Synergising Public Health Concepts with the Sendai Framework for Disaster Risk Reduction: A Conceptual Glossary

How can the Sendai framework be implemented for disaster risk reduction and sustainable development? A qualitative study in Iran

BACKGROUND

The Sendai Framework is the United Nations' most significant approach to reducing the risk of disasters from 2015 to 2030. This framework designed for all communities. However, communities should create operational and remedial strategies based on their unique circumstances. Considering the gaps in the implementation of Sendai framework strategies in Iran, as a developing country, the present study was designed.

METHOD

This study was conducted by using a qualitative direct content analysis method to find out the expert's opinions on the implementation of the Sendai framework in Iran from 2021 to 2023. 35 experts in the focus group discussion and 9 experts in the interview were the participants of the study.

RESULTS

Study findings were merged and reported as one main theme entitled Executive actions for implementing the Sendai Framework, four categories, and 37 codes. Eleven codes for the strategy of understanding disaster risk, 11 codes for the strategy of strengthening disaster risk governance to manage disaster risk, eight codes for the strategy of Investing in disaster risk reduction for resilience, and finally, seven codes for the strategy of enhancing disaster preparedness for effective response and to "Build Back Better" in recovery, rehabilitation, and reconstruction were identified as implementation solutions.

CONCLUSION

The Sendai Framework has not provided any detailed implementation solutions because the countries' economic, social, level of development, etc., are different. The study's findings can be used as a guide for other developing countries.

Predicting Unmet Healthcare Needs in Post-Disaster: A Machine Learning Approach

Unmet healthcare needs in the aftermath of disasters can significantly impede recovery efforts and exacerbate health disparities among the affected communities. This study aims to assess and predict such needs, develop an accurate predictive model, and identify the key influencing factors. Data from the 2017 Long-term Survey on the Change of Life of Disaster Victims in South Korea were analyzed using machine learning techniques, including logistic regression, C5.0 tree-based model, and random forest. The features were selected based on Andersen's health behavior model and disaster-related factors. Among 1659 participants, 31.5% experienced unmet healthcare needs after a disaster. The random forest algorithm exhibited the best performance in terms of precision, accuracy, Under the Receiver Operating Characteristic (AUC-ROC), and F-1 scores. Subjective health status, disaster-related diseases or injuries, and residential area have emerged as crucial factors predicting unmet healthcare needs. These findings emphasize the vulnerability of disaster-affected populations and highlight the value of machine learning in post-disaster management policies for decision-making.

Assessing Socioeconomic Vulnerabilities Related to COVID-19 Risk in India: A State-Level Analysis

OBJECTIVE

There is a paucity of scientific analysis that has examined spatial heterogeneities in the socioeconomic vulnerabilities related to coronavirus disease 2019 (COVID-19) risk and potential mitigation strategies at the sub-national level in India. The present study examined the demographic, socioeconomic, and health system-related vulnerabilities shaping COVID-19 risk across 36 states and union territories in India.

METHODS

Using secondary data from the Ministry of Health and Family Welfare (MoHFW), Government of India; Census of India, 2011; National Family Health Survey, 2015-16; and various rounds of the National Sample Survey, we examined socioeconomic vulnerabilities associated with COVID-19 risk at the sub-national level in India from March 16, 2020, to May 3, 2020. Descriptive statistics, principal component analysis, and the negative binomial regression model were used to examine the predictors of COVID-19 risk in India.

RESULTS

There persist substantial heterogeneities in the COVID-19 risk across states and union territories in India. The underlying demographic, socioeconomic, and health infrastructure characteristics drive the vulnerabilities related to COVID-19 in India.

CONCLUSIONS

This study emphasizes that concerted socially inclusive policy action and sustained livelihood/economic support for the most vulnerable population groups is critical to mitigate the impact of the COVID-19 pandemic in India.

Analyzing Spatial Patterns of Health Vulnerability to Drought in the Brazilian Semiarid Region

Health determinants might play an important role in shaping the impacts related to long-term disasters such as droughts. Understanding their distribution in populated dry regions may help to map vulnerabilities and set coping strategies for current and future threats to human health. The aim of the study was to identify the most vulnerable municipalities of the Brazilian semiarid region when it comes to the relationship between drought, health, and their determinants using a multidimensional index. From a place-based framework, epidemiological, socio-economic, rural, and health infrastructure data were obtained for 1135 municipalities in the Brazilian semiarid region. An exploratory factor analysis was used to reduce 32 variables to four independent factors and compute a Health Vulnerability Index. The health vulnerability was modulated by social determinants, rural characteristics, and access to water in this semiarid region. There was a clear distinction between municipalities with the highest human welfare and economic development and those municipalities with the worst living conditions and health status. Spatial patterns showed a cluster of the most vulnerable municipalities in the western, eastern, and northeastern portions of the semiarid region. The spatial visualization of the associated vulnerabilities supports decision making on health promotion policies that should focus on reducing social inequality. In addition, policymakers are presented with a simple tool to identify populations or areas with the worst socioeconomic and health conditions, which can facilitate the targeting of actions and resources on a more equitable basis. Further, the results contribute to the understanding of social determinants that may be related to medium- and long-term health outcomes in the region.

Concepts and Terms for Addressing Disparities in Public Health Emergencies: Accounting for the COVID-19 Pandemic and the Social Determinants of Health in the United States

Public health emergencies, including the coronavirus disease 2019 (COVID-19) pandemic, highlight disproportionate impacts faced by populations with existing disparities. Concepts and terms used to describe populations disproportionately impacted in emergencies vary over time and across disciplines, but United States (US) federal guidance and law require equal access to our nation's emergency resources. At all levels of emergency planning, public health and their partners must be accountable to populations with existing inequities, which requires a conceptual shift toward using the data-driven social determinants of health (SDOH). SDOH are conditions in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks. This article reviews the historic use of concepts and terms to describe populations disproportionately impacted by emergencies. It also recommends a shift in emergency activities toward interventions that target the SDOH to adequately address long-standing systemic health disparities and socioeconomic inequities in the United States.

Social Vulnerability Indicators for Flooding in Aotearoa New Zealand

Social vulnerability indicators are a valuable tool for understanding which population groups are more vulnerable to experiencing negative impacts from disasters, and where these groups live, to inform disaster risk management activities. While many approaches have been used to measure social vulnerability to natural hazards, there is no single method or universally agreed approach. This paper proposes a novel approach to developing social vulnerability indicators, using the example of flooding in Aotearoa New Zealand. A conceptual framework was developed to guide selection of the social vulnerability indicators, based on previous frameworks (including the MOVE framework), consideration of climate change, and a holistic view of health and wellbeing. Using this framework, ten dimensions relating to social vulnerability were identified: exposure; children; older adults; health and disability status; money to cope with crises/losses; social connectedness; knowledge, skills and awareness of natural hazards; safe, secure and healthy housing; food and water to cope with shortage; and decision making and participation. For each dimension, key indicators were identified and implemented, mostly using national Census population data. After development, the indicators were assessed by end users using a case study of Porirua City, New Zealand, then implemented for the whole of New Zealand. These indicators will provide useful data about social vulnerability to floods in New Zealand, and these methods could potentially be adapted for other jurisdictions and other natural hazards, including those relating to climate change.

Learning and Collaboration during Crisis: A Novel University-Community Partnership to Manufacture Medical Personal Protective Equipment

Research on crisis management focuses on pre-planning for disasters in order to understand potential barriers. However, one significant barrier to crisis response is that organizations may come together in unplanned configurations during crisis response. This means that significant opportunities exist for understanding the process by which individuals learn, collaborate, and create new systems during crises. In this case report, we present the case of face shield production by a university, academic medical center, and community partners during the supply chain collapse of the early COVID-19 pandemic with the aim of identifying the relationships that formed during the COVID-19 response, so that this case of relationship formation and participant experiences might inform similar disaster response challenges in the future. Thirteen participants responded to an in-depth questionnaire designed to simulate an asynchronous in-depth interview. Respondents reported on the activities of 80 individuals from 38 units/organizations, providing insight into communication challenges and resolutions. Responses were analyzed using thematic analysis, highlighting roles and relationships among participants. The findings grant insight into the experience of learning from crisis response efforts, responding to recent calls for social scientific work on COVID-19 responses.

Linking Disaster Risk Reduction and Healthcare in Locations with Limited Accessibility: Challenges and Opportunities of Participatory Research

Disaster risk reduction and healthcare support each other, including the mitigation of further harm after illness or injury. These connections are particularly relevant in locations which have permanent or temporary limited accessibility. In these circumstances, people are required to be self-sufficient in providing emergency and long-term healthcare with limited resources. Planning and preparing to mitigate further harm after illness or injury from disasters (disaster risk reduction) must include people living and working in locations with limited accessibility, meaning that participatory research can be used. The challenges and opportunities of enacting participatory research in such contexts have not been thoroughly examined. The research question of this paper is therefore, "What challenges and opportunities occur when participatory research links disaster risk reduction and healthcare to mitigate illness and injury in locations with limited accessibility?" To answer this research question, the method used is a qualitative evidence synthesis, combined with an overview paper approach. Two principal themes of challenges and opportunities are examined: defining the data and collecting the data. The themes are explored in theory and then through contextual examples. The conclusion is that an overarching challenge is divergent goals of research and actions that, when recognized, lead to opportunities for improved connections between disaster risk reduction and healthcare.

Confidence in Health-Services Availability during Disasters and Emergency Situations-Does it Matter?-Lessons Learned from an Israeli Population Survey

The association between health and community resilience is well established in the literature. However, maintaining continuity of healthcare services during emergencies, and their contribution in the context of community resiliency have not been sufficiently studied. This study aims to explore the relationship between the public's confidence in the availability of healthcare services during and following emergencies, and community resilience. A cross-sectional study was conducted among 3478 Israeli adults, using the Conjoint Community Resilience Assessment Measurement (CCRAM) tool. Associations between confidence in health services availability during emergencies, socio-demographic variables, and community resilience as measured by the CCRAM score were analyzed. The results revealed that confidence in the availability of health services positively correlated with community resilience score (r(3377) = 0.580, p < 0.001), and that it contributed significantly to increasing resilience (OR = 2.67, 95% CI (2.4-2.9), p < 0.001). Maintaining continuity of healthcare services during emergencies has effects beyond the provision of medical treatment. For instance, the confidence of the population in the availability of these services contributes to community resilience. In turn, this finding can be translated into practical resilience building actions and to facilitate community health.

Reducing the Future Risk of Trauma: On the Integration of Global Disaster Policy within Specific Health Domains and Established Fields of Practice

The global increase in the frequency and severity of natural hazards and extreme climatic events necessitates more efficient global and national strategies to reduce the likelihood and impact of traumatic consequences for disaster-affected populations. The recent inclusion of mental health in the Sendai Framework for Disaster Risk Reduction marks a pivotal point in the recognition of the significant burden of disasters on mental health, and a global commitment to reducing its impacts. Nevertheless, effective agreement implementation and efforts to reduce disaster mental health risks are facing significant challenges. These include a lack of clarity about the conceptual interlinkages and place of disaster risk reduction principles within the field of disaster mental health, which is traditionally marked by a prevailing recovery orientation, and the need for effective translation into disaster mental health policy and practice. Therefore, this study drew on data from interviews with European disaster mental health and risk reduction experts in order to appraise the merit and implications of a global disaster risk reduction policy for advancing population mental health in the context of disaster. Study findings outline existing opportunities, challenges, and key strategies for the integration of disaster risk reduction within disaster mental health policy and practice.

The Inverse Response Law: Theory and Relevance to the Aftermath of Disasters

The Inverse Care Law is principally concerned with the effect of market forces on health care which create inequities in access to health services through privileging individuals who possess the forms of social capital that are valued within health care settings. The fields of disaster risk reduction need to consider the ways in which inequities, driven by economic and social policy as well as institutional decision-making, create vulnerabilities prior to a disaster, which are then magnified post disaster through entrenched structural differences in access to resources. Drawing on key principles within the Inverse Care Law, the Inverse Response Law refers to the idea that people in lower socio-economic groups are more likely to be impacted and to experience disparities in service provision during the disaster response and recovery phase. In a market model of recovery, vulnerable groups struggle to compete for necessary services creating inequities in adaptive capacity as well as in social and wellbeing outcomes over time. Both the Inverse Care Law and the Inverse Response Law focus on the structural organisation of services at a macro level. In this article, the Inverse Care Law is outlined, its application to medical treatment following disasters considered and an explanation of the Inverse Response Law provided. Case studies from recent disasters, in London, New Zealand, Puerto Rico and Mexico City are examined in order to illustrate themes at work relating to the Inverse Response Law.

Towards Improved Linkage of Disaster Risk Reduction and Climate Change Adaptation in Health: A Review

Climate change and climate-sensitive disasters significantly impact health. Linking Disaster Risk Reduction (DRR) and Climate Change Adaptation (CCA) is essential for addressing these ever present, complex and increasing risks. Recent calls have been made to build these links in health. However, there is a need to clearly articulate why linking DRR and CCA is important in health. Furthermore, little is known about how DRR and CCA should be linked in health. By extensively examining relevant literature, this review presents the current state of knowledge of linking DRR and CCA in health. This includes the potential for maximising conceptual synergies such as building resilience, and reducing vulnerability and risk. Additionally, technical and operational synergies are identified to link DRR and CCA in health, including: policy, Early Warning Systems, vulnerability and risk assessment, health systems strengthening, infrastructure resilience, disaster preparedness and response, and health impact pathways. Public health actors have a central role in building these links due to their expertise, work functions, and experience in addressing complex health risks. The review concludes with recommendations for future research, including how to better link DRR and CCA in health; and the opportunities, challenges and enablers to build and sustain these links.

Evaluating Community Partnerships Addressing Community Resilience in Los Angeles, California

Community resilience has grown in importance in national disaster response and recovery efforts. However, measurement of community resilience, particularly the content and quality of relationships aimed at improving resilience, is lacking. To address this gap, we used a social network survey to measure the number, type, and quality of relationships among organizations participating in 16 coalitions brought together to address community resilience in the Los Angeles Community Disaster Resilience project. These coalitions were randomized to one of two approaches (community resilience or preparedness). Resilience coalitions received training and support to develop these partnerships and implement new activities. Both coalition types received expert facilitation by a public health nurse or community educator. We also measured the activities each coalition engaged in and the extent to which partners participated in these activities at two time points. We found that the community resilience coalitions were initially larger and had lower trust among members than the preparedness communities. Over time, these trust differences dissipated. While both coalitions grew, the resilience community coalitions maintained their size difference throughout the project. We also found differences in the types of activities implemented by the resilience communities; these differences were directly related to the trainings provided. This information is useful to organizations seeking guidance on expanding the network of community-based organizations that participate in community resilience activities.

Resilience of an Earthquake-Stricken Rural Community in Southwest China: Correlation with Disaster Risk Reduction Efforts

Disaster risk reduction (DRR) activities have given growing attention to building community resilience, but the effects of such efforts on community resilience are still under-investigated, especially in China where the concept of community resilience has only just emerged. Using the Communities Advancing Resilience Toolkit Assessment Survey, data on self-perceived community resilience were collected in 2017 from a post-disaster Chinese rural community in Yingxiu Town, which was the epicenter of the Wenchuan earthquake (Magnitude = 8.0) in the year 2008. Linear regression analyses were conducted to explore the correlations between residents’ DRR behaviors and perceived community resilience with the control of their socio-demographic characteristics including age, ethnicity, gender, education, income level, employment status and marital status. Results indicate that residents who volunteered for DRR activities, received geological disaster education, participated in evacuation drills, and reported higher income levels had a perception of higher community resilience. Practice research is suggested to help clarify the cause and effect of DRR work on the enhancement of community resilience to disasters in China and abroad. Attention is also called to the development of a Chinese indigenous community resilience concept and assessment instrument.

Social Determinants of Health, Disaster Vulnerability, Severe and Morbid Obesity in Adults: Triple Jeopardy?

Severe and morbid obesity are associated with highly elevated risks of adverse health outcomes and the prevalence of severe obesity is increasing globally. To date, disaster literature has not considered severe and morbid obesity as a specific vulnerability, despite reports of people being left behind during disasters because of their body size, shape or weight. The complex causes of obesity are associated with the social determinants of health and one’s potential vulnerability to disasters. The absence of appropriate considerations may lead to people being exposed to disproportionate and potentially avoidable risk. The intersection of the social determinants of health, disaster vulnerability, severe and morbid obesity is explored. Previously identified vulnerable groups are also represented in severe and morbid obesity data. This poses the prospect for ‘triple jeopardy’ compounding the social determinants of health, disaster vulnerability and considerations with and for people with morbid obesity. When working to reduce disaster risk for vulnerable groups, the author proposes specific consideration is required to ensure ‘all-of-society engagement and partnership’ in an inclusive, accessible and non-discriminatory manner, to ensure no one is left behind.