While public health is generally expected to be dealing with the regular challenges of a health system trying to address the problems of health across the usual life course in stable societies, we also must recognize that disasters of various kinds can post a serious public health emergency. And public health needs to be ready not only to meet them, in terms of coping with them and providing appropriate relief through well geared up health services, but also to try and mitigate their impact through proper planning and preparedness. What we know about the changing environment is that temperature extremes are more likely with climate change and they will be an increased frequency and intensity of extreme climatic events. And these extreme weather events are likely to result in a variety of natural disasters. And these are likely to cause a huge amount of death and disability apart from economic loss. In the last four decades, natural disasters have caused more than three million deaths and more than two trillion dollars in economic losses. The Indonesian earthquake and tsunami of 2004 as well as the earthquake in Haiti in 2010 had the highest death toll from all natural disasters in recent times. In terms of human actions, which increase vulnerability to disasters, deforestation leading to landslides is a very good example of improper resource management by humans leading to avertable disasters. All of this is quite often seen in number of developing countries which are rapidly denuding their forests and leading to soil erosion and landslides which kill people and cause a lot of challenges to their health and wellbeing. In terms of urbanization, while it is inevitable that we will see more of urbanization, unplanned, rapid urbanization results in informal settlements being built poorly with poor access to services and unhygienic conditions. And should a disaster strike, these would be extremely vulnerable population groups. About nearly 200,000 new citizens are added to urban populations every day, globally. And urban slums are also growing proportionately with this increasing urbanization. When we look at how a disaster develops, it’s not as though it strikes suddenly and leaves devastation in its wake. There is also a huge amount of vulnerability which is built up ahead, which makes the disaster even deadlier than it should have been. There are individual factors like vulnerable age, gender and disability which enhance the vulnerability of individual persons. But at the level of the society itself, we also recognize that there are unsafe conditions, like the way buildings are constructed and way urbanization takes place in an unplanned manner with fragile slums. Also, with poor access to health services where needed in the wake of a disaster. Reduced capacity to cope which is created by inability of different planning systems. Also, lack of access to information as to what might happen in the case of a disaster, or even advance warning of a disaster. All of these enhance vulnerability of persons and people. But the trigger event is an environmental hazard which comes in the form of a natural disaster but the vulnerability that exists aggravates the damage done. When we’re really looking at a disaster, in terms of the income status of the countries, not unexpectedly, low income countries have much higher mortality in relation to the middle income countries and high income countries from disasters, because they’re low in resources and also low in preparedness. How do disasters affect human health? Quite often the images that spring in our mind are of people being washed away by flood waters, or being swallowed by the earth when earthquakes strike. But disasters can harm human health in very many other ways. For example, there can be severe damage to buildings and supply chains which can affect health. If there is damage to civil engineering structures and water sources, then you can have heavy contamination of water. You can also have personal shortages. The movement of emergency relief can be impeded if either people are unable to reach the spot or if they themselves are incapacitated and the transport systems are disrupted. The availability and access to drugs also becomes a problem as well as emergency relief equipment if the supply chains break down. Further, there is also the threat of vector control being thrown out of gear. We can have proliferation of breeding sites for example of mosquitoes and other vectors. There is increased human vector contact, created by the disaster zone. And there is a disruption of the routine disease control programs which provide the protection in usual times. Food handling also becomes a major issue and food safety is a matter of serious concern. Power outages can result in spoilage of refrigerated foods. There can be damage to food preparation facilities. And even the relief supplies that are being rushed can be contaminated or degraded by a disaster. At the same time, one of the critical challenges is the provision of clean water supply and adequate sanitation, both of which are compromised in a disaster situation. Emergency water supplies can be greatly impeded in terms of both quantity and quality. And the management of waste matter is a big problem and if that starts contaminating water supplies, then you can have a huge proliferation of water borne diseases, various infections that come with water contamination. When we come to management of disasters we really ought to be looking at vulnerability and risk assessment. And that starts with planning and also with organization of systems in order to provide a good response in a timely and efficient manner. And whenever there is a disaster, we have to quickly assess what the extent of the disaster was and what its impact has been, provide the right response and then go in for rehabilitation and reconstruction immediately after the disaster. But we also have to look at disaster mitigation, reducing the probability of a disaster or reducing the likely damage from a disaster. In terms of disaster management, we ought to be really looking at a cycle where we have the immediate response and relief followed by rehabilitation, reconstruction and then we go in for mitigation and prevention of a potential recurrence of the next disaster. But at the same time, should it happen, we should be even better prepared. So while trying to mitigate, we must also prepare for an eventuality where disasters might strike again. In terms of further steps in disaster management, we ought to be really looking at vulnerability assessment. By determining the spatial proximity of the population subgroups to potential hazards, according to personal and socioeconomic characteristics which increase the vulnerability. We also ought to take actions from mitigation by reducing the impacts of future hazard events and reduction in the susceptibility of high risk groups by proper planning. But further on, we must insure that there is adequate emergency preparedness through strengthened capacity building, to manage all types of emergency and transition quickly and efficiently from relief through recovery to sustainable development. We need to have adequate planning at all levels from individual to community to national and international levels. And this planning has to be reflected both in terms of policy as well as in capacity building again, at all levels. In terms of the response itself, this is adequately conditioned by preparedness if the planning has been well done. And we’d require experienced, trained personnel who are absolutely vital for providing the right kind of relief and the relief phase much merge with recovery and development over time in a seamless manner. In terms of rehabilitation, reconstruction and recovery, we ought to pay attention to the physical, social, as well as psychological elements in terms of restoration of community life, appropriate environmental health infrastructure, ensuring that sanitation, water supply, shelter, all of these are provided without delay. At the same time as the rehabilitation takes place, there are important mental health effects of a community that has been shocked and shaken as a result of the damage due to disaster. So we ought to provide the necessary support also for mental health.
