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Public Health Disaster Consequences of Disasters

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University of Pittsburgh. 29 September 2005 ... Memorial Global Fund, Graduate School of Public Health, University of Pittsburgh ... Of Pittsburgh ... – PowerPoint PPT presentation

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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
  • 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/cut
    ler2005/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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