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In 1994, the first World Conference on Natural Disaster Reduction held in Yokohama, Japan affirmed that “Disaster prevention, mitigation, and preparedness are better than disaster response in achieving the goals and objectives of the decade. Disaster response alone is not sufficient, as it yields only temporary results in a very high cost.” Since then, disaster risk reduction has become the mainstay for international development related to disasters. According to the National Research Council (Washington, DC USA), “Disaster research, which has focused historically on emergency response and recovery, is incomplete without the simultaneous study of the societal hazards and risks associated with disasters, which includes data on the vulnerability of people living in hazard prone areas.” Despite over 25 years of global policy development, the National Academies of Sciences, Engineering, and Medicine (Washington, DC USA) recently noted that, “while some disaster management and public health preparedness programming may be viewed as tangentially related, a multi-sectoral and inter-disciplinary national platform for coordination and policy guidance on involving disaster risk reduction in the United States does not exist.” Today, one of the world’s “seven targets in seven years” as agreed upon in the Sendai Framework for Disaster Risk Reduction is to substantially reduce global mortality by 2030. Significant reductions in health risk (including mortality) have historically required a comprehensive approach for disease management that includes both a preventive and a curative approach. Disaster risk management has arisen as a primary means for the world’s populations to address disaster losses, including those related to health. Prevention has been proven as an effective approach for managing health risk. This report describes the role of disease prevention in managing health risk due to disasters. KeimM . Managing disaster-related health risk: a process for prevention . Prehosp Disaster Med . 2018 ; 33 ( 3 ): 326 - 334 .
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Managing Disaster-Related Health Risk: A
Process for Prevention
Mark Keim, MD, MBA
1,2,3,4
1. Disaster Doc, LLC, Atlanta, GA USA
2. National Center for Disaster Medicine and
Public Health, Bethesda, MD USA
3. Beth Israel Deaconess Medical Center,
Disaster Medicine Fellowship, Harvard
University Medical School, Boston MA
USA
4. Rollins School of Public Health, Emory
University Atlanta, GA USA
Correspondence:
Mark Keim, MD, MBA
DisasterDoc LLC
Atlanta Georgia USA
E-mail: mark@disasterdoc.org
Abstract
In 1994, the rst World Conference on Natural Disaster Reduction held in Yokohama, Japan
afrmed that Disaster prevention, mitigation, and preparedness are better than disaster
response in achieving the goals and objectives of the decade. Disaster response alone is not
sufcient, as it yields only temporary results in a very high cost.Since then, disaster risk
reduction has become the mainstay for international development related to disasters.
According to the National Research Council (Washington, DC USA), Disaster research,
which has focused historically on emergency response and recovery, is incomplete without the
simultaneous study of the societal hazards and risks associated with disasters, which includes
data on the vulnerability of people living in hazard prone areas.Despite over 25 years of global
policy development, the National Academies of Sciences, Engineering, and Medicine
(Washington, DC USA) recently noted that, while some disaster management and public
health preparedness programming may be viewed as tangentially related, a multi-sectoral and
inter-disciplinary national platform for coordination and policy guidance on involving disaster
risk reduction in the United States does not exist.Today, one of the worldsseven targets in
seven yearsas agreed upon in the Sendai Framework for Disaster Risk Reduction is to
substantially reduce global mortality by 2030.Signicant reductions in health risk (including
mortality) have historically required a comprehensive approach for disease management that
includes both a preventive and a curative approach. Disaster risk management has arisen as a
primary means for the worlds populations to address disaster losses, including those related to
health. Prevention has been proven as an effective approach for managing health risk. This
report describes the role of disease prevention in managing health risk due to disasters.
Keim M. Managing disaster-related health risk: a process for prevention.
Historical Background
Twenty-ve years ago, world policy makers began to formalize relationships between health,
sustainable development, and disaster management and began to implement this alignment
within international strategies for risk management.
1
The outputs of these meetings
(furthered by subsequent development of international standards for risk management) have
since contributed to a global doctrine for disaster risk management for all sectors, including
health.
2
Table 1,
1,3-9
lists key events in the development of international policies for
managing disaster-related health risk according to a comprehensive approach.
Disaster Risk Management
Risk
Risk can be viewed as a representation of the degree of uncertainty involving the interaction between
an event and its outcome. Uncertainty adversely effects ability to predict the risk of outcome.
Management
Processes that decrease the degree of uncertainty among activities are known to improve the
likelihood of accomplishing the outcome (or objective). Management is a process used to
reduce the uncertainty of outcomes through organization and coordination of the activities
intended to achieve dened objectives.
Process Management
A process is a set of activities that interact to achieve a result (or outcome). Process
management is an approach based upon systems to measure and control processes to
Conicts of interest/funding/disclaimer: This
work was sponsored by DisasterDoc, LLC
(Atlanta, Georgia USA), a private consulting
rm specializing in disaster research and
education. The author attests that there are no
conicts of interest involved with the
authorship and publication of this work. The
material in this manuscript reects solely the
views of the author. It does not necessarily
reect the policies or recommendations of the
National Center for Disaster Medicine and
Public Health (Bethesda, Maryland USA).
Keywords: disaster; disaster risk management;
health risk; prevention; public health emergency
Received: April 8, 2017
Revised: August 30, 2017
Accepted: September 24, 2017
doi:10.1017/S1049023X18000419
SPECIAL REPORT
Prehospital and Disaster Medicine
Year Context Event Output Significance
1992 Rio UN Conference on
Environment and
Development
Agenda 21 Identified the goal of Reducing health risks from
environmental pollution and hazardsas one of
five key priority actions for sustainable
development.
1994 Yokohama World Conference on Natural
Disaster Reduction
Yokohama Strategy
and Plan of Action
for a Safer World
Recognized that sustainable economic growth and
sustainable development cannot be achieved in
many countries without adequate measures to
reduce disaster losses…”
1994 BPoA Global Conference on
Sustainable Development
of Small Island Developing
States
Barbados Program of
Action
First conference that translated Agenda 21 into a
program of action for a group of countries.
Recognized that Small island developing states
are particularly vulnerable to natural as well as
environmental disasters and have a limited
capacity to respond to and recover from such
disasters.
2002 UNISDR The Geneva Mandate on
Disaster Reduction
United Nations
International
Strategy for
Disaster Reduction
Established the United Nations International
Strategy for Disaster Reduction, the secretariat to
ensure coordination and synergiesamong
United Nations member risk reduction activities.
2002 Rio + 10 World Summit on Sustainable
Development
The Johannesburg
Plan of
Implementation
First recognized that An integrated, multi-hazard,
inclusive approach to address vulnerability, risk
assessment, and disaster management,
including prevention, mitigation, preparedness,
response, and recovery, is an essential element of
a safer world in the twenty-first century.
2004 Pacific Health
Summit
Pacific Health Summit for
Sustainable Disaster Risk
Management
Declaration of the
Pacific Health
Summit
First conference that translated BPoA and Rio + 10
into a regional plan for the health sector of multiple
nations.
Called for an integrated, multi-hazard, and
inclusive approach to address vulnerability, risk
assessment and disaster management, including
prevention, mitigation, preparedness, response
and recovery.
2005 Yokohama + 10 Second World Conference on
Disaster Reduction
Hyogo Declaration Recognized that a culture disaster prevention,
resilience, and associated pre-disaster strategies,
which are sound investments, must be fostered at
all levels, ranging from the individual to the
international levels.
Stated that, disaster risks hazards and their
impacts pose a threat but appropriate response to
these can and should lead to actions to reduce
risks and vulnerabilities in the future.
2005 BPoA + 10 Mauritius International
Meeting for review of the
BPoA
Mauritius Strategy for
Implementation
Recognized the need to enhance and establish, if
necessary, means and tools at the international
level aimed at implementing a preventive
approach for natural disasters.and properly
integrating risk management into development
policies and programs…”
2012 Rio + 20 United Nations Conference
on Sustainable
Development
Rio + 20 Outcome
Document
Emphasized the need for action on the social and
environmental determinants of healthand called
for disaster risk reduction and the building of
resilience to disasters to be addressed with a
renewed sense of urgency in the context of
sustainable development…”
2015 Yokohama + 20 Third World Conference on
Disaster Reduction
Sendai Framework
for Disaster Risk
Reduction 2015-
2030
15-year, voluntary, non-binding agreement
articulates the need for improved understanding
of disaster risk in all its dimensions of exposure
and vulnerability in hazard characteristics
inclusive of health.
Keim © 2018 Prehospital and Disaster Medicine
Table 1. Key Events in the Development of International Policies for Managing Disaster-Related Health Risk
1,3-9
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2 Managing Disaster-Related Health Risk
achieve an intended goal or outcome. Here, process is considered
as an input which accomplishes an outcome. These outcomes are
represented in terms of goals or objectives and are thus considered
as outputs of the system. Similarly, risk management systems apply
inputs (referred to as capacity) which accomplish an output
(known as capability).
Table 2 illustrates the relationship between inputs used for risk
management, process management, and performance manage-
ment. The signicance of these concepts is based upon the
recognition that risk management activities (ie, risk assessment)
are part of an integrated management system with measurable
inputs and outputs that may be controlled for efciency and
effectiveness.
Risk Management
Risk management is activity directed toward assessing, control-
ling, and monitoring risks. In risk management, evidence on risk
factors is collected and analyzed, contexts are assessed, and risk
treatment measures are implemented using standard strategies.
2
Strategies for risk management include risk assessment and risk
treatment measures. Risk assessment typically involves application
of an analytical risk assessment used to guide the most cost-
effective options for treatment of the risk.
These control measures include: avoiding the risk; reducing the
negative effect of the risk; transferring the risk to another party;
and accepting some or all of the consequences of a particular risk.
ISO 31000 is a set of international standards relating to risk
management as codied by the International Organization for
Standardization (Geneva, Switzerland).
2
Disaster Risk Management
Disaster risk management applies the general principles of risk
management to disasters. It is a comprehensive approach
that entails developing and implementing strategies for the entire
disaster life cycle, before and after hazard impact.
10
Disaster risk
management includes pre-impact risk avoidance, reduction and
transfer measures, as well as post-impact measures including risk
transfer and risk retention.
Once risks have been identied and assessed, techniques to
manage or treatthe risk fall into one or more of these four major
categories described in Table 3,
11
(note that that efciency and cost
effectivenesstend to decrease for strategies listed lower in the table).
Figure 1 and Table 4,
12,13
describe the components of disaster
risk management, in terms of risk assessment and risk treatment.
Natural History of Disaster-Related Disease
Natural History of Disease
The fundamental principle upon which disease management is
based recognizes that development of any disease (which also
includes injury) progresses through a natural history that can be
broken into a series of stages. If left untreated, a disease will evolve
through a series of stages that characterize its natural history. But if
an intervention is applied, the natural history is modied to
improve the outcome. Preventive measures can be applied at any
stage along the natural history of a disease, with the goal of pre-
venting further progression of the condition.
14
Figure 2 represents the natural history of disease,the concept
of health and disaster-related disease as processes that unfold over
time in a series of steps. Effective disease management requires
management of the immediate problem, then of the patients risk
factors, and nally, of the underlying determinants.
Casual Factors for Disease
Disease does not occur randomly. It is caused when vulnerable
hosts are exposed to an environment containing agents that are
hazardous to health. It is therefore possible to study the causal
factors involving the agent, host, and environment, including both
risk and protective factors. Figure 3,
15
illustrates how disease is
caused by a complex interaction between the person (host), the
disease agent (hazard), and the environment (exposure).
The Natural History of Disaster-Related Injuries
The time between exposure to the hazard and onset of disease (the
incubation period) is of critical importance when prioritizing
public health activities intended to reduce disaster-related
mortality.
The period for developing a life-threatening injury is com-
monly measured in minutes to hours, whereas this period for
outbreaks of disease is most commonly measured in days to weeks.
This rapid onset of disaster-related injuries markedly limits the
effectiveness of secondary and tertiary prevention (eg, response
and recovery interventions). For example, the outcome of trau-
matic injuries is highly dependent upon the rapid availability of
denitive surgical care within one hour from exposure (commonly
known as the golden hourdue to its valuable critical impact on
survival outcome; Figure 4).
Risk Treatment
Measure Description Examples
Avoidance Elimination of the hazard
itself
Flood prevention
Smallpox
eradication
Reduction Reducing exposures to
the hazard
Population
evacuation
Public education
Transfer Transferring or sharing risk
with others
Insurance
Mutual aid
Retention Accepting and budgeting
for risk when it occurs
Preparedness
Response
Recovery
Keim © 2018 Prehospital and Disaster Medicine
Table 3. Four Strategies for Treating Disaster Risk
11
Systems-Based
Approach Inputs Outputs
Process Management Processes, the
means
Outcomes, the
ends
Risk Management Functions
(capacity-focused)
Goals
(capability-
focused)
Performance
Management
Efficiency Effectiveness
Keim © 2018 Prehospital and Disaster Medicine
Table 2. A Comparison of Systems for Managing Process,
Risk, and Performance
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Keim 3
Keim © 2018 Prehospital and Disaster Medicine
Figure 1. Schematic Overview of Disaster Risk Management Process.
10,12,13
Component Activities
Hazard Analysis
Hazard Identification
Hazard Probability
Identifying hazards with the potential to cause loss or damage of an asset.
Determining frequency of past hazard events.
Impact Analysis
Asset Assessment
Loss Assessment
Determining critical assets (ie, population or medical facilities).
Identifying expected loss or damage of each asset for each hazard.
Prioritizing assets based on consequence of loss.
Capacity Assessment Identifying strengths, attributes, and resources available to counter the adverse effects of a disaster.
Exposure Assessment Determining degree of asset contact with or exposure to the hazard.
Vulnerability Assessment
Susceptibility
Severity
Estimating degree of vulnerability of each asset for each hazard.
Identifying pre-existing countermeasures and their level of effectiveness.
Countermeasure Determination
Avoidance/Reduction
Transfer/Retention
Identifying new countermeasures which may be taken to eliminate or lessen hazards, and/or exposures,
and vulnerabilities.
Cost - Benefit Analysis Identifying countermeasure costs and benefits.
Prioritizing options.
Risk Communication Preparing a range of recommendations for decision makers and/or the public.
Risk Management Plan A plan for disaster risk treatment is developed for each phase of the emergency cycle.
Implementation and Monitoring The risk management program is implemented and monitored per plan.
Keim © 2018 Prehospital and Disaster Medicine
Table 4. Key Components of Disaster Risk Management
10,12,13
Q2
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4 Managing Disaster-Related Health Risk
However, the character of most large-scale, environmental (eg,
technological, hydro-meteorological, and geophysical) disasters
commonly precludes accessibility of life-saving surgical care for the
overwhelming majority of patients. This is of critical signicance
considering that 60% of the worlds disaster deaths during the past 50
years were due to injury caused by these same environmental hazards.
16
Keim © 2018 Prehospital and Disaster Medicine
Figure 2. Natural History of Disease.
14
Keim © 2018 Prehospital and Disaster Medicine
Figure 3. Causal Factors for Disease.
15
Abbreviations: PPE, personal protective equipment; WASH, water, sanitation, and
hygiene.
Prehospital and Disaster Medicine
Keim 5
Thus, the natural history of disaster-related injuries often limits
the effectiveness of secondary and tertiary prevention following
disasters from technological, geophysical, and hydro-
meteorological hazards, emphasizing the importance of primary
prevention before the event occurs. On the other hand, the com-
parably slower onset and chronic nature of events caused by
biological and societal hazards does allow more time for effective
mortality reduction through secondary and tertiary prevention
measures during response and recovery. In order to be effective in
reducing mortality, health-related actions must be applied during
the appropriate window of opportunity. It is important to recog-
nize the value of a comprehensive approach to the prevention for
disaster-related mortality.
Primary prevention of the exposure (before injury can occur) is
therefore of critical importance to reducing mortality risk from
these environmental hazards. In outbreaks and societal disasters,
there is frequently more time available to allow for effective clinical
and public health intervention before signicant disease, disability,
or death occurs.
Disease Prevention
Disease prevention includes a wide range of activities aimed at
reducing health risks and improving health outcomes. Prevention
occurs in four main stages: primordial, primary, secondary, and
tertiary.
14
Primordial prevention involves preventing health
hazards from occurring. Primary prevention involves preventing
exposure, given that hazards exist. Secondary prevention involves
preventing disease, given exposure has occurred. Tertiary preven-
tion involves preventing further progression (eg, prolonged
impairment; permanent disability; or death) given that disease
(including injury) has occurred.
Primordial prevention seeks to modify the fundamental health
determinants (the cause of the causeof disease). Primary, sec-
ondary, and tertiary prevention seek to modify risk and protective
factors. Primary prevention focuses on reducing risk factors for
exposure to the disaster hazard. Secondary and tertiary prevention
focus on reducing the risk factors for vulnerability to disease.
Secondary prevention seeks to prevent disease by reducing disease
susceptibility. Tertiary prevention seeks to prevent disability and
death by reducing disease severity. Table 5 represents a model
for integration of approaches for managing disease, disaster risk,
and emergencies.
Primordial Prevention
Primordial prevention involves preventing the hazard occurrence
and thus avoiding the environmental, economic, health, social,
behavioral, and cultural factors of vulnerability known to amplify
the risk of disease. It addresses broad health determinants rather
than preventing personal exposure to risk factors, which is the goal
of primary prevention.
14
Primordial prevention seeks rst to
prevent the disaster hazard from ever occurring. For example,
oodplain management in an area of frequent ooding may
actually prevent future ood hazards altogether, and therefore
aligns with the disaster risk management activity of hazard
avoidance. In examples where the hazard cannot be prevented,
primordial prevention may be used to guide developmental
decisions that avoid placing critical infrastructure and human
settlements within hazardous areas.
Primary Prevention
The adverse health effect of a hazard is often characterized by a
dose-response relationship. Typically, as the degree of exposure to
a health hazard increases, the adverse health effect appears in
more of the population. In the case of natural and infectious
disease disasters, the degree of exposure of a given population to
the hazard (eg, extremes of wind, temperature, precipitation,
seismicity, volcanism, or biological agent) has a direct relationship
to the incidence and severity of adverse health outcomes.
Persons receiving a higher dose (magnitude of exposure to the
disaster hazard over time) of the hazardous agent have a higher
risk for adverse health outcomes as compared with those less
exposed.
Primary prevention involves preventing exposures that would
lead to disease. The goal of primary prevention is to prevent
population exposure to risk factors.
17
It involves an inter-
disciplinary approach for identifying, characterizing, monitoring,
and avoiding exposure to human health hazards. This includes
those investigational aspects (like monitoring, forecasting,
modeling, and dose reconstruction), as well as structural (eg,
engineering controls, construction methods, and architectural
design) and nonstructural (eg, public policy, education, and
population protection measures) means for reducing exposures.
12
Secondary Prevention
The goal of secondary prevention is to prevent disease, given that
exposure has already occurred.
17
These activities typically involve
emergency response activities, such as search and rescue, mass-
casualty response, disease control, and hazardous material
response, that enable early diagnosis and appropriate management
of disease. Disaster response is predominantly focused on
immediate and short-term needs and is sometimes called disaster
relief.Response usually includes those actions immediately
necessary to remove the affected population from ongoing expo-
sure or risk of harm. Effective response reduces adverse health
impacts.
This element of risk retention accepts the risk of disease and
seeks to prepare and respond to disease incidence with ameliora-
tive and curative approaches. Risk retention involves accepting
disaster loss when it occurs and then attempting to respond and
recover (if possible). By default, all residual risks that are not
avoided or transferred are retained and will require allocation of
Keim © 2018 Prehospital and Disaster Medicine
Figure 4. Natural History of Disaster-Related Injuries.
Prehospital and Disaster Medicine
6 Managing Disaster-Related Health Risk
resources at some time in the future. Risk acceptance is not
considered sustainable since the likelihood of future losses created
by current developmental decisions is, in effect, being transferred
to future generations for subsequently more expensive ad hoc
emergency resource allocations.
Tertiary Prevention
The goal of tertiary prevention is to prevent the progression of
impairment, disability, and death given that disease has
occurred.
17
Tertiary prevention includes capabilities that reduce
vulnerability as applied to disease severity, thus minimizing the
risk of additional risk in the form of protracted illness, medical
complications, disability, and death.
The capabilities involved in the tertiary prevention of disaster-
related morbidity and mortality largely involve a network of
curative health, rehabilitative health, communication, and
social services intended to prevent additional or ongoing disability
and death after the disease or injury occurs. This rehabilitation
and recovery phase is characteristically long in duration and
often an opportune time to initiate new aspects of primary
prevention as the society attempts to build back betterand
reduce future risk.
Tertiary prevention of disaster risk involves measures taken
during the recovery and rehabilitation phase as a component of
risk retention. Recovery and rehabilitation begin soon after the
emergency phase has ended, and should be based on pre-existing
strategies and policies that facilitate clear institutional responsi-
bilities for recovery action and enable public participation. The
division between the response stage and the subsequent recovery
stage is not clear-cut. Some response actions, such as the supply of
temporary housing and health care, may extend well into the
recovery stage.
Public health has systematically developed signicant state,
national, and international capabilities to address the effects of
disasters (eg, mortality, morbidity, displacement, or loss of liveli-
hood), but less so for addressing the root causes (hazards, expo-
sures, and vulnerability). Figure 5 compares these root causes with
the associated outcomes of disaster-related health effects.
Table 6 reveals the means by which disease prevention may be
integrated to achieve the mutual goal of reducing disaster-related
health risk. All stages of prevention begin with an assessment of
the health risk. These data are collected from routine health sur-
veillance as well as other disaster-specic outreach activities
involving enhanced surveillance, needs, hazard characterization,
risk analysis, and communication.
Conclusion
Effective disaster risk management requires not only management
of the immediate problem (disaster-related injuries and disease),
but also of the patients risk factors and of the underlying
health determinants. This requires the involvement of many
sectors and disciplines which contribute to the management of
health risks associated with emergencies and disasters. Disaster-
related deaths are effectively reduced by health interventions and
other measures that occur within a framework of: primary
prevention (preventing hazards and exposures); secondary
prevention (preventing injury or disease following exposure); and
tertiary prevention (preventing disability and death following
injury/disease).
The natural history of disaster-related injuries often limits the
effectiveness of secondary and tertiary prevention following dis-
asters from technological, geophysical, and hydro-meteorological
hazards, emphasizing the importance of primary prevention before
the event occurs. On the other hand, the relatively slower onset
and often chronic nature of events caused by biological and societal
hazards does allow more time for effective mortality reduction
through secondary and tertiary prevention measures during
response and recovery. In order to be effective in reducing
mortality, health-related actions must be applied during the
appropriate window of opportunity. It is important to recognize
the value of a comprehensive approach to the prevention for
disaster-related mortality.
Stage of
Prevention Prevention Goal
Risk Management
Goal
Disaster Risk Management
Goal
Emergency Management
Goal
Primordial Prevent hazards Risk avoidance Hazard avoidance
Mitigation
Primary Prevent exposures Risk reduction Exposure reduction
Secondary Prevent disease
Risk transfer and
risk retention
Vulnerability reduction
(disease susceptibility)
Preparedness/ Response
Tertiary Prevent disability and death Vulnerability reduction
(disease severity)
Recovery/ Rehabilitation
Keim © 2018 Prehospital and Disaster Medicine
Table 5. Public Health Prevention as an Integrated Approach for Managing the Risk of Disease
Keim © 2018 Prehospital and Disaster Medicine
Figure 5. Relationship between Causal Factors and Outcomes
for Disaster-Related Health Risk.
Prehospital and Disaster Medicine
Keim 7
References
1. United Nations. United Nations Conference on Environment and Development -
Agenda 21. 1992. https://sustainabledevelopment.un.org/content/documents/
Agenda21.pdf. Accessed August 30, 2017.
2. ISO. ISO 31000 - Risk management a practical guide for subject matter exp erts. 2009.
https://www.iso.org/standard/43170.html. Accessed August 30, 2017.
3. United Nations. UN Report of the Ad Hoc Committee ofthe Whole of the 22nd Special
Session ofthe Gen. Assembly. New York, New York USA: United Nations; 1994: 1-30.
4. United Nations. UN Resolution adopted by the 56 Session Gen. Assembly:
International Strategy for Disaster Reduction. New York, New York USA: United
Nations; 2002: 1-5.
5. United Nations. UN Plan of Implementation of the World Summit on Sustainable
Development. New York, New York USA: United Nations; 2002: 1-62.
6. Centers for Disease Control (CDC). Declaration of the Pacic Health Summit for
Sustainable Disaster Risk Management. Pacic Health Dialogue 2004;13(1):5-10.
7. United Nations. UN Hyogo Declaration, in World Conference on Disaster
Reduction. Hyogo, Japan: United Nations International Strategy for Disaster
Reduction; 2005: 1-5.
8. United Nations. UN Draft Mauritius Strategy for the Further Implementation of the
Program of Action for the Sustainable Development of Small Island Developing
States, in International Meeting to Review the Implementation of the Program of
Action for the Sustainable Development of Small Island Developing States. Port
Louis, Mauritius: United Nations; 2005: 1-30.
9. United Nations. UN Resolution 66/28 The Future We Want. New York, New York
USA. United Nations 2012: 1-53.
Stage of Prevention
Disaster Risk
Management
Capability
Capabilities for Environmen-
tal Hazards
Capabilities for Societal
Hazards
Capabilities for Biol-
ogical Hazards
Primordial Prevention
Preventing Hazards
Risk Assessment Health surveillance
Geological and hydro-
meteorological hazard
analysis
Hazard mapping
Health surveillance
Disease risk assessment
Security threat assessment
Health surveillance
Disease risk assessment
Hazard Avoidance Land use regulation
Hazard substitution
Preventive maintenance
Engineering controls
Conflict resolution
Peacekeeping
Veterinary health
Agricultural sciences
Environmental health
Public utilities and
services
Primary Prevention
Preventing Exposures
after
Hazards Occur
Risk Assessment Health surveillance
Health impact assessment
Hazard, vulnerability, and
capacity analysis
Health surveillance
Disease risk assessment
Security threat assessment
Health surveillance
Disease risk assessment
Hazard Monitoring Health surveillance
Environmental monitoring
Industrial hygiene
Health surveillance
Medical intelligence
Health surveillance
Veterinary surveillance
Vector surveillance
Exposure
Reduction
Public warning systems
Weather forecasting
Industrial hygiene
Structural mitigation
Building codes
Evacuation
Sheltering/ settlement
Public warning systems
Evacuation
Sheltering/settlement
Security
Water, sanitation, and
hygiene (WASH)
Public warning systems
Isolation/Quarantine
Social distancing
Personal protective
equipment (PPE)
WASH
Secondary Prevention
Preventing Disease
after
Exposure Occurs
Risk Assessment Health surveillance
Rapid needs assessment
Exposure assessment
Damage/loss assessment
Health surveillance
Rapid needs assessment
Security threat
assessment
Health surveillance
Disease risk assessment
Disease early warning
systems
Vulnerability
Reduction
(susceptibility)
Emergency health services
Curative health services
Risk communication
Psychosocial services
Vaccination
Emergency health services
Curative health services
Risk communication
Psychosocial services
Emergency health
services
Curative health services
Risk communication
Psychosocial services
Tertiary Prevention
Preventing Disability/
Death after
Disease Occurs
Risk Assessment Health surveillance Health surveillance Health surveillance
Vulnerability
Reduction
(severity)
Emergency health services
Curative health services
Rehabilitative health services
Risk communication
Keim © 2018 Prehospital and Disaster Medicine
Table 6. Examples of Capabilities for Preventing Disaster-Related Health Effects
17
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8 Managing Disaster-Related Health Risk
10. Keim M. Disaster Risk Management for Health. In: David S, (ed). Textbook of
Emergency Medicine. Chicago, Illinois USA: Wolters Kluwer Health (Lippincott);
2010: 1309-1318.
11. Dorfman MS. Introduction to Risk Management and Insurance. 9th Edition.
Englewood Cliffs, New Jersey USA: Prentice Hall; 2007.
12. Keim M. Environmental Disasters. In: Frumkin H, (ed). Environmental Health
from Global to Local. San Francisco, California USA: Wiley and Sons; 2016;
667-692:843-875.
13. KeimM.IntentionalChemicalDisasters.In:HoganD,BursteinJ,(eds).Disaster Medicine.
Philadelphia, Pennsylvania USA: Lippincott Williams & Wilkins; 2002: 340-348.
14. Association of Faculties of Medicine of Canada. AFMC primer on population health.
2017. http://phprimer.afmc.ca/Glossary?l=H. Accessed August 30, 2017.
15. Frost WH. Some conceptions of epidemics in general. Am J Epidemiol 1976;103
(2):141-151.
16. Center for Research on the Epidemiology of Disasters (CRED). EM-DAT:
The International Disaster Database. 2017. www.emdat.be/. Accessed August 30,
2017.
17. Keim M, Abrahams J, Castilla-Echenique J. How do people die in disasters and what
can be done? http://disasterdoc.org/how-do-people-die-in-disasters/. Accessed
August 30, 2017.
Prehospital and Disaster Medicine
Keim 9
... Disaster response alone is not sufficient, as it yields only temporary results at a very high cost" (IPCC 2007). Since then, disaster risk reduction has become the mainstay for international development related to disasters (Keim 2018b). ...
... It is caused when hosts are exposed to an environment containing agents that are hazardous to health. It is therefore possible to study the causal factors involving the agent (i.e., hazard), host (i.e., vulnerability), and environment (e.g., exposure), including both risk and protective factors (Keim 2017(Keim , 2018a(Keim , 2018b. ...
... Thus, the natural history of disaster-related injuries often limits the effectiveness of secondary and tertiary prevention following disasters from climate-related hazards. Primary prevention of the exposure (before injury/illness can occur) is therefore of critical importance to reducing mortality risk from these hazards (Huppert and Sparks 2006;Keim 2018b;Schipper and Pelling 2006;World Bank 2007). ...
Presentation
Guest Lecturer, Disaster Medicine 201: Post-Earthquake Medical Challenges in the New Madrid Seismic Zone Title: The public health impact of climate change and Concept of operations for mass casualty management Festus, MO March 18-19, 2010
... Approximately 30 years ago, policymakers worldwide collaborated to formalize the relationship between the disaster management process and health, sustainable development, and disaster management 40 . The action plans and strategies developed as a result of these meetings contributed to the global doctrine formation for disaster risk management for all sectors 40 . ...
... Approximately 30 years ago, policymakers worldwide collaborated to formalize the relationship between the disaster management process and health, sustainable development, and disaster management 40 . The action plans and strategies developed as a result of these meetings contributed to the global doctrine formation for disaster risk management for all sectors 40 . The International Decade for Natural Disaster Risk Reduction was declared by the UN in the early 1990s to explain the significance of disaster risks to the international community and to raise awareness. ...
Article
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The scientific advancement of the disaster medicine concept started approximately five decades ago. Different disciplines, such as public health, emergency health services, emergency medicine, and military medicine, work within the disaster medicine framework. Disaster medicine aimed to ensure that health services and facilities are operational both in the pre- and post-disaster periods to prevent and reduce the negative health circumstances of the society facing disaster risks. It is a discipline with slow scientific progress due to unclearly systematized multidisciplinary structure and sub-study areas. However, important targets regarding the field of disaster medicine were indicated in the Sendai Framework for Disaster Risk Reduction 2015-2030 published by the United Nations. Among the global goals of disaster medicine, are to reduce the number of deaths and injuries, reduce the number of affected people, strengthen critical facility infrastructure, and ensure functional sustainably of these facilities during disasters. To achieve these goals, disaster medicine is expected to rapidly develop both institutionally and academically. Disaster medicine is a global, mass, administrative, and doctrinal discipline that means beyond clinical studies. Particularly, the development and dissemination of disaster medicine education were emphasized for the first time with the Sendai Framework for Disaster Risk Reduction, which was determined globally in 2015. The disaster medicine discipline is seen to reach a very strong point by 2030. Keywords: Disaster management, disaster medicine, public health, resilience, risk reduction
... Furthermore, it was emphasized that the response to the disaster alone is not enough since it only has temporary results and brings about a very high cost. Since then, disaster risk reduction has become a significant contributor to the international development against natural disasters [17]. ...
... It has also emphasized that risk management should enhance the economic and social reversibility of countries and reduce the vulnerability of individuals and property. Although the implementation of the HFA1 created gaps between the priorities, especially in the fourth priority, and in recognition of the stakeholders, HFA2 was considering an integrated framework for reducing disaster risk by updating orders, goals, strategies, and preferences that consider all levels [17]. ...
Article
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Background: At the end of the 19th century, international communities have realized the necessity of global planning and cooperation. Accordingly, worldwide meetings have been organized for several years. This study aims to assess the achievement of predetermined objectives by international conferences in the field of risk management. Materials and Methods: The search for articles and documents was done using several keywords of "international meetings", "Sendai", "Hyogo", and "Yokohama" in Scopus, Web of Science, PubMed, Cochrane Library, Science Direct, Google Scholar databases. Also, the risk management domain websites such as FEMA, UNISDR, and EM-Date were searched. Results: Three Disaster World Conferences have been organized, hosted by Japan: Yokohama 1994, Kobe 2005, and Sendai 2015. They proposed strategies and prioritized actions for managing disaster risk, reducing the risk of disasters, and coping with disasters. In the second and third conferences, as requested by the United Nations (UN General Assembly), the UN Office for Disaster Risk Reduction (UNISDR) helped as the coordinating body. Conclusion: Reducing the risks of disasters is a global issue, which needs international cooperation. Therefore, all countries should take steps to achieve disaster risk reduction goals. Since declaraions, documents, resolutions, and conferences do not impose an obligation on countries in this regard, the success rate of the programs is dependent on voluntary international cooperation. Moreover, while we do not expect that outcomes of these international agreements related to disaster risk reduction be achieved at the scheduled time plan, strengthening the international cooperation of the countries to facilitate the improvement of actions and programs would be effective.
... 11 12 Limited documentation exists on the process of developing BPHS, and there was no formal evaluation; not surprising in a country rebuilding after decades of conflict. [13][14][15] We evaluate and report the successes, challenges, and lessons from the multisectoral development of BPHS; our methods are described in box 1. ...
Article
Introduction: Failure to prepare students on fire safety and prevention in hostels adequately may result in various losses not limited to life and health but also in terms of properties, intellectual properties, and morale. As practices relates closely to knowledge and attitude, the aim of this study was to investigate the level of their knowledge, attitude and practices (KAP) in fire safety and prevention and its associated factors among hostels occupants in a university. Methods: A cross-sectional study was conducted from March 2020 to October 2020, using online questionnaire with five different sections to obtain respondents’ sociodemographic information, past-experiences and KAP related to fire safety and its prevention. Results: Out of 283 students, the prevalence of having acceptable level of knowledge, positive attitude and good practice were 62.0%, 87.9% and 49.3% respectively. Multiple logistic regression showed that non-Malay respondents were less likely (OR=0.301) to have acceptable knowledge level but those who had past-experiences in fire drill training particularly hands-on in fire drill training have significantly higher odds (OR=5.694; OR=2.353 respectively) of having acceptable knowledge in fire safety and prevention. Respondents who had hands-on in fire drill training was the predictor for positive attitude (OR = 2.285); whereas respondents with total household monthly income RM4,850-RM10,959 has 3.000 higher odds of good practice in fire safety and prevention. Conclusion: It may be worthwhile to explore other approaches in accident prevention besides KAP model (attitude change via knowledge to modify behaviour) in this case, fire safety and its prevention.
Article
At the Third UN World Conference on Disaster Risk Reduction (UNWCDRR) held in March 2015 in Sendai City, Japan, the Sendai Framework for Disaster Risk Reduction 2015–2030 (SFDRR) containing seven global targets was adopted by 187 UN member states. This study aims at uncovering the features of the existing literature concerning disaster statistics, especially the effort at the seven global targets of the SFDRR, toward boosting evidence-based policy-making for sustainable Disaster Risk Reduction, as well as implementing the seven global targets of the SFDRR. In this study, we conducted a general literature review of the previous studies related to the SFDRR in order to classify the previous studies related to the seven global targets of the SFDRR, followed by text mining analysis to confirm the results of the preceding literature review. As a result, characteristic words such as health, mortality, and so forth were recognized and grasped in both approaches, whereas words related to international cooperation or multi-hazard early warning systems were hardly used. According to the results, the seven global targets have not been treated equally in the existing literature.
Article
Sumario: Fundamentals and terminology -- Insurable loss exposures -- Risk management: essentials and advanced topics -- Private insurance companies -- Insurance occupations -- The insurance market: the economic problem -- Commercial property insurance -- General liability insurance -- Special liability insurance -- Bonding, crime insurance and reinsurance -- Insurance contracts -- Basic property and liability insurance contracts -- Homeowners insurance -- The personal auto policy -- Life insurance policies -- Annuities -- Life insurance planning -- Standard life insurance contract provisions and options -- Simplified life insurance mathematics -- Health and disability insurance -- Employee benefits -- Social security -- Unemployment and workers'compensation insurance -- Insurance regulation -- Glossary -- Appendix A: Homeowners insurance policy -- Appendix B: Personal auto policy -- Appendix C: Sample whole life insurance policy and application
Article
As bacteriology, protozoology and immunology have developed, and as the movements and changing character of epidemic diseases have been more closely studied in the new light which they have shed, conceptions of epidemiology have greatly broadened. It has been increasingly recognized that in the rise and fall of infectious diseases variables other than rate of exposure are concerned. Year by year evidence has accumulated pointing to variability in the properties of specific microorganisms. In particular cases the evidence has frequently been inconclusive; but in the aggregate, it has materially modified the older views of rigid fixity in specific properties. At the same time, there has been increasing recognition of variations in susceptibility to specific infections, variations related to prior infection without disease, and to inherent differences between individuals of the same species and the same specific history. With these broader conceptions of the factors in infection there has been, in recent years, a distinct revival of interest in and study of the nature and causes of epidemics. The studies especially directed to this end have been of two kinds. First, statistical studies of natural epidemics have been made especially by Ross, Brownlee and Greenwood, in England, and earlier by Farr, comparing the actual rise and fall of disease with the theoretical distributions deduced from various hypotheses. Still more recently, there has been a great development in experimental studies of spontaneous or induced epidemics of certain natural infections in laboratory animals, by Flexner, Amoss, Webster and Pritchett in this country, by Topley and Greenwood and their associates in England, and by Neufeld and others, in Germany. These have led in turn to more exact studies by the same observers, notably Webster and Pritchett, in which carefully controlled experimental methods have been applied to studies of the influence of dosage, microbial virulence and host susceptibility in experimental animals.
How do people die in disasters and what can be done?
  • M Keim
  • J Abrahams
  • J Castilla-Echenique
Keim M, Abrahams J, Castilla-Echenique J. How do people die in disasters and what can be done? http://disasterdoc.org/how-do-people-die-in-disasters/. Accessed August 30, 2017.
Declaration of the Pacific Health Summit for Sustainable Disaster Risk Management
Centers for Disease Control (CDC). Declaration of the Pacific Health Summit for Sustainable Disaster Risk Management. Pacific Health Dialogue 2004;13(1):5-10.
UN Draft Mauritius Strategy for the Further Implementation of the Program of Action for the Sustainable Development of Small Island Developing States, in International Meeting to Review the Implementation of the Program of Action for the Sustainable Development of Small Island Developing States
United Nations. UN Draft Mauritius Strategy for the Further Implementation of the Program of Action for the Sustainable Development of Small Island Developing States, in International Meeting to Review the Implementation of the Program of Action for the Sustainable Development of Small Island Developing States. Port Louis, Mauritius: United Nations; 2005: 1-30.
Disaster Risk Management for Health
  • M Keim
Keim M. Disaster Risk Management for Health. In: David S, (ed). Textbook of Emergency Medicine. Chicago, Illinois USA: Wolters Kluwer Health (Lippincott); 2010: 1309-1318.
Environmental Health from Global to Local
  • M Keim
Keim M. Environmental Disasters. In: Frumkin H, (ed). Environmental Health from Global to Local. San Francisco, California USA: Wiley and Sons; 2016; 667-692:843-875.
Association of Faculties of Medicine of Canada. AFMC primer on population health
  • M Keim
Keim M. Intentional Chemical Disasters. In: Hogan D, Burstein J, (eds). Disaster Medicine. Philadelphia, Pennsylvania USA: Lippincott Williams & Wilkins; 2002: 340-348. 14. Association of Faculties of Medicine of Canada. AFMC primer on population health. 2017. http://phprimer.afmc.ca/Glossary?l=H. Accessed August 30, 2017.