Disasters: The Public Health Impact

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Disasters The Public Health Impact

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• Disasters The Public Health Impact
• Mortality Morbidity
• Disasters cause deaths, injuries, and illnesses
• Disasters may overwhelm medical resources and
  health services
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disasters The Public Health Impact

• Health Care Infrastructure
• Disasters may destroy hospitals
• Disasters may disrupt routine health services
• Disasters may disrupt preventive activities
• Consequence long-term increases in morbidity
  and mortality
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disasters The Public Health Impact

• Environment Population
• Disasters may increase potential for communicable
  diseases
• Disasters may exacerbate environmental hazards
• Consequences increases in morbidity and
  premature death, decreased quality of life
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disasters The Public Health Impact

• Psychological and Social Behavior
• Disasters may cause generalized panic or
  paralyzing trauma
• Disasters may provoke increases in anxiety,
  depression and neuroses
• Disasters may lead to post-traumatic stress
  disorder (PTSD) at epidemic levels
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disasters The Public Health Impact

• Food Supply
• Disasters may disrupt the food supply
• Disasters leading to food shortages may cause
  specific micronutrient deficiencies
• Disasters may provoke severe nutritional
  consequences including famine and starvation
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disasters The Public Health Impact

• Population Displacement
• Disasters may cause large spontaneous or
  organized population movements
• Population movement may increase morbidity and
  mortality
• Population movement may precipitate epidemics of
  communicable diseases in both displaced and host
  communities
• Crowding of populations and overlay of refugee
  and host populations may lead to injuries and
  violence
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Epidemiologic Methods in Disasters
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Epidemiologic Methods in Disasters

• Before a disaster (Interdisaster Phase)
• Conducting hazards vulnerability analyses of
  the population
• Modeling/simulating disaster scenarios
• Conducting drills
• Designing emergency protocols
• Assessing level of emergency preparedness
• Assessing flexibility of surveillance systems
• Training health and safety personnel
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• During a disaster (Emergency Phase)
• Conducting disaster damage assessment
• Conducting rapid field investigations
• Identifying urgent needs matching resources
• Prioritizing relief efforts
• Conducting disaster surveillance
• Conducting epidemic investigations
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• After a disaster (Reconstruction Phase)
• Conducting post-disaster epidemiologic follow-up
  studies
• Identifying risk factors for death injury
• Planning strategies to reduce impact-related
  morbidity mortality
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• After a disaster (Reconstruction Phase)
• Developing specific interventions
• Evaluating effectiveness of interventions
• Conducting descriptive analytical studies
• Planning medical public health response to
  future disasters
• Conducting long-term follow-up of
  rehabilitation/reconstruction activities
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Applying epidemiologic methods in the context of
• Physical destruction
• Public fear
• Social disruption
• Lack of infrastructure for data collection
• Time urgency
• Movement of populations
• Lack of local support and expertise
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Selecting study designs
• Cross-sectional
• Studies of frequencies of deaths, illnesses,
  injuries, adverse health affects
• Limited by absence of population counts
• Case-control
• Best study to determine risk factors, eliminate
  confounding, study interactions among multiple
  factors
• Limited by definition of specific outcomes,
  issues of selection of cases controls
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Selecting study designs
• Longitudinal
• Studies document incidence and estimate
  magnitude of risk
• Limited by logistics of mounting a study in a
  post-disaster environment and subject follow-up
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Need standardized protocols for data collection
  immediately following disaster
• Need standardized terminology, technologies,
  methods and procedures
• Need operational research to inventory medical
  supplies and determine 1) actual needs, 2) local
  capacity, 3) needs met by national/international
  communities
• Need evaluation studies to determine efficiency
  and effectiveness of relief efforts and emergency
  interventions
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Need databases for epidemiologic research based
  on existing disaster information systems
• Need to identify injury prevention interventions
• Need to improve timely and appropriate medical
  care following disaster (search rescue,
  emergency medical services, importing skilled
  providers, evacuating the injured)
• Need measures to quickly reestablish local health
  care system at full operating capacity soon after
  disaster
• Source EK Noji, The Public Health Consequences
  of Disaster

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Epidemiologic Methods in Disasters

• Challenges for Epidemiologists
• Need uniform disaster-related injury definitions
  and classification scheme
• Need investigations of disease transmission
  following disasters and public health measures to
  mitigate disease risk
• Need to study problems associated with massive
  influx of relief supplies and relief personnel
• Need cost-benefit and cost-effectiveness analyses
• Source EK Noji, The Public Health Consequences
  of Disaster

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The Disaster Cycle
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Disaster Cycle

• Sudden impact natural disasters
• can be considered as a continuous time sequence
• of five phases
• Interdisaster
• Predisaster
• Impact
• Emergency
• Reconstruction
• Source EK Noji, Sivertson KT. Injury
  prevention in natural disasters a theoretical
  framework. Disasters 198711290-296.

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Disaster Cycle

• Interdisaster Phase
• Planning disaster prevention/preparedness/mitigati
  on
• Identifying risks
• Identifying vulnerabilities
• Creating a resource inventory
• Conducting professional training
• Conducting community education
• Synonym Nondisaster Phase

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Disaster Cycle

• Predisaster Phase
• Issuing timely warnings
• Implementing protective actions
• Undertaking emergency management activities
• Evacuating population as necessary
• Synonym Warning Phase

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Disaster Cycle

• Impact Phase
• Destruction
• Injuries
• Deaths
• may occur during impact

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Disaster Cycle

• Emergency Phase
• Implementing life-saving actions
• -search and rescue
• -first aid
• -emergency medical assistance
• Restoring emergency communications
• Restoring emergency transportation
• Implementing public health surveillance
• Evacuating vulnerable areas
• Synonyms Relief Phase, Isolation Phase

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Disaster Cycle

• Emergency Phase
• Note The immediate postimpact period is the
  isolation phase where most urgent rescue tasks
  are accomplished by the survivors using local
  resources
• Synonyms Relief Phase, Isolation Phase

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Disaster Cycle

• Reconstruction Phase
• Restoring predisaster conditions
• Reestablishing health services
• Reconstructing repairing damaged facilities
• Reflecting and debriefing on lessons learned
• Synonym Rehabilitation Phase

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Disaster Severity
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Disaster Severity

• A Decade of Natural Disasters
• 1 million thunderstorms
• 100,000 floods
• Tens of thousands of landslides, earthquakes,
  wildfires tornadoes
• Several thousand hurricanes, tropical cyclones,
  tsunamis volcanoes
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disaster Severity

• A Decade of Natural Disasters (1980s)
• Floods 39,000 deaths
• Tropical cyclones 14,000 deaths
• Hurricanes 1,000 deaths
• Earthquakes 54,000 deaths
• Other disasters 1,012,000 deaths
• TOTAL 1,120,000 deaths
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disaster Severity

• Factors Contributing to Disaster Severity
• -Human vulnerability due to poverty social
  inequality
• -Environmental degradation
• -Rapid population growth especially among the
  poor
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disaster Severity

• Influence of Poverty
• Persons in poverty
• -Live in poor housing unable to withstand seismic
  activity
• -Live in poor housing susceptible to landslides
• -Inhabit coastal areas and flood plains
  vulnerable to hurricanes, storm surges,
  flooding, and tidal waves
• -Live near hazardous industrial sites
• -Do not receive education on life-saving actions
  during disasters
• -Do not receive warning of impending disasters
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disaster Severity

• Influence of Poverty
• -Low-income countries
• 3,000 deaths per disaster
• -High-income countries
• 500 deaths per disaster
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disaster Severity

• Influence of Population Growth
• - Urban dwellers
• 1920 100 million
• 1980 1 billion
• 2000 2 billion
• - 2000 20 cities with gt10 million people
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disaster Severity

• Capabilities of Developed Nations
• That Mitigate Disaster Effects
• -Ability to forecast severe storms
• -Ability to enforce strict building codes
• -Ability to use communication networks to
  broadcast alerts and warnings
• -Ability to provide emergency medical services
• -Ability to engage in contingency planning
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disaster Perspectives
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Disaster Perspectives

• A disaster is a result of
• a vast ecological breakdown
• in the relation between
• humans and their environment,
• a serious or sudden event
• on such a scale that the stricken community
• needs extraordinary efforts
• to cope with it,
• often with outside help or international aid
• Source EK Noji, The Public Health Consequences
  of Disaster

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Disaster Perspectives

• Public Health View
• Disasters are defined
• by what they do to people...
• Source EK Noji, The Public Health Consequences
  of Disaster

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Disaster Perspectives

• Major Categories of Disasters
• -Natural Disasters
• -Human-generated Disasters
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disaster Perspectives

• Natural Disasters
• -Arise from forces of nature
• -Two subcategories
• Sudden impact or acute onset
• Slow or chronic onset
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disaster Perspectives

• Sudden Impact or Acute Onset Disasters
• Geological or climatic hazards
• Hurricanes/typhoons Tornadoes
• Earthquakes Volcanoes
• Floods Tsunamis
• Temperature extremes Wildfires
• Landslides Avalanches
• Epidemics
• Food, water, vector-borne diseases
• Person-to-person transmission diseases
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disaster Perspectives

• Slow or Chronic Onset Disasters
• Drought
• Famine
• Environmental degradation
• Chronic exposure to toxic substances
• Desertification
• Deforestation
• Pest infestation
• Sources CDC EK Noji, The Public Health
  Consequences of Disaster

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Disaster Perspectives
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Disaster Perspectives
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Disaster Perspectives
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Disaster Perspectives
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Disaster Perspectives
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Disaster Perspectives

• Human-Generated Disasters
• Industrial/technological
• Transportation (vehicular)
• Deforestation
• Material shortages
• Complex emergencies
• Source EK Noji, The Public Health Consequences
  of Disaster

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Disaster Perspectives

• Complex Emergencies
• -Wars and civil strife
• -Armed aggression
• -Insurgency
• -Other actions resulting in displaced persons and
  refugees
• Source EK Noji, The Public Health Consequences
  of Disaster

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Disaster Perspectives

• 2002 DEEP Center Classification
• -Natural disasters
• -Non-intentional human-generated disasters
• -Terrorist-perpetrated disasters
• -Complex disasters
• -Natural-technological disasters (NA-TECHS)

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Disaster Perspectives

• Terrorist-perpetrated Disasters
• -Biological
• -Nuclear
• -Incendiary
• -Chemical
• -Explosive
• Mnemonic B-NICE