Longterm Impacts of Natural Disasters on Public Health Systems, LORENZONI Nina
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6th International Disaster and Risk Conference IDRC 2016 Integrative Risk Management - Towards Resilient Cities. 28 August - 01 September 2016 in Davos, Switzerland
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Longterm Impacts of Natural Disasters on Public Health Systems, LORENZONI Nina
- 1. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Long-term Impacts of Natural Disasters on Public Health Systems Authors: M. Raich, N. Lorenzoni, H. Stummer UMIT – the health & life sciences university Austria
- 2. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Disasters & Public Health • Disasters “impact the public health system and its protective infrastructure that includes water, sanitation, shelter, food and health” (Altevogt et al., 2008) • Problem: Diversity of disasters‘ impact on public health systems is enormous. Complexity and interdependencies make disaster response particularly challenging. Substantial gaps concerning effective knowledge transfer between nations with regard to the lessons learned
- 3. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Direct and Indirect Impact of Disasters
- 4. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Complexity & Interdependencies Event-specific conditions Emergency management interventionsPre-impact conditions
- 5. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Case Studies Case Number of affected people Avalanche (Austria) 31 dead 22 injured Case Number of affected people Flood 6 dead, thousands had to be evacuated
- 6. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Research Design & Methodology
- 7. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Questionnaire
- 8. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Interview Guideline
- 9. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Data Analysis Impacts on Health Care Health System Performance Security and Health Protection • Financing • Creating resources • Stewardship • Delivering services • Optimize contingency and preparedness planning • Infrastructure • Training • Research funding activities • Information and communication 1. Questionnaire (Document Analysis) 2. Qualitative analysis of the interviews (Murray & Evans, 2003)
- 10. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Results - Avalanche Longer-term impact on health care Avalanche Impact on Security and Health Protection Infrastructure Avalanche barriers Meteorological station Reforestation Extension of security tunnels Uniforms for emergency psychologists (identification) Improved cooperation and coordination in Red Cross and between other rescue organisations Coordination with health insurance concerning psychological treatment and assumption of costs Establishment of KIT by Austrian Red Cross Psycho-social support Information, communication & research Improved tourist information Internet Service-Line Alpine Safety and Information Center (ASI) Avalanche simulation models ESI Internet platform Update checklists Contingency and preparedness planning Update contingency plans Establishment of alpS Larger capacity helicopters Adaption danger areas Dealing with media Health System Performance
- 11. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Results - Flood Infrastructure Construction of new public buildings in a flood proof way Speeding up the construction of planned flood protection measures (e.g. dams) Further reinforcement of “Team Österreich” (organisation coordinating volunteers) Increase of national disaster fund for reconstruction Work of volunteers in the health care system Information, communication & research Information system for affected population Information for newly settled residents Contingency and preparedness planning Re-evaluation of danger areas Concepts for resettlement of endangered population Development and adaption of different protocols within emergency organisations Automated water level measurement stations Regular inter- organisational exchange Impact on Security and Health ProtectionHealth System Performance Longer-term impact on health care Flood
- 12. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Discussion • No standard definition of long-term impact on public health care or a standardised assessment tool was identified • The public health care system has to react differently, depending on the recovery needs of the people affected • Impacts are the results of collected experience, reflective analysis and learning circles • People living in endangered zones may perceive possible causes of risks as neutral compared to events that arise abruptly without any advanced warning (e.g., airplane crash or terror attack)
- 13. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Recommendations • Need for more systematic health evaluation programmes after disasters (incl. standard measurement system) • High quality analysis of long-term impacts needs decision- making support, public information, and scientific knowledge (incl. intensive collaboration between politicians, authorities and research institutions) • The ex-post identification of local practices could be highly valuable as basis for discussion and knowledge exchange within a broader audience of special interest groups • Establishment of a task force (team of experts) can avoid ad- hoc decision-making on-site
- 14. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Thank you for your attention!
Editor's Notes
- They have an immediate impact on human lives and often result in the destruction of the physical, biological and social environment of the affected people, thereby having a longer-term impact on their health, well-being and survival.
- Disasters may have direct and indirect impacts on the population’s health and healthcare system [1]. One aspect is the identification of direct health consequences such as deaths, injuries, psychological effects, and diverse diseases and illnesses [2]. Along with the population’s health, the healthcare system itself can be affected by disasters due to damages and/or losses of personnel. The indirect consequences of disasters refer not only to losses of primary healthcare and living conditions and to limited or reduced access to administration, but also damages to healthcare systems regarding external infrastructure such as the provision of water and/or electricity [1]. Frederick et al. [2] have remarked that the indirect impact factors are very often not subject to planning or political attention and mostly remain undetected, unmeasured, and under-evaluated.
- It consists of three pre-impact conditions: exposure to hazard, physical vulnerability, and social vulnerability. Three specific event conditions complement the framework: hazard event characteristics, improvised disaster response, and improvised disaster recovery. The hazard event characteristics and improvised disaster response, both parts of the event-specific conditions, in combination with the pre-impact conditions produce the disaster’s physical impacts that, together with recovery actions, consequently produce a disaster’s social impacts. Lindell (2011) has argued that communities can engage different types of emergency management interventions to reduce a disaster’s impacts. It is argued that hazard mitigation practices and emergency preparedness practices can reduce physical impacts and social impacts.
- We put special focus on the development of a questionnaire as an exploratory tool for capturing both: various dimensions of crises in the European context and distinct crisis management responses. This questionnaire was the guideline for the document analysis we conducted. Apart from findings of our literature review, additional expert discussions and interviews with relevant stakeholders and endorsers supported us in identifying the central topics and problems. The decision for using a case study approach was made first to accommodate to the complexity of disasters. This research approach allows the representation of complexity and the specific circumstances of each disaster.
- The questions in the questionnaire address different impacts of crisis on public healthcare. The main categories of the questionnaire are: General information about the chosen major incident, specific information concerning the chosen major incident, general coping strategies and direct effects on health, direct costs and follow-up costs (in €), long-term effects on the public healthcare system and long-term effects on culture and the community.
- The project partners interviewed experts from different fields like e.g. crisis managers (from several organisations), psychologists, forensics and politicians. This broad spectrum of different responsibilities helped us capturing the various aspects and issues of disasters. The interviewees provided first-hand data of the specific incident chosen, with the objective of identifying additional impact factors.
- The increased demand during and after a disaster has a direct effect on the health system performance, i.e. the delivering of services, the creation of resources, the stewardship, and finally the related financing (Murray and Evans, 2003). Two further important elements for our analysis on long-term impact on public healthcare are security and health protection. Security and health protection refers to post-disaster efforts aiming at optimising leadership and governance, contingency and preparedness planning, infrastructure and training, or may lead to an increase in security research funding activities as well as information and communication activities. Our findings in each case study have then been grouped into three categories, based on the content of answers to the questionnaire as well as interviews conducted and in relation to consequences of each disaster: health system performance [13] (e.g., health diagnoses and demand for health care services), security and health protection (e.g., contingency and preparedness planning). The analysis of the interviews applied the qualitative analysis method GABEK-WinRelan (Holistic Coping with Complexity - GAnzheitliche BEwältigung von Komplexität), which supports the structuring of expressed experiences, knowledge, and perceptions of participants in order to provide a comprehensive view of the individual aspects of the particular situation investigated [19].
- Because of the inadequate provision of psycho-social support the establishment of the KIT (Kriseninterventionsteam) by the Red Cross is one of the most relevant long-term impacts in the context of the health system performance. Missing structures and management have created a disorder (for example too many psychologists, no identification because of missing uniforms, reporters who masquerade as psychologists, etc.) had negative psychological impacts on the locals of Galtür. Many long-term changes were undertaken in the context of security measures and health protection to protect locals and tourists as well as to provide important information for decision makers.
- No PSS-measures. Also the investigated flood case, an area that is proned to flood, people are used to deal with the flood. Most people had family or friends closeby were they could stay during evacuation when needed. These two factors are assumed to be a huge reduction of stress for the effected people. As result of the major dimensions of natural disasters “Team Österreich” war created. “Team Österreich” is an initiative that organises and coordinates willing Austrian volunteers who want to help and support people affected by a disaster. High investments were also undertaken in the case of the Austrian flood. Improvements and extended flood protection measures with 34 new building projects were realized. The building process had to be sped up after the next flood because 17 projects had not been realised until then. For affected public buildings like kindergartens and community buildings, the high possibility of future floods was considered and a flood-proof way of construction and the addition of flood-resistant materials 98 were implemented. For better forecasts and accurate prognosis, automated water level measurement stations have been installed. As a consequence to the flood, the land registry plans have been re-evaluated and danger zones have been updated. Also, concepts for resettlement from the endangered areas have been developed. However, it is unclear if and how many people would agree to resettlement.
- Health care measures have to react differently, depending on the recovery needs of the people affected. Because of the village structure in Galtür, Austria, the locals supported themselves when coping with the disaster. For this reason, the demand for psycho-social support in the short- and long-term from outside experts was not given. This has a direct effect on the health care system’s demand-level for psycho-social support. However, different recovery needs have been identified and stressed depending on the different dimensions and contexts of the analysed disasters, analysed as well as different system conditions. We experienced during our analysis that learning circles play a significant role in the context of crisis management. Many identified long-term impacts on health care systems are the result of a learning process because of inadequate outputs in the past. Finally, most of the identified long-term impacts of the different case studies are the result of each disasters´ collected experiences and reflective analysis of operations and results (e.g., which implications can be drawn because of operations that lead to the adaption of emergency plans, communication structures, laws, infrastructure, etc.). As the detailed analysis of each 105 case study has shown, new structural, procedural, and legal concepts have been developed and implemented in elements of public health systems. The resistance of people living in an endangered zone can be influenced of their motivation and individual risk perception living in such an area. This conscious decision has an impact on the mental and physical health in the context of a disaster. The persons may dispose of a higher acceptance of the forces of the nature given by the fact that the interview partners of the avalanche do not evaluate the avalanches negatively.
- the need for health evaluation programmes after disasters to allow more thorough long-term impact analyses. This must be designed holistically in order to measure direct physical and mental health effects, as well as indirect health effects like job loss, schooling consequences, and so on in order to identify the multilayer long-term impacts of disasters. Although each disaster is unique in its progress and coping, we ask for the design of a uniform measurement system for specific questions of interest. Additionaly, for the comparison of similar disasters the data reliability and validity can be facilitated. For high quality analysis of long-term impacts, we need decision-making support, public information, and scientific knowledge. In addition, an intensive collaboration between politicians, authorities and research institutions to manage programme evaluations in European countries is needed. Because of the multiple dimensions that must be taken into consideration, we demand the participation of multiple stakeholders from different disciplines. We also suggest an information platform with the objective to provide the results (e.g., programme success, case study analysis) for other European countries to share the experienced data. The ex-post identification of local practices could be highly valuable as basis for discussion within a broader audience of special interest groups (e.g., experts for avalanche risk areas in Austria, Italy and France). It might prove difficult to compare single, different crisis management cases in order to elect one best practice example; nevertheless, the potential of mutual learning appears promising for cases that are embedded in and contingent on a complex web of local, regional, national and supranational institutional actors and stakeholders. Not only the rescue teams, but every organisation and group of stakeholders affected by the catastrophe has to suddenly deal with non-routine operations in a highly uncertain situation (e.g. due to information asymmetry or the uncertainty of additional interrupting events). Based on a definition of major threats identified within the European Union, the establishment of a task force (team of experts) can avoid ad-hoc decision-making on-site of the setting that may cause negative long-term effects. Here, the ad-hoc formation of a small team of experienced specialists could be very useful in addition to a quick construction of support structures on the local or national level who take short- and long-term impacts into consideration.