Health concerns & regulatory role in disaster risk reduction & management

1. Health concerns & regulatory role in disaster risk reduction & management Rohan Samarajiva Course on Regulatory Design and Practice Nay Pyi Taw, September 2017 This work was carried out with the aid of a grant from the International Development Research Centre, Canada.

2. What people in Myanmar are experiencing is rapid change

3. It’s natural to worry . . .. And for worry to be concentrated on cancer, the scariest of all diseases.

4. So let us look at evidence from an expert: Dr Siddhartha Mukherjee •  Assistant professor of medicine at Columbia University and staff physician at Columbia University Medical Center in New York City. • His 2010 book, The Emperor of All Maladies: A Biography of Cancer was • Awarded the 2011 Pulitzer Prize for General Non-Fiction • Named one of the 100 most influential books written in English since 1923 by the magazine Time • One of the 100 notable books of 2010 by The New York Times Magazine. • A hematologist and oncologist, Mukherjee is also known for his work on the formation of blood and the interactions between the micro-environment ("niche") and cancer cells. • Awarded fourth highest civilian award of India, the Padma Shri, in 2014.

5. Mukherjee (2011), Do Cellphones Cause Brain Cancer? • If a cancer-causing agent increases incidence of a particular cancer in a population then overall incidence of that cancer will rise • An aging population will seem more cancer-afflicted, even if real cancer incidence has not changed  need for age adjustment • From 1990 to 2002 — the 12-year period during which cellphone users grew from 4 million to 135 million in US — the age-adjusted incidence rate for overall brain cancer remained nearly flat

6. Correlation without a causal mechanism? • In 2010, a larger study updated these results, examining 1992- 2006 trends and found no increase in overall incidence in brain cancer • But if population sub-divided into groups • In females ages 20 to 29 (but not in males) age-adjusted risk of cancer in front of brain grew slightly, from 2.5 cases per 100,000 to 2.6 • These cancers appear in the frontal lobe — a knuckle-shaped area immediately behind the forehead and the eye • How, or why, would a phone’s toxicity have skipped over the area nearest to it and caused a tumor in a distant site? • Most epidemiologists and biologists do not find such a tissue-skipping mechanism plausible and most doubt that there is any causal link between frontal tumors and phones

7. Confusing correlations • In 2010, Interphone, a study with 5000+ cases and controls from 13 countries ran for 10 years, raised even more puzzling issues • No evidence for association between brain tumors and cellphones • But when cancer and no cancer cohorts were subdivided according to frequency of mobile use • There was an apparently decreased risk of brain tumors in regular phone users, compared with rare users or nonusers; regular cellphone use seemed to reduce the risk of brain tumors • In stark contrast, very high cellphone use (measured as a user’s cumulative call time) seemed to increase the risk of a particular subtype of brain tumor

8. Mukherjee’s conclusion • “. . little theoretical basis for anticipating that RF energy would have significant biological effects at power levels used by modern mobile phones and their base station antennas. The epidemiological evidence for a causal association between cancer and RF energy is weak and limited. Animal studies have provided no consistent evidence that exposure to RF energy at non-thermal intensities causes or promotes cancer. Extensive in vitro studies have found no consistent evidence of [DNA damage] potential, but in vitro studies assessing the epigenetic potential of RF energy are limited. Over all, a weight-of-evidence evaluation shows that the current evidence for a causal association between cancer and exposure to RF energy is weak and unconvincing.”

9. What the evidence says • Mobile use does not cause cancer, according to • Two USA studies, 1992-2010 • 13 country 10-year Interphone study • 20-year Australian study

10. Regulators’ roles in disaster risk reduction

12. Physical and symbolic worlds, absent linking technologies Mediated interpersonal Physical world where hazards occur Symbolic world where action originates

13. The physical, the symbolic & their linking through ICTs, simplified Physical world where hazards occur Warnings (telecom) Mediated interpersonal TV, Radio & Cell broadcasts Symbolic world where action originates Warnings (telecom) More time to run; more lives saved

14. Types of hazards Optimum effect of ICTs

15. Early warning is a chain; A chain is as strong as its weakest link • Detection and monitoring of rapid-onset, large-scale hazards (cyclones, tsunamis, etc.) quite advanced • National warning systems can be improved • Getting the message to the people-at-risk (“last mile”) is the weakest link • Failed in Myanmar; Bangladesh; Indonesia, etc. • Risk reduction also requires that people know what to do and can do it (e.g., orderly evacuations) • False warnings and unnecessary evacuations can have serious consequences • High cyclone deaths in Bangladesh in 2007 were caused by false tsunami evacuation of 12 September 2007

16. Media & Telecom Operators Citizens National early warning center First responders Early warning chain (standard form)

17. Two easy ways to strengthen the early warning chain • Improve communication from National Early Warning Center (NEWC) to media and first responders using SMS+ (or Whatsapp, Viber) • Add cell broadcasting to public warning provided by electronic media

18. SMS+ for first responders & media • SMS is a point-to-point technology that is inherently susceptible to congestion if too many people come on the network at the same time • Unsuited for public warning and in immediate aftermath of disaster • Useful to alert small numbers before the news is widespread • SMS module of Sahana suite allows one-touch dissemination of 140-character message to pre-registered first responders and journalists • Additional information provided through a robust website capable of handling a spike of use

19. SMS+ • Immediately implementable solution that is part of widely implemented open-source disaster-management software suite, Sahana • Principal advantage is that it reaches mobile handsets that are highly likely to be within immediate reach of intended recipients

20. Cell broadcasting for public warning • As a broadcast mode (point-to-multipoint) CB is inherently immune to congestion • No pre-registration required, reaches all handsets within a base station area • Can be targeted to specific areas, unlike national radio and TV • Negative is that audible alert may not be possible on all handsets yet • Now practical for Myanmar • All operators must install additional software modules

21. What regulators can do • Ensure reliable, redundant communication links needed for • Hazard detection & monitoring • Linking warning center to media and to first responders (police, etc.) • Mandate cell broadcasting capability; work with ASEAN and others to ensure common standards, so visitors will also be protected • Create platform for interaction between operators and disaster warning entities • Standards for disaster-resilient infrastructure, including load factors and tower locations • Best arrived at/implemented with operators • Efficient management of short codes

22. Regulatory response • Requirements for quick response to disaster • Contact persons/numbers • Emergency kits • Mutual support arrangements • Interface between operators and government agencies • Regulatory agency to be 24/7 contactable • Tampere Convention on Provision of Telecom Resources for Disaster Mitigation & Relief Operations • National authority • Preparation of inventory can assist preparedness

23. Regulatory role at time of disaster • “State of exception” • Procedures for approvals/licenses/ authorizations • Customs clearance of emergency equipment • Survivors need to contact families/people need to locate loved ones • Prior arrangements re • Databases • BPO/Call centers

24. Regulatory role in recovery phase • Post-disaster assessments • Requirements to preserve data • Bring operators together to improve procedures • Who is to pay for damage? • If government pays, wrong incentives • If government does pay, use matching funds • Insurance requirements • Deal with the immediate problem but also ensure incentives for robust network planning are not affected

25. Regulatory role in recovery phase • Restoring service • Temptation to fall back to command and control mindset • Regulator can balance the political needs of government with avoidance of administrative expropriation • Provide neutral ground to work out restoration schedule • If government wants to give people free service, it should pay for it • Corporate Social Responsibility is voluntary