Disasters:

The Public Health

Impact
 Disasters: The Public Health Impact
Mortality & Morbidity
Disasters cause deaths, injuries, and
illnesses
Disasters may overwhelm medical
resources and health services

Sources: CDC & EK Noji, The Public Health

Consequences of Disaster
Disasters: The Public Health Impact
Health Care Infrastructure
Disasters may destroy hospitals
Disasters may disrupt routine health
services
Disasters may disrupt preventive activities
Consequence: long-term increases in
morbidity and mortality
Sources: CDC & EK Noji, The Public Health
Consequences of Disaster
Disasters: The Public Health Impact
Environment & Population
Disasters may increase potential for
communicable diseases
Disasters may exacerbate environmental
hazards
Consequences: increases in morbidity and
premature death, decreased quality of life
Sources: CDC & EK Noji, The Public Health
Consequences of Disaster
Disasters: The Public Health Impact
Psychological and Social Behavior
Disasters may cause generalized panic or
paralyzing trauma
Disasters may provoke increases in anxiety,
depression and neuroses
Disasters may lead to post-traumatic stress
disorder (PTSD) at epidemic levels

Sources: CDC & EK Noji, The Public Health

Consequences of Disaster
Disasters: The Public Health Impact

Food Supply
Disasters may disrupt the food supply
Disasters leading to food shortages may
cause specific micronutrient deficiencies
Disasters may provoke severe nutritional
consequences including famine and
starvation
Sources: CDC & EK Noji, The Public Health
Consequences of Disaster
 Disasters: The Public Health Impact
Population Displacement
Disasters may cause large spontaneous or
organized population movements
Population movement may increase
morbidity and mortality
Population movement may precipitate
epidemics of communicable diseases in
both displaced and host communities
Crowding of populations and overlay of
refugee and host populations may lead to
injuries and violence
Sources: CDC & EK Noji, The Public Health Consequences of
Disaster
 Epidemiologic
Methods in Disasters
Epidemiologic Methods in Disasters
Before a disaster (Interdisaster Phase):
Conducting hazards & vulnerability
analyses of the population
Modeling/simulating disaster scenarios
Conducting drills
Designing emergency protocols
Assessing level of emergency preparedness
Assessing flexibility of surveillance systems
Training health and safety personnel
Source: EK Noji, The Public Health Consequences of
Disaster
Epidemiologic Methods in Disasters
During a disaster (Emergency Phase):
Conducting disaster damage assessment
Conducting rapid field investigations
Identifying urgent needs & matching
resources
Prioritizing relief efforts
Conducting disaster surveillance
Conducting epidemic investigations
Source: EK Noji, The Public Health Consequences of
Disaster
 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
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
The Disaster Cycle
 Disaster Cycle
Sudden impact natural disasters
can be considered as a continuous time sequence
of five phases:
Interdisaster
Predisaster
Impact
Emergency
Reconstruction
Source: EK Noji, Sivertson KT. Injury prevention in
natural disasters: a theoretical framework. Disasters
1987;11:290-296.
Disaster Cycle
Interdisaster Phase
Planning disaster
prevention/preparedness/mitigation
Identifying risks
Identifying vulnerabilities
Creating a resource inventory
Conducting professional training
Conducting community education

Synonym: Nondisaster Phase

Disaster Cycle

Predisaster Phase
Issuing timely warnings
Implementing protective actions
Undertaking emergency management
activities
Evacuating population as necessary

Synonym: Warning Phase

Disaster Cycle

Impact Phase
Destruction
Injuries
Deaths
may occur during impact
Disaster Cycle
Emergency Phase
Implementing life-saving actions
-search and rescue
-first aid
-emergency medical assistance
Restoring emergency communications
Restoring emergency transportation
Implementing public health surveillance
Evacuating vulnerable areas

Synonyms: Relief Phase, Isolation Phase

Disaster Cycle

Emergency Phase
Note: The immediate postimpact period is
the isolation phase where most urgent
rescue tasks are accomplished by the
survivors using local resources

Synonyms: Relief Phase, Isolation Phase

 Disaster Cycle

Reconstruction Phase
Restoring predisaster conditions
Reestablishing health services
Reconstructing & repairing damaged facilities
Reflecting and debriefing on lessons learned

Synonym: Rehabilitation Phase

Disaster Severity
Disaster Severity
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
Disaster Severity
A Decade of Natural Disasters (1980s)
Floods 39,000 deaths
Tropical cyclones 14,000 deaths
Hurricanes 1,000 deaths
Earthquakes 54,000 deaths
Other disasters 1,012,000 deaths
TOTAL 1,120,000 deaths

Sources: CDC & EK Noji, The Public Health

Consequences of Disaster
Disaster Severity
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
 Disaster Severity
Influence of Poverty
Persons in poverty:
-Live in poor housing unable to withstand seismic
activity
-Live in poor housing susceptible to landslides
-Inhabit coastal areas and flood plains vulnerable
to hurricanes, storm surges, flooding, and tidal
waves
-Live near hazardous industrial sites
-Do not receive education on life-saving actions
during disasters
-Do not receive warning of impending disasters
Sources: CDC & EK Noji, The Public Health Consequences of Disaster
Disaster Severity

Influence of Poverty
-Low-income countries:
3,000 deaths per disaster
-High-income countries:
500 deaths per disaster

Sources: CDC & EK Noji, The Public Health Consequences of Disaster

Disaster Severity
Influence of Population Growth
- Urban dwellers:
1920: 100 million
1980: 1 billion
2000: 2 billion

- 2000: 20 cities with >10 million people

Sources: CDC & EK Noji, The Public Health Consequences of Disaster

Disaster Severity

Capabilities of Developed Nations

That Mitigate Disaster Effects
-Ability to forecast severe storms
-Ability to enforce strict building codes
-Ability to use communication networks to
broadcast alerts and warnings
-Ability to provide emergency medical
services
-Ability to engage in contingency planning
Sources: CDC & EK Noji, The Public Health Consequences of Disaster
 Disaster:
Perspectives
Disaster: Perspectives
“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
Disaster: Perspectives

Public Health View

“Disasters are defined
by what they do to people...”

Source: EK Noji, The Public Health Consequences of Disaster

Disaster: Perspectives

Major Categories of Disasters

-Natural Disasters
-Human-generated Disasters

Sources: CDC & EK Noji, The Public Health Consequences of

Disaster
Disaster: Perspectives

Natural Disasters
-Arise from forces of nature
-Two subcategories:
– Sudden impact or acute onset
– Slow or chronic onset
Sources: CDC & EK Noji, The Public Health Consequences of
Disaster
Disaster: Perspectives
Sudden Impact or Acute Onset
Disasters
Geological or climatic hazards
Hurricanes/typhoons Tornadoes
Earthquakes Volcanoes
Floods Tsunamis
Temperature extremes Wildfires
Landslides Avalanches
Epidemics
Food, water, vector-borne diseases
Person-to-person transmission diseases
Sources: CDC & EK Noji, The Public Health Consequences of Disaster
Disaster: Perspectives

Slow or Chronic Onset Disasters

Drought
Famine
Environmental degradation
Chronic exposure to toxic substances
Desertification
Deforestation
Pest infestation
Sources: CDC & EK Noji, The Public Health Consequences of
Disaster
Disaster: Perspectives
Disaster: Perspectives
Disaster: Perspectives
Disaster: Perspectives
Disaster: Perspectives
 Disaster: Perspectives

Human-Generated Disasters
Industrial/technological
Transportation (vehicular)
Deforestation
Material shortages
Complex emergencies
Source: EK Noji, The Public Health Consequences of Disaster
Disaster: Perspectives
Complex Emergencies
-Wars and civil strife
-Armed aggression
-Insurgency
-Other actions resulting in displaced
persons and refugees

Source: EK Noji, The Public Health Consequences of

Disaster
 Disaster: Perspectives

2002 DEEP Center Classification

-Natural disasters
-Non-intentional human-generated disasters
-Terrorist-perpetrated disasters
-Complex disasters
-Natural-technological disasters (NA-TECHS)
Disaster: Perspectives

Terrorist-perpetrated Disasters
-Biological
-Nuclear
-Incendiary
-Chemical
-Explosive

Mnemonic: B-NICE