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Disasters: The Public Health Impact. Disasters: The Public Health Impact Mortality & Morbidity Disasters cause deaths, injuries, and illnesses Disasters may overwhelm medical resources and health services Sources: CDC & EK Noji, The Public Health Consequences of Disaster.

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Disasters: The Public Health Impact


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Disasters: The Public Health Impact

Mortality & Morbidity

Disasters cause deaths, injuries, and illnesses

Disasters may overwhelm medical resources and health services

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


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Health Care Infrastructure

Disasters may destroy hospitals

Disasters may disrupt routine health services

Disasters may disrupt preventive activities

Consequence: long-term increases in morbidity and mortality

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

Disasters: The Public Health Impact


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Environment & Population

Disasters may increase potential for communicable diseases

Disasters may exacerbate environmental hazards

Consequences: increases in morbidity and premature death, decreased quality of life

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

Disasters: The Public Health Impact


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Psychological and Social Behavior

Disasters may cause generalized panic or paralyzing trauma

Disasters may provoke increases in anxiety, depression and neuroses

Disasters may lead to post-traumatic stress disorder (PTSD) at epidemic levels

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

Disasters: The Public Health Impact


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Food Supply

Disasters may disrupt the food supply

Disasters leading to food shortages may cause specific micronutrient deficiencies

Disasters may provoke severe nutritional consequences including famine and starvation

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

Disasters: The Public Health Impact


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Population Displacement

Disasters may cause large spontaneous or organized population movements

Population movement may increase morbidity and mortality

Population movement may precipitate epidemics of communicable diseases in both displaced and host communities

Crowding of populations and overlay of refugee and host populations may lead to injuries and violence

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

Disasters: The Public Health Impact



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Epidemiologic Methods in Disasters

Before a disaster (Interdisaster Phase):

Conducting hazards & vulnerability analyses of the population

Modeling/simulating disaster scenarios

Conducting drills

Designing emergency protocols

Assessing level of emergency preparedness

Assessing flexibility of surveillance systems

Training health and safety personnel

Source: EK Noji, The Public Health Consequences of Disaster


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Epidemiologic Methods in Disasters

During a disaster (Emergency Phase):

Conducting disaster damage assessment

Conducting rapid field investigations

Identifying urgent needs & matching resources

Prioritizing relief efforts

Conducting disaster surveillance

Conducting epidemic investigations

Source: EK Noji, The Public Health Consequences of Disaster


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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


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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


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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


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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


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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


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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


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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


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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



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Sudden impact natural disasters

can be considered as a continuous time sequence

of five phases:

Interdisaster

Predisaster

Impact

Emergency

Reconstruction

Source: EK Noji, Sivertson KT. Injury prevention in natural disasters: a theoretical framework. Disasters 1987;11:290-296.

Disaster Cycle


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Interdisaster Phase

Planning disaster prevention/preparedness/mitigation

Identifying risks

Identifying vulnerabilities

Creating a resource inventory

Conducting professional training

Conducting community education

Synonym: Nondisaster Phase

Disaster Cycle


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Predisaster Phase

Issuing timely warnings

Implementing protective actions

Undertaking emergency management activities

Evacuating population as necessary

Synonym: Warning Phase

Disaster Cycle


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Impact Phase

Destruction

Injuries

Deaths

may occur during impact

Disaster Cycle


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Emergency Phase

Implementing life-saving actions

-search and rescue

-first aid

-emergency medical assistance

Restoring emergency communications

Restoring emergency transportation

Implementing public health surveillance

Evacuating vulnerable areas

Synonyms: Relief Phase, Isolation Phase

Disaster Cycle


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Emergency Phase

Note: The immediate postimpact period is the isolation phase where most urgent rescue tasks are accomplished by the survivors using local resources

Synonyms: Relief Phase, Isolation Phase

Disaster Cycle


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Reconstruction Phase

Restoring predisaster conditions

Reestablishing health services

Reconstructing & repairing damaged facilities

Reflecting and debriefing on lessons learned

Synonym: Rehabilitation Phase

Disaster Cycle



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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

Disaster Severity


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A Decade of Natural Disasters (1980s)

Floods 39,000 deaths

Tropical cyclones 14,000 deaths

Hurricanes 1,000 deaths

Earthquakes 54,000 deaths

Other disasters 1,012,000 deaths

TOTAL 1,120,000 deaths

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

Disaster Severity


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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

Disaster Severity


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Influence of Poverty

Persons in poverty:

-Live in poor housing unable to withstand seismic activity

-Live in poor housing susceptible to landslides

-Inhabit coastal areas and flood plains vulnerable to hurricanes, storm surges, flooding, and tidal waves

-Live near hazardous industrial sites

-Do not receive education on life-saving actions during disasters

-Do not receive warning of impending disasters

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

Disaster Severity


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Influence of Poverty

-Low-income countries:

3,000 deaths per disaster

-High-income countries:

500 deaths per disaster

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

Disaster Severity


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Influence of Population Growth

- Urban dwellers:

1920: 100 million

1980: 1 billion

2000: 2 billion

- 2000: 20 cities with >10 million people

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

Disaster Severity


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Capabilities of Developed Nations

That Mitigate Disaster Effects

-Ability to forecast severe storms

-Ability to enforce strict building codes

-Ability to use communication networks to broadcast alerts and warnings

-Ability to provide emergency medical services

-Ability to engage in contingency planning

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

Disaster Severity


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Disaster:Perspectives


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“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

Disaster: Perspectives


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Public Health View

“Disasters are defined

by what they do to people...”

Source: EK Noji, The Public Health Consequences of Disaster

Disaster: Perspectives


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Disaster: Perspectives

Major Categories of Disasters

-Natural Disasters

-Human-generated Disasters

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


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Disaster: Perspectives

Natural Disasters

-Arise from forces of nature

-Two subcategories:

  • Sudden impact or acute onset

  • Slow or chronic onset

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


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Disaster: Perspectives

Sudden Impact or Acute Onset Disasters

Geological or climatic hazards

Hurricanes/typhoons Tornadoes

Earthquakes Volcanoes

Floods Tsunamis

Temperature extremes Wildfires

Landslides Avalanches

Epidemics

Food, water, vector-borne diseases

Person-to-person transmission diseases

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


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Disaster: Perspectives

Slow or Chronic Onset Disasters

Drought

Famine

Environmental degradation

Chronic exposure to toxic substances

Desertification

Deforestation

Pest infestation

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







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Disaster: Perspectives

Human-Generated Disasters

Industrial/technological

Transportation (vehicular)

Deforestation

Material shortages

Complex emergencies

Source: EK Noji, The Public Health Consequences of Disaster


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Disaster: Perspectives

Complex Emergencies

-Wars and civil strife

-Armed aggression

-Insurgency

-Other actions resulting in displaced persons and refugees

Source: EK Noji, The Public Health Consequences of Disaster


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Disaster: Perspectives

2002 DEEP Center Classification

-Natural disasters

-Non-intentional human-generated disasters

-Terrorist-perpetrated disasters

-Complex disasters

-Natural-technological disasters (NA-TECHS)


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Disaster: Perspectives

Terrorist-perpetrated Disasters

-Biological

-Nuclear

-Incendiary

-Chemical

-Explosive

Mnemonic: B-NICE