The importance of health action in disasters
Access to healthcare is a critical determinant for survival in the initial stages of disaster. Disasters almost always have significant impacts on the public health and well-being of affected populations. The public health impacts may be described as direct (e.g. death from violence and injury) or indirect (e.g. increased rates of infectious diseases and/or malnutrition). These indirect health impacts are usually related to factors such as inadequate quantity and quality of water, breakdowns in sanitation, disruption of or reduced access to health services and deterioration of food security. Lack of security, movement constraints, population displacement and worsened living conditions (overcrowding and inadequate shelter) can also pose public health threats. Climate change is potentially increasing vulnerability and risk.
The primary goals of humanitarian response to humanitarian crises are to prevent and reduce excess mortality and morbidity. The main aim is to maintain the crude mortality rate (CMR) and under-5 mortality rate (U5MR) at, or reduce to, less than double the baseline rate documented for the population prior to the disaster (see table on baseline reference mortality data by region). Different types of disaster are associated with differing scales and patterns of mortality and morbidity (see table on public health impact of selected disasters), and the health needs of an affected population will therefore vary according to the type and extent of the disaster.
The contribution from the health sector is to provide essential health services, including preventive and promotive interventions that are effective in reducing health risks. Essential health services are priority health interventions that are effective in addressing the major causes of excess mortality and morbidity. The implementation of essential health services must be supported by actions to strengthen the health system. The way health interventions are planned, organised and delivered in response to a disaster can either enhance or undermine the existing health systems and their future recovery and development.
An analysis of the existing health system is needed to determine the system’s level of performance and to identify the major constraints to the delivery of, and access to, health services. In the early stages of a disaster, information may be incomplete and important public health decisions may have to be made without all of the relevant data being available. A multi-sectoral assessment should be conducted as soon as possible (see Core Standard 3).
Better response is achieved through better preparedness. Preparedness is based on an analysis of risks and is well linked to early warning systems. Preparedness includes contingency planning, stockpiling of equipment and supplies, establishment and/or maintenance of emergency services and stand-by arrangements, communications, information management and coordination arrangements, personnel training, community-level planning, drills and exercises. The enforcement of building codes can dramatically reduce the number of deaths and serious injuries associated with earthquakes and/or ensure that health facilities remain functional after disasters.
Public health impact of selected disasters NB: Even for specific types of disaster, the patterns of morbidity and mortality vary significantly from context to context.