Public Health Disaster Consequences of Disasters

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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

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• 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/
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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

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Disasters and Emergencies
Natural Disasters Transportation
Disasters Terrorism
Technological Disasters Pandemics
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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

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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

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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

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

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Escalating ethnic based conflicts with civilians
as military targets

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Forced Migration
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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)
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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

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Disaster Epidemiology

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

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Disaster Epidemiology
Data for Decision-Making

• Purpose
• Identify requirements, local capabilities, gaps
• Avoid unnecessary and damaging assistance

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"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

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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

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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

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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.

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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

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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
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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

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WHAT DOES THE FUTURE HOLD?
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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)

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

...create the potential for simultaneous creation
of large numbers of casualties
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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

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Final Thought

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

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EXTRA SLIDES

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

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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

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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

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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

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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

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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

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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

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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

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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