Disaster Risk Reduction: The global paradigm shift Mark Keim, MD Associate Director for Science National Center for Environmental Health Agency for Toxic Substances and Disease Registry

An Evolution in Approaches Response Preparedness Risk Management

What is Disaster Risk Management? Definition “The systematic process of using administrative directives, organizations, and operational skills and capacities to implement strategies, policies and improved coping capacities in order to lessen the adverse impacts of hazards and the possibility of disaster”. Components Risk assessment Risk avoidance Risk reduction Risk transfer Risk retention UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

Disaster risk management and the emergency management cycle 4/20/2017 Disaster risk management and the emergency management cycle Risk reduction measures are Delivered pre-impact Most cost-effective Community based Sustainable Pre- impact Post - impact Risk retention measures are Delivered post-impact Least cost-effective Nationally and internationally based Non-sustainable From: Keim M. Building human resilience. Am J Prev Med 2008;35(5):508-516

Prevention and disaster risk management From: Keim M. Disaster Risk Management for Health. In Ed., David S. Textbook of Emergency Medicine. Lippincott) New Dehli 2012

How Do We Estimate Disaster Risk? D = H x V, where V = E x S R D = Risk of disaster H = Hazard V = Vulnerability of population E = Exposure to the hazard S = Susceptibility to the hazard R = Resilience

What is a hazard? Definition of a hazard “A dangerous phenomenon, substance, human activity or condition that may cause loss of life, injury or other health impacts, property damage, loss of livelihoods and services, social and economic disruption, or environmental damage” UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

Examples of hazards Earthquakes Floods Radiation Typhoons Outbreaks Tornadoes

What is vulnerability? “The characteristics and circumstances of a community, system or asset that make it susceptible to the damaging effect of a hazard” UNISDR 2009 Or simply put… Likely to incur physical or emotional illness or injury UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

Public health vulnerability Certain populations are more vulnerable to disaster-related morbidity and mortality

Vulnerability = (E x S) / R Factors affecting vulnerability: Exposure Susceptibility Resilience

What is exposure? Exposure Example of exposure “People, property, systems, or other elements present in hazard zones that are thereby subject to potential losses” Example of exposure Living in an area that floods UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

What is susceptibility? “The state of being at risk, if exposed to a hazard” Example of susceptibility Not being able to swim UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

What is resilience? Resilience Example of resilience “The ability of a system, community or society exposed to hazards to resist, absorb, accommodate to and recover from the effects of a hazard in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions”. Example of resilience Living among people that can help you UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

Mapping human vulnerability

How can we reduce our vulnerability to disasters? Disaster reduction occurs at the community level † Community health sectors can play an active role in reducing human vulnerability Reducing susceptibility “Health people” †† Reducing exposure “Healthy homes” †† Increasing resilience “Healthy communities” †† † Schipper L, Pelling M 2006, Disaster risk, climate change and international development. Disasters, vol. 30, no. 1, pp. 19-38. †† Srinivasan S, Creating healthy communities, healthy homes and healthy people. Am J Public Health 2003;93:1446-50.

Vulnerability reduction: reducing exposures Floodplain management Dams, levees, weirs Population protection measures Evacuation Mass care Land use planning and regulation PPE, sanitation/hygiene

Vulnerability reduction: reducing susceptibility Health promotion Health care Poverty reduction Healthy lifestyles Immunization

Human resilience as a means for vulnerability reduction The ability to cope with and recover from disasters Resilience is comprised of: Adaptive capability Response capacity Recovery capacity Human behaviors that increase disaster resilience Preparedness Response Recovery

Our milestones for international DRR August 2011 NCEH inducted as a member of the Asia-Pacific Disaster Risk and Resilience consortium November 2012 TA to WHO/HQ for development of a Global DRR Framework for Health Feb 2013 Hosting regional workshop for proposal-writing, “Reducing Disaster Risk for a Healthy Pacific”

To learn more about international DRR: http://www.unisdr.org/ http://www.preventionweb.net/english/

Thank You mjk9@cdc.gov National Center for Environmental Health Agency for Toxic Substances and Disease Registry