1. VULNERABILITY & RESPONSE TO THE HEALTH IMPACTS OF FLOODING Roger Few School of Development Studies University of East Anglia Environmental Inequalities Seminar 3: Inequalities, Flooding and Water Resources. University of Surrey, 24/25 October 2006

2. Floods and health impacts  Drowning  Physical injury  Increased exposure to infectious disease  Respiratory disease  Exposure to chemical hazards  Food security/malnutrition  Stress and mental health outcomes

3. contact with floodwater increased exposure to pathogens disruption of food supply disruption of health systems, water/sanitation disruption of livelihood, assets displacement drowning, injury respiratory disease waterborne disease mosquito-borne disease nutritional disease mental health outcomes chronic disease Flood Hazard Flood Proximity RecoveryHealth Risk Effect Health Outcome land use control, flood defences, warning & evacuation avoidance: modify dwelling improve latrines, mosquito control protection: hygiene behaviour, water treatment, emotional support access to care, emergency planning, strategic supplies, support networks Floods - pathways of health impact/vulnerability

4. Flood HazardFlood ProximityHealth Risk Effect contact with floodwater increased exposure to pathogens disruption of food supply disruption of health systems, water/sanitation disruption of livelihood, assets displacement

5. Health Risk EffectHealth Outcome contact with floodwater increased exposure to pathogens disruption of food supply disruption of livelihood, assets displacement disruption of health systems, water/sanitation drowning, injury respiratory disease waterborne disease mosquito-borne disease nutritional disease chronic disease mental health outcomes

6. Flood Hazard Flood Proximity RecoveryHealth Risk Effect Health Outcome flood defences, land use control, warning & evacuation etc avoidance: modify dwelling, improve latrines, mosquito control etc protection: hygiene behaviour, water treatment, emotional support etc access to care, emergency plans, strategic supplies, support networks etc

7. Health Outcome RecoveryFlood Hazard Flood Proximity Health Risk Effect social-economic-political-cultural context environmental change hazard intensity/range disease distribution

9. Vietnam: Mekong Delta Annual floods – extremes in 2000, 2001, (2002) 16 million people (40,000 sq km) 16 million people (40,000 sq km) Urban and rural areas prone to flooding Urban and rural areas prone to flooding Income inequalities: poverty line for state benefits is c$16 per month Income inequalities: poverty line for state benefits is c$16 per month Research with University of Social Sciences and Humanities, Ho Chi Minh City Interviews with local government, health facilities, community leaders, mass organisations (urban areas: Cao Lanh and Long Xuyen) Interviews with local government, health facilities, community leaders, mass organisations (urban areas: Cao Lanh and Long Xuyen) Interviews on risk perception, health behaviour, flood response with 24 households in 4 sites Interviews on risk perception, health behaviour, flood response with 24 households in 4 sites

10. ‘Flood-adapted’ but health hazards common, especially for the poor – injury, infection, stress “During September and October my house is flooded two times per day at high tide and the water level is this much [c20cm] from the floor. Because the environment is polluted, each time the water comes up waste drifts into the home.” (resident, Ward My long, Long Xuyen) (resident, Ward My long, Long Xuyen) Health impacts

11.  Draw on specific examples from studies to illustrate the multiple factors shaping vulnerability/coping capacity

12. Local flood management and livelihoods  Establishment of dyke systems small-scale dykes/roadways small-scale dykes/roadways 50% resident contribution 50% resident contribution houses of poor often remain inundated houses of poor often remain inundated prioritization of access/transport prioritization of access/transport  Loss of income floods affect many income activities of the poor e.g. fishing, casual labour, motorcycle, lottery tickets floods affect many income activities of the poor e.g. fishing, casual labour, motorcycle, lottery tickets less able to diversify income options less able to diversify income options less money for food/medicine + anxiety, stress less money for food/medicine + anxiety, stress “We became poor after the flood of 2000. The flood totally destroyed our shrimp pond and we had no income. Now, in each flood, we feel stress and worry about being jobless and not having enough food – this causes sleeplessness, strain and quarrel between family members.” (resident, My Ngai commne, Cao Lanh)

13.  Fishpond latrines traditional ‘rural’ sanitation in urban areas traditional ‘rural’ sanitation in urban areas health risk especially during floods health risk especially during floods official intolerance – but is it cultural conservatism or lack of resources ? official intolerance – but is it cultural conservatism or lack of resources ?  Drinking water common use of river water from creeks common use of river water from creeks incomplete treatment, especially during flood incomplete treatment, especially during flood hygiene education uneven hygiene education uneven risk perception risk perception Water, sanitation and hygiene

14. Health protection services  Health sector preparedness tiered network of preparedness committees including health sector tiered network of preparedness committees including health sector emergency planning – e.g. medical boats, drug supplies emergency planning – e.g. medical boats, drug supplies volunteers (education, monitoring, first aid, boat transport to HFs) volunteers (education, monitoring, first aid, boat transport to HFs) variation in extent and access to these services variation in extent and access to these services  Flood kindergartens child drownings in 2000 child drownings in 2000 unattended young children unattended young children special kindergarten scheme for poor families special kindergarten scheme for poor families sustainability? sustainability? “We prepare an emergency medical boat and 4 teams for assisting people, including Red Cross members and health volunteers” (head of health station, My Hoa Hung commune, Long Xuyen) “Access in floods can only be by boat, and so poor people without boats cannot get access to the health station. We have no resources to organize mobile health teams” (head of health station, My Ngai commune, Cao Lanh)

15. Ongoing analysis….  Factors closely, but not solely, related to livelihoods/poverty, e.g. policy/planning process policy/planning process access to health education access to health education social/cultural norms social/cultural norms support networks support networks physical location physical location  For health risk, additional consideration is an individual’s ongoing health status  Many opportunities for in-depth research on specific aspects of vulnerability and/or coping capacity re. health along the health impact pathway from hazard -> outcome along the health impact pathway from hazard -> outcome

16.  For further information, see: Few, R. (2007) ‘Health and climatic hazards: framing social research on vulnerability, response and adaptation’, Global Environmental Change 17, 281- 295. Few, R. (2007) ‘Health and climatic hazards: framing social research on vulnerability, response and adaptation’, Global Environmental Change 17, 281- 295. Pham Gia Tran and Few, R. (2006) ‘Local responses to floods in the Mekong Delta, Viet Nam’. In Few, R. and Matthies, F. (eds) Flood hazards and health: responding to present and future risks, Earthscan, London, pp.128-144 Pham Gia Tran and Few, R. (2006) ‘Local responses to floods in the Mekong Delta, Viet Nam’. In Few, R. and Matthies, F. (eds) Flood hazards and health: responding to present and future risks, Earthscan, London, pp.128-144 http://www1.uea.ac.uk/cm/home/schools/ssf/dev/people/academic /Few/hazardshealth http://www1.uea.ac.uk/cm/home/schools/ssf/dev/people/academic /Few/hazardshealth