Health Risk from Natural Disasters Mollie Mahany, MPH Senior Public Health Advisor Centers for Disease Control and Prevention

Definition of a natural disaster A disaster that is caused by naturally-occurring hazards Natural disasters are defined as: “Disasters that are caused by naturally-occurring hazards” Naturally-occurring hazards include meteorological, geological and biological hazards Examples of natural disasters include: Tornadoes Typhoons floods Storm surges Windstorms Wildfires Heat waves Dust storms Snowstorms Earthquakes Tsunamis Volcanic Landslides Avalanches Outbreaks of infectious disease

Classes of natural disasters Hydro- meteorological Floods Storm surges Windstorms Wildfires Heat waves Dust storms Snowstorms Geological Earthquakes Tsunamis Volcanic Landslides Avalanches Biological Epidemics Pandemics Disasters may also be classified according to the type of hazard that causes the disaster. This is the most common type of classification, and the one that we will use for most of this course There are three main hazard-based classifications for natural disasters. These are as follows: hydro-meteorological – having to do with weather (i.e. floods, typhoons, heat waves, etc.) geological – having to do with the earth, land and sea (i.e. earthquakes, volcanoes, tsunamis, landslides, etc) biological – refers to infectious diseases (i.e. influenza, dengue fever, etc)

Hazard-based classification of natural disasters Geological Hydro-meteorological Seismic Volcanic High precipitation Low precipitation Earth-quake Tsunami Volcanic eruption Land-slide Tropical Cyclone Flood Drought Wildfire This table shows how 2 of the 3 hazard-based classification may be further sub-divided. The 3 categories of natural disasters are caused by geological, hydro-meteorological and biological hazards Geological disasters may be further sub-divided into seismic and volcanic hazards: Seismic means having to do with earthquakes and the tsunamis that result from earthquakes. Volcanic – disasters related to volcanic eruptions Hydro-meteorological disasters maybe further subdivided into high precipitation and low precipitation events: High precipitation events involve hazards that our associated with too much rain. As you can see on the slide, landslides are geological events that have to do with the earth, but landslides are also in the high precipitation area because, in some cases, they are also caused by heavy rain. For example, in 2002, heavy rains associated with Typhoon Chata’an caused landslides to occur in Chuuk, Micronesia killing 43 persons. Low precipitation events involve hazards that are associated with too little rain. Biological natural disasters may also be further subdivided. These subdivisions include: outbreaks; epidemics; and pandemics Keim 2010

Pacific islanders carry the highest disaster burden in the world Number of disasters reported: (Incidence a measure of the frequency with which new events occur among a population during a specified period.  In the case of this graph, the incidence of natural disasters is being reported on an annual basis.) The graph reveals that there has been a sharp increase in the number of natural disasters reported every year over the last 100 years. It is not yet understood why the number of natural disasters has been steadily decreasing since 2000

Pacific islanders have the 2nd highest mortality rate in the world Number of disasters reported: (Incidence a measure of the frequency with which new events occur among a population during a specified period.  In the case of this graph, the incidence of natural disasters is being reported on an annual basis.) The graph reveals that there has been a sharp increase in the number of natural disasters reported every year over the last 100 years. It is not yet understood why the number of natural disasters has been steadily decreasing since 2000

Pacific islands have the 2nd highest per capita losses in the world Number of disasters reported: (Incidence a measure of the frequency with which new events occur among a population during a specified period.  In the case of this graph, the incidence of natural disasters is being reported on an annual basis.) The graph reveals that there has been a sharp increase in the number of natural disasters reported every year over the last 100 years. It is not yet understood why the number of natural disasters has been steadily decreasing since 2000

The incidence of natural disasters is increasing worldwide (1900-2005) Natural disasters according to type: Biological – infectious disease outbreaks (e.g. SARS, influenza) – the dark purple line Geological – related to the earth (e.g. earthquakes, tsunamis) – a light purple line Hydrometeorological – related to weather (e.g. typhoons, tornadoes)- the light blue line As we can see in this graph, the incidence of hydro-meteorological (weather-related) disasters has increased remarkably since the 1960’s It is not yet known why weather-related disasters have been increasing so much more in recent years, but it is thought to be related to climate change.

Top 4 causes of death due to disasters in the Pacific Tsunamis Cyclones Floods Landslides During the last 4 decades, the world’s five worst natural disasters each killed well over 100,000 people In many cases the deaths were over 200,000 – 300,000 people killed. These numbers are deaths only, doesn’t include the number of people affected by these large events Photo is of the Indian Ocean tsunami in 2004. (source: http://www.emdat.be/search-details-disaster-list)

Most disaster deaths occur BEFORE emergency response Hazard Cause of death Tsunami Severe trauma and drowning Cyclones Drowning Floods Landslides Severe trauma

Vulnerability to natural disasters 95% of natural disaster deaths occur among 66% of the poorest countries The Pacific is one of the most disaster prone area in the world followed by Asia; Latin America and Africa; and North America, Europe, and Australia, the least. Reasons why disaster deaths occur more frequently in developing countries among the poor: Housing: Poor are least able to afford housing that can withstand natural disasters such as earthquakes and hurricanes; they often live along the coast in developing countries where hurricanes, storm surge, or tsunamis may affect them; or in flood planes; on unstable slopes that are susceptible to landslides; or next to hazardous industrial sites. Education: poor generally aren’t as educated in preparedness behaviors or actions they can take in disasters to save their lives. Building codes: Generally, in developing countries building codes are either not present or not as strict and not enforced if present and therefore are less likely to withstand earthquakes and hurricane Disaster warnings and alerts as well as evacuation plans are not as well developed as in industrialized countries. Disaster planning and education of the public generally not as developed as in industrial countries. Developing countries have the less resources for emergency medical response and less highly trained responders. Developing countries have fewer resources and have decreased capacity to respond and recover from disasters.

Public health consequences of natural disasters Death Injuries Loss of clean water Loss of shelter Loss of personal household goods Major population movements Loss of sanitation Loss of routine hygiene Disruption of solid waste management Public concern for safety Increased pests & vectors Damage to health care system Worsening of chronic illnesses Loss of electricity Toxic/ hazardous exposure Loss of food supply There are 16 categories of public health consequences related to all natural disasters. Despite the fact that there are many different types of natural disasters, all may have these consequences that can be grouped into 16 categories Differences between the different natural disasters a related to the degree that one public health consequences may be increased as compared to another. For example, during typhoons , there are usually relatively few deaths. However, there is a large area , which commonly loses shelter and clean water. In comparison, during landslides there are usually more deaths than typhoons, but less loss of shelter and clean water. So in both cases we should be planning for the public health consequences of: deaths, loss of clean water, and loss of shelter, regardless of the cause. By preparing for each of these 16 categories we can be prepared for all natural disasters. Although we classify the list as public health consequences – “having an impact on the health of the public” – it should be noted that during a disaster response, many agencies beyond public health are required to assist the public. It is not just a problem to be handled by public health professionals alone. Example: Getting soap and clean water to a shelter could involve a variety of government and private agencies. Public health probably does not have large quantities of soap and water so they would require help from other agencies to provide these items to those who need them. This is true for many other consequences, such as loss of electricity, etc.

Earthquakes and tsunamis often cause many severe injuries. Consequence Earthquake Tsunami Volcanic eruption Landslide Tropical Cyclone Flood Drought Wildfire Deaths Many Few to moderate Few, but many in poor nations Few Severe injuries Unlikely Loss of clean water Focal to widespread   Focal Widespread Loss of shelter Loss of personal / household goods Major population movements Loss of routine hygiene Loss of sanitation Disruption of solid waste mgt Public concern for safety High Moderate to High Low to moderate Increased pests Loss or damage of health care system Worsening of chronic illnesses Loss of electrical power Toxic exposures Few to moderate for CO poisoning Widespread for air, soil and surface water Widespread for air Food scarcity Common in low-lying coastal areas Widespread in poor nations This is a table showing the public health consequences common to all natural disasters. Almost all of the consequences will (or may) happen for almost every hazard The impact (degree or severity of the consequence) will vary depending on the type and size of the event. Examples – Earthquakes and tsunamis often cause many severe injuries. Volcanoes and landslides commonly cause a few or a moderate number of severe injuries. Cyclones, floods and wildfires often cause fewer injuries. It is unlikely that drought will cause any severe injuries at all.

So, how do we reduce health risk? Reduce exposures Identify the hazard Monitor the hazard Provide early warning Evacuate people at risk Reduce vulnerability Promote health and education Strengthen public health and healthcare Protect key resources Livelihoods, shelter, food, water, sanitation

Thank you