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Surveillance and Health Equity Considerations in Health Emergencies
Ronald St. John, MD, MPH
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Types of Emergencies � Natural and Humanitarian disasters
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Types of Emergencies � Outbreaks of Infectious Disease
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Some Characteristics of Health Emergencies
� Health crises are not gender neutral.
� All situations begin at local level.
� Initial periods (hours to days to weeks) are characterized by uncertainty.
� First to respond are always local.
� Local capacities can be overwhelmed quickly.
� External support may be limited: � By fear � By physical constraints � Surveillance can be difficult.
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Given the local nature of all emergencies, what are the gender
issues?
� It depends: � In conflict or disasters, women often endure extreme
hardship, and � Women may provide additional care, domestic and
livelihood responsibilities. � Relief efforts to help all those affected must
encompass cultural norms and women’s role in society to avoid increasing insecurity and reverse gains.
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Gender Issues (cont.) � Women are often in a disadvantaged position in
many developing, as well as developed countries.
� Some issues: � incidence of gender-based violence—including rape,
human trafficking and domestic abuse—increases exponentially during and after disasters.
� Most disasters place an undue burden on women and girls who are responsible for unpaid work such as providing care, water and food for households.
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Some facts � Disasters lower women’s life expectancy more than
men’s, according to data from 141 countries affected by disaster between 1981 and 2002.
� Women, boys and girls are 14 times more likely than men to die during a disaster.
� Most of the victims trapped in New Orleans after Hurricane Katrina were African-American women and their children, the poorest demographic group in that part of the country.
� Following a disaster, it is more likely that women will be victims of domestic and sexual violence; many even avoid using shelters for fear of being sexually assaulted.
Source: http://www.unocha.org/about-us/gender-equality-programming
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Experiencing Disasters � Women, girls, boys and men experience disasters
differently.
� There are gender, biological, economic, occupational, socio-cultural, religious, political factors.
Source: http://apps.who.int/disasters/repo/5509.pdf
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Traditional Gender Roles Responsibility Female Male
Security + ++
Provide water +++ --
Provide food ++ +
Shelter & Sanitation ++ +
Fuel, pots, utensils +++ --
Health ++ +
Education ++ +
Public Health • Health education • Nutrition • Vaccination • Disease control • Maternal/child
+++ +++ +++ - +++
+ + -- +++ --
Source: http://apps.who.int/disasters/repo/5509.pdf
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Shifting Roles in Emergencies
� Existing gender inequalities may be exacerbated while changing gender roles in times of crises can also create new or additional disparities.
� Disaster may lead to unequal access to resources, support services and protection from exploitation and abuse.
� Disruption of societies’ traditional protection systems increases vulnerability. � Kenya 2007 � Lord’s Resistance Army � Boko Haram in Northern Nigeria � Bulgaria – Syrian refugees
� Women in camps have more sexual violence if sanitation facilities or water points are poorly lit or situated in an out-of-the-way location
Source: http://www.unicef.org/esaro/7310_Gender_and_emergencies.html
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Infectious Diseases � H5N1 avian influenza affects women
disproportionately: � Females were at increased risk of death (OR 1.75,
95% CI 1.27–2.44) � But young age, in particular <5 years of age (OR
0.44, 95% CI 0.25–0.79 for death), was protective.
� Disparities in African American vaccine uptake were result of limited trust in Los Angeles County communities that have been chronically underserved by health care providers.
Source: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089697
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What can we conclude? � In natural disasters, surveillance systems may be
casualties; rough and ready counts of injuries and casualties may be required, with special attention paid to known vulnerable populations.
� In outbreak emergencies, knowledge of the distribution of social determinants will help identify the vulnerable populations. � How many are elderly or young, have limited or no English
proficiency, experience geographic or cultural isolation? � 23 million U.S. residents (roughly 12% of the total
population aged 16 to 64 years) have special healthcare needs (SHCN) due to disability.
12 Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646456/
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Thank You
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