1. Body and mind: the probable health effects of the 2005 Carlisle flooding Dr Lorna Fewtrell

2. Flooding: it’s enough to make you sick Dr Lorna Fewtrell

3. Structure  Case study population  Research areas (part 1)  Quantitative microbial risk assessment  Research areas (part 2)  Overall health impact assessment  Thoughts to ponder

4. 2005 flooding

5. Case study population  Denton Holme  725 homes  <0.01 to 2.25 m  Ave velocity between 0.11 and 0.35 m/s

6. Case study population  Age profile  Health status  Long-term illness  Occupancy level  Housing type

7. Research areas Contamination profile Flood withdrawal & clean-up behaviour

8. Contamination profile

10. Flood withdrawal & clean-up

11. Quantitative microbial risk assessment (QMRA) of gastrointestinal illness Reference pathogens Campylobacter Cryptosporidium Rotavirus Dose-response relationships Pathogen levels in floodwater Exposure scenarios Flood phase Clean-up phase

12. Disability adjusted life years (DALYs)  Summary measures of health  Combines the length of time lived with a disability with (if applicable) years of life lost through premature death  Different levels of disability are accounted for using severity weights

13. QMRA results

15. 41

16. QMRA thoughts  41 cases of illness – 2.5% of the flooded population but less than 1% of the whole Denton Holme population  Assumptions gloves are protective and reduce exposure to zero rotavirus concentrations

17. Research areas Contamination profile Flood withdrawal & clean-up behaviour Media analysis Mental health study

18. Media analysis Don’t let kids go in the water Peril... kids brave Oxford flood water that contains bacteria and viruses Signs of E. coli in Mud After Cumbria Floods A sample of mud from a house hit by the recent flooding in Cumbria has been found to contain the DNA ‘signature’ of bacterium E. coli 0157 EXCLUSIVE: Hundreds could die, says scientist HUNDREDS of flood victims could be killed by a brew of terrifying bugs lurking in the murky water. Virus expert Dr Ken Flint said potentially lethal bacteria like e.coli and salmonella would be left behind in the sludge in houses and streets for weeks or even months after the floods recede. And he claimed the elderly, the very young and the infirm were at serious risk from gastroenteritis. Microbiologist Dr Flint added: "I expect to see three to four times the normal rate for these diseases in coming weeks. That would mean the potential for low hundreds of people dying." His stark warning came as scientists found evidence of around a dozen dangerous viruses in flood water samples taken from swamped Gloucestershire streets. Killer bugs in flood waters

19. Mental health study  Questionnaire survey Building on large survey conducted by the HPA  Number of standard instruments Psychological distress Anxiety Depression Probable post traumatic stress disorder  Three years after flooding

20. Overall health impact assessment Quantifiable health effects

21. Overall health impact assessment Quantifiable health effects Case study population

22. HIA results

24. Context

28. It really is enough to make you sick

31. Thoughts to ponder  Deaths and serious injuries are picked up  Stomach upsets aren’t really a big deal but something the media can get their teeth into  Mental health problems aren’t immediate

32. Thoughts to ponder  “Given the relatively mild nature of the flooding, the high prevalence rates [of mental health problems] identified in the present study may be questioned.” Mason et al., 2010 The psychological impact of exposure to floods. Psychology and Health 15, 61-73

33. Thoughts to ponder  The recovery process has been termed ‘the second disaster’ “that was the heartbreaking part of it. When they walked down the drive with crowbars in their hands I thought, ‘they aren’t going to be nice about this’ …”

34. And finally