Public health and natural disasters: disaster preparedness and response in health systems

The number of natural disasters and the severity of their impact have increased in recent decades. These developments highlight the need for improved preparedness and response in the health sector, inter alia, and the important role of public health in disaster management. The purpose of this paper, which is based on a literature review, is to provide background information about the general framework of disaster management and present the core concepts of disaster preparedness and response in health systems. Three different strategies were used to collect information for this article. First, information was collected from various international databases. Then, the virtual health library for disasters provided by the World Health Organization (WHO) and the WHO Health Action in Crisis (HAC) online sources were reviewed for relevant WHO and Pan American Health Organization (PAHO) books, working papers and reports. Finally, PubMed abstracts were searched with key words and phrases. For greater completeness, five disaster journals were hand searched. Additional sources such as text books, working papers, and articles were included, relying on the bibliography of the original study mentioned in the introduction to this paper. The studies reviewed indicated that fragmented and response-oriented approaches have begun to change world wide, at least in the literature. Despite the publication of increasing numbers of research projects in disaster issues, there are still gaps in sharing experience through scientific papers, such as systematic evaluation of activities in different phases of disaster situations.

Management of animal health emergencies in North America: prevention, preparedness, response and recovery

Animal health emergency management (AHEM) is one of the most important issues confronting the world today and is the key to both food security (safety, quality, wholesomeness, affordability and abundance) and economic stability for many countries. Although the primary objective of emergency management in each of the countries of North America (Canada, Mexico and the United States of America [USA]) is implemented through individual AHEM systems, North America shares four common goals, as follows: preventing the introduction of foreign animal pathogens into North America being prepared to manage the outbreak of a foreign animal disease developing appropriate response strategies for control and eradication of disease taking active measures to recover from the animal health emergency in question. In the course of this paper, the authors provide an introduction to, and overview of, AHEM in North America. Furthermore, they outline the general infrastructure of prevention, preparedness, response and recovery strategies for Canada, Mexico and the USA. Finally, the authors discuss the future of AHEM in North America, concluding with a review of some of the joint activities currently being conducted with regard to AHEM.     

ISEA2007 panel: integration of better exposure characterizations into disaster preparedness for responders and the public

An expert panel was convened in October 2007 at the International Society for Exposure Analysis Annual Meeting in Durham, NC, entitled "The Path Forward in Disaster Preparedness Since WTC-Exposure Characterization and Mitigation: Substantial Unfinished Business!" The panel prospectively discussed the critical exposure issues being overlooked during disaster responses and highlighted the needs for an optimal blending of exposure characterizations and hazard controls within disaster settings. The cases were made that effective and timely exposure characterizations must be applied during responses to any disaster, whether terrorist, manmade, or natural in origin. The consistent application of exposure sciences across acute and chronic disaster timelines will assure that the most effective strategies are applied to collect the needed information to guide risk characterization and management approaches. Exposure sciences must be effectively applied across all phases of a disaster (defined as rescue, reentry, recovery, and rehabitation-the four Rs) to appropriately characterize risks and guide risk-mitigation approaches. Failure to adequately characterize and control hazardous exposures increases the likelihood of excess morbidity and mortality. Advancing the infrastructure and the technologies to collect the right exposure information before, during, and immediately after disasters would advance our ability to define risks and protect responders and the public better. The panel provided conclusions, recommendations, and next steps toward effective and timely integration of better exposure science into disaster preparedness, including the need for a subsequent workshop to facilitate this integration. All panel presentations and a summary were uploaded to the ISES(1) website (http://www.iseaweb.org/Disaster_Preparedness/index.php).     

Evaluation of mental health emergency preparedness among health professionals

The purpose of this study was to identify if health professionals report an increase in mental health preparedness abilities with having only two mental health components as part of a 2-day preparedness training conference. At each of three conferences, identical pretraining and posttraining surveys were administered to conference participants. A 3-month follow-up survey was administered to respondents who volunteered to complete them. At pretraining, respondents (n = 603) reported generally greater mental health preparedness abilities than non-mental health preparedness abilities. This trend continued at posttraining (n = 490) and at 3 months posttraining (n = 195). Participants reported significantly increased mental health preparedness abilities at immediate posttraining and at 3 months posttraining from pretraining. This current study suggests that even when mental health items are included as a secondary component of disaster preparedness training, significant and meaningful growth in participants' confidence in their abilities can occur.     

The shadow of context: Neighborhood and school socioeconomic disadvantage,perceived social integration,and the mental and behavioral health of adolescents

The number of youths who experience mental distress has been increasing over the past years. Adolescents with mental health problems also show high rates of co-occurring substance-related behaviors such as illicit drug use. This study leverages large-scale and nationally representative Add Health data to evaluate whether the risks conferred by neighborhood and school socioeconomic disadvantages adversely impact adolescents' mental and behavioral health (i.e., depressive symptoms and illicit drug use). We further investigate whether levels of perceived social support from friends, parents, and teachers moderate the associations between contextual disadvantages and adolescents' mental and behavioral outcomes. Results from cross-classified multilevel modeling analysis suggest that neighborhood socioeconomic disadvantages, and to a lesser degree, school socioeconomic disadvantages, uniquely and simultaneously predict mental and behavioral outcomes of adolescents. Although social support is likely to offset the mental and behavioral consequences of disadvantaged social context to all, high levels of social support is most protective for adolescents of least disadvantaged neighborhoods. This study highlights the possibility that structural disadvantage— within both the school and neighborhood contexts—may adversely impact adolescents’ mental well-being and increase their risk for illicit drug use.     

Evidence of the effectiveness of health sector preparedness in disaster response: the example of four earthquakes

In this article, evidence that health sector preparedness improves response performance in disasters was examined. Case fatality and survival data were compared for four earthquakes, in relation to health sector emergency preparedness levels. Vast differences in performance were found. The two California systems, with a high preparedness index, had low case fatality rates (about one death per 100 injuries). Kobe, Japan, with mixed levels of preparedness, had 31 deaths per 100 injuries, and Armenia (low preparedness index) had 167. Public health and health sector preparedness made a significant difference in the ability to respond effectively to meet patient needs in disasters, although it is only one of several factors that determine the health outcome of disaster victims.     

The H1N1 crisis: a case study of the integration of mental and behavioral health in public health crises

In substantial numbers of affected populations, disasters adversely affect well-being and influence the development of emotional problems and dysfunctional behaviors. Nowhere is the integration of mental and behavioral health into broader public health and medical preparedness and response activities more crucial than in disasters such as the 2009-2010 H1N1 influenza pandemic. The National Biodefense Science Board, recognizing that the mental and behavioral health responses to H1N1 were vital to preserving safety and health for the country, requested that the Disaster Mental Health Subcommittee recommend actions for public health officials to prevent and mitigate adverse behavioral health outcomes during the H1N1 pandemic. The subcommittee's recommendations emphasized vulnerable populations and concentrated on interventions, education and training, and communication and messaging. The subcommittee's H1N1 activities and recommendations provide an approach and template for identifying and addressing future efforts related to newly emerging public health and medical emergencies. The many emotional and behavioral health implications of the crisis and the importance of psychological factors in determining the behavior of members of the public argue for a programmatic integration of behavioral health and science expertise in a comprehensive public health response.     

Analysis of media agenda setting during and after Hurricane Katrina: implications for emergency preparedness, disaster response, and disaster policy

Media agenda setting refers to the deliberate coverage of topics or events with the goal of influencing public opinion and public policy. We conducted a quantitative content analysis of 4 prominent newspapers to examine how the media gathered and distributed news to shape public policy priorities during Hurricane Katrina. The media framed most Hurricane Katrina stories by emphasizing government response and less often addressing individuals' and communities' level of preparedness or responsibility. Hence, more articles covered response and recovery than mitigation and preparation. The newspapers studied focused significantly more on government response than on key public health roles in disaster management. We discuss specific implications for public health professionals, policymakers, and mass media so that, in the future, coordination can be enhanced among these entities before, during, and after disasters occur.     

After Hurricane Floyd passed: investigating the social determinants of disaster preparedness and recovery

In September 1999, Hurricane Floyd struck eastern North Carolina. Investigators from the health promotion study "Health Works for Women/Health Works in the Community" responded by initiating a focused research study, "Health Works After the Flood." Participatory research involving a multilevel design and qualitative methods was applied to investigate how community preparedness, response, and recovery are affected by social factors such as social capital, social cohesion, and collective efficacy. This article presents evidence from qualitative research conducted for "Health Works After the Flood" and links these findings to observations regarding current conceptualizations of social capital and related concepts.     

A logic model for the integration of mental health into chronic disease prevention and health promotion

Mental illnesses such as depression or anxiety affect an individual's ability to undertake health-promoting behaviors. Chronic diseases can have a profound impact on an individual's mental health; in turn, mental health status affects an individual's ability to participate in treatment and recovery. A group of mental health and public health professionals convened to develop a logic model for addressing mental health as it relates to chronic disease prevention and health promotion. The model provides details on inputs, activities, and desired outcomes, and the designers of the model welcome input from other mental health and public health practitioners.     

The courts, public health, and legal preparedness

The judicial branch's key roles, as guardian of civil liberties and protector of the rule of law, can be acutely relevant during public health emergencies when courts may need to issue orders authorizing actions to protect public health or restraining public health actions that are determined to unduly interfere with civil rights. Legal preparedness for public health emergencies, therefore, necessitates an understanding of the court system and how courts are involved in public health issues. In this article we briefly describe the court system and then focus on what public health practitioners need to know about the judicial system in a public health emergency, including the courts' roles and the consequent need to keep courts open during emergencies.     

Hurricane Katrina and the healthcare infrastructure: A focus on disaster preparedness, response, and resiliency

The aftermath of Hurricane Katrina provides a window of opportunity to address a frail and failing healthcare system. Katrina was the rare incident that disrupted the external systems supplying hospitals with key services and resources needed for the organizations to function; increased the number of patients, both present and expected, that required medical care; and affected directly the physical plants of the hospitals, challenging their functionality. Sorting through and gleaning useful lessons to increase the resilience of hospitals for this type of catastrophic incident will take time and will require system-wide public health planning and intervention. In this article, the authors focus on how hospitals prepared for, responded to, and coped with Katrina. They also provide a brief overview of the current situation and the healthcare crisis confronting hospitals and communities in the region affected by Katrina and discuss the impending need to develop disaster-resilient medical and healthcare systems. Planning, access to adequate resources, networking, effective communication and coordination, and training and education of doctors, nurses, technicians, and medical staff are essential in the development of a resilient healthcare infrastructure that will be able to provide the much needed services to populations affected by future disasters.