Morbidity and Mortality Associated with Disasters

Principles of risk decision-making

Risk management decisions in public health require consideration of a number of complex, often conflicting factors. The aim of this review was to propose a set of 10 fundamental principles to guide risk decision-making. Although each of these principles is sound in its own right, the guidance provided by different principles might lead the decision-maker in different directions. For example, where the precautionary principle advocates for preemptive risk management action under situations of scientific uncertainty and potentially catastrophic consequences, the principle of risk-based decision-making encourages decision-makers to focus on established and modifiable risks, where a return on the investment in risk management is all but guaranteed in the near term. To evaluate the applicability of the 10 principles in practice, one needs to consider 10 diverse risk issues of broad concern and explore which of these principles are most appropriate in different contexts. The 10 principles presented here afford substantive insight into the process of risk management decision-making, although decision-makers will ultimately need to exercise judgment in reaching appropriate risk decisions, accounting for all of the scientific and extra-scientific factors relevant to the risk decision at hand.

A systematic analysis of worldwide disasters, epidemics and pandemics associated mortality of 210 countries for 15 years (2001-2015)

In recent years, the unprecedented death tolls resulting from epidemics and natural disasters made everyone interested, from the general public to country heads, to know about the mortality rates. The coronavirus issue is the most recent example all over the media, and everyone is talking about corona-induced mortality. The study aimed to estimate the disaster-induced mortality rates at the global level for two hundred and ten countries for fifteen years (2001-2015). Using a retrospective study design, we extracted datasets from two data sources, EM-DAT and UNFPA, in October 2019. The cut-off time for the data download was midnight Central European Time, October 17, 2019. The most noticeable finding in this study is that, against the common prevailing notion, both developed and developing countries equally carry the brunt of disaster-induced mortality. This study proposes empirical confirmation of the direction and magnitude of any year-over-year correlation of disaster and mortality rates. Furthermore, the analysis of the trend in mortality rate over the past fifteen years concludes it is not linear. However, there are huge variations across the years and the countries. The study is of paramount importance to initiate a debate amongst the concerned policymakers and stakeholders to regularly monitor the disaster-induced mortality rates. So that effective interventions can be devised to decrease the mortality rates.

Protective policies for all? An analysis of Covid-19 deaths and protective policies among low-, medium-, and high-vulnerability groups

Protective policies have been unequally and inconsistently applied in the United States throughout the Covid-19 pandemic. This study investigates the relationship between state and local policies and Covid-19 deaths, combining three datasets: the Centers for Disease Control and Prevention's Social Vulnerability Index; local laws and regulations from the COVID Analysis and Mapping of Policies (AMP) database; and Covid-19 deaths by county reported by The New York Times. It examines, using propensity score matching, local policies and regulations as treatments during the crisis, and assesses how, inter alia, face mask requirements, gathering restrictions, stay-at-home orders, and social distancing mandates enacted at the county level altered Covid-19 deaths. The results indicate that the first three variables reduced average Covid-19 deaths in high-vulnerability communities. Despite clear gaps in federal policy guidance and coordinated policies, some efforts led by local and state governments promoted safer behaviour and lessened the impact of Covid-19 in communities, especially those with higher social vulnerability rates.

The Ontological Praxis Between Disaster Studies and Demography—Extension of the Scope

This chapter serves as a summary of the learnings from the present volume and an extension of the scope on disaster-demography nexus. We outline the benefits of exploring the disaster-demography nexus and develop a categorisation summarising seven different approaches to the interlink of disasters with demography from examinations of existing literature. These are: disaster impacts on population, measuring vulnerability, mass displacement, spatial-regional approach, climate change, urbanisation and an applied approach. These seven approaches are our attempt to highlight the complex and multifarious nexus between demography and disasters which may not simply be linked to vulnerability. It is recognised that others may separate or merge some of these approaches in different ways.

Which Household Emergency Plans are More Helpful in Tornadoes? Through the Lens of Gerontology

OBJECTIVE

This study investigated how the effectiveness of household emergency plans during tornadoes was associated with family discussions, and the attributes of the plan for different age groups.

METHODS

A telephone survey was conducted in 2014, one year after two 2013 Enhanced Fujita 4/5 tornadoes. The working sample included 223 respondents who reported having a household emergency plan before the tornadoes. The latent class analysis was used to identify the patterns of the plans and develop a typology based on their content. Logistic regression was used to examine predictors for plan effectiveness.

RESULTS

Two classes of plans were identified: quality plans that were rich in content and limited plans that had lower levels of content richness. Older adults were less likely to have quality plans and less likely to have family discussions. Quality of the plan and discussions with family members increased plan effectiveness among older adults, but not younger adults.

CONCLUSIONS

Better emergency planning could be more important for older than for younger adults. The findings were discussed from a gerontological perspective that focuses on older adults' unique needs, vulnerabilities, and resilience factors.

Giving a voice to medically vulnerable populations: A mixed-methods investigation of their unique perceptions and needs in emergency situations

Older adults in poor health represent a growing sector of the population worldwide. These medically vulnerable individuals often tend to be ill-prepared for emergencies. In times of crisis they are at higher risk of experiencing adverse health outcomes and are liable to place an additional burden on health and social care services. The aim of this study was to explore the unique perceptions and diverse needs of community-dwelling medically vulnerable individuals in Israel in order to gain insights that could be used to promote future preparedness. A mixed methods design was employed that included 16 in-depth interviews, followed by a quantitative survey of 179 participants. Data were collected between 2016 and 2017. The analysis process included thematic analysis for qualitative data. Quantitative data analysis focused on estimating associations between preparedness levels and participants' characteristics and perceptions. The results indicated low levels of preparedness-only 13.5% of participants reported having prepared a full emergency kit with supplies. Family members played a key role in almost every dimension related to emergency preparedness; alongside certain authorities perceived by the participants as responsible for initiating the preparedness process. Additional issues that emerged were related to information and communication and to the logistics of medication handling and special nutrition. The findings suggest that it is vital to adopt a proactive approach to the problem of preparedness in this population. This conclusion should be of value to health and social care practitioners in the community as well as to family members and caregivers. Practical and simple recommendations for enhancing preparedness based on these findings are provided. Viewing preparedness as a process that is the joint responsibility of the individual, the family, caregivers, and community health and social welfare services could contribute to maintaining continuity of care among vulnerable populations and mitigate adverse health outcomes in future events.

A bellweather for climate change and disability: educational needs of rehabilitation professionals regarding disaster management and spinal cord injuries

Study design

Cross-sectional survey.

Objective

Persons with disabilities are disproportionately impacted by extreme weather disasters and climate change. Individuals with spinal cord injury (SCI) are especially at risk due to inability to control their body temperature and mobility concerns. We surveyed rehabilitation professionals in the field of SCI to determine their experiences, concerns and educational needs regarding natural disasters, climate change and sustainability and the effects on their clientele.

Setting

Online survey available to an international cohort.

Methods

The survey was developed by the authors and conducted in 2019. It was distributed amongst various international health care organizations whose members care for persons with SCI. Descriptive statistics and chi-square test for association were performed using Microsoft Excel 2016.

Results

Of 125 respondents, 50% were from Europe, 18% from North America, and 18% from Asia; 74% were physicians and 13% physical therapists. In total 57.6% believed climate change had impacted their client's health and well-being. Respondents from North America were significantly less likely to report climate change had an impact on their patient's health than those from Asia or Europe (p < 0.01). In total 82.5% of respondents thought professionals should be concerned with sustainability and 85.5% were interested in further education.

Conclusions

Most respondents acknowledged a need for more information related to the disasters, climate change, and disability. Results underscore the need for further research, professional, and consumer education.

Health systems' "surge capacity": state of the art and priorities for future research

CONTEXT

Over the past decade, a number of high-impact natural hazard events, together with the increased recognition of pandemic risks, have intensified interest in health systems' ability to prepare for, and cope with, "surges" (sudden large-scale escalations) in treatment needs. In this article, we identify key concepts and components associated with this emerging research theme. We consider the requirements for a standardized conceptual framework for future research capable of informing policy to reduce the morbidity and mortality impacts of such incidents. Here our objective is to appraise the consistency and utility of existing conceptualizations of health systems' surge capacity and their components, with a view to standardizing concepts and measurements to enable future research to generate a cumulative knowledge base for policy and practice.

METHODS

A systematic review of the literature on concepts of health systems' surge capacity, with a narrative summary of key concepts relevant to public health.

FINDINGS

The academic literature on surge capacity demonstrates considerable variation in its conceptualization, terms, definitions, and applications. This, together with an absence of detailed and comparable data, has hampered efforts to develop standardized conceptual models, measurements, and metrics. Some degree of consensus is evident for the components of surge capacity, but more work is needed to integrate them. The overwhelming concentration in the United States complicates the generalizability of existing approaches and findings.

CONCLUSIONS

The concept of surge capacity is a useful addition to the study of health systems' disaster and/or pandemic planning, mitigation, and response, and it has far-reaching policy implications. Even though research in this area has grown quickly, it has yet to fulfill its potential to generate knowledge to inform policy. Work is needed to generate robust conceptual and analytical frameworks, along with innovations in data collection and methodological approaches that enhance health systems' readiness for, and response to, unpredictable high-consequence surges in demand.