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Disasters: The Public Health Impact

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Title: Disaster: Perspectives Author: James M. Shultz Last modified by: Sa Created Date: 12/20/2001 2:34:21 AM Document presentation format: – PowerPoint PPT presentation

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Title: Disasters: The Public Health Impact


1
Disasters The Public Health Impact

2
  • Disasters The Public Health Impact
  • Mortality Morbidity
  • Disasters cause deaths, injuries, and illnesses
  • Disasters may overwhelm medical resources and
    health services
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

3
Disasters The Public Health Impact
  • Health Care Infrastructure
  • Disasters may destroy hospitals
  • Disasters may disrupt routine health services
  • Disasters may disrupt preventive activities
  • Consequence long-term increases in morbidity
    and mortality
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

4
Disasters The Public Health Impact
  • Environment Population
  • Disasters may increase potential for communicable
    diseases
  • Disasters may exacerbate environmental hazards
  • Consequences increases in morbidity and
    premature death, decreased quality of life
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

5
Disasters The Public Health Impact
  • Psychological and Social Behavior
  • Disasters may cause generalized panic or
    paralyzing trauma
  • Disasters may provoke increases in anxiety,
    depression and neuroses
  • Disasters may lead to post-traumatic stress
    disorder (PTSD) at epidemic levels
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

6
Disasters The Public Health Impact
  • Food Supply
  • Disasters may disrupt the food supply
  • Disasters leading to food shortages may cause
    specific micronutrient deficiencies
  • Disasters may provoke severe nutritional
    consequences including famine and starvation
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

7
Disasters The Public Health Impact
  • Population Displacement
  • Disasters may cause large spontaneous or
    organized population movements
  • Population movement may increase morbidity and
    mortality
  • Population movement may precipitate epidemics of
    communicable diseases in both displaced and host
    communities
  • Crowding of populations and overlay of refugee
    and host populations may lead to injuries and
    violence
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

8
Epidemiologic Methods in Disasters
9
Epidemiologic Methods in Disasters
  • Before a disaster (Interdisaster Phase)
  • Conducting hazards vulnerability analyses of
    the population
  • Modeling/simulating disaster scenarios
  • Conducting drills
  • Designing emergency protocols
  • Assessing level of emergency preparedness
  • Assessing flexibility of surveillance systems
  • Training health and safety personnel
  • Source EK Noji, The Public Health Consequences
    of Disaster

10
Epidemiologic Methods in Disasters
  • During a disaster (Emergency Phase)
  • Conducting disaster damage assessment
  • Conducting rapid field investigations
  • Identifying urgent needs matching resources
  • Prioritizing relief efforts
  • Conducting disaster surveillance
  • Conducting epidemic investigations
  • Source EK Noji, The Public Health Consequences
    of Disaster

11
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

12
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

13
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

14
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

15
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

16
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

17
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

18
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

19
The Disaster Cycle
20
Disaster Cycle
  • Sudden impact natural disasters
  • can be considered as a continuous time sequence
  • of five phases
  • Interdisaster
  • Predisaster
  • Impact
  • Emergency
  • Reconstruction
  • Source EK Noji, Sivertson KT. Injury
    prevention in natural disasters a theoretical
    framework. Disasters 198711290-296.

21
Disaster Cycle
  • Interdisaster Phase
  • Planning disaster prevention/preparedness/mitigati
    on
  • Identifying risks
  • Identifying vulnerabilities
  • Creating a resource inventory
  • Conducting professional training
  • Conducting community education
  • Synonym Nondisaster Phase

22
Disaster Cycle
  • Predisaster Phase
  • Issuing timely warnings
  • Implementing protective actions
  • Undertaking emergency management activities
  • Evacuating population as necessary
  • Synonym Warning Phase

23
Disaster Cycle
  • Impact Phase
  • Destruction
  • Injuries
  • Deaths
  • may occur during impact

24
Disaster Cycle
  • Emergency Phase
  • Implementing life-saving actions
  • -search and rescue
  • -first aid
  • -emergency medical assistance
  • Restoring emergency communications
  • Restoring emergency transportation
  • Implementing public health surveillance
  • Evacuating vulnerable areas
  • Synonyms Relief Phase, Isolation Phase

25
Disaster Cycle
  • Emergency Phase
  • Note The immediate postimpact period is the
    isolation phase where most urgent rescue tasks
    are accomplished by the survivors using local
    resources
  • Synonyms Relief Phase, Isolation Phase

26
Disaster Cycle
  • Reconstruction Phase
  • Restoring predisaster conditions
  • Reestablishing health services
  • Reconstructing repairing damaged facilities
  • Reflecting and debriefing on lessons learned
  • Synonym Rehabilitation Phase

27
Disaster Severity
28
Disaster Severity
  • 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

29
Disaster Severity
  • A Decade of Natural Disasters (1980s)
  • Floods 39,000 deaths
  • Tropical cyclones 14,000 deaths
  • Hurricanes 1,000 deaths
  • Earthquakes 54,000 deaths
  • Other disasters 1,012,000 deaths
  • TOTAL 1,120,000 deaths
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

30
Disaster Severity
  • 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

31
Disaster Severity
  • Influence of Poverty
  • Persons in poverty
  • -Live in poor housing unable to withstand seismic
    activity
  • -Live in poor housing susceptible to landslides
  • -Inhabit coastal areas and flood plains
    vulnerable to hurricanes, storm surges,
    flooding, and tidal waves
  • -Live near hazardous industrial sites
  • -Do not receive education on life-saving actions
    during disasters
  • -Do not receive warning of impending disasters
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

32
Disaster Severity
  • Influence of Poverty
  • -Low-income countries
  • 3,000 deaths per disaster
  • -High-income countries
  • 500 deaths per disaster
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

33
Disaster Severity
  • Influence of Population Growth
  • - Urban dwellers
  • 1920 100 million
  • 1980 1 billion
  • 2000 2 billion
  • - 2000 20 cities with gt10 million people
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

34
Disaster Severity
  • Capabilities of Developed Nations
  • That Mitigate Disaster Effects
  • -Ability to forecast severe storms
  • -Ability to enforce strict building codes
  • -Ability to use communication networks to
    broadcast alerts and warnings
  • -Ability to provide emergency medical services
  • -Ability to engage in contingency planning
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

35
Disaster Perspectives
36
Disaster Perspectives
  • 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

37
Disaster Perspectives
  • Public Health View
  • Disasters are defined
  • by what they do to people...
  • Source EK Noji, The Public Health Consequences
    of Disaster

38
Disaster Perspectives
  • Major Categories of Disasters
  • -Natural Disasters
  • -Human-generated Disasters
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

39
Disaster Perspectives
  • Natural Disasters
  • -Arise from forces of nature
  • -Two subcategories
  • Sudden impact or acute onset
  • Slow or chronic onset
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

40
Disaster Perspectives
  • Sudden Impact or Acute Onset Disasters
  • Geological or climatic hazards
  • Hurricanes/typhoons Tornadoes
  • Earthquakes Volcanoes
  • Floods Tsunamis
  • Temperature extremes Wildfires
  • Landslides Avalanches
  • Epidemics
  • Food, water, vector-borne diseases
  • Person-to-person transmission diseases
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

41
Disaster Perspectives
  • Slow or Chronic Onset Disasters
  • Drought
  • Famine
  • Environmental degradation
  • Chronic exposure to toxic substances
  • Desertification
  • Deforestation
  • Pest infestation
  • Sources CDC EK Noji, The Public Health
    Consequences of Disaster

42
Disaster Perspectives
43
Disaster Perspectives
44
Disaster Perspectives
45
Disaster Perspectives
46
Disaster Perspectives
47
Disaster Perspectives
  • Human-Generated Disasters
  • Industrial/technological
  • Transportation (vehicular)
  • Deforestation
  • Material shortages
  • Complex emergencies
  • Source EK Noji, The Public Health Consequences
    of Disaster

48
Disaster Perspectives
  • Complex Emergencies
  • -Wars and civil strife
  • -Armed aggression
  • -Insurgency
  • -Other actions resulting in displaced persons and
    refugees
  • Source EK Noji, The Public Health Consequences
    of Disaster

49
Disaster Perspectives
  • 2002 DEEP Center Classification
  • -Natural disasters
  • -Non-intentional human-generated disasters
  • -Terrorist-perpetrated disasters
  • -Complex disasters
  • -Natural-technological disasters (NA-TECHS)

50
Disaster Perspectives
  • Terrorist-perpetrated Disasters
  • -Biological
  • -Nuclear
  • -Incendiary
  • -Chemical
  • -Explosive
  • Mnemonic B-NICE
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