Community Resilience to Disasters

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What is resilience when it comes to talking about communities and disasters? I discuss the emergence and importance of social vulnerability as it relates to public health preparedness, too.

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  • In August 2011 a magnitude 5.9 earthquake struck the northeast coast.  Business Insider magazine caught how the quake sent people to twitter to blast out their 140 character witticisms in a piece they titled "The Best Tweets about the D.C. Earthquake".  Along with millions in damages there was alot of facebook and twitter activityes.
  • This last one on cannabilism plays on a common theme in disasters: their penchant for antisocial behavior and individuals relying on their survivor skills.
  • [ask the students their opinion on these various ways of perceiving
    disasters and then ask – does it matter?]
    apathetic political atmosphere
    leads to adjustments, improvements, solutions we choose if are going to act
    e.g. view of disasters as social phenomena allows such happenings to be incorporated as a part of the nation’s development process. Disaster planning is not primarily the search for the implementation of technological solutions.
  • Disastro=disaster Bc Resulting from unfavorable alignment of the stars and planets.
    “Act of God” `---- Earliest (and continuing) usage = divine retribution for human misdeeds and failings
    [So what are the implications of this?]
    Seen as ‘just the way things are’, accept it and move on, fatalism (so why try to do anything to mitigate or prepare)
    Notice sometime how officials use the terms ‘acts of God,’ ‘forces of nature’ and ‘freak events’ ---this distances themselves and their organizations from any complicity and responsibility
  • The Great Lisbon earthquake of 1755 = catastrophic disaster. With 80% of the buildings destroyed and 40,000 persons dead, the leading families, the rich, pious suffered as much from the 8.5- 9.0 catastrophic earthquake, fires and tsunami that pretty much destroyed Lisbon. So Act of God seems not possible.
    First look for causes in the earth itself. Seen as physical agents---root cause is extremes of nature.
    [Implications?]
    So, Now the belief was that disasters are Acts of Nature and that they affect persons randomly. Disasters are simply bad “stuff that happens” – get used to it . Thus, just as in the “disaster as an agent of the Fates” or “God,” disaster as “an agent of Nature” is susceptible to fatalism – “being in the wrong place at the wrong time.”
    The supernatural is replaced by the natural….hence “natural disaster”.
  • In the 1930s begins recognition that it takes the failure of society’s protections to be a disaster. Disasters are simply the collapse of cultural protections; thus, they are principally man-made. Carr: 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.”
  • Not enough that there is a human component. Now see victims of larger social forces. Sees blame.
    Moral stance vs amoral traditional science approach
  • The fact is that some groups ARE more at risk of harm than others; they are more vulnerable in disasters. One understanding now in the disaster field is tthat people and communities are not equally likely to be harmed by a hazard such as an earthquake or hurricane.
    [WHAT DO YOU THINK OF THIS VIEW?]
    [CAN YOU THINK OF WHO IS MORE VULNERABLE? WHY?]
    Implication: It is no longer merely a matter of building to specific standards or of disallowing development in hazardous areas. . . . They are not likely to have much impact until such problems as poverty, land and income distribution and equity issues are resolved.”
  • The 2001 anthrax attack was a wake up call for public health as public health was found to have limited laboratory capacity, little or no computer or internet access, little understanding of its role in such national security events, how to communicate with the public about disasters
  • When the CDC introduced this campaign I think it surprised people. One reason is that public health has not been traditionally associated with getting people prepared for disasters. How have we gotten to the place where public health, once known for its focus on local infectious disease outbreaks and providing health services to underserved communities, is using zombies to promote disaster preparedness?
  • Hurricane Katrina demonstrated the inequalities that occur during disasters.
    A large segment of American society lives without the social and economic resources to protect themselves during disasters.
    Certain groups are more likely to be harmed during a disaster e.g., elderly were over-represented among the fatalities.
  • Disparities in storm damage disproportionately affected the vulnerable of New Orleans:
    Damaged areas were 75% African American compared to 46% in undamaged areas; damaged areas 46% renters compared to 31% in undamaged communities.
  • Hurricane Katrina and then again Superstorm Sandy demonstrated that certain groups are more vulnerable, that is more likely to be harmed during a disaster e.g., the elderly were over-represented among the fatalities in both events.
    And we understand why this is in general.
    Older adults are of course more likely to be socially isolated or have health and functional limitations that impair their ability to prepare, rapidly evacuate, or put them at greater risk from lost services such as power.
  • Hurricane Katrina and then again Superstorm Sandy demonstrated that certain groups are more vulnerable, that is more likely to be harmed during a disaster e.g., the elderly were over-represented among the fatalities in both events.
    And we understand why this is in general.
    Older adults are of course more likely to be socially isolated or have health and functional limitations that impair their ability to prepare, rapidly evacuate, or put them at greater risk from lost services such as power.
  • In fact, disasters are primary care emergencies too. Katrina demonstrated for health professionals what we had previously warned against: the number of people who needed chronic disease medications taxed medical response efforts.
    >25% in one survey reported chronic illness exacerbation (MMWR 55(02);38-41). Over 70% of Hurricane Katrina survivors who had a chronic disease before the hurricane experienced unavailability of their prescription medicine after the hurricane. In another study, 68% of all medications dispensed to Gulf Coast evacuees were for treatment of chronic diseases; 39% were cardiovascular medications. In a study done after Charley 2004 33% of households with a chronic illness reported illness condition worsened (MMWR 53(36);837-840)
    *
  • A recent abstract from the European Cardiology Society illustrates this issue further. After Japan’s 2011 earthquake and tsunami heart failure, unstable angina, MI, stroke, pneumonias and cardiac arrests all increased. More to our point, heart failure and pneumonia remained elevated in incidence for a full 6 weeks after the disaster struck.
  • Dr. Hiroaki Shimokawa, one of the authors of the study says that factors such as drug discontinuation, excessive salt intake from preserved food, and mental and physical stresses over the 6 week period likely contributed to the sustained increase in heart failure cases.
    The cardiac arrest rate returned to levels seen in previous years two weeks after the earthquake, whereas the heart failure rate remained elevated
  • On a routine day, the prescription drug care industry is a complex, interdependent system that relies on insurers to authorize benefits, providers to write prescriptions, pharmacists to fill and carry medications, wholesalers to deliver supplies, and consumers to navigate this process
    During a disaster failures may occur in a process that depends upon electronic, telephone, and delivery/transportation systems to work effectively.
    Response plans often focus on acute medical and pharmaceutical needs. Without planning for chronic disease medications:
    Morbidities
    Medical response efforts may be taxed.
    Systems are needed for patients with stable medication regimens to acquire and maintain personal stockpiles.
    At minimum: 7-day supply
    Preferred: 15- to 30-day supply
  • Respondents who requested that the survey be conducted in Spanish were less likely to have a 3-day supply of medications than those administered the survey in English (Spanish, 51.7%; English, 90.6%),
  • Put disaster preparedness literature in your waiting room.
  • Shakeout is based on principles of individual preparedness + internet/media.
  • The next Disaster Myth is that nothing we do to prepare matters since the government will help us. Though this belief has diminished greatly since Hurricane Katrina, still some people believe that the local responders will be able to help them and that local responders will be helped by state and federal government in the first days after a disaster. But, for decades emergency managers and public health have urged citizens to plan on being self sufficient for three days or longer after a disaster. In a major disaster local responders will not be able to respond to everyone's rescue, food, shelter and medical care needs. Emergency response from outside the area may take days to get to your neighborhood.
  • RESILIENT Communities NOT PREPARED INDIVIDUALS ARE WHAT WE NEED MOST. Studies show that friends and neighbors who are in the disaster with you are your key to survival in the first few days right after a disaster.  Remember, in a disaster There just aren’t enough rescue personnel, firefighters, and so forth to help us all. So you will help yourself and the people around you.  And the people around you will help you, too. In the first few days, they are the ones who will conduct rescues, provide first aid, transport to the hospital, provide food, water and shelter.  
    Neighbors and bystanders may be more helpful than what we anything we buy. communities with more history of cooperation, greater trust of neighbors, volunteerism and participation in local events and festivals recover faster and more completely. He shows that stronger bonds between neighbors and better and quicker recovery from a disaster.
  • So let’s look at Sandy.
  • Hipsters snorkeled in Brooklyn
  • Phones needed to be charged
  • And those with power came to the rescue
  • There were bikes that charged phones
  • And even fire
  • Doctors offered their services for free
  • People opened their homes
  • Restaurants gave away free food
  • People showed their spirit
  • Moving from Me to We. This idea is at the heart of what we is called "community disaster resilience" and there is a national consensus behind this idea (HSS 2009; NHSS 2010). Community disaster resilience is really a sea change in how we see community and their role.  Now we see the public as an asset and not something to command and control. Enhancing resilience means enhancing people power.
    “That kind of spirit of resilience and strength, but most importantly looking out for one another, that’s why we always bounce back from these kind of disasters.” Barak Obama.
    Instead of urging us all to stockpile and look after ourselves we should be urging knowing your neighbors, block parties and fairs to build neighborhood connections. We could be encouraging greater involvement and responsibility for local decisions. We could be actively promoting civic engagement.
  • The strategic objectives are supported by 50 operational capabilities which promote the ability of individuals, communities, and governments to prevent, protect against, respond to, and recover from threats to the Nation’s health and well-being.
  • 1. These two capabilities work in line with what we’re already doing.
    2. But mandate us to approach the community in our work.
  • But, you say, this is Los Angeles
  • Launching early February
  • Community Resilience to Disasters

    1. 1. 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: deisenman@mednet.ucla.edu
    2. 2. 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.
    3. 3. Disasters as Acts of GodDisasters as Acts of God or Fateor Fate  (dis, astro)—roughly, “formed on a star.”  “Acts of God”
    4. 4. 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
    5. 5. 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.”
    6. 6. 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.
    7. 7. 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. . .”
    8. 8. 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.
    9. 9. Federal investments led to improved public health preparedness  Strategic National Stockpile  Laboratory Response Network  Workforce improvements  Biowatch/Bioshield  Mass casualty care
    10. 10. 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.”
    11. 11. Disaster Risk = Hazard x Vulnerability
    12. 12. 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
    13. 13. Katrina highlighted social vulnerabilities in U.S. disasters
    14. 14. 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.
    15. 15. Factors in Evacuation MessageMessage understandingunderstanding HealthHealth TransportationTransportation ShelterShelter MistrustMistrust Money, jobs,Money, jobs, propertyproperty Risk perceptionRisk perception Social networkSocial network
    16. 16. – 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
    17. 17. – Large hospitals evacuated – Effect on residents with functional needs – Long term psychological consequences Lessons of Katrina and Sandy
    18. 18. 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)
    19. 19. •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
    20. 20. 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.”
    21. 21. 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
    22. 22. 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
    23. 23. Platica  Small group discussion, 1 hour  Led by a trained promotora  Held at community site.
    24. 24. Eisenman, et al., Am J Prev Med, 2009
    25. 25. Disasters are primary care emergencies.
    26. 26. 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
    27. 27. 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
    28. 28. 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
    29. 29. 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
    30. 30. 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%
    31. 31. Preparedness v1.0 v2.0
    32. 32. 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
    33. 33. Moving from “Me” to “We”Moving from “Me” to “We”
    34. 34. 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
    35. 35. Levers and Components of CR Chandra et al, 2011 66
    36. 36.  Public is an “asset” not something to be commanded and controlled  Community engagement.  Social capital and social networks. “We” vs “Me”
    37. 37. 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
    38. 38. 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
    39. 39. 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
    40. 40. 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
    41. 41. 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
    42. 42. 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
    43. 43. 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
    44. 44. 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.
    45. 45. 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
    46. 46. Pilot Communities selected from 8 Service Planning Areas (SPAs) in LA County 79
    47. 47. 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
    48. 48. Multimedia Campaign 81 Source: BBPR, Inc.
    49. 49. 82
    50. 50. 83
    51. 51. 84
    52. 52. 85
    53. 53. bereadyla.org 86
    54. 54. 87
    55. 55. Publichealth.lacounty.gov/eprp 88
    56. 56. 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?
    57. 57. David P. Eisenman, MD, MSHSDavid P. Eisenman, MD, MSHS deisenman@mednet.ucla.edudeisenman@mednet.ucla.edu 310-794-2452310-794-2452

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