Disaster Preparedness 2023.pptx

Disaster Preparedness & Environmental Health Issues Marci Contreras, Ed.D., PA-C Preventive Medicine Fall 2023 Objectives: Disaster Preparedness Cognitive 1. Identify which individuals may be particularly vulnerable to the consequences of “disasters.” 2. Discuss the nine determinants of population...

Disaster Preparedness & Environmental Health Issues Marci Contreras, Ed.D., PA-C Preventive Medicine Fall 2023 Objectives: Disaster Preparedness Cognitive 1. Identify which individuals may be particularly vulnerable to the consequences of “disasters.” 2. Discuss the nine determinants of population health after disasters. 3. Indicate the primary mechanisms by which having low community socioeconomic status can affect health during times of disaster. 4. Discuss ways in which culture may play a role in health in the post-disaster period. 5. Identify health and social resources available for postdisaster recovery in a) your local community b) your state c) United States. 6. Describe ways in which the physical environment plays a role in certain health conditions and in infrastructure. Objectives: Environmental Health Issues 7. Define environmental health. 8. List the different types of environmental health hazards. 9. Discuss the role of healthcare practitioners in assessing environmental health issues. 10.Discuss the concepts of cumulative risk and multiple stressors (chemical, physical, biological, social). 11.Discuss approaches to risk assessment, risk management, and risk communication regarding environmental health issues. 12.Describe the role of the Environmental Protection Agency in protecting the environment. 13.Explain the purposes of the Clean Water Act and the Safe Drinking Water Act. Disaster Defined… Traumatic events that are experienced by many people and may result in a wide range of mental and physical health consequences. Natural disasters occur outside the control of humans Technological disasters are breakdowns in human-made systems (e.g. grid, oil spill, chemical spills, etc.) Complex emergencies (911 terrorist attack) Emergency vs. Disaster Emergency= any event that requires the unanticipated use of additional community or agency resources. Disaster= is an emergency that requires resources beyond those available locally. Call on state or federal government to intervene How do disasters contribute to individual and population health? Physical trauma, acute disease and emotional trauma. Disasters may increase the morbidity and mortality associated with chronic disease and infectious disease. Poor and medically underserved, especially in rural areas, bear an inequitable amount of the burden. Health care system is immediately overwhelmed; possible damage to healthcare facilities. Food shortage, damage to water systems, etc. Statistics Disasters affect millions of people around the globe every year. There is, on average, at least one disaster every day worldwide Nearly 20% general population in U.S. experience a natural disaster in their lifetime. Who are considered vulnerable? Children Elderly Pregnant women Poor and homeless Disabled Chronically Ill Determinants of population health after disasters 1. 2. 3. 4. 5. 6. 7. 8. 9. Geography Political structure and governance Community socioeconomic status Distribution of income and wealth Culture Health and social services Physical environment Social environment Civic society Geography Areas below sea level (or near bodies of water) Arid areas~ vulnerable to fires Risk of recurrence is unavoidable Solution: Re-locate at-risk populations into lower-risk areas Strategize and mobilize the post-disaster response Political structure and governance Establish parameters > that shape many other contextual factors > that then shape health of individual or population/community Effectiveness of government Food, water, sanitation, health care, other resources Law enforcement Air/Army National Guard Community socioeconomic status Individual poverty Lower perception of disaster risk Poorer disaster preparedness Limited communication of disaster warnings Greater physical and psychological impacts Limited access to emergency response Community socioeconomic status Low socioeconomic status High rates of poverty Unemployment Low education levels Low income levels Health affected by means of 2 primary mechanisms: Limited availability of resources Psychosocial stress accompanying chronic shortage of resources Distribution of income and wealth Inequalities of income distribution = looting, chaos, violence, etc. Psychosocial stress associated with living in communities with high income disparities = violence Actual and perceived inequality = social distrust Lack of investment in community resources Community income inequality may be associated with greater risk of psychopathology after a disaster (PTSD, suicide, homicide), independent of the contribution of individual income. Culture “shared, learned behaviors and meanings that are transmitted socially” Social relationships Religious institutions—safety and housing “Moral economy”~ sharing community resources, creating informal support networks Health and social services Pre-disaster availability of health and social resources is linked to post-disaster recovery. Galveston bounced back pretty well after Ike because of pre-disaster preparedness In U.S. dozens of social agencies~ each with a distinct mission/ service package Local health & social service practitioners have local knowledge, accepted by local community members, and are much more likely to provide continuity of care. Physical Environment Environment ~ related to health conditions: Asthma, other respiratory conditions—molds, legionnaires disease (waterborne) Injuries Psychological distress (e.g. depression/anxiety, PTSD, addiction, suicide) Child development Quality of housing, scale/ connectivity of streets, use of land, aesthetic qualities of place Physical Environment Infrastructure How a city provides water (and drainage), disposes of garbage, provides energy Damage = additional strain Water scarcity 1.5 billion people lack safe drinking water (predisaster) Water pollution 5 million deaths per year due to water-borne diseases Social Environment Social order/ stability= conducive to conformity Disorder= conducive to crime Limited social “cohesion” predisposes persons to poorer coping and adverse health outcomes Pre-existing social stressors influence social interactions between disaster-affected communities and those attempting to provide post-disaster aid. Civic Society Defines the space, not controlled by government or the market, where residents interact to achieve common goals Community-based organizations (CBOs) Nongovernmental organizations (NGOs) Faith-based organizations, places of worship For some, this may be the only formal societal structure standing that has the population’s respect and trust. Lack of trust in government, lean toward non-governmental, civic, local organization for relief and aid. (American Red Cross, Salvation Army, etc.) Implementation Strategies for Health Care Professionals Focus on the fundamental determinants of population health! Understand the context of disaster Educate/assess patients regarding disaster preparedness Interventions that are misdirected (either at the wrong modifiable variable or at the wrong level) ~ may have unintended consequences. Emergency Responders Law enforcement, EMTs, paramedics, and firefighters Healthcare Providers, RNs, RTs, mental health, social work Public health ~ CDC Office of Emergency Management (OEM) Health departments (CDC) During heat wave~ provide shelter for those lacking A/C Ensure safety of water supply, water quality during floods, etc. State level may provide assistance to hospitals, Long-Term Care Facilities, home health clients. Evacuate > Triage > Treat Emergency Management Resources FEMA (Federal Emergency Management Agency) = lead agency for federal disaster response DHS (U.S. Department of Homeland Security) = lead federal agency for emergency response and for federal coordination and standard setting U.S. Department of Health and Human Services = lead agency for public health and specific medical issues Stages of Disaster 1. Preparedness (pre-event phase)- Activities undertaken before a disaster. Continuous process involving efforts to identify threats, determine vulnerabilities, and identify required resources. 2. Response- addressing the short-term, direct effects of an incident. Immediate actions to preserve life, property, and the environment, meet basic human needs, and maintain social, economic, and political structure of the affected community. This phase lasts hours to days depending on nature. Stages of Disaster (cont.) 3. Recovery- Actions needed to help individuals and communities return to normal, when feasible. Actions include development, coordination, and execution of service and site rebuilding/restoration plans. “Getting back to normal” 4. Mitigation- efforts that may be taken either before, during, or after an emergency to lessen its effects (i.e. reinforcing buildings to withstand earthquakes/ hurricanes) if it occurs again. Preparedness Cycle Develop the emergency plan Develop and provide training, based on the plan Test the plan (series of drills and exercises) and repeat Use lessons learned to revise plans and training Employees should know what they’re expected to do! Environmental Health Issues Statistics Environmental health focuses on the relationship humans have with the environment and fosters healthy and safe communities. More than 12 million people around the world die every year because they live or work in unhealthy environments. Environmental Health Hazards air pollution global warming urban sprawl acid rain waste disposal chemical pollution ozone layer depletiondisease-causing microbes water pollution lack of access to health climate change care poor infrastructure Environmental Health Issues Respiratory diseases (e.g. asthma, allergies, COPD, RSV) Heart disease Some types of cancer Infections Endocrine disruption Reproductive health Think of vulnerable populations Environmental Health Issues Risk  Risk is the likelihood that harm will occur if exposure to a hazard occurs.  Risk = Hazard × Exposure × Probability  Cumulative risk refers to the combined threats from exposure via all relevant routes to multiple stressors including chemical, physical, biological, and social factors.  Risk assessment establishes whether a risk is present and, if so, the range or magnitude of that risk.  In the risk management process, the results of the risk assessment are integrated with other considerations, such as economic or legal concerns, to reach decisions regarding the need for and practicability of implementing various risk reduction activities.  Risk communication is an exchange of information among individuals, groups, and institutions related to the assessment, characterization, and management of risk. The ultimate goal of risk communication is to help people make Environmental Protection Agency (EPA) Mission: protect human health and the environment. Ensure clean air, water, soil. Develop and enforce standards or regulations pursuant to environmental statutes Monitor pollutants in the environment Conduct research Promote public environmental education Laws & regulations Clean Water Act (1972) maintain chemical, biological and physical integrity of the navigable waters of the United States. Safe Drinking Water Act (1974) Does not apply to bottled water (reg. by FDA) Does not apply to private wells Clean Air Act (1970) protect public health and public welfare regulate emissions of hazardous air pollutants What can you do? Go GREEN Reduce, reuse, recycle Learn more. Stay up-to-date on topics related to environmental health (e.g. legislation, projects & happenings in the community, etc.) Get involved- nonprofit orgs, cleanup, city/state reps Educate on- Lead, mold, pesticides, smoke, bed bugs, etc. References Environmental Protection Agency (EPA) 2023. https://www.epa.gov/aboutepa/our- mission-and-what-we-do Giorgadze, T., et al. (2011). Disasters and their consequences for public health. Georgian medical news, (194), 59–63. Gorin S.S., Arnold J. (2006) Health Promotion in Practice. San Francisco, CA: Jossey- Bass. Healthy People 2030. https://health.gov/healthypeople/objectivesand-data/browse-objectives/environmentalhealth#:~:text=Environmental%20pollutants%20ca n%20cause %20health,and%20some%20types%20of% 20cancer.&text=People %20with%20low%20incomes %20are,health%20problems %20related%20to%20pollution. Wallace R.B. (2022). Epidemiology and public health. Boulton M.L., & Wallace R.B.(Eds.), Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill. https://accessmedicine-mhmedicalcom.ezproxy.franklinpierce.edu/content.aspx?boo kid=3078&sectionid=255987237 WHO https://www.who.int/activities/environmental-health-impacts