Public Health Preparedness: Environmental Health is Critical! Environmental Health Australia Conference 9 December 2016 Kristine M. Gebbie, DrPH, RN Flinders University

Presentation goals Brief overview of the importance of environmental health in disasters Key areas of environmental concern Drinking water Sanitation and Waste (general/hazardous) Food safety Communicable diseases and vectors Evacuation centres and shelters Public Health & Disasters

Where you are matters! Environment is a key contributor to the health of the public Action on environment of historic importance to public health Protection has become more complex Population density Increased technology Conflicting attitudes and expectations Public Health & Disasters

Is there a difference? Environmental health emergency or disaster or Environmental health in emergencies and disasters? It’s a distinction without a difference for the core concerns! Public Health & Disasters

Safe water: a challenge when The established system for safe delivery of water is contaminated The established system for safe delivery of water and removal of waste is damaged/disrupted A population is moved to an area that lacks adequate safe water Public Health & Disasters

Priorities for water Drinking, cooking, personal hygiene (handwashing!) use:7-15 litres/person (3-5 for drinking/cooking) Livestock or crops (may be critical to re-establishment of livelihoods) Health facilities/hospitals (should be planned for separately; 40-60 litres/day/person) 5 August 2015

Within Australia If system is intact but contaminated, boiling is good measure Delivery of safe water can generally be arranged within a short time Depending on packaging, may add to the waste disposal challenge! Resilience development suggests family storage of 2-3 day supply Public Health & Disasters

Contaminated system Cut off distribution of contaminated water Alert population to institute protective actions (e.g.,boiling/filtration) Be alert to cost of chemicals or fuel Flush or otherwise clean the system If repair will take extended time, arrange alternate water supply Public Health & Disasters

The terrorist threat Deliberate contamination of a major drinking water system Security measures have been dramatically increased in recent decades Reasonable suspicion of contamination may lead to temporary shutdown, decontamination Public Health & Disasters

Post earthquake, Costa Rica Town of 40,000 with no water system Soft drink company in capitol bottled water and began supplying within 18 hours New dam brought water to treatment plant; trucks then delivered to town Within 60 days, service available 6 hours/day Public Health & Disasters

Sanitation and Waste Human waste management is a priority if usual systems are disrupted Temporary measures may be essential Photo: New Zealand Handwashing essential! Public Health & Disasters

Other waste Solid waste from food/water/other packaging Medical waste if care is being given on site Hazardous materials, depending on nature of emergency Public Health & Disasters

One non-issue 1-2 bodies generally well-handled, but some emergencies lead to hundreds Panicked disposal of human remains is not appropriate! Respectful storage of bodies away from water and food supply and protected from insects/animals is correct Given climate, cooling (often in refrigerated trucks) is a best choice Public Health & Disasters

Food safety Household preparedness education always includes food recommendation Logistics for emergency response teams includes food supply Challenges Disrupted supply chain for longer events Overly eager volunteer food suppliers Public Health & Disasters

Communicable diseases and vectors Large groups in small spaces increase the opportunities for spread of disease Poor arrangements for food storage or waste disposal invite vectors of disease (flies, rodents, other) A well-supported vaccine program is protective and an emergency may provide an opportunity for increasing uptake of basic vaccines (measles, polio, DTP) Public Health & Disasters

Cholera- a frequent concern Not reported recently in Australia, but. . One reason for taking great care with human waste Public Health & Disasters

Displaced or relocated population Numbers of displaced rising steadily Weather-related events (flood, tsunami, typhoon) Internationally, civil unrest/war Large numbers of refugees/displaced persons require emergency supports Internally displaced may be more difficult to help than those who cross borders Public Health & Disasters

Phases of response Immediate measures (to sustain life) Intermediate measures (from about 2 to 6 weeks after the disaster, or the arrival of refugees in a camp) Long-term solutions (from about 6 weeks) Generally not a problem in Australia, though some families are still in ‘temporary’ situations several years after major fires Public Health & Disasters

Safe places for defecation and handwashing Must be provided quickly Should be clearly marked and separated from drinking water and food sources Should take into account cultural expectations (e.g., extent of gender/age separation) Public Health & Disasters

Evacuation centres and shelters Pre-selected, pre-supplied locations are the best! Short-term use rarely a challenge Longer term use (48 hours or more) requires attention to Adequate water -- Rest/sleep space Waste disposal -- Child safety Food supply -- Health care Usual use of the facility Public Health & Disasters

ENVIRONMENTAL HEALTH ASSESSMENT FORM FOR SHELTERS For Rapid Assessment of Shelter Conditions during Disasters (https://emergency.cdc.gov/shelterassessment/pdf/shelter-tool-form.pdf) Major categories for assessment Facility itself Food supply Water & ice Health Sanitation & solid waste Child care Sleeping Companion animals Handicapped access Public Health & Disasters

One final area Communication! You will be asked for information by the public or by your family and friends You are responsible to be a part of the planned response, not a spreader of rumor or guesswork Think before you speak Be where rumours go to die Public Health & Disasters

Public Health & Disasters

Useful Resources Environmental Health Training in Emergency Response (EHTER) http://www.cdc.gov/nceh/ehs/ETP. World Health Organization http://www.who.int/environmental_health_emergencies/en/ http://apps.who.int/iris/bitstream/10665/42561/1/9241545410_eng.pdf?ua=1 Public Health & Disasters

Thank you! Public Health & Disasters