The Role of Public Health Within the United Nations Post-2015 Framework for Disaster Risk Reduction

This article explores the role of public health systems before, during, and after disasters, particularly within the scope of the United Nations Post-2015 Framework for Disaster Risk Reduction. It also examines the role of scientific and technological developments in assisting with improving the resilience of public health professionals and the communities they work in. In addition, it explores how the wide-ranging activities in public health have already contributed to the improved management of disasters and a decrease in associated risks. The article identifies areas of synergy in five key areas of recent policy and practice in public health(the health systems approach, risk assessments, the WHO/UNISDR/HPA Disaster Risk Management fact sheets, chronic disease and disasters, and mental health impacts following disasters) and makes suggestions based on lessons identified from the previous(2005) global disaster risk reduction framework. In particular, we advocate the use of scientific evidence that addresses health and disaster risk simultaneously to increase the effectiveness of policy and practice in disaster risk reduction, health, and public health.     

Taking Children's Voices in Disaster Risk Reduction a Step Forward

Disaster risk reduction(DRR) continues to gain momentum globally and locally, but there is a notable void in the DRR literature on the role of children in communitylevel disaster risk management in Zimbabwe. Children are among the most vulnerable groups when disasters occur,yet their voices in disaster risk reduction are rarely heard.Using a qualitative methodology, this article examines the extent to which children are involved in disaster risk reduction in Muzarabani District, Zimbabwe. Despite evidence of the potential positive impact that children can have on DRR, their involvement in risk reduction planning in Zimbabwe is negligible. To achieve greater resilience to disasters requires that children's voices are heard and recognized as central to improved disaster risk reduction.     

Preventing disasters: public health vulnerability reduction as a sustainable adaptation to climate change

Global warming could increase the number and severity of extreme weather events. These events are often known to result in public health disasters, but we can lessen the effects of these disasters. By addressing the factors that cause changes in climate, we can mitigate the effects of climate change. By addressing the factors that make society vulnerable to the effects of climate, we can adapt to climate change. To adapt to climate change, a comprehensive approach to disaster risk reduction has been proposed. By reducing human vulnerability to disasters, we can lessen--and at times even prevent--their impact. Human vulnerability is a complex phenomenon that comprises social, economic, health, and cultural factors. Because public health is uniquely placed at the community level, it has the opportunity to lessen human vulnerability to climate-related disasters. At the national and international level, a supportive policy environment can enable local adaptation to disaster events. The purpose of this article is to introduce the basic concept of disaster risk reduction so that it can be applied to preventing and mitigating the negative effects of climate change and to examine the role of community-focused public health as a means for lessening human vulnerability and, as a result, the overall risk of climate-related disasters.     

Disasters and public health: an approach from the theoretical framework of epidemiology

Throughout the 1990-2000 period, disasters (catastrophes) caused an average of 75,000 deaths yearly, injuring an average of 256 million people a year and causing economic losses totaling more than 650 billion euros. The magnitude of this problem, its impact on public health and on the degree of development of the populations involved are of such major importance as to warrant special interest from the public health standpoint, especially as a result of what are known as complex emergencies. The objective of this study is that of reviewing the definitions, the main concepts and the basic characteristics of disaster epidemiology. An analysis is also made of the risk factors involved in disasters, the impacts on public health of the main types of disasters and the main preventive strategies in terms of the different stages of the disaster cycle.     

洪涝灾害公众健康防护建议

洪涝灾害是世界范围内最严重的自然灾害之一,对受灾群众造成不可估量的影响。本研究参照我国相关法规、应急手册,结合广泛的文献、资料调研进行综合分析与提炼,并根据流行病学与相关防护证据和专家咨询,分类解析洪涝灾害的环境健康危害因素,从事前预防、事中干预、事后救助的策略角度提出针对公众的多环节、多人群、分阶段的综合防护措施,为推进受洪涝灾害影响的公众健康防护水平、改善公众健康结局提供科学依据。     

Impact of public health emergencies on modern disaster taxonomy, planning, and response

Current disaster taxonomy describes diversity, distinguishing characteristics, and common relations in disaster event classifications. The impact of compromised public health infrastructure and systems on health consequences defines and greatly influences the manner in which disasters are observed, planned for, and managed, especially those that are geographically widespread, population dense, and prolonged. What may first result in direct injuries and death may rapidly change to excess indirect illness and subsequent death as essential public health resources are destroyed, deteriorate, or are systematically denied to vulnerable populations. Public health and public health infrastructure and systems in developed and developing countries must be seen as strategic and security issues that deserve international public health resource monitoring attention from disaster managers, urban planners, the global humanitarian community, World Health Organization authorities, and participating parties to war and conflict. We posit here that disaster frameworks be reformed to emphasize and clarify the relation of public health emergencies and modern disasters.     

The role of environmental health in disaster management: an overview and review of barriers and facilitators for action

Environmental health has a significant role to play in all stages of disaster management, from planning through to recovery. The conceptualizetion of the environmental health role by environmental health practitioners and other disciplines involved with disaster management is the focus of this review. To provide context for this discussion, we present an overview of disasters and disaster management and the public health and environmental health impact of disasters. The literature indicates that the role of environmental health in disaster management is not clearly conceptualized, and the following barriers have been identified: the continued emergence of environmental health as a professional discipline, ambiguity about environmental health functions in disasters, limited representation in disaster planning, low visibility profile of the profession, positioning of environmental health within public health, power and politics within agencies that result in a narrow assignment of the environmental health role, and a top-down approach to disaster management. The Australian experience indicates that if environmental health practitioners can overcome such barriers and increase their involvement in disaster management, then this achievement will raise the profile of the profession and renegotiate the environmental health role in disaster management. Ultimately, this success will also improve our capacity to manage disaster situations, and the higher profile, greater recognition, and representation of environmental health that is gained will then be able to flow into normal day-to-day activities.     

The public health response to disasters in the 21st century: reflections on Hurricane Katrina

Ten years ago, in 1996, the author published a commentary on disasters, the environment, and public health, reviewing progress in the field. Despite many advances, significant events have occurred during the intervening decade, including the September 11, 2001, terrorist attacks and the 2005 Hurricane Katrina disaster. The recent lessons from Hurricane Katrina indicate that public health professionals still need to do more to protect the public in times of national disasters. Since recurring disasters will continue to adversely affect human health, public health providers and others involved with disaster management should again reflect on the importance of this issue and the need for action. Such action includes key public health professionals being present and actively involved in the field before and immediately following disaster impact.     

Integrating Health Into Disaster Risk Reduction Strategies: Key Considerations for Success

The human and financial costs of disasters are vast. In 2011, disasters were estimated to have cost $378 billion worldwide; disasters have affected 64% of the world’s population since 1992. Consequently, disaster risk reduction strategies have become increasingly prominent on national and international policy agendas. However, the function of health in disaster risk reduction strategies often has been restricted to emergency response.To mitigate the effect of disasters on social and health development goals (such as risk reduction Millennium Development Goals) and increase resilience among at-risk populations, disaster strategies should assign the health sector a more all-encompassing, proactive role.We discuss proposed methods and concepts for mainstreaming health in disaster risk reduction and consider barriers faced by the health sector in this field.Recent decades have witnessed a growing scientific and evidence-based approach to the concept of disaster risk reduction. The United Nations Office for Disaster Risk Reduction (UNISDR) and the World Health Organization (WHO) define the term disaster as

a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources.1

The term also describes an event that can be defined spatially and geographically that results from the interaction of an external stressor with a human community and that carries the implicit concept of nonmanageability in a local context.1Statistics on the effects of recent disasters and their increasing global frequency are startling.2 In the past 12 years, an estimated $1.3 trillion of damage has been sustained through disasters, and in 2012, an estimated 51 million people in 16 countries required some form of humanitarian assistance.3,4 Multibillion dollar natural hazard–related disasters are becoming more common, and five of the 10 costliest disasters have occurred between 2008 and 2012.5 In 2011, disasters were estimated to have cost $378 billion, breaking the previous record of $262 billion in 2005.5 More than 1.5 billion people currently live in countries affected by fragility, conflict, or large-scale violence,6 and overall, more than 4.4 billion people—64% of the world’s population—have been affected by disasters in some way since 1992.7 As the effects of climate change become more palpable, this may be associated with a rise in the frequency of natural hazard–related disasters.8Consequently, taking action to better mitigate hazards, prepare for disasters, and reduce their effect has assumed an increasingly prominent position on global and national agendas. Since the Buyin-Zara Earthquake in Iran in 1962, the United Nations (UN) and its member states have worked toward the development of a global disaster risk reduction strategy.9 Early milestones included the UN declaration of an International Decade for Natural Disaster Reduction in the 1990s and the launch of the Yokohama Strategy in 1994, designed to “provide guidelines for natural disaster prevention, preparedness and mitigation.”10 The process gained added momentum following the 2003 Bam Earthquake and 2004 Asian Tsunami, with efforts culminating in 2005 with the adoption by 168 countries of a 10-year strategy, the Hyogo Framework for Action. The Hyogo Framework for Action was intended to build the resilience of nations and communities to disasters through cooperation and technical assistance (see the box on the next page). In addition, since 2007, the UNISDR Global Platform has been convened on a biennial basis to review progress on the framework by international agencies, countries, institutions, and civil society actors. The platform also provides a forum to discuss and exchange views on the latest scientific and evidence-based interventions and strategies currently available to achieve those aims.12

Health and the Hyogo Framework for Action (2005–2015): Five Priorities

Health facilities safety in natural disasters: experiences and challenges from South East Europe

The United Nations named 2010 as a year of natural disasters, and launched a worldwide campaign to improve the safety of schools and hospitals from natural disasters. In the region of South East Europe, Croatia and Serbia have suffered the greatest impacts of natural disasters on their communities and health facilities. In this paper the disaster management approaches of the two countries are compared, with a special emphasis on the existing technological and legislative systems for safety and protection of health facilities and people. Strategic measures that should be taken in future to provide better safety for health facilities and populations, based on the best practices and positive experiences in other countries are recommended. Due to the expected consequences of global climate change in the region and the increased different environmental risks both countries need to refine their disaster preparedness strategies. Also, in the South East Europe, the effects of a natural disaster are amplified in the health sector due to its critical medical infrastructure. Therefore, the principles of environmental security should be implemented in public health policies in the described region, along with principles of disaster management through regional collaborations.     

Building human resilience: the role of public health preparedness and response as an adaptation to climate change

Global climate change will increase the probability of extreme weather events, including heatwaves, drought, wildfire, cyclones, and heavy precipitation that could cause floods and landslides. Such events create significant public health needs that can exceed local capacity to respond, resulting in excess morbidity or mortality and in the declaration of disasters. Human vulnerability to any disaster is a complex phenomenon with social, economic, health, and cultural dimensions. Vulnerability to natural disasters has two sides: the degree of exposure to dangerous hazards (susceptibility) and the capacity to cope with or recover from disaster consequences (resilience). Vulnerability reduction programs reduce susceptibility and increase resilience. Susceptibility to disasters is reduced largely by prevention and mitigation of emergencies. Emergency preparedness and response and recovery activities--including those that address climate change--increase disaster resilience. Because adaptation must occur at the community level, local public health agencies are uniquely placed to build human resilience to climate-related disasters. This article discusses the role of public health in reducing human vulnerability to climate change within the context of select examples for emergency preparedness and response.     

Disasters, the environment, and public health: improving our response.

Natural and human-made disasters continue to adversely affect all areas of the world in both predictable and unpredictable ways. To highlight the importance of natural disasters, the United Nations declared the 1990s the International Decade for Natural Disaster Reduction. This paper considers the public health response to disasters. It highlights environmental health issues and approaches since disasters are extreme environmental events, and it reviews developments relating to capacity building, training, and collaboration. Although progress is noted, a comprehensive federal or academic approach is not evident in the United States and the proper linkage to environmental health is lacking. With the International Decade now half over, public health professionals and others involved with disaster management should reflect on progress made to date and goals for the future.     

Disaster preparedness among families of children with special health care needs

Families with children with special health care needs may present a challenge for disaster responders. This study examined the level of personal disaster preparedness among this at-risk population in relation to the general population, and explores whether special health care needs or perception of disaster risk affects preparedness levels. A convenience sample of 145 families presenting to an urban tertiary care children's hospital was surveyed using a previously validated instrument to gather information on levels of preparedness and factors influencing preparedness. In spite of significant special health care needs and concern about disasters, families remain unprepared for a disaster event. Health care and psychosocial support workers are in a unique position to increase preparedness levels in this at-risk population.     

Climate Change's Role in Disaster Risk Reduction's Future:Beyond Vulnerability and Resilience

A seminal policy year for development and sustainability occurs in 2015 due to three parallel processes that seek long-term agreements for climate change, the Sustainable Development Goals, and disaster risk reduction.Little reason exists to separate them, since all three examine and aim to deal with many similar processes, including vulnerability and resilience. This article uses vulnerability and resilience to explore the intersections and overlaps amongst climate change, disaster risk reduction, and sustainability. Critiquing concepts such as "return to normal"and "double exposure"demonstrate how separating climate change from wider contexts is counterproductive. Climate change is one contributor to disaster risk and one creeping environmental change amongst many, and not necessarily the most prominent or fundamental contributor. Yet climate change has become politically important, yielding an opportunity to highlight and tackle the deep-rooted vulnerability processes that cause "multiple exposure"to multiple threats. To enhance resilience processes that deal with the challenges, a prudent place for climate changewould be as a subset within disaster risk reduction. Climate change adaptation therefore becomes one of many processes within disaster risk reduction. In turn, disaster risk reduction should sit within development and sustainability to avoid isolation from topics wider than disaster risk. Integration of the topics in this way moves beyond expressions of vulnerability and resilience towards a vision of disaster risk reduction's future that ends tribalism and separation in order to work together to achieve common goals for humanity.     

苍南县居民防灾意识及认知水平调查分析

目的了解苍南县居民防灾意识及灾害认知水平,为开展有效的减灾教育,提高公众灾害风险意识和抗灾技能提供依据。方法采用自制调查问卷,对578名居民进行调查。结果居民防灾意识平均得分率为68.40%,防灾意识农村高于城镇,已婚者高于未婚者;文化程度越高,防灾意识越强;不同经济收入居民以平均月收入2000～4999元组防灾意识最强,5000元以上组最低。居民灾害认知水平平均总得分率为76.74%,其中农村高于城镇;年龄小者、文化程度和平均月收入高者,灾害认知水平也高;不同职业居民以医务人员灾害认知水平最高,国家机关、企事业人员次之,商业和服务业人员最低。结论苍南县居民防灾意识和认知水平较低,存在着城乡、年龄、文化程度、婚姻状况、职业状态和不同经济收入水平的差异,应针对不同人群,采取不同的教育方法和重点教育内容,进一步加强灾害风险意识和防灾知识教育。     

Socio-environmental vulnerability, disaster risk-reduction and resilience-building: lessons from the earthquake in Haiti and torrential rains in the mountain range close to Rio de Janeiro in Brazil

Data on disasters around the world reveal greater seriousness in countries with lower social and economic development levels. In this context, disaster risk-reduction and resilience-building policies are priorities in the sustainable development agenda, featuring among the topics selected for the Rio+20 Summit. By means of a contribution of a conceptual nature and from examples of disasters in countries with different development levels, namely the Haiti earthquake and the torrential rains in the mountain range close to Rio de Janeiro in Brazil, the scope of this article is to demonstrate how socio-environmental vulnerability creates conditions for disasters, while at the same time limiting strategies for their prevention and mitigation. Lastly, some of the measures that disaster risk reduction and resilience-building demand in a socio-environmental vulnerability context are highlighted. These involve changes in the current patterns of social, economic and environmental development geared toward ecological sustainability and social justice as pillars of sustainable development.     

Methodology for analysing toxic chemical risks to animal health

As a contribution to community-based disaster management, a methodology was designed for analysing toxic chemical risks to animal health, in line with national and international approaches to these issues. The methodology includes: hazard identification, risk assessment of the animal population according to its degree of vulnerability and other communication and risk management tools. Its validation in thirteen Cuban communities shows that the methodology provides the necessary technical basis for formulating and implementing disaster risk mitigation plans in compliance with current legislation. It also facilitates decision-making for disaster risk control in a community by acting as an early warning mechanism for toxic chemical risks to public health and the environment and by promoting multi-sector action in the field of veterinary public health.     

Dispelling disaster myths about dead bodies and disease: the role of scientific evidence and the media.

For decades, after nearly every natural disaster, fear of disease has encouraged communities, local authorities, and governments to rapidly dispose of the bodies of the victims without first identifying them. In May 2004 this journal published the first-ever review article to comprehensively assess the scientific evidence on the infectious disease risks of dead bodies following natural disasters, along with an editorial commenting on the persistence of myths concerning the dangers allegedly posed by dead bodies. This paper assesses the impact that the review article and the editorial have had on the way that health risks from dead bodies have been reported by the media over the following year, especially focusing on the South Asian tsunami disaster of December 2004. While some media outlets have reported erroneous information, hundreds of other news stories have accurately reported that dead bodies pose no public health risk, and have explained the priority for properly identifying the deceased. Nevertheless, publication of scientific evidence alone is insufficient to bring about public health action. International agencies need to continue their work on producing standards, guidelines, and practical guidance on managing dead bodies. There needs to be a community-centered approach to informing communities about the management of the dead following disasters and the rights of individuals to be treated respectfully after death. Nongovernmental organizations should be encouraged to provide expertise and technical support in identifying and burying large numbers of dead. There also needs to be ongoing assessment of the technical processes involved in the recovery, identification, and disposal of dead bodies, as well as the effectiveness of disaster preparedness plans and communication with the affected population.