disasters and public health learning from recent history l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Disasters and Public Health: Learning from Recent History PowerPoint Presentation
Download Presentation
Disasters and Public Health: Learning from Recent History

Loading in 2 Seconds...

play fullscreen
1 / 37

Disasters and Public Health: Learning from Recent History - PowerPoint PPT Presentation


  • 252 Views
  • Uploaded on

Disasters and Public Health: Learning from Recent History. Richard Keller, PhD Dept. of Medical History and Bioethics University of Wisconsin-Madison rckeller@wisc.edu. Public Health and the History of Disasters.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Disasters and Public Health: Learning from Recent History' - Albert_Lan


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
disasters and public health learning from recent history

Disasters and Public Health:Learning from Recent History

Richard Keller, PhD

Dept. of Medical History and Bioethics

University of Wisconsin-Madison

rckeller@wisc.edu

public health and the history of disasters
Public Health and the History of Disasters
  • What can we learn about public health by studying recent natural and environmental disasters?
  • What do disasters teach us about risk and vulnerability?
  • What about this research is “translatable” to public health practice?
poll question
Poll Question

In your opinion, are there any practical things that can be done to enhance a community’s resilience prior to the experience of a disaster?

A. Yes

B. No

examples
Examples
  • Bhopal: 3 December 1984
  • Chernobyl: 26 April 1986
  • Chicago heat wave: July 1995
  • European heat wave: August 2003
  • Hurricane Katrina: August–September 2005
  • Each with important lessons on risk, vulnerability, and coupling of human-natural systems
objectives
Objectives

This presentation will help participants:

  • Develop the ability to recognize social dimensions of risk
  • Understand how environmental and technological hazards are often linked to poor health outcomes
  • Define policy initiatives that could promote greater resilience among vulnerable populations
disaster in a social frame
Disaster in a Social Frame

Much study of disaster is conducted in fields such as physical geography, geology, seismology, volcanology, meteorology, toxicology.

Great Sumatra/ Andaman Earthquake

slide8
But…

Recent episodes demonstrate importance of understanding social and cultural dimensions of disaster.

Hurricane Katrina

bhopal
Bhopal
  • Internationalization of risk and responsibility
  • Critical factors
    • Uncontrolled urbanization
    • Outsourcing of risk
    • Engineered unpreparedness
  • Outcomes
    • Unclear m&m
    • Nonexistent management
    • Aimless litigation and resentment
hurricane katrina
Hurricane Katrina
  • Revelation of unequal burden of vulnerability
  • Poor management
  • Public health consequences ongoing
  • Q: Who is a disaster victim?
poll question11
Poll Question

In your opinion, which of the following are victims of a disaster?

A. Someone stranded on a rooftop by a flood

B. Someone who drowns in a flood

C. Someone displaced by a flood, who commits suicide years later

D. All of the above

mapping resilience and vulnerability
Mapping Resilience and Vulnerability
  • Neighborhood studies
  • Corollary to epidemiological case-control studies
    • How does one neighborhood experience relatively little damage or bounce back quickly, while a nearby neighborhood experiences utter devastation?
  • Examples
    • Fire in Southern California
    • Heat in Chicago
    • Heat in Paris
fire in greater los angeles davis 1999
Fire in Greater Los Angeles (Davis 1999)
  • Malibu
    • Regular wildfires; insurance and federal/state programs cover damage and ensure rapid response
  • Downtown LA
    • Regular building fires; poorly funded fire stations, disregard for building codes, absence of funding mean greater aggregate damage and failure of state to respond
  • Movie stars vs. immigrants, ethnic minorities
    • Socioeconomic, cultural, and political inequality
heat wave in chicago july 1995 klinenberg 2002
Heat Wave in Chicago, July 1995 (Klinenberg 2002)
  • ~700 excess deaths, mostly African-American, very few whites and Latinos
  • City, public health officials offer dubious cultural explanation for divergent mortality
    • Latinos more habituated to heat
    • Latinos have closer family ties, therefore less isolated (questionable)
neighborhood study
Neighborhood Study
  • Qualitative analysis of two neighborhoods
    • North Lawndale (African-American)
    • Little Village (Latino)
  • Abutting communities
  • Identical microclimates
  • Similar socioeconomic conditions
  • Similar age of populations
north lawndale
North Lawndale
  • Degraded infrastructure and decaying housing stock: Economic decline in aftermath of “white flight” and industrial relocation
  • Aging and unfit population: High rates of obesity, hypertension, heart disease
  • Drug trafficking, gang warfare, high crime rate creates climate of fear
  • Result: Difficult for aging populations to leave home, poor social integration of most vulnerable populations
  • Isolation in brick apartments/houses, with windows shut out of fear
little village
Little Village
  • Similar population size, income level, age, lower, significant crime rate and gang activity
  • Less white flight
  • Most important: Significant economic/commercial activity and street life
  • Result: Vulnerable populations leave apartments, even at night, for air-conditioned/cooler locations, lowering risk factors
  • Not ethnic protection factor: Lower mortality even among whites in Little Village
  • Not socioeconomic: More a function of different behavior than one of different incomes
poll question19
Poll Question

In your opinion, which of the following goals of public policy is most important to your local community’s resilience in the face of a disaster?

A. Robust local economic/commercial activity

B. Equity of social and physical infrastructures

C. Community cohesion and social integration

D. Clear plans for disaster response

deaths from heat wave
Deaths from Heat Wave

Deaths by Age and Sex, 1–20 August 2003

16,000

14,000

12,000

10,000

Women

8,000

Men

Total

6,000

4,000

2,000

0

44 and

45–74

75 and

Total

under

over

Source: INSERM

ile de france
Ile-de-France
  • 32.9% of excess mortality concentrated in one region (4866 unanticipated deaths)
  • Paris: 7.2% (1066)
  • But only roughly 3.33% of French population
  • Other hard-hit areas:
    • Hauts-de-Seine (5.4%)
    • Val-de-Marne (5.1%)
    • Seine-Saint-Denis (3.9%)
why did they die
Why Did They Die?
  • Poor thermoregulation
  • Lower perception of thirst
  • Highest risk groups: those over 75 years of age and psychiatric/neurological patients
risk factors socioeconomic status
Risk Factors: Socioeconomic Status

4.0

3.5

Management, executive

3.0

Middle management

2.5

Employee

2.0

1.5

Artisan, skilled labor

1.0

Worker, other

0.5

0.0

Source: InVS

risk factors ses and its markers
Risk Factors: SES and Its Markers

Housing situation

Odds ratio

Other than top floor

1.12

Top floor

2.33

No elevator

1.39

Bath facilities

Odds ratio

Shower

1.00

Shower and bath

0.86

Bath

1.49

None

2.47

Source: InVS

risk factors behavior during heat wave
Risk Factors: Behavior During Heat Wave

Departure from home

Odds ratio

Regular, no reason specified

1.00

Seeking a cool place

0.54

Rare (weekly or less)

3.90

Grocery delivery

4.97

Shower/bath frequency

Odds ratio

More than daily

1.00

Daily

3.14

Every other day

12.09

Weekly

15.61

Never

20.76

Source: InVS

Media exposure: TV/Radio

0.47

risk factors social integration
Risk Factors: Social Integration

Degree of social interaction

OR

Living alone

0.59

Frequency of visitors

OR

Never or rarely

1.00

2–4 x weekly

2.81

Daily or more

3.60

No social activity

6.12

poverty isolation accumulation of risk
Poverty, Isolation, Accumulation of Risk

Risk factor

OR

Rare departure

3.90

No social interaction

6.12

Top floor of building

2.33

No bath facilities

2.47

SES: Worker/other

3.64

marginalization and social citizenship
Marginalization and Social Citizenship

“You know, the elderly, they don’t have very good memories, often from one moment to another, so the preventive messages that we could air…well, they’d forget them the same day!”

—Jean-François Mattéi 15 August 2003

Source: INA

a science of resilience critical themes and concepts
A Science of Resilience: Critical Themes and Concepts
  • Integrating social scientific and humanistic knowledge in disaster risk reduction and assessments of vulnerability and resilience
  • Mapping resilience and vulnerability
  • Intersections of health, citizenship, and resilience
  • Violence and vulnerability: Research problems and possibilities
  • Goal: A societal resilience index?
political social dimensions of resilience
Political/Social Dimensions of Resilience

Problem: “Biological citizenship” and cultures of reparation

  • Claims to citizenship based on vulnerability
  • Chernobyl

Chernobyl memorial, Vilnius. Photo: Alma Pater

other examples
Other Examples
  • Bhopal
  • Brazil’s AIDS program
  • What potential mechanisms can ensure other forms of security to avoid replication of such patterns, particularly in developing countries?
opportunity
Opportunity?
  • Relative dearth of research on basic social factors promoting vulnerability or resilience
    • Ultimate vs. proximate causes
  • Importance of civic, economic, political, and practical equality as components of resilient societies, vs. prevalence of structural violence (economic, social, political marginalization; inhibited agency) as critical factor determining vulnerability
goal a societal resilience index
Goal: A Societal Resilience Index?
  • Building on models of vulnerability
    • Can we determine an index of resilience
    • To what uses can this index be put (insurance, resource allocation)?
  • Critical variables
    • Age, personal wealth, ethnicity, occupation, and infrastructure dependence
    • Density of the built environment, housing stock, and tenancy
    • Coupling of technological systems
slide36
We are now going to open the phone lines and ask people to verbally share one thing you might do differently in your practice in light of today’s discussion.

Simply raise your hand by clicking on the “hand raise” icon. We will call on you.