The role of environmental health in disaster management: a qualitative study of Australian experiences

Even though environmental health is widely considered to be an integral component of disaster management, limited research on this topic has been conducted. Using a qualitative approach, the authors conducted in-depth interviews of practitioners in Queensland, Australia, to explore the role of environmental health in disaster management and determine how those internal and external to the profession perceive this role. The major themes that emerged described a process in which the "view of health" is socially constructed, and this process is instrumental in shaping perception of the environmental health role in disaster management. The authors also found that the role of environmental health in disaster management is experiencing renegotiation due to a complex process of challenging the socially constructed view of health, raising the profile of the profession, and achieving increased representation in disaster management. Ultimately, increased recognition and a heightened profile of environmental health will result in a more effective disaster management system and will carry over into day-to-day activities.     

Operationalizing Iterative Risk Management under Limited Information:Fiscal and Economic Risks Due to Natural Disasters in Cambodia

Iterative risk management and risk-sensitive public investment planning are increasingly seen as essential elements of natural disaster resilience. This article assesses the disaster risk facing the hazard-prone Southeast Asian country of Cambodia and discusses its fiscal preparedness and need for proactive disaster risk management.The study provides a bottom-up assessment of flood and cyclone risks to public and private buildings including educational structures, health facilities, and housing and estimates the total direct economic damage to range from approximately USD 304 million for a 5-year return period event to USD 2.26 billion for a 1000-year return period event. These estimates were further analyzed using the fiscal risk due to disasters, which indicates that Cambodia will likely face a resource gap whenever a hazard as large as that of a 28-year return period event strikes. Given the frequent occurrence of disasters and rapid accumulation of capital assets taking place, proactive risk reduction is highly advisable. But interviews with national policymakers also revealed that there are a number of barriers to effective risk reduction and management in Cambodia. The general lack of awareness regarding risk-based concepts and the limited availability of local risk information necessitate a continued and sustained effort to build iterative risk management in Cambodia.     

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.     

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.     

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.     

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.     

A socio-ecological autopsy of the E. coli O157:H7 outbreak in Walkerton, Ontario, Canada

The socio-political context of modern environmental health disasters tends to be defined as being outside the scope of official public health and epidemiological investigations into the causes of such disasters. On the other hand, popular accounts of these disasters tend to focus exclusively on the role of particular individuals and/or political actors, while minimizing the role of ecological factors. It is argued that an exclusive focus on either set of causal factors gives an incomplete or distorted picture of the origins of an environmental health disaster. In this paper, a socio-ecological analysis is developed to demonstrate how the largest outbreak of waterborne E. coli O157:H7 in Canadian history was the emergent product of a complex interplay and intertwining of social and ecological processes. The socio-ecological autopsy approach that is developed here traces the social and ecological chain of events that ultimately led to the outbreak and demonstrates, in particular, the need for investigative analysis to focus on the socio-ecological "incubation" of an environmental health disaster. Drawing from both the social sciences (particularly, the sociology of disasters and organizational sociology), and from the ecological sciences (particularly disease ecology), the analysis developed here responds to the call for the application of a more transdisciplinary approach to the study of contemporary environmental health problems.     

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.     

Productivity improvement and job satisfaction among public health nutritionists.

A workshop for public health nutritionists which scrutinized ways to improve productivity and job satisfaction is reported. Participants believed that productivity could be improved most by improving the execution of tasks, followed by better planning of programs, office management, and skills in group education, and by delegation of non-professional activities to lesser-trained personnel. Job satisfaction of public health nutritionists could be increased by reducing stress and discomfort and promoting feelings of personal effectiveness and efficiency through role clarification and by management training. There is a large potential for greater productivity in the profession. Realization of this potential will contribute measurably to the cost-effectiveness of nutritional services.     

Marketing social marketing: getting inside those "big dogs' heads" and other challenges

Social marketing provides a powerful process for planning and implementing public health programs. Although often applied to the promotion of healthier lifestyles, social marketing can also be used to promote utilization of direct services or policy changes. Despite growing popularity among public health professionals, resistance by senior management, community advocates, policy makers, and others can create barriers to the use of the social marketing model. This article draws on the authors' observations, practice experiences, extensive training interactions, and qualitative studies with public health practitioners across the nation. It examines some of the key reasons that public health practitioners encounter resistance to using social marketing and discusses how a logic model can be used to market social marketing in organizations and communities.     

Evolving need for alternative triage management in public health emergencies: a Hurricane Katrina case study

In many countries, traditional medical planning for disasters developed largely in response to battlefield and multiple casualty incidents, generally involving corporal injuries. The mass evacuation of a metropolitan population in the aftermath of Hurricane Katrina evolved into life-and-death triage scenarios involving thousands of patients with nontraumatic illnesses and special medical needs. Although unprecedented in the United States, triage management needs for this disaster were similar to other large-scale public health emergencies, both natural and human-generated, that occurred globally in the past half-century. The need for alternative triage-management processes similar to the methodologies of other global mass public health emergencies is illustrated through the experience of disaster medical assistance teams in the first 3 days following Katrina's landfall. The immediate establishment of disaster-specific, consensus-based, public health emergency-related triage protocols-developed with ethical and legal expertise and a renewed focus on multidimensional, multifactorial matrix decision-making processes-is strongly recommended.     

The potential impacts of climate variability and change on health impacts of extreme weather events in the United States

Extreme weather events such as precipitation extremes and severe storms cause hundreds of deaths and injuries annually in the United States. Climate change may alter the frequency, timing, intensity, and duration of these events. Increases in heavy precipitation have occurred over the past century. Future climate scenarios show likely increases in the frequency of extreme precipitation events, including precipitation during hurricanes, raising the risk of floods. Frequencies of tornadoes and hurricanes cannot reliably be projected. Injury and death are the direct health impacts most often associated with natural disasters. Secondary effects, mediated by changes in ecologic systems and public health infrastructure, also occur. The health impacts of extreme weather events hinge on the vulnerabilities and recovery capacities of the natural environment and the local population. Relevant variables include building codes, warning systems, disaster policies, evacuation plans, and relief efforts. There are many federal, state, and local government agencies and nongovernmental organizations involved in planning for and responding to natural disasters in the United States. Future research on health impacts of extreme weather events should focus on improving climate models to project any trends in regional extreme events and as a result improve public health preparedness and mitigation. Epidemiologic studies of health effects beyond the direct impacts of disaster will provide a more accurate measure of the full health impacts and will assist in planning and resource allocation.     

"Knife before wife": an exploratory study of gender and the UK medical profession

PURPOSE: The paper aims to explore the increasing feminisation of the medical profession and career progression of women in the medical profession. Furthermore, the paper explores the implications of gender segregation in the medical profession for health service provision. DESIGN/METHODOLOGY/APPROACH: The paper presents an overview of studies in this area and draws upon primary, empirical research with medical practitioners and medical students. However, unlike most other studies the sample includes male and female participants. The research involved elite interviews and self-completion questionnaires in order to provide perspectives of both male and female medical practitioners and medical students. FINDINGS: The findings are consistent with those of other studies; that gender discrimination and segregation is still prevalent in the medical profession. But there are significant differences in perceptions between the genders. Moreover, it is concluded that the gendered career structure and organisational culture of the health sector and medical profession create a role conflict between personal and professional lives. The current difficulties in reconciling this role conflict create barriers to the career progression of women in the medical profession. RESEARCH LIMITATIONS/IMPLICATIONS: Further research in this area could include a longitudinal study of medical students and the impact of changes in the design of medical training and career structures to assess whether these changes enable female career progression in the medical profession. Further analysis is needed of gendered practices and career development in specific specialist areas, and the role of the medical profession, NHS and Royal Colleges should play in addressing gender and career progression in medicine. PRACTICAL IMPLICATIONS: Gender segregation (vertical and horizontal) in the medical profession will have implications for the attraction, retention and increased shortages of practitioners in hospital and surgical specialities with the resultant economic and health provision inefficiencies. ORIGINALITY/VALUE: The paper provides a review of literature in this area, thereby providing a longitudinal perspective of gender and the medical profession. Moreover, the research sample includes both male and female medical practitioners and medical students, which provides perspectives from both genders and from those who have experience within the medical profession and from those beginning their career in the medical profession. The research will be of value to the medical profession, the NHS and Royal Colleges of Medicine.     

Cause and control: education and training of professional industrial hygienists for 2020.

By the year 2020, the environmental movement will have established a recognized profession, expert at studying deleterious effects in the working and public domains. Environmental science practitioners will be better able to identify and relate ill effects to the presence of adverse agents in the environment; they will not, however, necessarily be skilled at developing systems for control. Industrial hygienists should provide the unique and special skills required to establish economically optimum control systems. Industrial hygiene should by then have been redefined to emphasize this critical role of its professional members. A new orientation for education is therefore proposed to provide a sound basis for the professional needs of industrial hygienists who should be at the peak of their careers in 2020. Members of the profession should then be the leaders in research on, and practice of, the science and engineering of design, installation, and monitoring of control systems for occupational and environmental hazards. The preferred educational background for entry to the profession should be some branch of engineering, which by then must have recovered its lost status and be divided into fewer specialized compartments than it is today. Engineering should provide a broader base for students entering professional education in this field, who will be more concerned with prevention and engineering control of both occupational and environmental hazards, rather than with measurement and epidemiology of the biological and toxicologic sciences. Preparation for professional work in industrial hygiene will call for the specialized education of engineers required to design and maintain processes that minimize the use, production, or generation of hazardous substances.(ABSTRACT TRUNCATED AT 250 WORDS)     

The role of the veterinarian during natural disasters

After a reminder of the main types of natural hazards that can lead to genuine disasters, the author examines the impact of such disasters on animal health. The conceptual approach to various groups of animals in a disaster situation is explained, as well as the direct and indirect effects of such disasters. Preparatory measures are presented within the general framework of prevention and forecasting, together with the veterinary measures to be implemented. Training of veterinarians and planning of activities are described in detail. A traditional approach to organising large-scale assistance is advocated, based on the competence of the personnel involved and a predefined hierarchical organisation. The author then describes veterinary actions to be taken in a disaster situation where emergency aid is required. Particular reference is made to providing assistance to save human lives, including search operations by dog teams for buried victims, and the subsequent phase of restoring human activities, during which assistance to animals is taken into account. Inter-ministerial co-ordination using crisis units and priority management implying real political choices are discussed. Finally, based on the example of the operational organisation of the French Civil Defence, the author describes the support available to Veterinary Services and the potential involvement of the profession, in particular veterinary officers attached to the emergency fire service.     

Developing public health nursing: barriers perceived by community nurses

OBJECTIVES: To understand the key issues for field nursing in developing their public health role within five primary care trusts (PCTs) in Merseyside, in the North West of England. DESIGN: Qualitative study. METHODS: Fourteen school nurses and 30 health visitors participated in 11 focus groups consisting of others from their profession working within the same PCT, and 24 practitioners responded to a questionnaire. RESULTS: The findings suggest that there are a number of shared obstacles that need to be overcome before the public health approach can be fully developed within community nursing. These include: the need for facilitation to deal with organisational change, lack of clarity around the public health role, inadequate administrative support, general practitioner attachment problems, poor interprofessional partnerships, competing priorities and resistance to change. CONCLUSIONS: The development of public health nursing in England envisaged in current government policy will not occur in full unless the kind of issues identified in this study are adequately addressed. This will require participative, interprofessional approaches to redesigning services by all relevant public health practitioners.     

Understanding and Addressing Barriers to Implementation of Environmental and Policy Interventions to Support Physical Activity and Healthy Eating in Rural Communities

Purpose: Rural residents are at greater risk of obesity than urban and suburban residents. Failure to meet physical activity and healthy eating recommendations play a role. Emerging evidence shows the effectiveness of environmental and policy interventions to promote physical activity and healthy eating. Yet most of the evidence comes from urban and suburban communities. The objectives of this study were to (1) identify types of environmental and policy interventions being implemented in rural communities to promote physical activity or healthy eating, (2) identify barriers to the implementation of environmental or policy interventions, and (3) identify strategies rural communities have employed to overcome these barriers. Methods: Key informant interviews with public health professionals working in rural areas in the United States were conducted in 2010. A purposive sample included 15 practitioners engaged in planning, implementing, or evaluating environmental or policy interventions to promote physical activity or healthy eating. Findings: Our findings reveal that barriers in rural communities include cultural differences, population size, limited human capital, and difficulty demonstrating the connection between social and economic policy and health outcomes. Key informants identified a number of strategies to overcome these barriers such as developing broad‐based partnerships and building on the existing infrastructure. Conclusion: Recent evidence suggests that environmental and policy interventions have potential to promote physical activity and healthy eating at the population level. To realize positive outcomes, it is important to provide opportunities to implement these types of interventions and document their effectiveness in rural communities.     

The integration of mental and behavioral health into disaster preparedness, response, and recovery

The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health into disaster and emergency preparedness and response activities. One vital opportunity to improve integration is the development of clear and directive national policy to firmly establish the role of mental and behavioral health as part of a unified public health and medical response to disasters. Integration of mental and behavioral health into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services, addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.     

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.