Public Health Disaster Consequences of Disasters

							       Public Health Disaster
     Consequences of Disasters
      Eric K. Noji, M.D., M.P.H.
         Medical Epidemiologist
Centers for Disease Control & Prevention
            Washington, DC


Second Annual John C. Cutler Global
      Health Lecture and Award

          University of Pittsburgh
            29 September 2005
This lecture has been supported by
   John C. Cutler Memorial Global
  Fund, Graduate School of Public
  Health, University of Pittsburgh

 Coordinated through the Global
   Health Network Supercourse
    project, WHO Collaborating
     Centre, Uni. Of Pittsburgh

  Faina Linkov, Ph.D. Eugene
  Shubnikov, MD, Mita Lovalekar,
   M.D., Ronald LaPorte, Ph.D.


                                     www.pitt.edu/~super1/
        Definition of Disaster

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
    Disasters and Emergencies

Natural Disasters   Technological
                    Disasters
Transportation
Disasters           Pandemics

Terrorism
1994-2004: 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
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
Influence of Population Growth

• Urban   dwellers:
  1920:   100 million
  1980:   1 billion
  2004:   2 billion

• 2004: 20 cities with >10 million
  people
Political destabilization in the post
Cold War era with increased
regional violence
Escalating ethnic based conflicts with civilians as military targets
Forced Migration
Emerging themes in Epidemiology

     The role of the applied
 epidemiologist in armed conflict

  Sharon M McDonnell, Paul Bolton, Nadine
Sunderland, Ben Bellows, Mark White and Eric
                    Noji


          For more information visit
  http://www.ete-online.com/content/1/1/4
              (biomed central)
   Epidemiology and its applications
 in measuring the effects of disasters


Epidemiology –
The quantitative study of
 the distribution and
 determinants of health
 related events in human
 populations
Disaster Epidemiology

  Assessment  and Surveillance
  Injury and disease profiles
  Research methodologies
  Disaster management
  Vulnerability and hazard assessment
     Data for Decision-Making
              Disaster Epidemiology

• Purpose:
  – Identify requirements, local capabilities, gaps
  – Avoid unnecessary and damaging assistance

                               Available
                               Services

    Victims
    Needs
"The reason for collecting, analyzing
 and disseminating information on a
  disease is to control that disease.
Collection and analysis should not be
  allowed to consume resources if
       action does not follow."

        William H. Foege, M.D.
        International Journal of
      Epidemiology 1976; 5:29-37
 Objectives of Health Information
     Systems in Emergency
           Populations
• Establish health care priorities
• Follow trends and reassess
  priorities
• Detect and respond to epidemics
• Evaluate program effectiveness
• Ensure targeting of resources
• Evaluate quality of health care
     Myths and Disaster Realities

1) Myth: Foreign medical volunteers with any
    kind of medical background are needed.

Reality :
•   The local population almost always covers
    immediate lifesaving needs.
•   Only skills that are not available in the
    affected country may be needed.
•   Few survivors owe their lives to outside
    teams
  2) Myth:Any kind of assistance is
  needed, and it’s needed now!
• Reality: A hasty response not based on
  impartial evaluation only contributes to
  chaos

• Un-requested goods are inappropriate,
  burdensome, divert scarce resources,
  and more often burned than separated
  and inventoried

• Not wanted, seldom needed
  – used clothing, OTC, prescription drugs,
  or blood products; medical teams or field
  hospitals.
3) Myth:  Epidemics and plagues are
     inevitable after every disaster.
Reality:
• Epidemics rarely ever occur after a
  disaster
• Dead bodies will not lead to catastrophic
  outbreaks
  of exotic diseases
• Proper resumption of public health
  services will ensure the public’s safety
   – Immunizations, sanitation, waste disposal,
     water quality, and food safety
• Caveat: Criminal or terror-intent disasters
  require special considerations
4) Myth:   Disasters bring out the worst
           in human behavior.
• Reality: While isolated cases of antisocial
  behavior exist, the majority of people
  response spontaneously and generously


                              “40-60% Drop in murder
                              rate surprises NYC”
                              - “fewest since 1958”.
                              - USA Today 03/25/2002



Kenyans line up for 2-3 km in August heat
to donate blood after US Embassy bombing
 5) Myth:   The community is too
            shocked and helpless

• Reality: Many find new strengths
• Cross-cultural dedication to common good is most
  common response to natural disasters

• Thousands volunteer to rescue strangers and sift
  through rubble after earthquakes from Mexico
  City, California, and Turkey.

• Most rescue, first aid, and transport is from other
  casualties and bystanders
WHAT DOES THE
FUTURE HOLD?
 Increasing disaster risk
Increasing population density
Increased settlement in high-risks
 areas
Increased technological hazards and
 dependency
Increased terrorism: biological,
 chemical, nuclear?
Aging population in industrialized
 countries
Emerging infectious diseases (SARS)
International travel (global village)
• Increasing Global Travel
• Rapid access to large
  populations
• Poor global security &
  awareness
...create the potential for
simultaneous creation of large
numbers of casualties
Health Information Needs in
Emergency Populations
   Establish health care priorities
   Follow trends and reassess priorities
   Detect and respond to epidemics
   Evaluate program effectiveness
   Ensure targeting of resources
   Evaluate quality of health care
      Final Thought
NOTHING REPLACES WELL
 TRAINED, COMPETENT AND
 MOTIVATED PEOPLE! NOTHING!

PEOPLE ARE THE MOST
 IMPORTANT ASSET
                EXTRA SLIDES

    Please refer to Cutler lecture website

http://www.publichealth.pitt.edu/specialevents/cutler2005/webcast.h
                                  tml


       to obtain full version of the lecture
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
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
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
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
Epidemiologic Methods in Disasters

  Challenges for Epidemiologists
  Selecting study designs:
   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
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
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
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