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

2. 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

3. 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

4. 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

5. 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

6. 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; litres/day/person)
5 August 2015

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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

17. 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

18. 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

19. 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

20. 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

21. ENVIRONMENTAL HEALTH ASSESSMENT FORM FOR SHELTERS For Rapid Assessment of Shelter Conditions during Disasters (
Major categories for assessment
Facility itself
Food supply
Water & ice
Health
Sanitation & solid waste
Child care
Sleeping
Companion animals
Handicapped access
Public Health & Disasters

22. 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

23. Public Health & Disasters

24. Useful Resources
Environmental Health Training in Emergency Response (EHTER)
World Health Organization
Public Health & Disasters

25. Thank you!
Public Health & Disasters