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Structural Barriers to Disaster Resilience: Health and Disability. Session 14. Session Objectives. Relate disabilities and health problems to other risk factors Identify specific concerns of people with disability and health issues

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Structural barriers to disaster resilience health and disability

Structural Barriers to Disaster Resilience:Health and Disability

Session 14

Session objectives

Session Objectives

  • Relate disabilities and health problems to other risk factors

  • Identify specific concerns of people with disability and health issues

  • Critically assess traditional emergency management approaches to disability and health

  • Identify resources and strategies for mitigating vulnerabilities of those who live with chronic health problems and disabilities

Who defines disabled or sick

Who Defines “Disabled”or “Sick”?



Disabilities Act

World Health Organization

How do people become disabled or ill

How Do People Become Disabled or Ill?

  • Social labeling

  • Genetic inheritance

  • Accidents

  • Violence

  • Aging

  • Patterns of everyday life

    • Living and working conditions

    • Organization culture and practice of nation’s health care system

    • Differing cultural, age and/or gender norms

    • Environmental conditions

Social trends increasing the proportion of americans with impairments

Increased longevity

Increasing access to health care extending life

Persistent and increasing workplace hazards

Increased exposure to air and water pollution

Rising rates of homelessness and poverty with increased health risks and decreased access to health care

High rates of self-inflicted injury

Lifestyle “choices”

“Diseases of affluence”

Social Trends Increasing the Proportion of Americans with Impairments

Exposure to hazards disasters increases impairment

Exposure to Hazards/Disasters Increases Impairment

  • Disabling injuries increase vulnerability to future disasters

  • Armed conflict can inflict disabling illness and psychosocial stress on civilians and noncombatants

  • Technological or human-agent disasters can be emotionally debilitating

  • Prolonged food scarcity and malnutrition following major environmental disasters undermine public health and disaster resilience

  • Prolonged exposure to environmental toxins increases incidence of debilitating illnesses

Intersecting vulnerabilities

Racial/ethnic status

Many health problems higher among racial//ethnic minority populations

Exposure to toxins and pollutants higher among ethnic groups in hazardous occupations

African Americans have higher rates of disability than Anglos


Pre- and post-health needs increase childbearing women’s vulnerability

Women more than men live with chronic depression

Men more than women live with heart disease

Women more than men exposed to postdisaster violence

Socioeconomic status

High rates of physical and mental illness among poor and low-income people

Poverty associated with malnutrition and functional disabilities

Restricted access to medical equipment, supplies, medicine, etc. among poor

Lack of secure employment

Disabled persons more likely to be unemployed and be poor


Infants and frail elderly most susceptible and least resistant to pre- and post-disaster illness and injury

Cognitive and physical impairments increase with age

Functional limitations increase with age

Intersecting Vulnerabilities

Risky living conditions of people with disabilities

Risky Living Conditions of People with Disabilities

  • On lower incomes than non-disabled counterparts

  • In un-reinforced masonry buildings

  • Outside caregiving institutions with legislated obligations to prepare for emergencies

  • Inside caregiving institutions which may lack features designed to enhance safety of residents

  • On their own

  • With social distance or stigma associated with being labeled “disabled” in a society valuing self-sufficiency

People living with disabilities tend to live:

Risky living conditions of the severely or chronically ill

Risky Living Conditions of the Severely or Chronically Ill

  • Biological hazards (due to malnutrition, weakened immune systems, etc.)

  • Life-threatening disruptions in medical care during emergencies

  • Deteriorating mental and physical health due to loss of caregiver support systems

Severely or chronically ill persons are at increased risk of:

Vulnerability of disabled or severely chronically ill

Vulnerability of Disabled or Severely/Chronically Ill

Social changes accompanying disaster can increase vulnerability by:

  • Increasing the social isolation of persons who often live alone

  • Increasing rates of temporary disability among disaster survivors

  • Causing debilitating injuries, trauma and post-disaster stress

  • Increasing public health hazards such as water contamination

  • Decreasing people’s access to health and daily living support services

  • Increasing exposure to severe environmental conditions worsening pre-existing illness

Myths about disabilities

Myths about Disabilities

  • Disabilities are visible

  • Disabled persons reside primarily in institutions

  • Disabilities make people dependent on others

  • Disabilities and chronic illnesses are “master identities”

Stereotypes underlie emergency management approach

Stereotypes Underlie Emergency Management Approach

  • Reinforces or creates dependency

  • Displaces focus from preventing problems to dealing with”special populations” as burdensome

  • Ignores resources of advocacy groups

  • Deprives persons with functional impairments of equitable access to resources

  • Undermines long-term recovery

Disability issues


Egress and access for wheelchair users, sight-impaired, etc.

Accessible emergency routes

Capacity to evacuate needed equipment

Early warning to provide time for complex moves


Involving disabled and advocacy organizations in emergency exercises

Stockpiling of needed equipment

Recording medical needs and caregiver contact information

Emergency Relief Centers

Knowledgeable volunteers trained to understand needs and capacities of disabled persons and chronically ill

Appropriate medical equipment

Interpersonal support networks

Provision for helper animals


Increased accessibility into public buildings

Priority attention to functionality of health care facilities and systems

Peer counseling

Health care workers knowledgeable about specialized medical needs

Disability Issues

Traditional emergency management approaches to health and disability


Neglects specific needs which can affect people’s ability to anticipate, prepare fore, cope with, survive, and recover from disaster

Neglects capacities and resources of the group

Negates opportunities for partnering with groups and organizations knowledgeable about vulnerabilities and capacities of this social group


Is an overly medicalized approach

Focuses on the person rather than the group

Inadequately assesses complex and inter-related needs

Neglects self-care capacities of those with disabilities and health barriers

Reinforces stereotypes

Traditional Emergency Management Approaches to Health and Disability

Participatory planning approach to health and disability

Participatory Planning Approach to Health and Disability

  • Increases self-organization among persons in these social groups

  • Promotes organizational collaboration between emergency managers and advocacy groups

  • Results in services designed by, for, and with persons with mental and physical limitations

  • Is a rights-based approach whereby members of these social groups are full and equal participants in planning and receive equitable and appropriate services

  • Empowers people living with disabilities and/or health barriers

  • Increased political visibility and strength of this group’s concerns during emergency relief and long-term reconstruction

Strategies for mitigating vulnerabilities

Strategies for Mitigating Vulnerabilities

  • Make necessary accommodations to ensure equity

  • Critically evaluate and assess disaster policies, plans, services, and operations to reduce risk of undermining independence

  • Adopt a human rights rather than a “special needs” approach

  • Collaborate with local self-help and advocacy groups to reduce risk

Collaborative advocacy organizations

Collaborative Advocacy Organizations

  • Disease-based support groups

  • Local service organizations

  • Disability rights organizations

  • HIV/AIDS advocates and grassroots groups

  • Environmental justice groups involved with health issues

  • National advocacy groups

Obstacles to cooperation

Obstacles to Cooperation

  • Conflicts over interpretation of Americans with Disabilities Act with respect to accessible sheltering

  • Shelter managers may resist pressure to develop ADA-compliant shelters or be unable to locate appropriate facilities

  • Stereotyping about presumed medical needs of persons with disabilities can preclude communication

  • Advocacy groups and government agencies may conflict over implementation of program or, providing of appropriate services

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