Structural Barriers to Disaster Resilience: Health and Disability
Session 14
Session Objectives
Relate disabilities and health problems to
other risk factors Identify specific concerns of people with disability and health issues Critically assess traditional emergency management approaches to disability and health Identify resources and strategies for mitigating vulnerabilities of those who live with chronic health problems and disabilities
Session 14 2
Who Defines “Disabled” or “Sick”?
http://www.nod.org
Americans With Disabilities Act http://www.usdoj.gov/crt/ada/adahom1.htm
World Health Organization
http://www.who.org
Session 14 3
How Do People Become Disabled or Ill?
Social labeling
Genetic inheritance
Accidents Violence
Aging
Patterns of everyday life – Living and working conditions – Organization culture and practice of nation’s health care system – Differing cultural, age and/or gender norms – Environmental conditions
Session 14 4
Social Trends Increasing the Proportion of Americans with Impairments
Increased longevity Rising rates of
Increasing access to
health care extending life Persistent and increasing workplace hazards Increased exposure to air and water pollution
homelessness and poverty with increased health risks and decreased access to health care High rates of selfinflicted injury Lifestyle “choices” “Diseases of affluence”
Session 14
5
Exposure to Hazards/Disasters Increases Impairment
Disabling injuries increase vulnerability to future
disasters Armed conflict can inflict disabling illness and psychosocial stress on civilians and noncombatants Technological or human-agent disasters can be emotionally debilitating Prolonged food scarcity and malnutrition following major environmental disasters undermine public health and disaster resilience Prolonged exposure to environmental toxins increases incidence of debilitating illnesses
Session 14
6
Intersecting Vulnerabilities
Racial/ethnic status – Many health problems higher among racial//ethnic minority populations – Exposure to toxins and pollutants higher among ethnic groups in hazardous occupations – African Americans have higher rates of disability than Anglos Gender – Pre- and post-health needs increase childbearing women’s vulnerability – Women more than men live with chronic depression – Men more than women live with heart disease – Women more than men exposed to postdisaster violence
Session 14
Socioeconomic status – High rates of physical and mental illness among poor and lowincome people – Poverty associated with malnutrition and functional disabilities – Restricted access to medical equipment, supplies, medicine, etc. among poor – Lack of secure employment – Disabled persons more likely to be unemployed and be poor
Age – Infants and frail elderly most susceptible and least resistant to pre- and post-disaster illness and injury – Cognitive and physical impairments increase with age – Functional limitations increase with age 7
Risky Living Conditions of People with Disabilities
People living with disabilities tend to live:
On lower incomes than non-disabled counterparts
In un-reinforced masonry buildings Outside caregiving institutions with legislated
obligations to prepare for emergencies Inside caregiving institutions which may lack features designed to enhance safety of residents On their own With social distance or stigma associated with being labeled “disabled” in a society valuing self-sufficiency
Session 14 8
Risky Living Conditions of the Severely or Chronically Ill
Severely or chronically ill persons are at increased risk of:
Biological hazards (due to malnutrition,
weakened immune systems, etc.) Life-threatening disruptions in medical care during emergencies Deteriorating mental and physical health due to loss of caregiver support systems
Session 14 9
Vulnerability of Disabled or Severely/Chronically Ill
Social changes accompanying disaster can increase vulnerability by:
Increasing the social isolation of persons who often live alone
Increasing rates of temporary disability among disaster
survivors Causing debilitating injuries, trauma and post-disaster stress Increasing public health hazards such as water contamination Decreasing people’s access to health and daily living support services Increasing exposure to severe environmental conditions worsening pre-existing illness
10
Session 14
Myths about Disabilities
Disabilities are visible Disabled persons reside primarily in
institutions
Disabilities make people dependent on others Disabilities and chronic illnesses are “master
identities”
Session 14
11
Stereotypes Underlie Emergency Management Approach
Reinforces or creates dependency Displaces focus from preventing problems to
dealing with”special populations” as burdensome Ignores resources of advocacy groups Deprives persons with functional impairments of equitable access to resources Undermines long-term recovery
Session 14
12
Disability Issues
Evacuation Emergency Relief Centers
– Egress and access for wheelchair users, sightimpaired, etc. – Accessible emergency routes – Capacity to evacuate needed equipment – Early warning to provide time for complex moves
Preparedness
– Knowledgeable volunteers trained to understand needs and capacities of disabled persons and chronically ill – Appropriate medical equipment – Interpersonal support networks – Provision for helper animals
Reconstruction/Recovery
– Involving disabled and advocacy organizations in emergency exercises – Stockpiling of needed equipment – Recording medical needs and caregiver contact information
– Increased accessibility into public buildings – Priority attention to functionality of health care facilities and systems – Peer counseling – Health care workers knowledgeable about specialized medical needs
13
Session 14
Traditional Emergency Management Approaches to Health and Disability
Exclusion
– Neglects specific needs which can affect people’s ability to anticipate, prepare fore, cope with, survive, and recover from disaster – Neglects capacities and resources of the group – Negates opportunities for partnering with groups and organizations knowledgeable about vulnerabilities and capacities of this social group
Inclusion
– Is an overly medicalized approach – Focuses on the person rather than the group – Inadequately assesses complex and inter-related needs – Neglects self-care capacities of those with disabilities and health barriers – Reinforces stereotypes
Session 14
14
Participatory Planning Approach to Health and Disability
Increases self-organization among persons in these social
groups Promotes organizational collaboration between emergency managers and advocacy groups Results in services designed by, for, and with persons with mental and physical limitations Is a rights-based approach whereby members of these social groups are full and equal participants in planning and receive equitable and appropriate services Empowers people living with disabilities and/or health barriers Increased political visibility and strength of this group’s concerns during emergency relief and long-term reconstruction
15
Session 14
Strategies for Mitigating Vulnerabilities
Make necessary accommodations to ensure
equity Critically evaluate and assess disaster policies, plans, services, and operations to reduce risk of undermining independence Adopt a human rights rather than a “special needs” approach Collaborate with local self-help and advocacy groups to reduce risk
Session 14 16
Collaborative Advocacy Organizations
Disease-based support groups Local service organizations Disability rights organizations HIV/AIDS advocates and grassroots groups
Environmental justice groups involved with
health issues National advocacy groups
Session 14
17
Obstacles to Cooperation
Conflicts over interpretation of Americans with
Disabilities Act with respect to accessible sheltering Shelter managers may resist pressure to develop ADA-compliant shelters or be unable to locate appropriate facilities Stereotyping about presumed medical needs of persons with disabilities can preclude communication Advocacy groups and government agencies may conflict over implementation of program or, providing of appropriate services
Session 14
18