Public Health Disaster Consequences of Disasters

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 Pittsburgh29 September 2005

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/

Definition of DisasterDefinition 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, Source: EK Noji, The Public Health Consequences of DisasterThe Public Health Consequences of Disaster

Disasters and Emergencies

Natural Disasters

Transportation Disasters

Terrorism

Technological Disasters

Pandemics

1994-2004: A Decade of Natural Disasters

1 million thunderstorms1 million thunderstorms100,000 floods100,000 floodsTens of thousands of landslides, Tens of thousands of landslides,

earthquakes, wildfires & tornadoesearthquakes, wildfires & tornadoesSeveral thousand hurricanes, tropical Several thousand hurricanes, tropical

cyclones, tsunamis & volcanoescyclones, tsunamis & volcanoes

Sources: CDC & EK Noji, Sources: CDC & EK Noji, The Public Health Consequences of DisasterThe Public Health Consequences of Disaster

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, Sources: CDC & EK Noji, The Public Health Consequences of DisasterThe Public Health Consequences of Disaster

Influence of Population Growth

• Urban dwellers:1920: 100 million1980: 1 billion2004: 2 billion

• 2004: 20 cities with >10 million people

Sources: CDC & EK Noji, The Public Health Consequences of Disaster

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

Escalating ethnic based conflicts with civilians as military targets

Forced Migration

Emerging themes in Epidemiology

The role of the applied epidemiologist in armed conflict

Sharon M McDonnell, Paul Bolton, Nadine Sunderland, Ben Bellows, Mark

White and Eric Noji

For more information visithttp://www.ete-online.com/content/1/1/4

(biomed central)

http://www.ete-online.com/content/1/1/4

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

http://www.pitt.edu/~super1/lecture/lec0841/index.htm

Disaster EpidemiologyDisaster Epidemiology

Assessment and SurveillanceAssessment and Surveillance Injury and disease profilesInjury and disease profilesResearch methodologiesResearch methodologiesDisaster managementDisaster managementVulnerability and hazard assessmentVulnerability and hazard assessment

Disaster Epidemiology

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

VictimsNeeds

AvailableServices

Data for Decision-Making

"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; 5:29-37

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

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

2) Myth: Any kind of assistance is needed, and it’s 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.

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 public’s safety – Immunizations, sanitation, waste disposal, water quality, and

food safety• Caveat: Criminal or terror-intent disasters

require special considerations

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

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

WHAT DOES THE FUTURE HOLD?

Increasing disaster riskIncreasing population densityIncreased settlement in high-risks areasIncreased technological hazards and

dependencyIncreased terrorism: biological, chemical,

nuclear?Aging population in industrialized countriesEmerging infectious diseases (SARS)International travel (global village)

• Increasing Global TravelIncreasing Global Travel• Rapid access to large Rapid access to large

populationspopulations• Poor global security & Poor global security &

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

Health Information Needs in Health Information Needs in Emergency PopulationsEmergency Populations

Establish health care prioritiesEstablish health care priorities Follow trends and reassess prioritiesFollow trends and reassess priorities Detect and respond to epidemicsDetect and respond to epidemics Evaluate program effectivenessEvaluate program effectiveness Ensure targeting of resourcesEnsure targeting of resources Evaluate quality of health careEvaluate quality of health care

Final Thought

NOTHING REPLACES WELL TRAINED, COMPETENT AND MOTIVATED PEOPLE! NOTHING!

PEOPLE ARE THE MOST IMPORTANT ASSET

EXTRA SLIDES

Please refer to Cutler lecture website

http://www.publichealth.pitt.edu/specialevents/cutler2005/webcast.html

to obtain full version of the lecture



Epidemiologic Methods in DisastersEpidemiologic Methods in Disasters

After a disaster (Reconstruction Phase):After a disaster (Reconstruction Phase):

Conducting post-disaster epidemiologic Conducting post-disaster epidemiologic follow-up studiesfollow-up studies

Identifying risk factors for death & injuryIdentifying risk factors for death & injury

Planning strategies to reduce impact-related Planning strategies to reduce impact-related morbidity & mortalitymorbidity & mortality



After a disaster (Reconstruction Phase):After a disaster (Reconstruction Phase):Developing specific interventionsDeveloping specific interventionsEvaluating effectiveness of interventionsEvaluating effectiveness of interventionsConducting descriptive & analytical studiesConducting descriptive & analytical studiesPlanning medical & public health response to Planning medical & public health response to

future disastersfuture disastersConducting long-term follow-up of Conducting long-term follow-up of

rehabilitation/reconstruction activitiesrehabilitation/reconstruction activitiesSource: EK Noji, Source: EK Noji, The Public Health Consequences of DisasterThe Public Health Consequences of Disaster


Challenges for EpidemiologistsChallenges for EpidemiologistsApplying epidemiologic methods in the context of:Applying epidemiologic methods in the context of: Physical destructionPhysical destruction Public fearPublic fear Social disruptionSocial disruption Lack of infrastructure for data collectionLack of infrastructure for data collection Time urgencyTime urgency Movement of populationsMovement of populations Lack of local support and expertiseLack of local support and expertiseSource: EK Noji, Source: EK Noji, The Public Health Consequences of DisasterThe Public Health Consequences of Disaster


Challenges for EpidemiologistsChallenges for EpidemiologistsSelecting study designs:Selecting study designs: Cross-sectional:Cross-sectional:

Studies of frequencies of deaths, illnesses, injuries, Studies of frequencies of deaths, illnesses, injuries, adverse health affectsadverse health affectsLimited by absence of population countsLimited by absence of population counts

Case-control:Case-control:Best study to determine risk factors, eliminate Best study to determine risk factors, eliminate confounding, study interactions among multiple factorsconfounding, study interactions among multiple factorsLimited by definition of specific outcomes, issues of Limited by definition of specific outcomes, issues of selection of cases & controlsselection of cases & controls



Challenges for EpidemiologistsChallenges for Epidemiologists

Selecting study designs:Selecting study designs: Longitudinal:Longitudinal:

Studies document incidence and estimate Studies document incidence and estimate magnitude of riskmagnitude of riskLimited by logistics of mounting a study in Limited by logistics of mounting a study in a post-disaster environment and subject a post-disaster environment and subject follow-upfollow-up



Challenges for EpidemiologistsChallenges for Epidemiologists Need standardized protocols for data collection Need standardized protocols for data collection

immediately following disasterimmediately following disaster Need standardized terminology, technologies, methods Need standardized terminology, technologies, methods

and proceduresand procedures Need operational research to inventory medical supplies Need operational research to inventory medical supplies

and determine 1) actual needs, 2) local capacity, 3) and determine 1) actual needs, 2) local capacity, 3) needs met by national/international communitiesneeds met by national/international communities

Need evaluation studies to determine efficiency and Need evaluation studies to determine efficiency and effectiveness of relief efforts and emergency effectiveness of relief efforts and emergency interventionsinterventions



Challenges for EpidemiologistsChallenges for Epidemiologists Need databases for epidemiologic research based on Need databases for epidemiologic research based on

existing disaster information systemsexisting disaster information systems Need to identify injury prevention interventionsNeed to identify injury prevention interventions Need to improve timely and appropriate medical care Need to improve timely and appropriate medical care

following disaster (search & rescue, emergency following disaster (search & rescue, emergency medical services, importing skilled providers, medical services, importing skilled providers, evacuating the injured)evacuating the injured)

Need measures to quickly reestablish local health care Need measures to quickly reestablish local health care system at full operating capacity soon after disastersystem at full operating capacity soon after disaster



Challenges for EpidemiologistsChallenges for Epidemiologists Need uniform disaster-related injury definitions Need uniform disaster-related injury definitions

and classification schemeand classification scheme Need investigations of disease transmission Need investigations of disease transmission

following disasters and public health measures to following disasters and public health measures to mitigate disease riskmitigate disease risk

Need to study problems associated with massive Need to study problems associated with massive influx of relief supplies and relief personnelinflux of relief supplies and relief personnel

Need cost-benefit and cost-effectiveness analysesNeed cost-benefit and cost-effectiveness analysesSource: EK Noji, Source: EK Noji, The Public Health Consequences of DisasterThe Public Health Consequences of Disaster

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Public Health Disaster Consequences of Disasters