisms
• Specific preventive strategies
• Determinants of rate of recovery
• Impact on mental health and overall long-term
  health status
• Essential medications and supplies for stockpiles

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Summary Conclusions

• Previous preparedness efforts often neglected
  chronic diseases and vulnerable populations
• New emphasis offers opportunities for improved
  preparedness and health protection
• Surveillance, policy development, and assurance
  remain core functions

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Chronic Disease and Vulnerable Populations in
Natural Disasters Working Group at CDC

• Coordinating Center for Health Promotion
• Coordinating Office for Terrorism Preparedness
  and Emergency Response
• Other CDC Centers, Institutes, Offices
• Public health partners

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Preventing Chronic Diseases and Adverse Outcomes
in Vulnerable Population