vulnerability & response to the health impacts of flooding roger few school of development...

VULNERABILITY & RESPONSE VULNERABILITY & RESPONSE TO THE HEALTH IMPACTS OF TO THE HEALTH IMPACTS OF

FLOODINGFLOODING

Roger FewRoger FewSchool of Development StudiesSchool of Development Studies

University of East AngliaUniversity of East Anglia

Environmental Inequalities Seminar 3: Inequalities, Flooding and Water Resources.

University of Surrey, 24/25 October 2006

Floods and health impactsFloods and health impacts

DrowningDrowning Physical injuryPhysical injury Increased exposure to Increased exposure to

infectious diseaseinfectious disease Respiratory diseaseRespiratory disease Exposure to chemical hazardsExposure to chemical hazards Food security/malnutritionFood security/malnutrition Stress and mental health Stress and mental health

outcomesoutcomes

contact with floodwater

increased exposure to pathogens

disruption of food supply

disruption of health systems, water/sanitation

disruption of livelihood, assets

displacement

drowning, injury

respiratory disease

waterborne disease

mosquito-borne disease

nutritional disease

mental health outcomes

chronic disease

Flood Hazard

Flood Proximity

RecoveryHealth Risk Effect

Health Outcome

land use control, flood defences, warning & evacuation

avoidance:modify dwellingimprove latrines, mosquito control

protection: hygiene behaviour, water treatment, emotional support

access to care, emergency planning, strategic supplies, support networks

Floods - pathways of health impact/vulnerability

Flood Hazard Flood Proximity Health Risk Effect






displacement

Health Risk Effect Health Outcome





displacement


drowning, injury

respiratory disease

waterborne disease

mosquito-borne disease

nutritional disease

chronic disease

mental health outcomes

Flood Hazard

Flood Proximity

RecoveryHealth Risk Effect

Health Outcome

flood defences, land use control, warning & evacuation etc

avoidance:modify dwelling,improve latrines, mosquito control etc

protection: hygiene behaviour, water treatment, emotional support etc

access to care, emergency plans, strategic supplies, support networksetc

Health Outcome

RecoveryFlood Hazard

Flood Proximity

Health Risk Effect

social-economic-political-cultural context

environmental change

hazard intensity/rangedisease distribution

Contextual factors that may shape health-related response examples Social/cultural social networks access to psychosocial support gender relations mobility during emergencies beliefs, customs approaches to water supply and sanitation attitudes to risk emergency preparedness planning in health facilities education system understanding of hazards and health protection Economic economic structure alternative income opportunities markets and supply systems importation of food during crises access to insurance/credit willingness to evacuate home access to technology reliability of early warning systems infrastructure investment physical access to health facilities Political/Institutional policies and regulations risk management practices in public health institutional structures coordination between health-related sectors civil society coordination of health volunteer networks community participation community-based emergency health training state-citizen relations public trust in warnings external intervention activity of medical relief agencies Environmental land distribution feasibility of latrine improvement on marginal land access to natural resources alternative income or subsistence opportunities environmental degradation pollution of alternative water sources endemicity of disease ongoing health status

Vietnam: Mekong DeltaVietnam: Mekong Delta

Annual floods – extremes in 2000, 2001, Annual floods – extremes in 2000, 2001, (2002)(2002)

16 million people (40,000 sq km)16 million people (40,000 sq km) Urban and rural areas prone to floodingUrban and rural areas prone to flooding Income inequalities: poverty line for state Income inequalities: poverty line for state

benefits is c$16 per monthbenefits is c$16 per month

Research with University of Social Research with University of Social Sciences and Humanities, Ho Chi Minh Sciences and Humanities, Ho Chi Minh City City

Interviews with local government, health Interviews with local government, health facilities, community leaders, mass facilities, community leaders, mass organisations (urban areas: Cao Lanh and organisations (urban areas: Cao Lanh and Long Xuyen)Long Xuyen)

Interviews on risk perception, health Interviews on risk perception, health behaviour, flood response with 24 behaviour, flood response with 24 households in 4 siteshouseholds in 4 sites

‘‘Flood-adapted’ but health hazards common, Flood-adapted’ but health hazards common, especially for the poor – injury, infection, stressespecially for the poor – injury, infection, stress

““During September and October my house is flooded two times During September and October my house is flooded two times per day at high tide and the water level is this much [c20cm] per day at high tide and the water level is this much [c20cm] from the floor. Because the environment is polluted, each time from the floor. Because the environment is polluted, each time

the water comes up waste drifts into the home.”the water comes up waste drifts into the home.” (resident, Ward My long, Long Xuyen)(resident, Ward My long, Long Xuyen)

Health impactsHealth impacts

Draw on specific examples from studies to illustrate the Draw on specific examples from studies to illustrate the multiple factors shaping vulnerability/coping capacitymultiple factors shaping vulnerability/coping capacity

Local flood management and livelihoodsLocal flood management and livelihoods

Establishment of dyke systemsEstablishment of dyke systems small-scale dykes/roadwayssmall-scale dykes/roadways 50% resident contribution50% resident contribution houses of poor often remain houses of poor often remain

inundatedinundated prioritization of access/transportprioritization of access/transport

Loss of incomeLoss of income floods affect many income floods affect many income

activities of the poor e.g. fishing, activities of the poor e.g. fishing, casual labour, motorcycle, lottery casual labour, motorcycle, lottery ticketstickets

less able to diversify income less able to diversify income optionsoptions

less money for food/medicine + less money for food/medicine + anxiety, stressanxiety, stress

“We became poor after the flood of 2000. The flood totally destroyed our shrimp pond and we had no income. Now, in each flood, we feel stress and worry about being jobless and not having enough food – this causes sleeplessness, strain and quarrel between family members.” (resident, My Ngai commne, Cao Lanh)

Fishpond latrinesFishpond latrines traditional ‘rural’ sanitation in urban traditional ‘rural’ sanitation in urban

areasareas health risk especially during floodshealth risk especially during floods official intolerance – but is it cultural official intolerance – but is it cultural

conservatism or lack of resources ? conservatism or lack of resources ?

Drinking waterDrinking water common use of river water from creekscommon use of river water from creeks incomplete treatment, especially during incomplete treatment, especially during

flood flood hygiene education unevenhygiene education uneven risk perceptionrisk perception

Water, sanitation and hygieneWater, sanitation and hygiene

Health protection servicesHealth protection services

Health sector preparednessHealth sector preparedness tiered network of preparedness tiered network of preparedness

committees including health sectorcommittees including health sector emergency planning – e.g. medical emergency planning – e.g. medical

boats, drug suppliesboats, drug supplies volunteers (education, monitoring, volunteers (education, monitoring,

first aid, boat transport to HFs) first aid, boat transport to HFs) variation in extent and access to variation in extent and access to

these servicesthese services

Flood kindergartensFlood kindergartens child drownings in 2000child drownings in 2000 unattended young children unattended young children special kindergarten scheme for special kindergarten scheme for

poor familiespoor families sustainability?sustainability?

“We prepare an emergency medical boat and 4 teams for assisting people, including Red Cross members and health volunteers” (head of health station, My Hoa Hung commune, Long Xuyen)

“Access in floods can only be by boat, and so poor people without boats cannot get access to the health station. We have no resources to organize mobile health teams”

(head of health station, My Ngai commune, Cao Lanh)

Ongoing analysis….Ongoing analysis….

Factors closely, but not solely, related to Factors closely, but not solely, related to livelihoods/poverty, e.g. livelihoods/poverty, e.g.

policy/planning processpolicy/planning process access to health education access to health education social/cultural norms social/cultural norms support networks support networks physical locationphysical location

For health risk, additional consideration is an individual’s For health risk, additional consideration is an individual’s ongoing health statusongoing health status

Many opportunities for in-depth research on specific Many opportunities for in-depth research on specific aspects of vulnerability and/or coping capacity re. healthaspects of vulnerability and/or coping capacity re. health

along the health impact pathway from hazard -> outcomealong the health impact pathway from hazard -> outcome

For further information, see: For further information, see:

Few, R. (2007)Few, R. (2007) ‘Health and climatic hazards: framing ‘Health and climatic hazards: framing social research on vulnerability, response and social research on vulnerability, response and adaptation’, adaptation’, Global Environmental ChangeGlobal Environmental Change 17, 281- 17, 281-295. 295.

Pham Gia Tran and Few, R. (2006) ‘Local responses Pham Gia Tran and Few, R. (2006) ‘Local responses to floods in the Mekong Delta, Viet Nam’. In Few, R. to floods in the Mekong Delta, Viet Nam’. In Few, R. and Matthies, F. (eds) and Matthies, F. (eds) Flood hazards and health: Flood hazards and health: responding to present and future riskresponding to present and future risks, Earthscan, s, Earthscan, London, pp.128-144London, pp.128-144

http://www1.uea.ac.uk/cm/home/schools/ssf/dev/people/http://www1.uea.ac.uk/cm/home/schools/ssf/dev/people/academic/Few/hazardshealthacademic/Few/hazardshealth