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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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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 Pittsburgh

29 September 2005

slide2
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 disaster
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

slide4

Disasters and Emergencies

Natural Disasters

Transportation

Disasters

Terrorism

Technological

Disasters

Pandemics

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

1994-2004: A Decade of Natural Disasters
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

Factors Contributing to Disaster Severity
influence of population growth
Urban dwellers:

1920: 100 million

1980: 1 billion

2004: 2 billion

2004: 20 cities with >10 million people

Sources:

CDC & EK Noji, The Public Health Consequences of Disaster

Influence of Population Growth
slide11

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-online.com/content/1/1/4(biomed central)

epidemiology and its applications in measuring the effects of disasters
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

disaster epidemiology
Disaster Epidemiology
  • Assessment and Surveillance
  • Injury and disease profiles
  • Research methodologies
  • Disaster management
  • Vulnerability and hazard assessment
disaster epidemiology1

Available

Services

Victims

Needs

Data for Decision-Making

Disaster Epidemiology
  • Purpose:
    • Identify requirements, local capabilities, gaps
    • Avoid unnecessary and damaging assistance
william h foege m d international journal of epidemiology 1976 5 29 37

"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
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
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
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
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
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
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
increasing disaster risk
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)
slide24
Increasing Global Travel
  • Rapid access to large populations
  • Poor global security & awareness

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

health information needs in emergency populations
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
final thought
Final Thought

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

PEOPLE ARE THE MOST IMPORTANT ASSET

extra slides
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 disasters
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

epidemiologic methods in disasters1
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

epidemiologic methods in disasters2
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

epidemiologic methods in disasters3
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

epidemiologic methods in disasters4
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

epidemiologic methods in disasters5
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

epidemiologic methods in disasters6
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

epidemiologic methods in disasters7
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