1. Disasters: The Public Health Impact

2. Mortality & Morbidity Disasters cause deaths, injuries, and illnesses Disasters may overwhelm medical resources and health services Sources: CDC & EK Noji, The Public Health Consequences of Disaster

3. Disasters: The Public Health Impact Health Care Infrastructure Disasters may destroy hospitals Disasters may disrupt routine health services Disasters may disrupt preventive activities Consequence: long-term increases in morbidity and mortality Sources: CDC & EK Noji, The Public Health Consequences of Disaster

4. Disasters: The Public Health Impact Environment & Population Disasters may increase potential for communicable diseases Disasters may exacerbate environmental hazards Consequences: increases in morbidity and premature death, decreased quality of life Sources: CDC & EK Noji, The Public Health Consequences of Disaster

5. Disasters: The Public Health Impact Psychological and Social Behavior Disasters may cause generalized panic or paralyzing trauma Disasters may provoke increases in anxiety, depression and neuroses Disasters may lead to post-traumatic stress disorder (PTSD) at epidemic levels Sources: CDC & EK Noji, The Public Health Consequences of Disaster

6. Disasters: The Public Health Impact Food Supply Disasters may disrupt the food supply Disasters leading to food shortages may cause specific micronutrient deficiencies Disasters may provoke severe nutritional consequences including famine and starvation Sources: CDC & EK Noji, The Public Health Consequences of Disaster

7. Disasters: The Public Health Impact Population Displacement Disasters may cause large spontaneous or organized population movements Population movement may increase morbidity and mortality Population movement may precipitate epidemics of communicable diseases in both displaced and host communities Crowding of populations and overlay of refugee and host populations may lead to injuries and violence Sources: CDC & EK Noji, The Public Health Consequences of Disaster

8. Epidemiologic Methods in Disasters

9. Before a disaster (Interdisaster Phase): Conducting hazards & vulnerability analyses of the population Modeling/simulating disaster scenarios Conducting drills Designing emergency protocols Assessing level of emergency preparedness Assessing flexibility of surveillance systems Training health and safety personnel Source: EK Noji, The Public Health Consequences of Disaster

10. Epidemiologic Methods in Disasters During a disaster (Emergency Phase): Conducting disaster damage assessment Conducting rapid field investigations Identifying urgent needs & matching resources Prioritizing relief efforts Conducting disaster surveillance Conducting epidemic investigations Source: EK Noji, The Public Health Consequences of Disaster

11. Epidemiologic Methods in Disasters After a disaster (Reconstruction Phase): Conducting post-disaster epidemiologic follow-up studies Identifying risk factors for death & injury Planning strategies to reduce impact- related morbidity & mortality Source: EK Noji, The Public Health Consequences of Disaster

12. Epidemiologic Methods in Disasters After a disaster (Reconstruction Phase): Developing specific interventions Evaluating effectiveness of interventions Conducting descriptive & analytical studies Planning medical & public health response to future disasters Conducting long-term follow-up of rehabilitation/reconstruction activities Source: EK Noji, The Public Health Consequences of Disaster

13. Epidemiologic Methods in Disasters Challenges for Epidemiologists Applying epidemiologic methods in the context of: Physical destruction Public fear Social disruption Lack of infrastructure for data collection Time urgency Movement of populations Lack of local support and expertise Source: EK Noji, The Public Health Consequences of Disaster

14. Epidemiologic Methods in Disasters Challenges for Epidemiologists Selecting study designs: Cross-sectional: Studies of frequencies of deaths, illnesses, injuries, adverse health affects Limited by absence of population counts Case-control: Best study to determine risk factors, eliminate confounding, study interactions among multiple factors Limited by definition of specific outcomes, issues of selection of cases & controls Source: EK Noji, The Public Health Consequences of Disaster

15. Epidemiologic Methods in Disasters Challenges for Epidemiologists Selecting study designs: Longitudinal: Longitudinal: Studies document incidence and estimate magnitude of risk Limited by logistics of mounting a study in a post-disaster environment and subject follow-up Source: EK Noji, The Public Health Consequences of Disaster

16. Epidemiologic Methods in Disasters Challenges for Epidemiologists Need standardized protocols for data collection immediately following disaster Need standardized terminology, technologies, methods and procedures Need operational research to inventory medical supplies and determine 1) actual needs, 2) local capacity, 3) needs met by national/international communities Need evaluation studies to determine efficiency and effectiveness of relief efforts and emergency interventions Source: EK Noji, The Public Health Consequences of Disaster

17. Epidemiologic Methods in Disasters Challenges for Epidemiologists Need databases for epidemiologic research based on existing disaster information systems Need to identify injury prevention interventions Need to improve timely and appropriate medical care following disaster (search & rescue, emergency medical services, importing skilled providers, evacuating the injured) Need measures to quickly reestablish local health care system at full operating capacity soon after disaster Source: EK Noji, The Public Health Consequences of Disaster

18. Epidemiologic Methods in Disasters Challenges for Epidemiologists Need uniform disaster-related injury definitions and classification scheme Need investigations of disease transmission following disasters and public health measures to mitigate disease risk Need to study problems associated with massive influx of relief supplies and relief personnel Need cost-benefit and cost-effectiveness analyses Source: EK Noji, The Public Health Consequences of Disaster

19. The Disaster Cycle

20. Disaster Cycle Sudden impact natural disasters can be considered as a continuous time sequence of five phases: InterdisasterPredisasterImpactEmergencyReconstruction Source: EK Noji, Sivertson KT. Injury prevention in natural disasters: a theoretical framework. Disasters 1987;11:290-296.

21. Disaster Cycle Interdisaster Phase Planning disaster prevention/preparedness/mitigation Identifying risks Identifying vulnerabilities Creating a resource inventory Conducting professional training Conducting community education Synonym: Nondisaster Phase

22. Disaster Cycle Predisaster Phase Issuing timely warnings Implementing protective actions Undertaking emergency management activities Evacuating population as necessary Synonym: Warning Phase

23. Disaster Cycle Impact Phase DestructionInjuriesDeaths may occur during impact

24. Disaster Cycle Emergency Phase Implementing life-saving actions -search and rescue -first aid -emergency medical assistance Restoring emergency communications Restoring emergency transportation Implementing public health surveillance Evacuating vulnerable areas Synonyms: Relief Phase, Isolation Phase

25. Disaster Cycle Emergency Phase Note: The immediate postimpact period is the isolation phase where most urgent rescue tasks are accomplished by the survivors using local resources Synonyms: Relief Phase, Isolation Phase

26. Disaster Cycle Reconstruction Phase Restoring predisaster conditions Reestablishing health services Reconstructing & repairing damaged facilities Reflecting and debriefing on lessons learned Synonym: Rehabilitation Phase Synonym: Rehabilitation Phase

27. Disaster Severity

28. A Decade of Natural Disasters 1 million thunderstorms 100,000 floods Tens of thousands of landslides, earthquakes, wildfires & tornadoes Several thousand hurricanes, tropical cyclones, tsunamis & volcanoes Sources: CDC & EK Noji, The Public Health Consequences of Disaster

29. Disaster Severity A Decade of Natural Disasters (1980s) Floods 39,000 deaths Tropical cyclones 14,000 deaths Hurricanes 1,000 deaths Earthquakes 54,000 deaths Other disasters1,012,000 deaths TOTAL1,120,000 deaths Sources: CDC & EK Noji, The Public Health Consequences of Disaster

30. Disaster Severity Factors Contributing to Disaster Severity -Human vulnerability due to poverty & social inequality -Environmental degradation -Rapid population growth especially among the poor Sources: CDC & EK Noji, The Public Health Consequences of Disaster

31. Disaster Severity Influence of Poverty Persons in poverty: - Live in poor housing unable to withstand seismic activity -Live in poor housing susceptible to landslides -Inhabit coastal areas and flood plains vulnerable to hurricanes, storm surges, flooding, and tidal waves -Live near hazardous industrial sites -Do not receive education on life-saving actions during disasters -Do not receive warning of impending disasters Sources: CDC & EK Noji, The Public Health Consequences of Disaster

32. Disaster Severity Influence of Poverty -Low-income countries: 3,000 deaths per disaster -High-income countries: 500 deaths per disaster Sources: CDC & EK Noji, The Public Health Consequences of Disaster

33. Disaster Severity Influence of Population Growth - Urban dwellers: 1920: 100 million 1980: 1 billion 2000: 2 billion - 2000: 20 cities with >10 million people Sources: CDC & EK Noji, The Public Health Consequences of Disaster

34. Disaster Severity Capabilities of Developed Nations That Mitigate Disaster Effects -Ability to forecast severe storms -Ability to enforce strict building codes -Ability to use communication networks to broadcast alerts and warnings -Ability to provide emergency medical services -Ability to engage in contingency planning Sources: CDC & EK Noji, The Public Health Consequences of Disaster

35. Disaster: Perspectives

36. “A disaster is a result of a vast ecological breakdown in the relation between humans and their environment, a serious or sudden event on such a scale that the stricken community needs extraordinary efforts to cope with it, often with outside help or international aid” Source: EK Noji, The Public Health Consequences of Disaster

37. Disaster: Perspectives Public Health View “Disasters are defined by what they do to people...” Source: EK Noji, The Public Health Consequences of Disaster

38. Disaster: Perspectives Major Categories of Disasters -Natural Disasters -Human-generated Disasters Sources: CDC & EK Noji, The Public Health Consequences of Disaster

39. Disaster: Perspectives Natural Disasters -Arise from forces of nature -Two subcategories: – Sudden impact or acute onset – Slow or chronic onset Sources: CDC & EK Noji, The Public Health Consequences of Disaster

40. Disaster: Perspectives Sudden Impact or Acute Onset Disasters Geological or climatic hazards Hurricanes/typhoonsTornadoes Hurricanes/typhoonsTornadoes EarthquakesVolcanoes EarthquakesVolcanoes FloodsTsunamis FloodsTsunamis Temperature extremesWildfires Temperature extremesWildfires LandslidesAvalanches LandslidesAvalanchesEpidemics Food, water, vector-borne diseases Person-to-person transmission diseases Sources: CDC & EK Noji, The Public Health Consequences of Disaster

41. Disaster: Perspectives Slow or Chronic Onset Disasters DroughtFamine Environmental degradation Chronic exposure to toxic substances DesertificationDeforestation Pest infestation Sources: CDC & EK Noji, The Public Health Consequences of Disaster

42. Disaster: Perspectives

47. Human-Generated Disasters Industrial/technological Transportation (vehicular) Deforestation Material shortages Complex emergencies Source: EK Noji, The Public Health Consequences of Disaster

48. Disaster: Perspectives Complex Emergencies -Wars and civil strife -Armed aggression -Insurgency -Other actions resulting in displaced persons and refugees Source: EK Noji, The Public Health Consequences of Disaster

49. Disaster: Perspectives 2002 DEEP Center Classification -Natural disasters -Non-intentional human-generated disasters -Terrorist-perpetrated disasters -Complex disasters -Natural-technological disasters (NA-TECHS)

50. Disaster: Perspectives Terrorist-perpetrated Disasters -Biological-Nuclear-Incendiary-Chemical-Explosive Mnemonic: B-NICE