Humanitarian Health Action

Health and the Post-2015 Framework for Reducing Risks of Disasters

19 April - 17 May 2013 (Online consultation)

Pakistan earthquake 2010. People looking for shelter.
WHO/Christopher Black

Hazards pose significant risks to communities which may result in emergencies and disasters with substantial consequences for public health in terms of deaths, injuries, illness and disabilities. The Hyogo Framework for Action 2005-2015: Building the Resilience of Nations and Communities to Disasters (HFA) describes the required actions from all sectors and actors to reduce disaster losses and improve the management of risks associated with emergencies and disasters.

As the current HFA is due to end in 2015, consultations are under way across the world to shape the recommendations for the development of a post-2015 framework. As of mid- April 2013, the issue of health has not featured much in in the consultations, and only a few people from the health community have been actively engaged in the process at national, regional and global levels.

The purpose of this online consultation is to stimulate discussion on health, and to gather the perspectives from the global community on how a post-2015 framework and the actions of all stakeholders can achieve optimal health outcomes for people at risk of emergencies and disasters. The consultation will provide vital inputs to papers and dialogues at the 4th Session of the Global Platform for Disaster Risk Reduction including in the informal plenary sessions on the post-2015 framework and in side events with a health dimension to them.

Share your opinion

- How well is health addressed in the current HFA and in practise?
- What key points should be considered in the post-2015 framework in order to improve health outcomes for people at risk of emergencies and disasters?

Participate in the online discussion by filling in the form. The online discussion will be open until 10 May 2013. We look forward to receiving your input.

All inputs will be monitored for appropriate content.

Although terminology is critical it is getting in the way of practical implementation tools

13 May

There has been a significant advancement in DRR and health over the years, may thanks for the drive to move this forward and strengthen it over the coming years

As a global community we need to get to the country and community level with practical guidance and tools for policy makers, program managers, service delivery staff and communities. The discussions are still mainly at the global and regional levels.

Although terminology is critical it is getting in the way of practical implementation tools. We need to take DRR, resilience, climate change adaptation, emergencies, development, transition, etc. and make it practical for country and community levels.

We talk quite a bit about multi-sectoral integrated approach to DRR, but in the end what does that mean to the program manager at the country and community levels? We need to work at a technical level with other sectors to tease this out. Furthermore we need to more widely develop the evidence base for this approach.

Additionally we need to systematically collect information, data, best practices and challenges and put that back into practice, develop the evidence base.

Dr Heather Papowitz, UNICEF

Provide a more coordinated perspective on the role that paramedics play both before and during disasters.

13 May

Executive Summary

The Hyogo Framework for Action 2005-2015 describes established priorities for disaster risk reduction, creating improved resiliency and strengthened preparation. International Paramedic proposes that the United Nations International Strategy for Disaster Reduction consider that 1) paramedics have not been fully consulted in this process and 2) the emerging subspecialty of Community Paramedic may have a specialized role to play in improving resilience.

Paramedics: the world's responders

Disaster and emergency response is the hallmark of the paramedic profession in all its various levels of development: from fully matured advanced life support systems in developed nations to the volunteer community responder in resource poor countries. Paramedics worldwide will always be the first medical professionals to respond when natural or man-made disaster occurs.

Although it bears the burden of response post occurrence, Paramedicine is often an ignored partner in pre-disaster efforts, because of its varied integration into health and response systems around the world. Paramedic Service response is always associated with disaster responses yet the paramedic professionals are rarely included in consultation unless associated with other disaster response groups. The unique perspective of the paramedic needs to be understood.

Community Paramedicine: an emerging subspecialty

Paramedicine, developed as a means of responding to out-of-hospital emergencies, by delivering increasingly more advance medical care at a patient's side and transporting those patients to hospital. It did not allow for independent treatment. Although traditionally paramedics have been associated with ambulance transport, this situation is changing. Emergency response has always been associated with paramedic services, yet more and more paramedics are expected to play a more definitive role in community health. They are increasingly being asked to participate in the maintenance of their community resilience by working in a variety of community based settings alongside allied health professionals. Community Paramedics are taking a broader view of health issues and are being used in previously unthought-of situations from outbreak management to chronic care management. Keeping patients healthier, and allowing alternatives to transport, reduces the burden on hospitals. This will in turn allow hospitals to function more effectively in disaster.

Community paramedicine is a new development in the profession and is not yet fully understood. Supporting concept documents are attached to help fully explain this concept. It is acknowledged that there is currently a paucity of literature but early anecdotal evidence is promising. A collection of existing literature on this subject can be found on the website of the International Roundtable of Community Paramedics (www.ircp.info). With their natural systems thinking, Community Paramedics are expected to link previously unrelated health agencies thus increasing the health system ability to respond and manage. Healthier communities will cope better in disaster situations.

International Paramedic

International Paramedic is an international convener of the paramedic thought leaders. It is aware through the dialogue that occurs on its various methods of communication that paramedics worldwide feel disenfranchised and disconnected.

Recommendation

International Paramedic urges the UNISDR to elicit more opinion from critical front line paramedic professionals, provide a more coordinated perspective on the role that paramedics play both before and during disasters, and acknowledge the specific role paramedics are expected to play in maintaining the health of a community. The UNISDR should develop, or use existing, international and national paramedic networks to focus dialogue around front line paramedic response rather than gather opinion from associated agencies. It should support the paramedic profession to more fully understand and disseminate the developing role of Community Paramedics in resiliency

Ms Penny Price, International Paramedic

Revisit the concept of creeping disasters and within the framework of economic crisis.

10 May

Strengthen the interface between disaster management and public health, conceptually, THEORETICALLY and practically.

Review the various instruments available such as sphere, utstein template, risk models.

Develop a modular academic program at the confluence of public health and disaster management.

Develop competences within the framework of public health disaster management Strengthen regional actions in the Balkans [SEE].

Revisit the concept of creeping disasters and within the framework of economic crisis.

Prof Dr Jeffrey Levett, NSPH, GREECE AND ECPD, SERBIA

Standardization, Consultative Workshops, Involvement of Academic Institutions and Awareness Raising

10 May

Based my working experience in the country of China, I would like to raise the following health points for WHO post-2015 framework development and for on-line consultation:

1. Support country to develop standardized format/template for reporting health information sharing and dissemination for disasters and emergencies (there is a need for national partners to understand what vital information to be shared with international organizations from health sectors in emergencies and disasters) 2. Advocacy and consultative workshops on WHO Health Cluster implementation functional on disaster and emergency management among cross-sectoring agencies at country level 3. Active involvement and contribution of academic institutions and agencies supported by the governmental policy and finance on disaster health researches and education ( i.e. public health emergency curriculum development and courses open for medical students in medical university; and case study and research on health services deliveries in emergency for the vulnerable groups ( i.e. children, reproductive health and mental health.) 4. Awareness raising for disaster and emergency knowledge and health consultation at community-based education to the public

Support local cities for WHO safe hospital campaign implementation and urban health emergency profile and action plan development for city resilience from disasters (to identify risks and priorities of health needs for the city on resources and services provision)

Ms Jiang Fanxiao; MD, MPH, School of Public Health Emergency

We need to generate a global change of thinking where individualism and collectivism do not compete

9 May

In short we need to generate a global change of thinking where individualism and collectivism do not compete and direct efforts toward addressing the global tragedy of the commons.

The tragedy of the commons is the depletion of a shared resource by individuals, acting independently and rationally according to each one's self-interest, despite an understanding that depleting the common resource is contrary to the group's long-term best interests.

The tragedy of the commons is an economic concept often cited in connection with sustainable development, meshing economic growth and environmental protection, as well as in the debate over global warming.

We need a change of thinking and primary values; Combine the positive values of collectivism and individualism - stop them competing; The technological primary has to be outer space; The moral primary has to be our global well being; The intellectual primary is the challenge of capitalism and humanitarian space; The emotional and future primary is our children

Mr Daniel Baschiera, Charles Darwin University NT Australia

Emergency and disaster risk management for health as "a way of life"

8 May

First of all, thank you so much for this on-line consultation. While ideas/opinions/views won't get feedback right away in comparison to a face-to-face meeting, expressing oneself formally (without travel and thereby no or very little greenhouse gas emissions) in this kind of communication mode is well appreciated and highly recommended. What matters most for me is that discussion on this very important subject continues so, thanks again for this opportunity.

I would like to provide my humble thoughts and answers to the 2 questions posed for this consultation.

Q1: How well is health addressed in the current HFA and in practise?

Sufficiently I would think, as far as the current HFA document is concerned. The word "health", with reference to the health sector, health facilities and health care, was mentioned along with the words "safe", "safer" and (culture of) "safety" and "hospitals safe from disasters" and "safe hospital". As disaster risk reduction (DRR) has always been considered as a cross-cutting issue, then, health and its determinants (social, economic, environmental) would always be an integral part of DRR.

I am proud to state that I was a witness and participant to the face-to-face, on-line and off-line deliberations in mid- to late 2004 and early 2005 (before and during WCDR held in Kobe/Hyogo) as to health inputs to the current HFA so I can attest that there was a tremendous and purposeful effort as to health issues being systematically discussed and addressed in crafting the HFA. Thank you to all those who have dedicated their intellectual resources to the HFA.

In practice, I would say that the HFA has been very useful in providing an international political guidance document realizing in essence that individual and population well-being or health is the ultimate aim of DRR. During meetings at the city, country, regional and/or global levels that I've attended post-HFA, it's been quite inspiring to listen to professionals and people inside and outside of the health sector to express their support for the philosophy and core value of health as an input to and as an outcome and impact, too, of DRR. The association between DRR and health sometimes becomes too obvious and palpable that people would not articulate it explicitly.

With regard to the "agreed" goal on "hospitals safe from disasters" which was quite highlighted in the current HFA, I would say that, in practice, progress has been achieved to some extent but in the scheme of things globally and locally, in both developed and developing countries, based on lessons learned, I would perhaps evaluate, if I may, that there have been considerable challenges through all these eight years in terms of promoting the structural, nonstructural and functional dimensions of health facilities. Diplomatically, I would state that incremental work is in progress and there are still around 2 years to go for implementation, then, evaluation, and further action towards hospitals safe from disasters.

This brings me I think to my message that investing in and actualizing HFA in the health system at all levels and in different settings, for me, remains as a critical item for debate and reiterative action. I think that addressing health sufficiently in a guiding framework such as the HFA is logically helpful but what is needed, in reality and in practice, is a concrete operational workplan (written as what we always advice for contingency plans) on how at different levels of governance, programmes and activities would move forward. I know that this is quite an ambitious plan but I think that it is something doable. While we should always be cognizant of certain limitations and threats, the rule of the game is to never give up and never get tired in pursuing the strategic objective "to reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact".

I am delighted that efforts have cascaded from the international level to the national level and to the city/municipal levels with campaigns such as the ongoing UNISDR's Making Cities Resilient campaign and WHO's whole-year 2010 urbanization and health campaign which had a call to "make urban areas resilient to emergencies and disasters". I believe that there a lot of initiatives top-to-bottom and bottom-up and success stories that can be shared as to the theory and practice of DRR in health. Yet, documentation of experiences and the entry of such into the e-literature is perhaps something worth looking into in order to facilitate learning, cross-fertilization and uptake of good practices.

Q2: What key points should be considered in the post-2015 framework in order to improve health outcomes for people at risk of emergencies and disasters?

1) Emergency and disaster risk management for health as "a way of life"

I would emphasize for the post-2015 framework (labeled for now as HFA2) that there should be no complacency at any time when it comes to the 5 HFA priorities for action, inclusive of health emergency preparedness, response and recovery as actualizing HFA would mean sustainable development for villages, municipalities, cities, provinces, regions and countries. The language/words/concepts may be incorporated into HFA2 but what is really crucial is also to have a separate more detailed document on the "how" - how would each political entity and health office (including health facilities) in each country would integrate and mainstream in its guiding and operational policies the theory and practice of emergency and disaster risk management for health.

2) Health system resilience building and strengthening

In terms of strategy, I would suggest both continuity and acceleration for programmes that are found to be working and on-track such as work on and towards "hospitals safe from disasters"; and change and innovation - making use of established fundamentals and useful technologies (e.g., mobile phones, social media, etc) to achieve the strategic objective. It would be necessary to include universal health coverage as a means to building resilience of individuals and families to emergencies and disasters. As it is the health system that is concerned, investment (public and private) needs to be provided to all the 6 building blocks of the health system.

3) A culture of risk communication and risk countermeasures across the life course

Critical for HFA2 is to consider the long-term work on DRR that spans all ages - from womb to tomb. Resilience would entail education and communication on risks brought about by the interaction of multiple hazards, vulnerabilities and capacities with emphasis on countermeasures and proactiveness (e.g., to climate change risks). This needs a great effort on the part of the health sector and multiple sectors (e.g., education, mass media) to communicate well the risks on one hand as well as things that can be done to reduce the risks on the other hand guided by science and precautionary measures (e.g., to biological, geological, hydro-meteorological risks, etc). It would be important for the psychosocial (mental) health of humanity to be equipped with risk countermeasures incorporated in educational curricula and educational media (e.g., movies, stage plays, songs, dances, paintings, sculptures, museums, etc) and also targeted to specific populations: children, older people, people with disabilities, etc.

Thank you for your kind attention.

Dr Jostacio Moreno Lapitan, WHO Centre for Health Development (WHO Kobe Centre)

Support to the Frontlines, Long-Term Vision, Learning Lessons from the Past and Equity

7 May

I would like to add four brief points to the discussion and contributions to date.

1) Support to frontline workers and the systems in which they operate should be a core component of any disaster risk reduction, mitigation and preparedness activities. In this respect, ensuring that the health system and health workers are prepared to deal with conflicts, natural disasters, and other hazards is crucial. Health preparedness, planning and preventive activities need to be fully integrated with national planning activities and risk reduction initiatives. [We have done some work focused on health workers in times of crises and would be happy to share these].

2) I did not see any mention of documenting successes and failures, learning lessons, and improving policy and practice into the future. All efforts should be underpinned by evidence and insights from the field - we should be actively promoting evidence-informed responses in all spheres. Efforts to support careful documentation of lessons from the practitioners on the ground should be reinforced and actively promoted.

3) Health and other sectors need to look beyond the acute emergency and/or disaster to the longer term support and development of systems, and ultimately their sustainability. The health sector, amongst others, should be promoting more seamless interfaces between emergency response, humanitarian relief, and supporting systems development as well as the associated risk reduction activities. This is an opportunity to call for longer term funding, even in emergencies, so that longer term systems can be supported and local ownership and sustainability assured.

4) There is little mention of equity - we all know that the poor are often exposed to greater risks (consider the factory workers in the Bangladesh building collapse, or the most poor often affected by natural disasters and conflict), are more vulnerable and less resilient to the impact of disasters, and have least voice and power to change the circumstances in which they live and the risks to which they are exposed. Addressing disparities in access to services and support, and assuring participation of communities in disaster risk reduction and climate change adaptation exercises should be high on the agenda. Particular attention should be given to promoting the agency of those affected so as to support their efforts at transforming the risk environments in which many live.

5) We have recently undertaken a systematic review of how and in what ways community based disaster risk management reduces the social and economic costs of disasters - and this highlights a number of key issues that ought to be actively promoted - an integration of indigenous local and technical knowledges, support to transformative community engagement and empowerment, use of new technologies, attention to safety and security, and importantly, the integration of socio-economic and livelihood support mechanisms if communities are not to survive adversity and "build back better" in a variety of dimensions.

Happy to provide more details on some of the points above if any readers are interested.

Professor Anthony Zwi, The University of New South Wales, Sydney, Australia

There is a need to address vulnerable groups

7 May

There is little discussion about health, health needs and consequences on health following disasters.

There is especially a need for discussion or mention of vulnerable groups such as older people and those with disabilities (though mentioned in the General Considerations, there are no further references in the document).

Further, in the International Organizations section, there could be a mention of WHO-led initiatives to provide guidelines about disaster response in vulnerable populations.

Dr Andrea Foebel, World Health Organization

Each Village should have awareness programmes

7 May

In every village awareness programmes to disaster management should be formed. Each Village should have a management team, consisting of leaders or representers (district ,state, country, etc.). Every newly established plan should be forwarded to the villages as awareness programmes. Thank you.

Bademalki Mohammed Rafi

Mental health should be a top priority for health policy in disaster settings

1 May 2013

Mental health is a key global public health concern, both in times of disaster and otherwise. The Global Burden of Disease study shows the crucial importance of mental disorders for the global burden of disease. Globally, mental, neurological, and substance use disorders contribute 14% to the global burden of disease. Five of the top 10 causes for disability were in this category, and they are the strongest contributor among non-communicable diseases.

In disaster settings, researchers have found elevated rates of psychological distress, and a wide range of common and severe mental disorders.

In the last years, several consensus-based policy guidelines have been published on best practices in the implementation of mental health and psychosocial support interventions. Moreover, there is evidence from rigorous evaluation studies that such interventions can effectively improve mental health and psychosocial wellbeing.

Given the current shift in global health policy to emphasize the importance of non-communicable diseases and the likelihood that these will feature in the post-2015 MDG, there really is no reason that future disaster-related health policy would not give strong emphasis to interventions that protect and promote wellbeing and treat and prevent mental disorders.

Wietse Tol, Johns Hopkins Bloomberg School of Public Health Mark van Ommeren, World Health Organization

Dr Wietse A. Tol

Health as a Bridge for Effective Disaster Risk Reduction

30 April 2013

Thank you for all of your input so far. It is very interesting to hear your opinions on how health can be supported in the next framework for disaster risk reduction.

This is indeed a chance to strengthen health outcomes and agree on an integrated multi-sectoral approach between all sectors to strengthen the resilience of communities and societies at risk. Health, just like disaster risk reduction, is a shared responsibility among many actors. It is linked to most aspects of disaster risk reduction, and many disaster risk reduction actions from the many sectors result in health outcomes. Therefore, health serves as a bridge for disaster risk reduction. Countries and communities have shown that a focus on health can bring together sectors and agencies to focus on the common interest of people’s health.

Please continue to share your opinions and views to make the places we live in healthier and safer. Every voice counts. Your contribution will help assess the needs and find the solutions for a safer and healthier environment before, during and after disasters.

Thank you and I look forward to your comments.

Jonathan Abrahams, WHO

Special funds should be always allocated for health emergencies and disasters

26 April 2013

Health is currently addressed in the HFA. However, any further emphasis on Health under Post 2015 framework is most welcome as the projects focusing on Health should always be priority to any society and any national/international agenda. More funds on Health projects should always be considered and also focused on developmental and emergency areas. Special funds should be always allocated for emergencies and disasters.

Ms Miranda Shami, WHO

A post-2015 framework should strongly emphasize the importance of health protection in emergency management

24 April 2013

Progress is slowly being achieved in the integration of health protection in emergency management, but there are still significant challenges and a distinctly reactive approach to health prevention in disasters. A forthcoming publication by WHO (Floods: Health effects and prevention in the WHO European Region) illustrates these issues with relevant examples in a European regional context.

For instance, a questionnaire was sent to Member States in the WHO European region with regard to public health protection before, during and after floods. The responses revealed that most countries had general emergency management plans in place, and several of them specific plans for floods. However, health preparedness and response to floods was generally segregated from the main civil emergency response mechanisms, and the health sector was not directly involved in over half of the emergency plans.

Moreover, in the plans in which health was considered explicitly, usually only short term effects were included. The plans did not generally address the needs of vulnerable groups and/or gender considerations, and only a third of the plans involved provisions for coordination with neighboring countries.

A post-2015 framework should strongly and explicitly emphasize the importance of health protection in emergency management, specifically through the involvement of health stakeholders in every stage of the cycle. It should also emphasize the role of surveillance including long-term effects, and propose the consideration of vulnerable groups, as well as international coordination to improve the effectiveness and timeliness of responses.

Mr Gerardo Sanchez Martinez

The next HFA is an opportunity to shift emphasis from the institutions working on disaster risk management to the health sector itself

22 April 2013

Dear colleagues, thanks for opportunity to participate - a couple views:

Based on the ongoing monitoring of the Hyogo Framework and other progress reviews, many good initiatives seem to be taking place in countries - and hopefully we will hear of more of them through this consultation. There does seems to remain a gap between the strong rhetoric of the need to integrate disaster risk reduction into the health sector (it is referred to in many papers, plans and policies) and the actual ownership of the disaster risk discourse by the health sector , beyond dealing with emergency response.

The next HFA is an opportunity to shift emphasis from the institutions working on DRM (and their responsibility to mainstream the issue into the health sectors) to the health sector itself. Many of you have commented on the fact that the current HFA does not differentiate sufficiently the responsibilities regarding its goals and priority actions.

This would allow moving beyond the usual 'safe hospitals' approach to a level of granularity required to effectively address disaster risk across the fast moving and changing health sector, and its many sub-sectors, services and policies (at a recent consultation at WHO, to address disaster risk across its policies and programmes, interesting figure were provided on the scale of the health system in overall GDP, if memory correct about 10%, and of course the health sector is one of the largest segments of the overall workforce etc...).

The UN, with WHO, is starting to make such a shift, ensuring greater accountability by the agencies with sectoral leads, on their efforts to address disaster risk reduction within their policies and programmes (see attached a synthesis paper of HFA2 consultations to date).

Mr John Harding, UN Office for Disaster Risk Reduction (UNISDR)

Online discussion on the role of health in the future framework for disaster risk reduction

Analysing Disrupted Health Sectors in Countries in Crisis course

Amsterdam, the Netherlands
17-28 June 2013