To start early is easy going, to start late is breakneck —Maori proverb
In order to communicate effectively about disasters as an empirical endeavor, clear definitions of the specific terms must be used on a consistent basis. This chapter will, therefore, apply a standard nomenclature for disaster terminology. For clarity, key terms are emphasized in italics (when first used) and defined in Box 32-1 .
Absorptive capacity: A limit to the rate or quantity of impact that can be absorbed (or adapted to) without exceeding the threshold of disaster declaration
All-hazard approach: Developing and implementing emergency management strategies for the full range of likely emergencies or disasters, including both natural and technological (which also includes conflict-related hazards of terrorism and warfare)
Capability: The ability to achieve a desired operational effect under specified standards and conditions through combinations of means and ways to perform a set of tasks
Capacity: The combination of all the strengths, attributes, and resources available within a community, society, or organization that can be used to achieve agreed goals
Consequences: The result or effect when a vulnerable asset is exposed to a disaster hazard
Disaster: A serious disruption of the functioning of a community or a society, involving widespread human, material, economic, or environmental losses and impacts, which exceed the ability of the affected community or society to cope using its own resources
Disaster risk: The potential disaster losses, in lives, health status, livelihoods, assets, and services, which could occur to a particular community or a society over some specified future period
Disaster risk management: The systematic process of using administrative directives, organizations, and operational skills and capacities to implement strategies, policies, and improved coping capacities in order to lessen the adverse impacts of hazards and the possibility of disaster
Disaster risk reduction: The concept and practice of reducing disaster risks through systematic efforts to analyze and manage the causal factors of disasters, including through reduced exposure to hazards, lessened vulnerability of people and property, wise management of land and the environment, and improved preparedness for adverse events
Early warning system: The set of capacities needed to generate and disseminate timely and meaningful warning information to enable individuals, communities, and organizations threatened by a hazard to prepare and to act appropriately and in sufficient time to reduce the possibility of harm or loss
Exposure: People, property, systems, or other elements present in hazard zones that are thereby subject to potential losses
Hazard: 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
Impact: A measure of the severity of consequences caused by disaster hazards
Mitigation: The lessening or limitation of the adverse impacts of hazards and related disasters
Natural hazard: Natural process or phenomenon 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
Preparedness: The knowledge and capacities developed by governments, professional response, and recovery organizations, communities, and individuals to effectively anticipate, respond to, and recover from, the impacts of likely, imminent, or current hazard events or conditions
Prevention: The outright avoidance of adverse impacts of hazards and related disasters
Recovery: The restoration and improvement where appropriate, of facilities, livelihoods, and living conditions of disaster-affected communities, including efforts to reduce disaster risk factors.
Residual risk: The risk that remains in unmanaged form, even when effective disaster-risk-reduction measures are in place, for which emergency response and recovery capacities must be maintained
Resilience: The ability of a system, community, or society exposed to hazards to resist, absorb, accommodate, and recover from the effects of a hazard in a timely and efficient manner, including through the preservation and restoration of its essential basic structures and functions
Response: The provision of emergency services and public assistance during or immediately after a disaster in order to save lives, reduce health impacts, ensure public safety, and meet the basic subsistence needs of the people affected
Risk: The probability of harmful consequences or expected losses (deaths, injuries, property, livelihoods, economic activity disrupted, or environment damage) resulting from interactions between natural or human-induced hazards and vulnerable conditions
Risk assessment: A methodology to determine the nature and extent of risk by analyzing potential hazards and evaluating existing conditions of vulnerability that together could potentially harm exposed people, property, services, livelihoods, and the environment on which they depend.
Risk management: The systematic approach and practice of managing uncertainty to minimize potential harm and loss
Sustainable development: Development that meets the needs of the present without compromising the ability of future generations to meet their own needs
Technological hazard: A hazard originating from technological or industrial conditions, including accidents, dangerous procedures, infrastructure failures, or specific human activities, that may cause loss of life, injury, illness, or other health impacts; property damage; loss of livelihoods and services; social and economic disruption; or environmental damage
Vulnerability: The characteristics and circumstances of a community, system, or asset that make it susceptible to the damaging effects of a hazard
A disaster is “a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses that exceed the ability of the affected community or society to cope using its own resources.”
Disaster consequences may include loss of life, injury, disease, and other negative effects on human physical, mental and social well-being, together with damage to property, destruction of assets, loss of services, social and economic disruption, and environmental degradation. The severity of these consequences is referred to as disaster impact. Disasters occur as a result of the combination of population exposure to a hazard; the conditions of human vulnerability that are present; and insufficient capacity or measures to reduce or cope with the potential negative consequences.
All disasters are said to follow a cyclical pattern known as the disaster life cycle, which includes five stages: prevention, mitigation, preparedness, response, and recovery. , These phases often overlap each other in time and in scope. The emphasis on a “life-cycle” approach to risk management is important in the case of disasters.
Disaster Risk Management
Disaster risk management is a comprehensive all-hazard approach that entails developing and implementing strategies for each phase of the disaster life cycle. Disaster risk management includes both predisaster risk reduction (prevention, mitigation, and preparedness), as well as postdisaster retention of residual risk (response and recovery).
The underlying drive of disaster management is to reduce risk to both human life and systems important to livelihood.
Box 32-1 defines other key terms in disaster risk management. , ,
Recently the overall approach to emergencies and disasters among nations has shifted from postimpact activities to a more systematic and comprehensive process of risk management that also emphasizes the importance of preimpact activities, including prevention, mitigation, and preparedness. ,
Preparedness is considered one of the three components of disaster risk reduction because (like prevention and mitigation) it represents activities performed before the disaster. However, preparedness may also be contrasted with these other two elements of disaster risk reduction, in that prevention and mitigation focus primarily on reducing the causes of exposure to disaster hazards, while preparedness focuses on reducing the effects of those exposures on the population.
As preparedness increases, the ability of the society to absorb the event and thus lessen adverse outcomes is augmented as a dependent variable of the preparedness. By increasing preparedness, we increase resilience, and thus lessen the risk of disasters. In addition, effective disaster-risk-reduction activities strengthen the buffering capacity of a population to respond to those everyday emergencies found in all societies (thus minimizing the change in an essential function for a given change in available resources).
Events of the past three decades have given birth to an understanding of the importance of disaster preparedness. The Guatemala earthquake of 1976 killed 23,000 people and led to the publication of multiple articles analyzing aspects of the international response. , Post-Event analyses of this and other subsequent large-scale disasters reveals a strong case for multihazard disaster preparedness. During the 1980s, new concepts based on the notions of hazards and vulnerabilities evolved. Governments of industrialized nations began to abandon their disaster relief approaches to better reflect the importance of preparedness. This growing awareness was bolstered by a growing body of disaster research; an increasing professionalism in the field that grew to include academic coursework, the development of manuals and standardized tools, a growing response fatigue among donor nations and organizations, and an economic appreciation of the cost-effectiveness of prevention and preparedness as weighed against extremely expensive response efforts. The growing burden of disasters on global health was becoming all too clear. During the following 20-year period (1990-2010), natural disasters alone killed 3 million people worldwide, affected 800 million lives, and resulted in property damage exceeding $23 billion. , In response to this growing threat, the United Nations General Assembly declared the 1990s to be the International Decade of Natural Disaster Reduction (IDNDR) and called for a global effort to reduce the suffering and losses.
In May 1994, one major achievement of the UN IDNDR was the hosting of the 1994 World Conference on Natural Disaster Reduction, which resulted in the Yokohama Strategy and Plan of Action for a Safer World: Guidelines for Natural Disaster Prevention, Preparedness, and Mitigation. One of the strategies within the Yokohama Plan of Action stated that: “[the world] Will develop and strengthen national capacities and capabilities and, where appropriate, national legislation for natural and other disaster prevention, mitigation and preparedness, including the mobilization of non-governmental organization and participation of local communities.”
The Yokohama Strategy and Plan of Action affirmed that, “Disaster prevention, mitigation and preparedness are better than disaster response in achieving the goals and objectives of the Decade. Disaster response alone is not sufficient, as it yields only temporary results at a very high cost. We have followed this limited approach for too long. This has been further demonstrated by the recent focus on response to complex emergencies, which, although compelling, should not divert from pursuing a comprehensive approach. Prevention contributes to lasting improvement in safety and is essential to integrated disaster management.”
The Johannesburg World Summit for Sustainable Development (WSSD) plan of implementation further stated that, “An integrated, multihazard, inclusive approach to address vulnerability, risk assessment and disaster management, including prevention, mitigation, preparedness, response and recovery, is an essential element of a safer world in the twenty-first century.”
The United Nations General Assembly resolution on natural disasters and vulnerability then took into account the outcomes of the WSSD and the role of the International Strategy for Disaster Reduction and coordinated a review of the Yokohama Strategy and Plan of Action as requisite to the Second World Conference on Disaster Reduction held in 2005.
Through its resolution A/RES/58/214, the United Nations General Assembly convened a World Conference on Disaster Reduction (WCDR), in Kobe, Hyogo, Japan, during January 2005.
The conference provided a unique opportunity to promote a strategic and systematic approach to reducing vulnerabilities and risks to hazards. It underscored the need for, and identified ways of, building the resilience of nations and communities to disasters.
One of the key outcomes of the WCDR included the Hyogo Declaration, a joint statement recognizing “that a culture of disaster prevention and resilience, and associated pre-disaster strategies, which are sound investments, must be fostered at all levels, ranging from the individual to the international levels.”
Another key outcome of the WCDR was the 2005-2015 Hyogo Framework for Action (HFA).
The HFA suggested five specific priorities for action:
Making disaster risk reduction a priority
Improving risk information and early warning
Building a culture of safety and resilience
Reducing the risks in key sectors
Strengthening preparedness for response
In 2003, as a result of catastrophic terrorist attacks, including the World Trade Center attack and the anthrax letter mailings, Homeland Security Presidential Directive 8 (HSPD-8) otherwise known as the National Preparedness Directive was released. This directive established policies to strengthen the preparedness of the United States to prevent and respond to threatened or actual domestic terrorist attacks, major disasters, and other emergencies by requiring a national domestic all-hazards preparedness goal, establishing mechanisms for improved delivery of federal preparedness assistance to state and local governments, and outlining actions to strengthen preparedness capabilities of federal, state, and local entities.
This emphasis led to the emergence of health security as a new legislative focus as Congress recognized the need to expand the resiliency of the public health system to respond to national security threats. The Pandemic and All-Hazards Preparedness Act (PAHPA) of 2006 was passed, specifically including health security. The PAHPA broadened the previous focus on bioterrorism to a more comprehensive, all-hazards approach that acknowledged the growing concern of emerging or reemerging infectious diseases and natural disasters, in addition to intentional threats from chemical, nuclear, or radiological incidents. In turn, the U.S. Department of Health and Human Services released its National Health Security Strategy.
In 2011, the White House released Presidential Policy Directive 8: National Preparedness (PPD-8). The directive was aimed at strengthening the security and resilience of the United States through systematic preparation for the threats that pose the greatest risk to the security of the nation, including acts of terrorism, cyber-attacks, pandemics, and catastrophic natural disasters. PPD-8 directed the development of a National Preparedness Goal that identifies the core capabilities necessary for preparedness and a National Preparedness System to guide activities that will enable the nation to achieve the goal. PPD-8 also called development of an annual National Preparedness Report based upon the National Preparedness Goal.
The Approach to Disaster Preparedness
“Emergency preparedness is a program of long-term development activities whose goals are to strengthen the overall capacity and capability of a country to manage all types of emergencies and bring about an orderly transition from relief through recovery and back to sustained development.”
To be most effective, disaster preparedness programs should be one component of an overall disaster-risk-management strategy and should not be implemented as an isolated project. Disaster preparedness should be guided by a range of principles in order to adequately protect communities, property, and the environment. To be most effective the approach must be , :
Multisectoral and intersectoral
Community based and user friendly
Culturally sensitive and specific
The all-hazard approach concerns developing and implementing emergency management strategies for the full range of likely emergencies or disasters, including both natural and technological (which also includes conflict-related hazards of terrorism and warfare).
The multisectoral and intersectoral approach means that all organizations, including government, private and community, and traditional, as well as informal leadership, should be involved in disaster preparedness. If this approach is not used, emergency management is likely to be fragmented and inefficient. The multisectoral and intersectoral approach will also help to link emergency management to sustainable development, through the institutionalization of risk reduction and the use of its principles in long-term development projects.
The concept of preparedness at the community level is based upon the premise that the members, resources, organizations, and administrative structures of a community should all form the foundation of any emergency preparedness program. As the saying goes, “All disasters are local,” meaning all disaster responses start at the local level.
These combined approaches will also help to link risk reduction to sustainable development, through the institutionalization of emergency management and the use of its principles in development projects. The resulting program becomes the responsibility of all and is undertaken at all administrative levels of both government and nongovernment organizations. The program concentrates not only on disasters but also on sustainable development of the society as a whole. These elements should be created at community, provincial, and national levels. An inherent capacity for risk reduction at each of these levels is a precondition for effective response and recovery when an emergency or disaster strikes. Without these capacities, any link from recovery to development will not be sustainable.
Health Objectives of Disaster Preparedness
Objectives of preparedness for health emergencies have been offered as follows :
Prevent morbidity and mortality
Provide care for casualties
Manage adverse climatic and environmental conditions
Ensure restoration of normal health
Reestablish health services
Protect public health and medical assets
The actions required to meet these needs can be grouped in four categories :
Preventive measures: for example, building codes and floodplain management
Protective measures: for example, early warning and community education
Life saving measures: for example, rescue and relief
Rehabilitation: for example, resettlement and rebuilding
Key Elements of Disaster Preparedness
Even though the terms preparedness and planning are sometimes used interchangeably or redundantly, planning constitutes only one component of a comprehensive program of disaster preparedness. Box 32-2 lists the typical elements of an emergency preparedness program. ,
Training and education
Specialized communication systems
Information databases and knowledge management systems
Resource management systems
Population protection systems
Incident management systems
Monitoring and evaluation
A Capability-Based Approach for Disaster Preparedness Programs
Populations at risk for disasters may face many vastly different hazards and threats within a nearly infinite set of unpredictable scenarios. This unpredictability is poorly suited to scenario-based approaches to risk management (i.e., risk management that focuses only on specific prioritized hazards). Even though the hazards that cause disasters may vary greatly, the potential public health consequences and subsequent public health and medical needs of the population do not. , For example, warfare, chemical releases, floods, hurricanes, and earthquakes all displace people from their homes. All of these various disaster hazards require the same public health capability of shelter with only minor adjustments for the impact (severity according to hazard rapidity of onset, scale, duration, location, and intensity). Regardless of the hazard, disasters cause what are categorized into 15 public health consequences, which are addressed by 32 categories of public health and medical capabilities. Tables 32-1 and 32-2 list the public health consequences most commonly associated with major natural and technological disasters, respectively. Note that for most of the disaster hazards represented in these tables, variation exists only for the relative degree of impact for each of the public health consequences. Thus, the all-hazard preparedness program focuses not on the specific hazard but also on addressing each of the expected public health and medical consequences.
|Public Health Consequence||Epidemics||Flood||Heat Wave||Storm||Tropical Cyclone||Drought||Wildfire|
|Number of deaths||Can be many||Few, but many in poor nations||Can be many (especially in large urban areas)||Few||Few, but many in poor nations||Few, but many in poor nations||Few|
|Severe injuries||Insignificant||Few||Can be many (heat illness)||Few||Few||Unlikely||Few|
|Loss of clean water||Insignificant||Focal to widespread||Insignificant||Focal||Focal to widespread||Widespread||Focal|
|Loss of shelter||Insignificant||Focal to widespread||Insignificant||Focal||Focal to widespread||Focal to widespread||Focal|
|Loss of personal/household goods||Insignificant||Focal to widespread||Insignificant||Focal||Focal to widespread||Focal to widespread||Focal|
|Major population movements||Insignificant||Focal to widespread||Insignificant||Focal||Focal to widespread||Focal to widespread||Focal|
|Loss of routine hygiene||Insignificant||Focal to widespread||Insignificant||Focal||Focal to widespread||Widespread||Focal|
|Loss of sanitation||Insignificant||Focal to widespread||Insignificant||Focal||Focal to widespread||Focal||Focal|
|Disruption of solid waste management||Insignificant||Focal to widespread||Insignificant||Focal||Focal to widespread||Focal||Focal|
|Public concern for safety||Moderate||Moderate to High||Low to moderate||Low to moderate||High||Low to moderate||Moderate to High|
|Increased pests||Insignificant||Focal to widespread||Insignificant||Focal||Focal to widespread||Focal to widespread||Unlikely|
|Loss or damage of health care system||Insignificant||Focal to widespread||Insignificant||Focal||Focal to widespread||Focal||Focal to widespread|
|Worsening of chronic illnesses||Focal to widespread||Focal to widespread||Focal to widespread||Focal||Focal to widespread||Widespread||Focal to widespread|
|Loss of electrical power||Insignificant||Focal to widespread||Occasionally focal||Focal||Focal to widespread||Focal||Unlikely|
|Toxic exposures||Insignificant||Widespread for CO poisoning||Insignificant||Focal for CO poisoning||Widespread for CO poisoning||Focal||Widespread for air|
|Food scarcity||Insignificant||Focal to widespread||Insignificant||Insignificant||Common in low-lying coastal areas||Widespread in poor nations||Focal|
|Public Health Consequence||Hazardous Material Release||Urban Fire||Explosions/ Bombings||Transport Crash||Structural Failure|
|Deaths||Moderate to many||Few to moderate||Moderate to many||Few to moderate||Moderate to many|
|Severe injuries||Moderate to many||Moderate to many||Moderate to many||Moderate to many||Moderate to many|
|Loss of clean water||Focal||Focal||Focal||Focal||Focal|
|Loss of shelter||Focal||Focal||Focal||Focal||Focal|
|Loss of personal and household goods||Focal||Focal||Focal||Focal||Focal|
|Major population movements||Focal||Focal||Focal||Focal||Focal|
|Loss of routine hygiene||Focal||Focal||Focal||Focal||Focal|
|Loss of sanitation||Focal||Focal||Focal||Focal||Focal|
|Disruption of solid waste management||Unlikely||Unlikely||Unlikely||Unlikely||Unlikely|
|Public concern for safety||High||High||High||High||High|
|Increased pests and vectors||Unlikely||Unlikely||Unlikely||Unlikely||Unlikely|
|Loss/damage of health care system||Focal||Focal||Focal||Focal||Focal|
|Worsening of existing chronic illnesses||Focal to widespread||Focal to widespread||Focal||Focal||Focal|
|Loss of electricity||Focal||Focal||Focal||Focal||Focal|
|Toxic exposures||Focal to widespread||Focal to widespread||Focal||Focal||Focal|
Table 32-3 lists the public health capabilities that are necessary to address those public health consequences listed in Tables 32-1 and 32-2 that are most commonly addressed in a disaster response. Thus, an effective emergency response can be developed through implementation of a preparedness program that builds capacity for each of the capabilities listed in Table 32-3 (in most cases, regardless of the hazard). An effective disaster preparedness program applies the key elements of emergency preparedness listed in Box 32-2 toward building capacity for each of the capabilities in Table 32-3 .
|Public Health Consequences||Public Health Capabilities|
|Common to all disasters||Resource management |
Information sharing §
Emergency operations coordination §
Responder safety and health §/occupational health & safety
Volunteer management §
|Deaths||Fatality management §/mortuary care |
Mental health services
|Illness and injuries||Health services |
Mental health services
Injury prevention and control
Public Health Surveillance §/epidemiological investigation
Disease prevention and control
Medical countermeasure dispensing §
Medical material management & distribution §
Public health laboratory testing §
Medical surge §
Nonpharmaceutical interventions (isolation, quarantine, social distancing, travel, and restriction/advisory) §
|Loss of clean water||Water, sanitation, and hygiene (WASH) |
Health services (e.g., hospitals and dialysis units)
|Loss of shelter||Mass care §/shelter & settlement |
|Loss of personal and household goods||Replacement of personal and household goods|
|Loss of sanitation and routine hygiene||Sanitation, excreta disposal and hygiene promotion |
Nonpharmaceutical interventions (hygiene) §
|Disruption of solid waste management||Solid waste management|
|Public concern for safety||Risk communication/emergency public information and warning § |
|Increased pests and vectors||Pest and vector control|
|Loss or damage of health care system||Health system and infrastructure support |
Reproductive health services
|Worsening of chronic illnesses||Health services|
|Food scarcity||Food safety, security, and nutrition|
|Standing surface water||Public works and engineering|
|Toxic exposures||Risk assessment and exposure modeling |
Population protection measures (evacuation/shelter in place
HazMat emergency response/decontamination §
Responder safety and health §/occupational health & safety