1. Course on Regulatory Design and Practice
Health concerns & regulatory role in disaster risk reduction & management
Rohan Samarajiva
Course on Regulatory Design and Practice
Nay Pyi Taw, September 2017
This work was carried out with the aid of a grant from the International Development Research Centre, Canada.

2. What people in Myanmar are experiencing is rapid change

3. It’s natural to worry And for worry to be concentrated on cancer, the scariest of all diseases.

4. So let us look at evidence from an expert: Dr Siddhartha Mukherjee
 Assistant professor of medicine at Columbia University and staff physician at Columbia University Medical Center in New York City.
His 2010 book, The Emperor of All Maladies: A Biography of Cancer was
Awarded the 2011 Pulitzer Prize for General Non-Fiction
Named one of the 100 most influential books written in English since 1923 by the magazine Time
One of the 100 notable books of 2010 by The New York Times Magazine.
A hematologist and oncologist, Mukherjee is also known for his work on the formation of blood and the interactions between the micro-environment ("niche") and cancer cells.
Awarded fourth highest civilian award of India, the Padma Shri, in 2014.

5. Mukherjee (2011), Do Cellphones Cause Brain Cancer?
If a cancer-causing agent increases incidence of a particular cancer in a population then overall incidence of that cancer will rise
An aging population will seem more cancer-afflicted, even if real cancer incidence has not changed  need for age adjustment
From 1990 to 2002 — the 12-year period during which cellphone users grew from 4 million to 135 million in US — the age-adjusted incidence rate for overall brain cancer remained nearly flat

6. Correlation without a causal mechanism?
In 2010, a larger study updated these results, examining trends and found no increase in overall incidence in brain cancer
But if population sub-divided into groups
In females ages 20 to 29 (but not in males) age-adjusted risk of cancer in front of brain grew slightly, from 2.5 cases per 100,000 to 2.6
These cancers appear in the frontal lobe — a knuckle-shaped area immediately behind the forehead and the eye
How, or why, would a phone’s toxicity have skipped over the area nearest to it and caused a tumor in a distant site?
Most epidemiologists and biologists do not find such a tissue-skipping mechanism plausible and most doubt that there is any causal link between frontal tumors and phones

7. Confusing correlations
In 2010, Interphone, a study with cases and controls from 13 countries ran for 10 years, raised even more puzzling issues
No evidence for association between brain tumors and cellphones
But when cancer and no cancer cohorts were subdivided according to frequency of mobile use
There was an apparently decreased risk of brain tumors in regular phone users, compared with rare users or nonusers; regular cellphone use seemed to reduce the risk of brain tumors
In stark contrast, very high cellphone use (measured as a user’s cumulative call time) seemed to increase the risk of a particular subtype of brain tumor

8. Mukherjee’s conclusion
“ . . little theoretical basis for anticipating that RF energy would have significant biological effects at power levels used by modern mobile phones and their base station antennas. The epidemiological evidence for a causal association between cancer and RF energy is weak and limited. Animal studies have provided no consistent evidence that exposure to RF energy at non-thermal intensities causes or promotes cancer. Extensive in vitro studies have found no consistent evidence of [DNA damage] potential, but in vitro studies assessing the epigenetic potential of RF energy are limited. Over all, a weight-of-evidence evaluation shows that the current evidence for a causal association between cancer and exposure to RF energy is weak and unconvincing.”

9. What the evidence says Mobile use does not cause cancer, according to
Two USA studies,
13 country 10-year Interphone study
20-year Australian study

10. Regulators’ roles in disaster risk reduction

12. Physical and symbolic worlds, absent linking technologies
Mediated
interpersonal
Physical world where
hazards occur
Symbolic world
where action
originates

13. The physical, the symbolic & their linking through ICTs, simplified
Physical world where
hazards occur
Warnings (telecom)
Mediated
interpersonal
TV, Radio & Cell broadcasts
Symbolic world
where action
originates
Warnings (telecom)
More time to run; more lives saved

14. Types of hazards Rapid onset (60 mts < t < 3 days) Slow onset
Optimum effect of ICTs
Rapid onset (60 mts < t < 3 days)
Slow onset
Large geographical effect
Tsunamis, cyclones, dam breaks (cascaded), floods
Drought, climate change
Local geographical effect
Dam breaks (single), land slides
Erosion

15. Early warning is a chain; A chain is as strong as its weakest link
Detection and monitoring of rapid-onset, large-scale hazards (cyclones, tsunamis, etc.) quite advanced
National warning systems can be improved
Getting the message to the people-at-risk (“last mile”) is the weakest link
Failed in Myanmar; Bangladesh; Indonesia, etc.
Risk reduction also requires that people know what to do and can do it (e.g., orderly evacuations)
False warnings and unnecessary evacuations can have serious consequences
High cyclone deaths in Bangladesh in 2007 were caused by false tsunami evacuation of 12 September 2007

16. National early warning center
Early warning chain (standard form)
Citizens
National early warning center
First responders
Media & Telecom
Operators

17. Two easy ways to strengthen the early warning chain
Improve communication from National Early Warning Center (NEWC) to media and first responders using SMS+ (or Whatsapp, Viber)
Add cell broadcasting to public warning provided by electronic media

18. SMS+ for first responders & media
SMS is a point-to-point technology that is inherently susceptible to congestion if too many people come on the network at the same time
Unsuited for public warning and in immediate aftermath of disaster
Useful to alert small numbers before the news is widespread
SMS module of Sahana suite allows one-touch dissemination of 140-character message to pre-registered first responders and journalists
Additional information provided through a robust website capable of handling a spike of use

19. SMS+
Immediately implementable solution that is part of widely implemented open-source disaster-management software suite, Sahana
Principal advantage is that it reaches mobile handsets that are highly likely to be within immediate reach of intended recipients

20. Cell broadcasting for public warning
As a broadcast mode (point-to-multipoint) CB is inherently immune to congestion
No pre-registration required, reaches all handsets within a base station area
Can be targeted to specific areas, unlike national radio and TV
Negative is that audible alert may not be possible on all handsets yet
Now practical for Myanmar
All operators must install additional software modules

21. What regulators can do
Ensure reliable, redundant communication links needed for
Hazard detection & monitoring
Linking warning center to media and to first responders (police, etc.)
Mandate cell broadcasting capability; work with ASEAN and others to ensure common standards, so visitors will also be protected
Create platform for interaction between operators and disaster warning entities
Standards for disaster-resilient infrastructure, including load factors and tower locations
Best arrived at/implemented with operators
Efficient management of short codes

22. Regulatory response Requirements for quick response to disaster
Contact persons/numbers
Emergency kits
Mutual support arrangements
Interface between operators and government agencies
Regulatory agency to be 24/7 contactable
Tampere Convention on Provision of Telecom Resources for Disaster Mitigation & Relief Operations
National authority
Preparation of inventory can assist preparedness

23. Regulatory role at time of disaster
“State of exception”
Procedures for approvals/licenses/
authorizations
Customs clearance of emergency equipment
Survivors need to contact families/people need to locate loved ones
Prior arrangements re
Databases
BPO/Call centers

24. Regulatory role in recovery phase
Post-disaster assessments
Requirements to preserve data
Bring operators together to improve procedures
Who is to pay for damage?
If government pays, wrong incentives
If government does pay, use matching funds
Insurance requirements
Deal with the immediate problem but also ensure incentives for robust network planning are not affected

25. Regulatory role in recovery phase
Restoring service
Temptation to fall back to command and control mindset
Regulator can balance the political needs of government with avoidance of administrative expropriation
Provide neutral ground to work out restoration schedule
If government wants to give people free service, it should pay for it
Corporate Social Responsibility is voluntary