Health Emergency Risk Health Emergency Risk ManagementManagement

Pir Mohammad Paya MD, MPH,DCBHDPir Mohammad Paya MD, MPH,DCBHDSenior Technical SpecialistSenior Technical SpecialistPublic Health in EmergenciesPublic Health in EmergenciesAsian Disaster Preparedness CenterAsian Disaster Preparedness Center

Outline• Definition of Public Health • Essential Public Health Functions• General effects of Disaster on Health• Health Emergency Risk Management

• Community • Disaster• Hazard • Vulnerability • Capacity

• Preparedness Programs• Steps in Responses• Services in emergencies

WHAT IS PUBLIC HEALTH?WHAT IS PUBLIC HEALTH?

Public health (PH) is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society,

organizations, public and private, communities and individuals"

(1920, C.E.A. Winslow)

Essential Public Health Functions

Essential Public Health Functions

Health Emergency RISKs MANAGEMENT

... is a comprehensive strategy for reducing threats and their consequences to public health and safety of communities by:

• Preventing exposure to hazards (target = hazards)• Reducing vulnerabilities (target group = community)• Developing response and recovery capacities

(target group = response agencies)

A Community Consists of 5 A Community Consists of 5 ElementsElements

What do you think?

1918-19

Disaster

A serious disruption of the functioning of a community or a society involving widespread human, material, economic or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own resources.

What is this?

A HazardA Hazard

isis

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

Types of HazardsTypes of HazardsThere are 4 classes of hazards:

An EmergencyAn Emergency

isis

• any any actualactual threat to public health and safety threat to public health and safety

The differenceThe difference

Hazard

Event

Damage

Emergency

Needs

Changes in Function

Local response

Outside response Disaster

An EMERGENCY is the occurrence of an

event that can be handled by local

response

A DISASTER is the occurrence of an

event that cannot be handled by local

response and requires outside

actors

What do you think?

VulnerabilityVulnerability

is

the characteristics and circumstances of a community, system or asset that make it susceptible to the damaging effects of a

hazard.

Factors influencing human vulnerability/Determinants of Health Risks

CapacityCapacity

The combination of all the strengths, attributes and resources available within a community, society or organization that can be used to achieve agreed goals.

RisksRisks

are:

The The probabilityprobability AND the AND the consequencesconsequences of of exposureexposure to a hazard to a hazard

Risk Hazard x Vulnerability

Capacity(for response and recovery)

Risk Analysis Process Community

Hazards x Vulnerabilities / Capacities Risks

Risk initiator Risk Modifier Risk Modifier Indicators

Hazards- Natural- Biological- Technological - Societal

People- Density and growth- Vulnerable groups / gender

Multi-sectoral collaborationContingency planningAll-hazard approachEmergency Preparedness

- Deaths- Injured- Displaced- Affected- Damage to infrastructure- Loss of property- Secondary hazards- Security

Property- Emergency and health infrastructure

LegislationManagement structuresAdministrative proceduresTechnical guidelinesInstitutional arrangementsInformation systemsWarning systemsResourcesEducation and researchTraining and simulationParticipationPrivate sector collaboration

Probability &Scale - magnitude - intensity- area - spread - duration

Services- Fire stations, vehicles, equipment - Hospitals and ambulances- Schools and community centers

Livelihoods-Employment-Income sources

Environment and resources-Water, soil, air quality- Forestry, agriculture

PREVENTION MITIGATION

+ VULNERABILITY REDUCTION + EMERGENCY PREPAREDNESS = RISK MANA-GEMENT

Hazardous events have potential Hazardous events have potential negative consequencesnegative consequences

Preparedness ProgramsPreparedness ProgramsPreparedness

is:

A long term institutionalised program of measures to build capacities to prevent, mitigate, respond to and recover from emergencies

A program has:

• A visible place in the organisational chart• Full time staff• A regular budget• An annual work PLAN

Preparedness is not a PLAN, it is: A program WITH A PLAN!

10 indicators of preparedness10 indicators of preparedness

National, provincial, local, agency and National, provincial, local, agency and institutional levelinstitutional level

Personal and Personal and community levelcommunity level

Health Emergency Managers

primarily concerned with protecting public safety and public health

Our clients are threatened and injured / damaged

communities

are

THANK YOU

Additional Slides

Aims of Risk CommunicationAims of Risk Communication

Provides meaningful, relevant, accurate meaningful, relevant, accurate and timely information and timely information on how to prepare for, prepare for, protect against, protect against, respond to, respond to, or recover from the riskor recover from the risk

For advocacyadvocacy and policy development Help prevent misallocation and wasting wasting

of resourcesof resources Can decrease illness, injuries and deathsdecrease illness, injuries and deaths

Different Different communication communication

objectivesobjectives

For each stage of the disaster, For each stage of the disaster, there is a different there is a different informational need of the informational need of the different audiencesdifferent audiences

Different messages

Communication ObjectivesCommunication Objectives

Preparedness Prevention Mitigation

Behavior changeBehavior changeAdvocacy for policy and structural reformsAdvocacy for policy and structural reformsCommunity organization and Community organization and mobilizationmobilizationPublic Information and educationPublic Information and education

Pre-Crisis Stage

Crisis Stage

Reduce injury, illness and deathReduce injury, illness and death

Information and education Information and education Behavior change Behavior change Social mobilizationSocial mobilization Process/effect/impact Process/effect/impact documentationdocumentation

Post Crisis StagePost Crisis Stage

CounselingCounselingBehavior changeBehavior changePublic information and educationPublic information and education Process documentationProcess documentationSocial mobilizationSocial mobilization

Recovery/RehabilitationRecovery/Rehabilitation

General context of emergency management

Source of risksHazards

PreventionMitigationPreparednessResponseRecovery

Risks identification

Risks EvaluationPrioritization

Risk Reduction

Monitor and review communicate and consult

Elements exposed -community

Probability -likelihood

Harmful consequences

Risks analysisLevels of risks

Options identification, selection, implementation

Capacity development

Overall policy and political commitment

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2

3 4 5

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8

Steps for Readiness

Service Needs in an EmergencyService Needs in an EmergencyStage Time-frame* Other sectors Health Sector Responsibilities

Immediate first search and rescue safe extraction, resuscitation and first aid

24 evacuation / shelter triage and transport system

hours food primary medical care

water detoxification /decontamination

public information system acute medical and surgical care (first line and referral)/tetanus prophylaxis

emergency coordination, communication, logistics and reporting systems (including injury and disability registers)

Short term end of security emergency epidemiological surveillance for VBD, VPD, DEP, DPHS**

first week energy (fuel, heating, light etc.) treatment and control of cases of VBD, VPD, DEP, DPHS, PUCD

environmental health services: strengthen blood banks and laboratories (diagnosis, confirmation, referral)

* vector control strengthen burns, spinal/head injury, orthotics/prosthetics, dental services

* personal hygiene strengthen referral system - curative, mental health and obstetric services

* sanitation, waste disposal etc. injury and disability surveillance

dead and missing (emergency measles vaccination and Vitamin A)

Medium end of protection (legal and physical) (re) establishment of the health information system

term first month employment restoration of preventative health care services such as EPI, MCH, etc.

public transport restoration of priority disease control programmes such as TB, malaria etc.

public communications restoration for services of non-communicable diseases/obstetrics

nutritional surveillance and support (including micronutrient supplementation)

psychosocial services water quality, food safety surveillance

Long term end of education reconstruction and rehabilitation

3 months agriculture specific training programmes/professional education

environmental protection health information campaigns/health education programmes

care of the disabled (mental and physical)/orthotics/prosthetics

Conclusion compensation/reconstruction evaluation of lessons learned

restitution/rehabilitation revision of policies, guidelines, procedures and plans

prevention and preparedness upgrade knowledge and skills, change attitudes and practices** VBD=vector born diseases, VPD=vaccine preventable diseases, DEP=disases of epidemic potential, DPHS=diseases of public health significance, PUCD=potentially unstable chronic diseases

* time frame varies according to the durantion, extent and severity of the hazard