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Public Health Disaster Consequences of Disasters

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Title: Public Health Disaster Consequences of Disasters


1
Public Health Disaster Consequences of Disasters
  • Eric K. Noji, M.D., M.P.H.
  • Medical Epidemiologist Centers
  • for Disease Control Prevention
  • Washington, DC
  • Second Annual John C. Cutler
  • Global Health Lecture and Award
  • University of Pittsburgh
  • 29 September 2005

2
  • This lecture has been supported by John C.
    Cutler Memorial Global Fund, Graduate School of
    Public Health, University of Pittsburgh
  • Coordinated through the Global Health Network
    Supercourse project, WHO Collaborating Centre,
    Uni. Of Pittsburgh
  • Faina Linkov, Ph.D.
  • Eugene Shubnikov, MD,
  • Mita Lovalekar, M.D.,
  • Ronald LaPorte, Ph.D.

www.pitt.edu/super1/
3
Definition of Disaster
  • 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

4
Disasters and Emergencies
Natural Disasters Transportation
Disasters Terrorism
Technological Disasters Pandemics
5
1994-2004 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

6
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

7
Influence of Population Growth
  • Urban dwellers
  • 1920 100 million
  • 1980 1 billion
  • 2004 2 billion
  • 2004 20 cities with gt10 million people
  • Sources
  • CDC EK Noji, The Public Health Consequences of
    Disaster

8
Political destabilization in the post Cold War
era with increased regional violence

9
Escalating ethnic based conflicts with civilians
as military targets

10
Forced Migration
11
Emerging themes in EpidemiologyThe role
of the applied epidemiologist in armed
conflictSharon M McDonnell, Paul Bolton, Nadine
Sunderland, Ben Bellows, Mark White and Eric
NojiFor more information visithttp//www.ete-o
nline.com/content/1/1/4(biomed central)
12
Epidemiology and its applications in measuring
the effects of disasters
  • Epidemiology
  • The quantitative study of the distribution and
    determinants of health related events in human
    populations

13
Disaster Epidemiology
  • Assessment and Surveillance
  • Injury and disease profiles
  • Research methodologies
  • Disaster management
  • Vulnerability and hazard assessment

14
Disaster Epidemiology
Data for Decision-Making
  • Purpose
  • Identify requirements, local capabilities, gaps
  • Avoid unnecessary and damaging assistance

15
"The reason for collecting, analyzing and
disseminating information on a disease is to
control that disease. Collection and analysis
should not be allowed to consume resources if
action does not follow."
  • William H. Foege, M.D.
  • International Journal of Epidemiology 1976
    529-37

16
Objectives of Health Information Systems in
Emergency Populations
  • Establish health care priorities
  • Follow trends and reassess priorities
  • Detect and respond to epidemics
  • Evaluate program effectiveness
  • Ensure targeting of resources
  • Evaluate quality of health care

17
Myths and Disaster Realities
  • 1) Myth Foreign medical volunteers with any
    kind of medical background are needed.
  • Reality
  • The local population almost always covers
    immediate lifesaving needs.
  • Only skills that are not available in the
    affected country may be needed.
  • Few survivors owe their lives to outside teams

18
2) Myth Any kind of assistance is needed, and
its needed now!
  • Reality
  • A hasty response not based on impartial
    evaluation only contributes to chaos
  • Un-requested goods are inappropriate, burdensome,
    divert scarce resources, and more often burned
    than separated and inventoried
  • Not wanted, seldom needed used clothing, OTC,
    prescription drugs, or blood products medical
    teams or field hospitals.

19
3) Myth Epidemics and plagues are inevitable
after every disaster.
  • Reality
  • Epidemics rarely ever occur after a disaster
  • Dead bodies will not lead to catastrophic
    outbreaks of exotic diseases
  • Proper resumption of public health services will
    ensure the publics safety
  • Immunizations, sanitation, waste disposal, water
    quality, and food safety
  • Caveat Criminal or terror-intent disasters
    require special considerations

20
4) Myth Disasters bring out the worst in
human behavior.
  • Reality While isolated cases of antisocial
    behavior exist, the majority of people response
    spontaneously and generously

40-60 Drop in murder rate surprises NYC-
fewest since 1958. - USA Today 03/25/2002 
Kenyans line up for 2-3 km in August heat to
donate blood after US Embassy bombing
21
5) Myth The community is too shocked
and helpless
  • Reality
  • Many find new strengths
  • Cross-cultural dedication to common good is most
    common response to natural disasters
  • Thousands volunteer to rescue strangers and sift
    through rubble after earthquakes from Mexico
    City, California, and Turkey. Most rescue,
    first aid, and transport is from other casualties
    and bystanders

22
WHAT DOES THE FUTURE HOLD?
23
Increasing disaster risk
  • Increasing population density
  • Increased settlement in high-risks areas
  • Increased technological hazards and dependency
  • Increased terrorism biological, chemical,
    nuclear?
  • Aging population in industrialized countries
  • Emerging infectious diseases (SARS)
  • International travel (global village)

24
  • Increasing Global Travel
  • Rapid access to large populations
  • Poor global security awareness

...create the potential for simultaneous creation
of large numbers of casualties
25
Health Information Needs in Emergency Populations
  • Establish health care priorities
  • Follow trends and reassess priorities
  • Detect and respond to epidemics
  • Evaluate program effectiveness
  • Ensure targeting of resources
  • Evaluate quality of health care

26
Final Thought
  • NOTHING REPLACES WELL TRAINED, COMPETENT AND
    MOTIVATED PEOPLE! NOTHING!
  • PEOPLE ARE THE MOST IMPORTANT ASSET

27
EXTRA SLIDES
  • Please refer to Cutler lecture website
  • http//www.publichealth.pitt.edu/
    specialevents/cutler2005/webcast.html
  • to obtain full version of the lecture

28
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

29
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

30
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

31
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

32
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

33
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

34
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

35
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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