1. Critical Systems Challenges for Chronic Diseases George A. Mensah, M.D. Associate Director for Medical Affairs National Center for Chronic Disease Prevention and Health Promotion George A. Mensah, M.D. Associate Director for Medical Affairs National Center for Chronic Disease Prevention and Health Promotion 2006 National Health Policy Conference Adjunct Meeting Feb. 8, 2006 2006 National Health Policy Conference Adjunct Meeting Feb. 8, 2006 Public Health Response in Disasters

2. Disclosure Statements No conflicts of interest Statements made in this presentation do not necessarily represent the views of the CDC, DHHS, or the US Government

3. CDC Foundation Kaiser Permanente

5. www.who.int

6. Katrina and Other Natural Disasters Panel 1: Lessons Learned – Impact on public health systems – Deployment of mobile hospitals – System evacuation issues – Mental health transformations Panel 2: Critical System Challenges – Surge Capacity Issues – Legal Issues – Chronic Disease Issues

7. Chronic Disease Issues in Natural Disasters - The Outline Triumphs and Successes Tradition of Neglect Critical Challenges Opportunities and Hope

8. Triumphs and Successes  Civil society response  International collaboration  Attention to provision of shelter, food and water for evacuees  Fatality from malnutrition Control of infectious outbreaks

9. Mokdad, Mensah, Posner, Reed, Simoes, Engelgau, and the Chronic Diseases and Vulnerable Populations in Natural Disasters Working Group. Prev Chronic Dis 2005 Nov http://www.cdc.gov/pcd/issues/2005/nov/05_0201.htm

10. Persons at Risk from Disasters – 1 Persons with underlying chronic diseases; mental illness Persons without health insurance Persons with low income, SES, and educational attainment Homeless persons Mokdad, Mensah, Posner, et al. Prev Chronic Dis 2005 Nov http://www.cdc.gov/pcd/issues/2005/nov/05_0201.htm

11. The elderly Pregnant women and infants Children and adolescents Mentally impaired People living with disabilities Prisoners and other institutionalized persons Persons at Risk from Disasters – 2 Other Vulnerable Populations

12. Chronic Diseases and Vulnerable Population Issues Lack of access to routine health care and medications Significant interruption in life- supporting treatments – home oxygen use – renal dialysis – insulin injections Mokdad, Mensah, Posner, et al. Prev Chronic Dis 2005 Nov http://www.cdc.gov/pcd/issues/2005/nov/05_0201.htm

13. Selected Observations from Surveys of Hurricane Evacuees Most health care visits were for chronic health conditions Up to 41% had at least one major chronic health condition. Non-traumatic deaths often result from existing chronic conditions.

14. Needs Assessment in Persons Staying in Evacuation Centers Leading the list of top 10 conditions were: – Hypertension – Cardiovascular diseases – Diabetes – Psychiatric disorders

15. Chronic Disease Issues in Natural Disasters - The Outline Triumphs and Successes Tradition of Neglect Critical Challenges Opportunities and Hope

17. Chronic Disease Management During Disasters and Emergencies “No generally accepted guidance on the management of chronic diseases during disasters has previously been established.” Humanitarian Charter and Minimum Standards; p 294

18. Priority Chronic Conditions During Disasters or Complex Emergencies Conditions for which an acute cessation of therapy was likely to result in death, including: – Dialysis-dependent chronic kidney failure – Insulin-dependent diabetes – Certain childhood cancers Humanitarian Charter and Minimum Standards; p 294

19. http://www.dhs.gov/interweb/assetlibrary/NRP_FullText.pdf

20. Frequency of Selected Terms in The National Response Plan http://www.dhs.gov/interweb/assetlibrary/NRP_FullText.pdf TERMFREQUENCY Outbreak 62 Infection/infectious disease 18 Cancer 1 Heart disease 0 Diabetes 0 Pregnant/pregnancy 0 Mental Illness 0

21. Chronic Disease Issues in Natural Disasters - The Outline Triumphs and Successes Tradition of Neglect Critical Challenges Opportunities and Hope

22. Data to Guide Chronic Disease Disaster Preparedness 1. Pre-disaster burden data 2. Estimates of immediate needs 3. Surge capacity of local and neighboring health care systems 4. Ability to rebuild infrastructure needed to support care

23. Surveillance Needs Before, During, and After a Disaster 1. Size, functional status, and needs prior to the disaster 2. Ability to assess the needs and levels of actual response during the disaster; 3. Ability to monitor the long- term effects of the disaster.

24. Chronic Disease Issues in Natural Disasters - The Outline Triumphs and Successes Tradition of Neglect Critical Challenges Opportunities and Hope

25. Humanitarian Charter and Minimum Standards in Disaster Response

26. Standard 2: Reproductive Health Guidance Note 1. Minimum Initial Service Package 2. Gender-based violence (GBV) 3. Emergency obstetric care 4. Comprehensive reproductive health services: Humanitarian Charter and Minimum Standards; p 290

27. Standard 4: Chronic Diseases Control of Non-Communicable Diseases

28. Essential Drugs and Supplies Life-threatening conditions – Acute heart attack & stroke care – Oxygen in severe lung disease – Insulin in type 1 diabetics – Dialysis in kidney failure – Obstetric complications – Acute care in certain cancers Medications for routine care

29. Chronic Disease and Vulnerable Populations: Research Issues Direct morbidity & mechanisms Specific preventive strategies Determinants of rate of recovery Impact on mental health and overall long-term health status Essential medications and supplies for stockpiles

30. Summary & Conclusions Previous preparedness efforts often neglected chronic diseases and vulnerable populations New emphasis offers opportunities for improved preparedness and health protection Surveillance, policy development, and assurance remain core functions

32. Chronic Disease and Vulnerable Populations in Natural Disasters Working Group at CDC Coordinating Center for Health Promotion Coordinating Office for Terrorism Preparedness and Emergency Response Other CDC Centers, Institutes, Offices Public health partners

33. Preventing Chronic Diseases and Adverse Outcomes in Vulnerable Population