Published on March 14, 2014
COMMUNITY DISASTER RESILIENCE AND THE PUBLIC’S HEALTH David P. Eisenman, MD MSHS UCLA Associate Professor of Medicine and Public Health Director, UCLA Center for Public Health and Disasters Preparedness Science Officer, LACDPH Natural Scientist, RAND USC Masters in Global Health, Summer 2013 Contact: firstname.lastname@example.org
Topics for the SeminarTopics for the Seminar The growing role of public health in disasters in the U.S. The current paradigm of community resilience and how it differs from prior paradigms. Real-life examples of public health and healthcare interventions in improving resilience.
Disasters as Acts of GodDisasters as Acts of God or Fateor Fate (dis, astro)—roughly, “formed on a star.” “Acts of God”
Disasters as Acts of Nature.Disasters as Acts of Nature. Lisbon 1755 – Effected everyone so how could it be act of God? Root cause is extremes of nature – “Natural disaster” First modern disaster
Disaster as Intersection ofDisaster as Intersection of Nature and SocietyNature and Society Carr, (1930): failure of society’s protections is required in disaster – Thus, man-made – “So long as the ship rides out the storm, so long as the city resists the earth-shocks, so long as the levees hold, there is no disaster. It is the collapse of the cultural protections that constitutes the disaster proper.”
Disaster as Avoidable Human Creation that Highlights Societal Injustices & Social Vulnerability Not enough that there is a human component. Now see victims of larger social forces. Focus on the vulnerability of people. – People who experience disaster are victims of social forces/powerful interests who have created the conditions for their hazard vulnerability Viewing as amoral the scientific (traditional) approaches. – Searching for blame.
Disaster as Highlighting Societal Injustices & Social Vulnerability Cannono: “disasters are not ‘natural’ (not even sudden ones) because hazards affect people differently within societies and may have very different impacts on different societies. . .”
Public Health changed after 2001…Public Health changed after 2001… Anthrax attacks put public health on the “front line of the battle for national security” Public health infrastructure found lacking New mission: preventing, preparing for, and responding to any act of bioterrorism or public health emergency.
Federal investments led to improved public health preparedness Strategic National Stockpile Laboratory Response Network Workforce improvements Biowatch/Bioshield Mass casualty care
Problem: Isolated elderly in heat waves Research Need: “evaluating heat response plans, focusing on environmental risk factors, identification of high-risk populations, effective communications strategies, and rigorous methods for evaluating effectiveness on the local level.”
Disaster Risk = Hazard x Vulnerability
Social Vulnerability The differential susceptibility of social groups to the impacts of hazards, as well as their abilities to adequately respond to and recover from hazards. – Poverty – Senior adults – Physical disability – Children
Katrina highlighted social vulnerabilities in U.S. disasters
The UN Hyogo Framework treats human actionsThe UN Hyogo Framework treats human actions and vulnerabilities as the main cause of disasters.and vulnerabilities as the main cause of disasters. Reducing human vulnerability is a key aspect of reducing disaster (and climate change) risk.
Factors in Evacuation MessageMessage understandingunderstanding HealthHealth TransportationTransportation ShelterShelter MistrustMistrust Money, jobs,Money, jobs, propertyproperty Risk perceptionRisk perception Social networkSocial network
– At-risk populations are disproportionately harmed –Children –Older Adults –Racial/ethnic minorities –Chronic illness/Disability – Communities left out of communication planning Lessons of Katrina and Sandy
– Large hospitals evacuated – Effect on residents with functional needs – Long term psychological consequences Lessons of Katrina and Sandy
5 Preparedness Items Emergency Plan AOR %95 CI AOR %95 CI 25-29 0.862 (0.597, 1.245) 1.036 (0.713, 1.504) 30-39 0.927 (0.679, 1.266) 1.060 (0.774, 1.452) 40-49 1.809 (1.316, 2.486) 1.639 (1.191, 2.256) 50-59 1.835 (1.295, 2.600) 1.589 (1.122, 2.251) 60-64 1.203 (0.753, 1.922) 2.194 (1.378, 3.492) 65 or over 1.876 (1.313, 2.681) 1.862 (1.300, 2.668) Latino 0.733 (0.554, 0.970) 1.131 (0.858, 1.491) African American 0.942 (0.676, 1.312) 1.166 (0.839, 1.620) API 0.768 (0.540, 1.093) 1.021 (0.719, 1.450) AI/Mixed/Other 0.659 (0.065, 6.653) 1.236 (0.131, 11.630) Less than $10,000 0.491 (0.331, 0.729) 1.130 (0.764, 1.674) $10,000-$20,000 0.499 (0.351, 0.709) 1.190 (0.838, 1.690) $20,000-$30,000 0.611 (0.434, 0.860) 1.488 (1.056, 2.096) $30,000-$40,000 0.772 (0.548, 1.086) 0.908 (0.643, 1.283) $40,000-$50,000 0.756 (0.530, 1.077) 0.730 (0.507, 1.052) $50,000-$75,000 0.738 (0.524, 1.041) 0.973 (0.691, 1.371) Spanish 1.091 (0.760, 1.564) 0.640 (0.447, 0.916) Mandarin 0.826 (0.366, 1.862) 1.104 (0.506, 2.409) Cantonese 0.521 (0.230, 1.181) 0.059 (0.014, 0.252) Korean 0.303 (0.109, 0.840) 0.085 (0.021, 0.337) Vietnamese 0.388 (0.105, 1.435) 0.475 (0.133, 1.695) Very good health 0.896 (0.695, 1.154) 0.812 (0.632, 1.044) Good health 0.812 (0.625, 1.056) 0.631 (0.485, 0.821) Fair health 0.603 (0.428, 0.850) 0.527 (0.372, 0.745) Poor health 0.588 (0.353, 0.978) 0.734 (0.442, 1.219) Disabled 1.141 (0.887, 1.467) 0.983 (0.764, 1.265)
•Programa para Responder a Emergencias con Preparación. •A culturally targeted educational intervention to promote disaster preparedness among low income Latinos, using community based participatory research (CBPR) methods •UCLA, Coalition for Community Health (CCH), Los Angeles County Department of Public Health
U.S. Latinos suffer disproportionately from disasters... Yet are still among least prepared Few culturally tailored programs – Review of 301 web-sites providing preparedness information found that half did not address racial/ethnic minorities. – Federal agencies provided “literal translations of English-language materials, with variable consideration of accuracy and cultural acceptability.”
Promotores Community health promoters = Local lay community residents trained in basic health promotion skills working with fellow community members who are under-served by the health care system. Use their cultural knowledge, social networks, and leadership role in the community to model behavior, overcome barriers, and create
Promotores Provide connections between community and health care system including informal counseling, service assistance, education. Improved health care access, prenatal care, health behaviors. Not previously used in disaster preparedness
Platica Small group discussion, 1 hour Led by a trained promotora Held at community site.
Eisenman, et al., Am J Prev Med, 2009
Disasters are primary care emergencies.
Disasters are primary care emergencies Demand shocks: increased injury, chronic illness exacerbation, mental distress – 5 of the top 6 conditions treated after Katrina were chronic disease exacerbations Supply shocks: diminished staff levels, staff capacity, damaged buildings and supplies
Heart Attacks, Strokes IncreasedHeart Attacks, Strokes Increased after Japan’s 2011 Earthquakeafter Japan’s 2011 Earthquake and Tsunamiand Tsunami Heart failure, unstable angina, MI, stroke, cardiac arrest, pneumonia Heart failure and pneumonia remained elevated for 6 weeks – Disrupted medications may have played a role -Shimokawa, 2012, European Society of Cardiology 2012; http://www.nlm.nih.gov/medlineplus/news/fullstory_128794.html
Preparing the chronically ill is an urgent issue 15% of LAC adults (est 1,085,000) use a chronic disease medication. National stockpiles and emergency response plans focus on acute medical and pharmaceutical needs. No planning for the prescription drug needs of communities sheltering in place or evacuating
Carameli, K. A., Eisenman, D. P., Blevins, J., d’Angona, B., & Glik, D. C. Disaster Medicine and Public Health Preparedness, 2010 Stockpiling medicines is another challenge for public health
Disparities in Medication SupplyDisparities in Medication Supply Percentage of participants reporting household disaster or emergency preparedness, by preparedness measure and language used in the interview — Behavioral Risk Factor Surveillance System, 14 states, 2006– 2010 90.6% 51.7%
Preparedness v1.0 v2.0
Resilience is people! National Academy of Sciences 2012 report focuses on physical infrastructure, insurance, risk prediction Daniel Aldrich, “Building Resilience” highlights role of human resilience and social capital in recovery and argues that it trumps amount of infrastructure damage and amount of aid received. Paradigm shift in public health emergency preparedness in emphasizing community strengths as well as simply describing vulnerabilities
Moving from “Me” to “We”Moving from “Me” to “We”
What is Community Resilience (CR)? In times of need, individuals and communities volunteer and spontaneously help each other “Ordinary skills in extraordinary circumstances.” Community strengths and assets are critical to recovery. CR is about looking at existing resources and relationships and strengthening them. CR is a community’s ability to build capacities to rebound from an emergency/disaster event
Levers and Components of CR Chandra et al, 2011 66
Public is an “asset” not something to be commanded and controlled Community engagement. Social capital and social networks. “We” vs “Me”
How is Community Resilience different? The Traditional Emergency Preparedness Approach 1. Focuses on individual households and response readiness 2. Emphasizes the role of government in the initial response 3. Promotes the need for emergency supplies and emergency plans 69
How is this different? The Community Resilience Approach 1.Emphasizes community members working together to plan, respond and recover 2.Promotes the inclusion of diverse sectors 3.Uses collaboration and community engagement for planning, preparedness and response activities 70
Involvement and Integration of CBOs and FBOs Enhance Both Response and Long-Term Recovery • Provide manpower and other resources – Information and referral – Direct services (e.g., case management, food) – Financial support National strategies recognize need for greater CBO/FBO participation in disaster planning, response and recovery Examples from across the United States: • Using promotoras to educate on disasters in Los Angeles • Connecting residents to social and mental health services after Hurricane Katrina in New Orleans
National Health Security Strategy 2 Goals Build community resilience Strengthen and sustain health and emergency response systems 10 Strategic Objectives 1. Foster informed, empowered individuals and communities 2. Develop and maintain the necessary workforce 3. Ensure situational awareness 10 Strategic Objectives 4. Foster integrated, scalable health care delivery systems 5. Ensure timely and effective communications 6. Promote and effective countermeasures enterprise 7. Ensure prevention or mitigation of environmental and emerging threats 8. Incorporate post-incident health recovery into planning 9. Work with cross boarder and global partners 10. Ensure that all systems are based on best available science, evaluation, and quality improvement methods
CDC’s Public Health and Emergency Preparedness Standards A great step forward in 2011 Important first attempt to define and measure community preparedness/resilience building and community recovery Successes & challenges: 11 Sectors defined, preliminary approach to quantify (median number of sectors “touched”); community engagement in planning 73
CDC Capabilities for CommunityCDC Capabilities for Community PreparednessPreparedness Four functions – Determine risks to the health of a jurisdiction – Build community partnerships to support health preparedness – Engage with community organizations to foster public health, medical, and mental/behavioral health social networks – Coordinate training to ensure community engagement in preparedness efforts
CDC Capabilities for CommunityCDC Capabilities for Community RecoveryRecovery Three Functions: – Identify and monitor public health, medical and mental/behavioral health systems recovery needs – Coordinate community public health, medical and mental/behavioral health system recovery operations – Implement corrective actions to mitigate damages from future incidents
11 Community Sectors 1. Business 2. Community leadership 3. Cultural and faith-based groups and organizations 4. Emergency management 5. Healthcare 6. Social services 7. Housing and sheltering 8. Media 9. Mental/behavioral health 10. State office of aging or its equivalent 11. Education and childcare settings 76Centers for Disease Control and Prevention. Public Health Preparedness Capabilities: National Standards for State and Local Planning. March 2011.
78 Circle of Influence: A Model for Collaborative Research© 2002 Jones, Martin,Circle of Influence: A Model for Collaborative Research© 2002 Jones, Martin, Pardo, Baker, and NorrisPardo, Baker, and Norris Resident Experts Partners Community Community Resident Experts Goal setting Planning Responsibility & authority Sharing of results Community Engagement Approach
Pilot Communities selected from 8 Service Planning Areas (SPAs) in LA County 79
Community Resilience ToolkitCommunity Resilience Toolkit ModulesModules 1. Intro to Community Resilience and Hazard Prioritization 2. Community Engagement and Leadership 3. Community Mapping 4. Psychological First Aid 5. Community Preparedness Coordinator Training 6. Community Forum Planning –80
Multimedia Campaign 81 Source: BBPR, Inc.
Challenges Conveying the message about CR Leadership development to embrace CR Building the capacity of CBOs/FBOs to be effective partners in building CR How do we build CR? How do we measure our impact?
David P. Eisenman, MD, MSHSDavid P. Eisenman, MD, MSHS email@example.com@mednet.ucla.edu 310-794-2452310-794-2452
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