29 october 1 november 2014, hong kong sar,...
TRANSCRIPT
The 6th Global Conference of the Alliance for Healthy Cities (AFHC)
29 October – 1 November 2014, Hong Kong SAR, China
Mr Alex Ross
Director, WHO Kobe Centre
“Prevention and preparedness
is the heart of public health.
Risk management is our bread
and butter."
“Our greatest concern
must always rest with
disadvantaged and
vulnerable groups.”
Dr Margaret Chan
WHO Director-General
Public health emergencies:
Every year, one out of 5 WHO Member States
experiences a crisis endangering the health and lives of its people
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Haiti
Pakistan Tunisia-Libya Border
Broad range of public health emergencies
resulting from various hazards.
• Influenza A (H7N9) in China
• Dhaka(Savar) building collapse
• Boston marathon bombing
• Hurricane Sandy
• Haiti earthquake
• Syria conflict
• Bangkok floods
• TC Ketsana in the Philippines
Risks: Many Types
• Biological
• Chemical
• Radiological
• Conflict
IHR (rev 2005)
DRM: A Paradigm Shift
From
disasters’ preparedness & response
to
disaster risk management
9
Emerging and communicable diseases
• Influenza
• MERS-Cov
• Dengue
• Chikungunya
• Food borne diseases
• Ebola
Public health sequelae of disasters
• Communicable diseases
• NCDs
• Continuity of care
• Psycho-social
In 2011...
Humanitarian Health Action
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Disaster risk reduction, preparedness, response and recovery
(DRR-PRR) is key.
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54% of the world is now urban. (World Urbanization Prospects 2014)
60% by 2030.
66% by 2050.
Urban Health is now recognized as a global public health issue.
Urbanization in numbers
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
1950
2010
2050
YEAR
COUNTRY 1950 2010 2050
Australia 77.0% 88.7% 92.9%
Cambodia 10.2% 19.0% 30.6%
China 11.8% 49.2% 75.8%
Japan 53.4% 90.5% 97.7%
Korea 21.4% 81.9% 87.6%
Malaysia 20.4% 70.9% 85.9%
Mongolia 20.0% 67.6% 84.8%
Philippines 27.1% 45.3% 56.3%
Vietnam 11.6% 30.4% 53.8%
Source: World Urbanization Prospects 2014 (UN); World Population Prospects 2013 (UN); WHO Global Health Observatory
3.3 Billion
in urban areas
1 Billion
in urban slums
3.3 Billion
in rural areas
6.4 Billion
2 Billion
2.9 Billion
2008
2050
(United Nations projections)
Urban residents -- Slums
Source: World Urbanization Prospects 2014 (UN); World Population Prospects 2013 (UN); World Economic Outlook 2014 (IMF)
10 Largest Cities 1960-2020
Rapid, Unplanned Urbanization • Irreversible transition from rural to urban
with concentration of opportunities
• Concentration of hazards,
vulnerabilities; increased health risks
• Driving forces: ageing, urbanization,
environmental change and technological
change
• 651 million lived in slums (2009)
• Public health emergencies
• Need for an appropriate governance
mechanism to be proactive
• What’s the role of city officials, city
planners, etc and citizens themselves?
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Public health emergencies
Urban • Poverty (“urban poor”) • Overcrowding • Inadequate infrastructure
• Insufficient land for
resettlement
• Complex political scenario • Quality health services but
poor access—economic, social-cultural
• Greater disaster response efforts but less coordinated
Rural • Poverty also present
• No overcrowding
• Infrastructure – very inadequate
• Sufficient land for resettlement; affected individuals can live with relatives
• Less complex politics
• Limited availability of health services—geographic access
• Response easier to organize
WPRO Regional Health Cluster
http://www.wpro.who.int/emergencies_disa
sters/en/
Asia Pacific Strategy for Emerging Diseases
(2010)
Securing Regional Health through APSED
Building sustainable capacity for managing
emerging diseases and public health events
DSE Securing our Region's Health
Western Pacific Regional
Food Safety Strategy 2011-
2015
The Great East Japan Earthquake
A story of a devastating natural disaster, a
tale of human compassion
WHO WPRO
Safe Hospitals
• Systems approach
- Health governance - Health care financing - Health workforce - Service delivery - Logistics - Health information - Cross-cutting issues
Aligned with and guided by the
“Hyogo Framework for Action (HFA): 2005-2015:
Building the resilience of nations and communities to disasters”
Disaster Resilient Cities
Actualizing the “Hyogo Framework for
Action” at the city-level
Preparedness (phase for
DRR)
Response
Recovery
(with reconstruction
and development)
• Temporal approach
• Policy, leadership, organization
• Coordination, partnerships, accountability, etc. Health governance
• Financial risk protection, efficiency
• Resource mobilization, etc. Health financing
• Management, type, deployment
• Capacity building, reserve force, etc. Health workforce
• Individual health services
• Population health services, etc. Service delivery
• Essential medicines and supplies, rational drug use
• Vaccines, laboratory, blood bank, etc. Logistics
• Monitoring of needs, resources and activities
• Disease surveillance and early warning system, etc. Health information
• Equity, availability, access, human rights, gender
• Community participation, privacy, etc. Cross-cutting issues
Urban Health Emergency Management | 12 November 2013 31 |
Strategic directions on UHEM (2012-2015)
Topic of concern
Enhancing resilience, risk reduction, preparedness, response and recovery among national and local health authorities in urban areas
RESILIENCE
Building technical surge capacity and urban health emergency management expertise WKC initiative: Project City LHITE with grant support from HEM21
HEALTH AND GOVERNANCE
Strengthening health systems to support urban health emergency management
HEALTH SYSTEMS
Ensuring the protection of the health of vulnerable urban populations
HEALTH EQUITY and SECURITY
Improving sector coordination for health by strengthening multi-sectoral partnership and community ownership
INTERSECTORAL COLLABORATION
Developing and adapting tools to urban contexts, including city health risk assessment and city plans WKC initiative: City Health Emergency Kit (CHEK)
RISK IDENTIFICATION AND MANAGEMENT
32 WHO WPRO, 2014
Urban planning
NCD risk factors; environmental
health
Health outcomes Emergency
preparedness, response, recovery
Strengthened resilience, health
systems
…WHO leads the Health
Cluster
Inter Agency Standing
Committee
http://www.who.int/hac/global_health_cluster/en/
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WHO's role in emergencies
Ministry of Health
WHO Operational
Plan
Health
secto
r/clu
ste
r
resp
on
se s
trate
gy
an
d o
pera
tion
al p
lan
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Performance standards
Mental and Psychosocial Health
Think globally, act locally!
For more information:
• Mr Alex Ross, Director, WKC: [email protected]
• Dr Jostacio Moreno Lapitan, Technical Officer,
WKC: [email protected]
URL: http://www.who.int/kobe_centre/en/
Information and Knowledge
management
Health and
related service
Resources (Human,
drugs & supplies, financial)
Governance, policy, planning
and coordination
MISSION:
Strengthen regional, national and subnational capacities to address
the health aspect of disaster risk management, thus enhancing
health and human security.
VISION:
Attain overall good health of populations at risk of, or affected by disasters
of any hazard, and minimize the related death, injury, disease and
disability.
Regional Framework for Action for Disaster Risk
Management for Health
Scope of the Regional Framework
for Action • Multiple hazards
• Multi-level
• Multi-sectorial
• Common language
• Leverages existing national and regional
• Promotes synergies
Guiding principles
• Adopt a whole of society multi-sectorial
approach
• Apply an all-hazards approach
• Building common capacities to manage
risks of many hazards
• Adopt a comprehensive approach across
the DRM cycle
Guiding principles (2)
• Rely on country ownership, commitment and investment
• Consider community empowerment and resilience as the driving forces of DRM-H
• Ensure planning, action and resource management are based on risk assessments of geological, hydrometeorological and technological hazards
• Strengthen national and local health system functions, and promote equity
Guiding principles (3)
• Position DRM-H as one of the pillars of
health security, which is a core component
of human security
Criteria to link specific health
issues to human security
5
1
• Scale how many people are affected
• Urgency for action
• Intensity depth and impact on society
• Externalities spill over effect beyond
particular areas or locations.
Health as a Human Security Priority for the 21st Century
Chen, 2004
May’s life history
Health as a Human Security Priority for the 21st Century Chen, 2004
Governance, Policy, Planning &
Coordination
Priority 1: Ensure health sector contribution in the shift from disaster management to disaster risk management, and its representation on the relevant governing bodies
Priority 2: Develop and revise relevant national health policies across the four phases of the DRM-H cycle
Priority 3: Strengthening of ministry of health unit(s) responsible for planning and coordinating DRM-H activities across the four phases of DRM
Information and Knowledge
Management Priority 4: Contribute to multisectoral risk assessments at national, subnational and local levels
Priority 5: Establish procedures for the management and utilization of information and knowledge from risk assessments among partners of health and other sectors
Priority 6: Develop policies, mechanisms and procedures for risk communication for public, media and responders
Health and related services
Priority 7: Match available health programme and services with hazards and risk assessment at the national and subnational level
Priority 8: Define or revise existing health services packages for routine activities and disaster response
Priority 9: Develop health service delivery strategies and mechanisms for response and recovery operations as part of national health preparedness plans
Priority 10: Develop or enhance the Safe Hospital Initiative
Resources (Human resources, Drugs & Supplies, Finance)
Priority 11: Review and develop disaster risk management for health skills and experiences available at national, subnational and local levels
Priority 12: Develop national and subnational plans and mechanisms to meet staffing needs for surge requirements
Priority 13: Identify critical medical supplies and equipment through risk assessment and analysis to ensure a minimum stocking level in appropriate locations
Priority 14: Develop procedures for emergency contracting of health supplies and services
Priority 15: Ensure policies for funding mechanism(s) to cover all components of the disaster risk management for health cycle
Priority 16: Establish or enhance contingency funding for disasters
Next steps
• Identify the priority recommendations that
are relevant within the national context on
which developing/revising ‘National Plan
on Disaster Risk Management for Health’.
Next steps (2)
• from regional perspective:
– Base lines mapped against hazards:
• health system
• health status/functioning
• Coverage of key health services
– Safe Hospitals
– Foreign Medical Teams
HEALTH IMPACTS OF A
DISASTER
• Complex managerial
issues
• Governance: breakdown
• Coordination:
– National/regional/local
– External assistance
• System intra-operability
and continuity
– Referral systems
– Medical records and Health Information
• Epidemiology systems
• Roles and Responsibilities
– Health care workers
– Regulation and licensing
– Coordination
• Basic needs:
communication, power,
shelter
• Evacuation, displacement,
return
Public Health Considerations for
the Recovery Process
• Know the epidemiology:
– Underlying community history
– Acute risks: epidemic diseases
vs. chronic/endemic diseases
– Injuries?
• Psycho-social and Mental health:
psychological, behavioral,
emotional, anxiety issues
• Food and water safety; sanitation
• Environmental health – reduction of
risks
• Morbidity/mortality risks:
immediate and longer term
– Immediate reductions in
health levels
• Decline in nutritional status
• Destruction of health
facilities and loss of
personnel, supply chains
• Destruction of health
records
Health Considerations for the
Recovery Process
Health Distinguish:
• Public health – Leadership, governance, communication
– Epidemiology, public health laboratories
– Community based systems (outreach, evacuation, etc)
– Pscyho-social, mental health
– Health care workers: all categories
– Water, sanitation; food safety
– Medical waste/hazardous materials
• Medical/clinical care systems – Institutions, referral patterns
– Health care workers
– Health informatics
– Acute and chronic conditions: treatment
Needs of the individual
• Post disaster, by: – Population group: aged, women, children
– Disease risk: chronic, acute
– Rehabilitation needs
– Health literacy; language; hearing/vision aids
– Evacuation status, family status
– Psycho-social, mental health
– Cultural issues: e.g., ability to accept aid
• Longer term: – Return to stricken area?
– Socio-economic issues
– Availability of health services (including water/sanitation)
HEALTH - a Systems approach
It is crucial to consider ‘health’ in recovery and reconstruction as a system, operating in
collaboration with other systems.
A systems approach to health draws attention to:
– Facilities and infrastructure: safe hospitals/clinics
– Human resources
– Supply chains (drugs, PPEs, supplies, etc)
– Financial resources
– Health information and its use
– Coordination: policy, planning, communication
HEALTH - Systems Approach A systems approach to health enables:
1. Adequate strategies – Understanding and enhancement of capacity of health system to
meet the health needs of population
– Understanding of and mitigation of system’s main vulnerabilities
– Understanding and filling of gaps in system - for instance, inclusion of surge capacity considerations
2. Appropriate allocation of resources throughout the health care system
3. Lessons learned from disaster in own or other countries to be incorporated into health system recovery and reconstruction