Community Disaster Resilience

David P. Eisenman, MD MSHSAssociate Professor of Medicine, UCLA

Adjunct Natural Scientist, RAND

EHS M411 Seminar Series, 2011

Contact: deisenman@mednet.ucla.edu

Goals for the SeminarGoals for the Seminar• Understand why this topic is important to Env. Health.

• Become familiar with relevant terminology and concepts from public health disasters.

• Discuss the concept of social vulnerability to disasters.

• Discuss the concept of community disaster resilience.

• Discuss research questions important to Env. Health.

Why this matters (Reason #1): Why this matters (Reason #1): MPH Core Competencies (ASPH)• Upon graduation a student with an MPH should be able to…

– Describe the direct and indirect human, ecological and safety effects of major environmental…agents.

– Describe…psychosocial factors that affect susceptibility to adverse health outcomes following exposure to environmental hazards.

– Specify approaches for assessing, preventing and controlling environmental hazards that pose risks to human health and safety.

– Discuss various risk management and risk communication approaches in relation to issues of environmental justice and equity.

TerminologyTerminology• Hazard: A threatening event or

potentially damaging phenomenon

• Disaster: “A serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources.”*

* UNISDR. (2009). Terminology on Disaster Risk Reduction. Available at: http://www.unisdr.org/eng/library/UNISDR- terminology-2009-eng.pdf

Disaster = Hazard x Vulnerability

What is individual vulnerability?What is individual vulnerability?

• Common use = “prone to or susceptible to damage or injury”

• Hazards use = 3 factors in human vulnerability– Exposure to the hazard– Susceptibility to harm– Capacity to cope with or

recover from adverse impacts (or, individual resilience)

Natural and built environment

ResourcesExposure to hazards

Society

Age—health—disability—poverty

Susceptibility to harm/ coping capacities

Societal disparities determine vulnerability

Vulnerability = Exposure x Susceptibility x Resilience

Are there social groups in your community you think may experience higher vulnerability to disasters?

Quick response research

9Recruitment begins

8Work in shelter clinic; IRB approval

7IRB submitted; fly to Houston

6 NSF grant

5Labor Day

2Sept 1Houston shelters house 27K

31Astrodome opens

30NOLA evacuated

Aug 29Katrina landfall

Eisenman camping trip

FriThursWedTuesMon

Social networks

• My plans were to leave. Unfortunately we received a call and we had to come back home. My mother-in- law had called for us to come back…. You know when they get a certain age they get confused.

• My mother-in-law wouldn't leave the house. My husband wouldn't leave her and I'm not going to leave him.

• I had a 90 year old mother that I was taking care of and she would not leave that house for hell or high water.

Health

• I could have made it on my own, but it was just my aunt and my uncle. Every few steps he made…she forgot his walker…every few steps he made he was falling down.

The influence of social networks

• Interactions between factors influencing evacuation

• Broad networks facilitated and facilitated evacuation

• Disaster planning must address social units not just individuals.

From post-Enlightenment…

A Brief History of Disaster Preparedness

…to Post-Modern

Disaster Risk Reductions

• Reduce Hazards: land-use planning and management, hazmat, disease surveillance

• Reduce Vulnerability: Structural reinforcement, mass evacuation/shelter, emergency planning, stockpiling, duck-cover- hold

• Different levels: community, household, institution, jurisdiction

• But is there still some legacy of the notion that a disaster is “An Act of God”?

An evolution in approach

• From Response and Relief

• To Risk Management

Slide courtesy of Mark Keim

Disaster Risk Management CycleDisaster Risk Management CycleMitigation: limits the adverse impact of hazard.

Preparedness: ensures effective response to hazard impact MitigationMitigation

PreventionPrevention

RecoveryRecovery

ResponseResponse

PreparednessPreparedness

Source: Keim M. Building human resilience. Am J Prev Med 2008;35(5):508-516

Preparedness v1.0 v2.0

Why this matters (Reason #2):Why this matters (Reason #2): The public health impact of extreme The public health impact of extreme weather eventsweather events

• Between 1970-1999, climate related hazards account for 90% of all global disasters 1

• The world’s poor are disproportionately affected 1

•• Global climate change will increase the probability of Global climate change will increase the probability of extreme weather events extreme weather events

• Expect increased morbidity & mortality due to increasing vulnerability of populations at risk

1 Center for Research on the Epidemiology of Disasters (CRED) http://wwwemdat.net/index.htm2Munich Re Group. Annual Review Natural Catastrophes. Munich Re Group, 2002. http://munichre.com/publications/302-03631_en.pdf

To summarize (Reason #3):To summarize (Reason #3):

• Emergencies or disasters have negative repercussions on the environmental health and safety of those affected.

• Environmental Health and Emergency Preparedness & Response Departments are charged to to prepare communities for such crises.

Slide courtesy Susanne Montgomery

Lessons of KatrinaLessons of Katrina

• Evacuation influenced by social inequities, social ties

• Community organizations left out of public planning

• Community strengths and assets were critical to recovery

• Deepwater Horizon oil spill 5 years later

A Resilience ModelA Resilience Model• Moving from “I” to “We”

• Defining roles and responsibilities for a broader array of organizations

• Leveraging community assets

• Reframing how we prepare for disaster on an ongoing basis

What is Community Resilience?What is Community Resilience?

• A community’s ability to build capacities to rebound from an emergency/disaster

• Strongly rooted in social determinants of health and health disparities (Lessons from Katrina)

• Components include:– Physical/psychological health; hazard, risk and

asset mapping; effective risk communication; integration of organizations (public-private); social ties; social/economic equity

– Empowerment, participatory engagement; acknowledges strengths of at-risk groups; wellness topic

Resilience is inherent in Adaptation, which “focuses on reducing vulnerability by taking steps to make social and environmental systems more resilient to the effects of climate-related hazards”. (Keim, AJPM 2008)

Model of Community Resilience (RAND)Model of Community Resilience (RAND)

Effective risk communicationinformation for all populations

Social connectedness for resource exchange, cohesion, response and recovery

Ongoing Development of Community ResilienceIntegration and

involvement of organizations (govt/NGO) in planning, response, and recovery

Social and economic well-being of the communityPhysical and psychological health of population

Quality - Collect, analyze, and utilize data on building community resilienceEfficiency - Leverage resources for multiple use and maximum effectiveness

Ongoing Activities

Education - Ensure ongoing information to the public about preparedness, risks, and resources before, during and after a disaster

Wellness - Promote pre- and post-incident population health, including behavioral healthAccess - Ensure access to high-quality health, behavioral health, and social services

Partnership - Develop strong partnerships within and between government and non -governmental organizations

Engagement- Promote participatory decision making in planning, response and recovery activities

Self Sufficiency - Enable and support individuals and communities to assume responsibility for their preparedness

Levers of Community Resilience Core Components of Community Resilience

Community context

Ongoing disaster experience

What are the strengths and weaknesses of this approach from the point of view of a person living with specific hazard vulnerabilities, e.g., a person with a “disability”?

Enhancing Community Resilience Can Enhancing Community Resilience Can Reduce the Consequences of These Reduce the Consequences of These

StressorsStressorsResilience -- the ongoing and developing capacity of the community to account for its vulnerabilities and develop capabilities that aid in:

•

preventing, withstanding, and mitigating the stress of an incident;

•

recovering in a way that restores the community to self- sufficiency and at least the same level of health and social functioning as before the incident; and

•

using knowledge from the response to strengthen the community's ability to withstand the next incident

(HHS Health Security)

Behavioral Science Supports Community Resilience

• The principles underlying community resilience are rooted in theories of community change (“more than the sum of resilient individuals”)

• Builds on literature base in areas of:– Neighborhood effects on individual and

community well-being– Knowledge acquisition, knowledge transfer– Trust, Social capital, social equity

Resilience ChallengesResilience Challenges

• Limited evidence base• Transformational: a cultural, policy and

programmatic change – FEMA: “Whole Community”– CDC: “Community Preparedness”

• Few models connecting theory to practice

Reason #4: Research

…understanding direct/indirect human health risks…

…risk factors that make people more vulnerable…

…guide public health interventions to prevent harm…

Research Need: “evaluating heat response plans, focusing on environmental risk factors, identification of high-risk populations, effective communications strategies, and rigorous methods for evaluating effectiveness on the local level.”

Problem: Homeless persons in Los Angeles

What research question should we ask? How might we do this research?

Research Need: “understanding of how psychological stress acts with other forms of environmental exposures to cause adverse mental health effects”

Problem: Gulf Oil Spill

What research question should we ask?

Barriers to a CommunityBarriers to a Community--Based Based Participatory Approach to Emergency Participatory Approach to Emergency PreparednessPreparedness

EH professionals generally receive little to no training on community-based participatory methodologies (Gaddis, Miles, Morse, & Lewis, 2007; Goldman & Coussens, 2007). The existing professional culture, may be resistant to changes:

Many EH professionals see themselves as code enforcers (Dyjack, et al., 2007). ambiguity about EH functions in disastersgenerally more traditional top-down approach to work in general and disaster management in specific (Berg, 2004; Dyjack, et al., 2007; Elderidge & Tenkate, 2006).