Long term planning for recovery after disasters

SSPA Research Workshop2 June 2011

Request

• Health begins where we live, learn, work, and play

• Rebuilding may either:– be used to create more sustainable, equitable society– or can exacerbate existing inequalities

• Guide for long term planning decisions drawn from international lessons

• Ensure health in all policies approach backed by evidence

Methods

• Search of international medical/health databases by Ministry of Health information service– mainly looked at impact assessment, natural disasters

• Supplementary searches of social science literature – recovery, planning, resilience, rebuilding

• Web browsing for relevant documents• New Zealand thesis with case study of Napier earthquake• Limitations

– Does not include acute health care needs post disaster – Limited New Zealand information - time and resource constraints– Brief overview of many large areas – not comprehensive – Internally peer reviewed only

Definitions

• Recovery brings the post disaster situation to some level of acceptability which may or may not be the same as the pre-impact level

• Restoration/reconstruction/recovery used interchangeably in the literature

• Recovery phases• emergency response • restoration of basic services and housing – patched

enough to function• reconstruction/rebuilding/replacement • long term betterment for sustainable and improved

city

Sequence and timing of reconstruction after Hurricane Katrina in New OrleansJacob et al (2008)

Reproduced with permission of American Society of Public Health

The Napier earthquake

• Critical infrastructure restored in days• Temporary housing set up • Business/shopping area (Tin Town) • Debris cleared – dumped on beach (no RMA)• Citizen’s committees quickly formed – next day

– had much input• Commissioner appointed by Borough Council• Community consultation on recovery and rebuilding • Compensation for property owners• Catalyst for building codes, Civil Defence• Society less dependent on technology and more used to hard

times • Social impact (including on Maori) has been little studied

Immediate response

• Core public health functions– water, sanitation, food safety, vector control– issue health advisories– immunisations– assess needs of vulnerable populations– ensure continuity of health care– injury prevention

• Surveillance– rates of injury, notifiable diseases, infectious disease,

drinking water– use and distribution of health services– gathering data informs immediate recovery and supports

long term planning but is often difficult in crisis

Integrating short and long term planning

• Phases of recovery overlap• Some recover more quickly than others

– less affected; more resources

• Tension between need to act quickly and taking time to plan well

• Short term decisions have impact on long term recovery

• Best approach is pre-disaster planning and forward planning to mitigate future disasters

Health in all policies

• Long term planning in all fields has an opportunity to improve (or worsen) population health– housing, environmental protection, sustainability, transport,

parks and recreation, urban redevelopment

• Seldom recognised as “health” even by acute health services

• Message needs simple language with focus on solutions not problems– warm homes, clean environments, access to services,

transport, supporting neighbourhood networks

Equity

• Those with more resources (physical, financial, intellectual) recover more quickly

• Most vulnerable: very old, very young, disabled, poor, low literacy, new immigrants

• Macro-level statistics do not always show difference

• Vigilance needed in rebuilding especially letting of contracts

• History of protections being waived in the rush to get recovery started

• Population growth may be socially and spatially uneven

Housing

• Displaced populations suffer worst impacts of disasters • Temporary housing needs:

– as close as possible to original area – minimal relocation– water, electricity, sewerage– jobs, schools, transport, food supply, services

• Cultural and social factors are important in decisions to leave/return

• Downstream effects on nearby communities– rent rises, housing shortages, need for more infrastructure

• If relocating entire communities– technically and economically feasible options– income support and employment

Mental health

• Most people recover without any psychological help

• Fostering self-efficacy and coping skills is best approach

• Small percentage have serious and continuing problems

• Displaced populations are more at risk– children: disruptive behaviour, learning problems, anxiety,

depression, stress– adults: addiction, mood disorders, co-occuring traumatic

stress and substance abuse• Domestic violence, substance abuse, PTSD,

suicide rates may rise in displaced people

There is no evidence that psychological debriefing is a useful treatment for the prevention of PTSD (Rose et al 2009).

No psychological intervention can be recommended for routine use following traumatic events. Psychological interventions may have an adverse effect on some individuals (Roberts et al 2009).

Community resilience

• Extended family and community networks buffer stress

• Major source of assistance in disasters– separation may be more damaging than the actual disaster

• People without this social capital are more vulnerable• Community networks

– more flexible than large organisations– respond more quickly

• Disasters may increase community attachment and solidarity

• Relationship between official agencies and community groups is often uneasy– autonomy vs need to accept funding/reimbursement

Community participation

• Accepted in principle that public participation in recovery is essential

• Should be anticipated – work with, not against the community

• Community groups cannot work alone• One official agency needs to take overall

responsibility (sometimes for hard decisions)• Community participation:

– different forms at different levels – depends on the social, political, and economic context– “community” does not speak with one voice– initiatives on a local scale are often successful

Economic recovery

• Economic recovery and community wellbeing are linked– workforce needed– economic base for retailers– restoration of employment – access to services needed for all community

• Economic recovery takes longer in poorer areas• Roller coaster trajectory – downward plunge then

intense upward surge before flattening• Need to build stronger and less vulnerable economy

– diversification (esp. if tourism dependent)– incorporate mitigation efforts for future– protect local and regional tax base

• Priorities: tourist facilities vs local community needs

Heritage buildings

• Important part of city identity• Low priority in immediate aftermath • Damage from disaster may be less than

actions taken afterwards • Heritage interests should:

– pre-disaster: take initiative to link with emergency services– post disaster: immediate collaboration with S&R – have teams of own experts ready for advice – separate/distinct placard for damage assessment

• Deconstruction/recycling/disposal of materials handed to community with emotional attachment to particular buildings

Sustainability

• Underlying social, economic, environmental factors give rise to vulnerability– exposure/sensitivity/resilience

• Merges with environmental management, poverty, reduction, climate change fields

• Single stressor responses (stop banks, building codes) not enough

• Improve (not just rebuild, replace)• Reduce burden of disease• Build social capital• Strengthen resilience

– energy efficiency, diversify economic base, sustainability principles

Limitations of evidence

• Very limited epidemological data – health care utilisation– demographic data on population change– aggregated data may conceal poor recovery of some

sectors• Social cohesion, community participation etc

difficult to measure• Available literature mostly US-based• Little New Zealand literature• Nothing specifically related to Maori • But consistent messages likely to be

generalisable for Christchurch

Lessons for Christchurch

• Seek membership on committees • Advocate

– for health and wellbeing in all policies using simple language (health starts in our homes, schools, and jobs)

– at interface between official and community groups

• Develop existing partnerships and pursue new ones with like-minded organisations– be watchful for policies and proposals that disadvantage

vulnerable groups (housing, relocation, letting of contracts)– resist getting bogged down in drawn out planning– ensure genuine community participation