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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
Transportation
Disasters
Terrorism
Technological
Disasters
Pandemics
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
Sources: CDC & EK Noji, The Public Health Consequences of Disaster
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.html
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
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