Preventing Disasters: Disaster Risk Reduction as a Sustainable Adaptation to Climate Change 1

1. Preventing Disasters: Disaster Risk Reduction as a Sustainable Adaptation to Climate Change1 Centers for Disease Control and Prevention Mark Keim, MD, MBA 1 Keim ME. Preventing Disasters. Disaster Med Public Health Prep. 2011 Jun;5(2):140-8.

2. A story of disaster risk reduction…

3. 15 years later… December 1981

4. 1982 Memorial Day holiday

5. Evacuation path

6. All deaths occurred during the impact phase May 1982 Duclos PJ, Ing RT. Injuries and Risk Factors for Injuries from the 29 May 1982 Tornado, Marion, Illinois. International Journal of Epidemiology 1989,18: 213-219.

7. Global climate change is predicted to increase the probability of extreme weather events • High precipitation disasters • Storms • Floods • Landslides • Low precipitation disasters • Heat • Drought • Wildfire 2 IPCC Working Group II, Impacts, Adaptation and Vulnerability, 2007 http://www.ipcc.ch/SPM13apr07.pdf

8. Death Injuries Loss of clean water Loss of shelter Major population movements Loss of sanitation Loss of routine hygiene Disruption of solid waste management Public concern for safety Increased pests & vectors Damage to health care system Worsening of chronic illnesses Loss of electricity Toxic exposure Loss of food supply Public health consequences of extreme weather events

9. Disasters are increasing worldwide… • …due to increasing vulnerability of populations at risk. • Interventions must therefore address the causes of vulnerability not merely the response Center for Research on the Epidemiology of Disasters : URL:http://www.unisdr.org/we/inform/disaster-statistics

10. An evolution in approaches

11. Disaster Risk Management Definition • “The systematic process of using administrative directives, organizations, and operational skills and capacities to implement strategies, policies and improved coping capacities in order to lessen the adverse impacts of hazards and the possibility of disaster”. Components • Risk assessment • Risk avoidance • Risk reduction • Risk transfer • Risk retention UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

12. Risk Management vs. Risk Reduction • Risk Management • Prevention • Mitigation • Preparedness • Response • Recovery • Risk Reduction • Prevention • Mitigation Risk Reduction lessens the likelihood of disaster

13. Causes Effects Prevention Mitigation Preparedness, Response & Recovery

14. Disaster Risk Reduction (DRR) for Health Why DRR? • More effective in reducing mortality • Majority of disaster deaths occur during impact phase What is DRR? • Preventing disaster-related adverse health impact beforeit happens • Deals with the root cause

15. Definition of risk • In epidemiology, it is most often used to express the “probability that a particular outcome will occur following a particular exposure” • Risk is the probability that an event will occur. Last JM, ed. A dictionary of epidemiology. 4th edition. New York: Oxford University Press, 2001.

16. Factors affecting disaster risk

17. Health-related disaster risk occurs as the result of convergence of 4 key factors: • The presence of a health hazardassociated with the occurrence of natural or man-made danger • The degree of exposureto the hazard sustained by the person (or population) • The degree of vulnerabilityof the person (or population) to that particular health hazard • The degree of capacityof the person (or population) in order to avoid or lessen harm From: Keim M. Disaster Risk Management for Health. In Ed., David S. Textbook ofEmergency Medicine. Lippincott) New Dehli 2012

18. Definition of a hazard • “A dangerous phenomenon, substance, human activity or condition that may cause loss of life, injury or other health impacts, property damage, loss of livelihoods and services, social and economic disruption, or environmental damage” UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

19. Examples of hazards Earthquakes Floods Radiation Typhoons Outbreaks Tornadoes

20. Definition of vulnerability “The characteristics and circumstances of a community, system or asset that make it susceptible to the damaging effect of a hazard” UNISDR 2009 Or simply put… Likely to incur physical or emotional illness or injury UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

21. Public health vulnerability • Certain populations are more vulnerable to disaster-related morbidity and mortality

22. Definition of exposure • “People, property, systems, or other elements present in hazard zones that are thereby subject to potential losses” • Example of exposure • Living in an area that floods UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html

23. Definition of capacity What is the difference between capacity vs. capability? • “The combination of all the strengths, attributes and resourcesavailable within a community, society or organization that can be used to achieveagreed goals” ‡ • Also known as absorptive capacity ‡‡ ‡ UNISDR 2009, http://www.unisdr.org/eng/terminology/terminology-2009-eng.html ‡‡ Sundnes K, Birnbaum M, Birnbaum E, eds. Health Disaster Management Guidelines for Evaluation and Research in the Utstein Style. USA: Prehospital and Disaster Medicine; 2003

24. Countering disaster risk

25. Reducing exposures • Floodplain management • Dams, levees, weirs • Population protection measures • Evacuation • Mass care • Land use planning and regulation • PPE, sanitation/hygiene

26. Reducing vulnerability • Health promotion • Health care • Poverty reduction • Community planning • Immunization

27. Mapping human vulnerability

28. National Prevention Strategy • Identifies goals, priorities, recommendations, and measures for improving health through prevention • Grounds recommendations in evidence-based practice • Aligns and focuses federal prevention and health promotion efforts, including existing national efforts • Healthy People 2020 • National Quality Strategy • First Lady’s “Let’s Move!” campaign • America’s Great Outdoor Initiative

29. National Prevention Strategy

30. Building capacity We build capacity by improving: • Preparedness • Response • Recovery Societal actions that build emergency health capacity • Public health & safety • Healthcare • Education • Poverty reduction

31. Examples of environmental health programs that reduce the risk of disaster-related morbidity and mortality • Reducing vulnerability (Healthy people) • Water, sanitation, hygiene • Food safety • Pest control • Environmental psychology • Environmental justice and ethics • Climate change adaptation • Reducing exposures (Healthy communities) • Healthy buildings • Built environment • Population protection measures • Risk assessment • Industrial hygiene • Waste management Cross-cutting programs: GIS, Risk communication, Public policy, Community involvement

32. NCEH DRR for Health:

33. Email mjk9@cdc.gov LinkedIn.com: www.linkedin.com/in/disasterdoc/ Disaster Risk Reduction for Health Discussion Group Agency for Toxic Substances and Disease Registry National Center for Environmental Health

34. Thank You For more information please contact Agency for Toxic Substances and Disease Registry or the Centers for Disease Control and Prevention ATSDR: 4770 Buford Highway NE, Chamblee, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: http://www.atsdr.cdc.gov CDC: 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Disease Registry National Center for Environmental Health Agency for Toxic Substances and Disease Registry