Preventing Disasters: Disaster Risk Reduction as a

Sustainable Adaptation to Climate Change1

Centers for Disease Control and Prevention

Mark Keim, MD, MBA

1 Keim ME. Preventing Disasters. Disaster Med Public Health Prep. 2011 Jun;5(2):140-8.

A story of disaster risk reduction…

15 years later…

December 1981

1982 Memorial Day holiday

Evacuation path

All deaths occurred during the impact phase

May 1982Duclos PJ, Ing RT. Injuries and Risk Factors for Injuries from the 29 May 1982 Tornado, Marion, Illinois. International Journal of

Epidemiology 1989,18: 213-219.

Global climate change is predicted to increase the probability of extreme

weather events• High precipitation

disasters– Storms – Floods– Landslides

• Low precipitation disasters– Heat – Drought– Wildfire

2 IPCC Working Group II, Impacts, Adaptation and Vulnerability, 2007 http://www.ipcc.ch/SPM13apr07.pdf

8

Public health consequences of extreme weather events

• Death• Injuries• Loss of clean water• Loss of shelter• Major population

movements• Loss of sanitation• Loss of routine hygiene• Disruption of solid

waste management

• Public concern for safety• Increased pests & vectors• Damage to health care

system• Worsening of chronic

illnesses• Loss of electricity• Toxic exposure• Loss of food supply

Disasters are increasing worldwide…

• …due to increasing vulnerability of populations at risk.

• Interventions must therefore address the causes of vulnerability not merely the response

Center for Research on the Epidemiology of Disasters : URL:http://www.unisdr.org/we/inform/disaster-statistics

An evolution in approaches

Response

Preparedness

Risk Management

Disaster Risk Management

Definition– “The systematic

process of using administrative directives, organizations, and operational skills and capacities to implement strategies, policies and improved coping capacities in order to lessen the adverse impacts of hazards and the possibility of disaster”.

Components– Risk assessment– Risk avoidance– Risk reduction– Risk transfer– Risk retention

UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

Risk Management vs. Risk Reduction

• Risk Management– Prevention– Mitigation– Preparedness– Response – Recovery

• Risk Reduction– Prevention– Mitigation

Risk Reduction

lessens

the likelihood

of disaster

Causes Effects

Hazard Exposure

Vulnerability

Mortality

Displace-ment

Morbidity

Loss of liveliho

od

Prevention

Mitigation

Preparedness, Response

& Recovery

Disaster Risk Reduction (DRR) for Health

What is DRR? Preventing

disaster-related adverse health impact before it happens

Deals with the root cause

Why DRR? More effective in

reducing mortality• Majority of disaster

deaths occur during impact phase

Definition of risk Risk is the

probability that an event will occur.

In epidemiology, it is most often used to express the “probability that a particular outcome will occur following a particular exposure”

Last JM, ed. A dictionary of epidemiology. 4th edition. New York: Oxford University Press, 2001.

Factors affecting disaster risk

RISK

Capacity

Vulner-ability

Hazard/ Exposure

Health-related disaster risk occurs as the result of

convergence of 4 key factors:• The presence of a

health hazard associated with the occurrence of natural or man-made danger

• The degree of exposure to the hazard sustained by the person (or population)

• The degree of vulnerability of the person (or population) to that particular health hazard

• The degree of capacity of the person (or population) in order to avoid or lessen harm

From: Keim M. Disaster Risk Management for Health. In Ed., David S. Textbook of Emergency Medicine. Lippincott) New Dehli 2012

– “A dangerous phenomenon, substance, human activity or condition that may cause loss of life, injury or other health impacts, property damage, loss of livelihoods and services, social and economic disruption, or environmental damage”

Definition of a hazard

UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

Examples of hazards

Floods

TornadoesTyphoons

Earthquakes

Radiation

Outbreaks

Definition of vulnerability“The characteristics

and circumstances of a community, system or asset that make it susceptible to the damaging effect of a hazard” UNISDR 2009

Or simply put…

Likely to incur physical or emotional illness or injury

UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

Public health vulnerability

• Certain populations are more vulnerable to disaster-related morbidity and mortality

Definition of exposure– “People, property,

systems, or other elements present in hazard zones that are thereby subject to potential losses”

• Example of exposure– Living in an area

that floods

UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

Definition of capacity

– “The combination of all the strengths, attributes and resources available within a community, society or organization that can be used to achieve agreed goals” ‡

• Also known as absorptive capacity ‡‡

What is the difference between capacity vs. capability?

‡ UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

‡‡ Sundnes K, Birnbaum M, Birnbaum E, eds. Health Disaster Management Guidelines for Evaluation and Research in the Utstein Style. USA: Prehospital and Disaster Medicine; 2003

Countering disaster risk

Hazard /Exposure andVulnerability

Increase Risk

Decreases

Risk

Reducing exposures

• Floodplain management– Dams, levees, weirs

• Population protection measures– Evacuation– Mass care

• Land use planning and regulation

• PPE, sanitation/hygiene

Reducing vulnerability

• Health promotion• Health care• Poverty reduction• Community

planning• Immunization

Mapping human vulnerability

National Prevention Strategy Identifies goals, priorities,

recommendations, and measures for improving health through prevention

Grounds recommendations in evidence-based practice

Aligns and focuses federal prevention and health promotion efforts, including existing national efforts Healthy People 2020 National Quality Strategy First Lady’s “Let’s Move!” campaign America’s Great Outdoor Initiative

National Prevention Strategy

Building capacity

We build capacity by improving:

– Preparedness– Response – Recovery

Societal actions that build emergency health capacity• Public health & safety• Healthcare• Education• Poverty reduction

Examples of environmental health programs that reduce the risk of disaster-related

morbidity and mortality

Reducing exposures (Healthy

communities) Healthy buildings Built environment Population protection

measures Risk assessment Industrial hygiene Waste management

Reducing vulnerability(Healthy people) Water, sanitation,

hygiene Food safety Pest control Environmental

psychology Environmental justice

and ethics Climate change

adaptation

Cross-cutting programs: GIS, Risk communication, Public policy, Community involvement

NCEH DRR for Health: Expected Outcome

 The substantial reduction in morbidity and mortality

Strategic Goals

 Integrate health-related disaster reduction into multi-sector approach

 Building resilience to health hazards

 Incorporate risk reduction approaches into preparedness, response and recovery programs 

Priorities for Action Promote

disaster risk reduction as a national and a local priority

Identify, assess and monitor

disaster risks and enhance early warning

Use knowledge innovation and

education to build a culture of resilience

at all levels

 Reduce the underlying risk

factors

Strengthen disaster

preparedness for effective

response at all levels

National Center for Environmental HealthAgency for Toxic Substances and Disease Registry

Email • mjk9@cdc.gov

LinkedIn.com: • www.linkedin.com/in/disasterdoc/• Disaster Risk Reduction for Health

Discussion Group

For more information please contact Agency for Toxic Substances and Disease Registry or the Centers for Disease Control and Prevention

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CDC:1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Disease Registry

National Center for Environmental HealthAgency for Toxic Substances and Disease Registry

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