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2 Linking Hazards and Public Health: Case Studies in Disaster
Pages 19-32

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From page 19...
... Eric Klinenberg of New York University stated that one of the immediate challenges faced by individuals attempting to persuade the public and government officials of the direct health threat presented by heat waves is the lack of imagery associated with a heat wave. Often people conjure images of children playing near a fire hydrant or people sipping lemonade on a front porch as ways to skip the heat.
From page 20...
... This is due to the density of brick and stone buildings, paved streets, and tar roofs that store heat and radiate it like a slowly burning furnace to create a "heat island." The worst heat disasters, in terms of loss of life, occur in large cities when a combination of four factors occurs for a period of several days: high daytime temperatures high humidity warm nighttime temperatures which prevent dissipation of stored day time heat abundance of sunshine, which can increase the heat index by 15F Examined independently these atmospheric conditions may be of little con sequence. However, in combination they can create an urban environment where infrastructure stores heat and continually releases it throughout the night until the next day, when more heat will be absorbed for the cycle to continue until temperatures drop.
From page 21...
... Although there is some debate, the delayed deaths in Europe may have occurred due to the temperatures and unusual atmospheric conditions reaching a critical juncture, whereas the conditions in Chicago resulted from a sudden onset of extraordinary atmospheric conditions. Complicating Factors in the Chicago Heat Wave of 1995 While high temperatures and unusual weather conditions are essential components of a heat wave, there are often a number of compounding issues, such as a lack of communication between government officials and a failure of critical infrastructure.
From page 22...
... Because of the delay in issuing an excessive heat advisory, emergency measures such as Chicago's five cooling centers were not fully utilized, severely taxing the medical system as thousands were taken to local hospitals with heat related problems. Lack of understanding: Klinenberg stated that a large part of the problem was with reporting and recognition -- a failure and in some cases a refusal to recognize the extent of the damage and the potential for further risks, such as the difficulty experienced by paramedics attempting to convince high-ranking officials that the health problems they were addressing con stituted a disturbing trend and a serious threat.
From page 23...
... Part of the traditional purpose of infrastructure is to protect human health, and so disaster planning needs to be explicitly incorporated into infrastructure design, operations, and maintenance. In addition, infrastructure services are interrelated, which has implications for public health.
From page 24...
... Infrastructure Under Non-Disaster Conditions In urban areas the quality of the built environment, which includes infrastructure, dramatically affects the health status of all urban residents. Zimmerman stated that air and water quality, for example, encompasses infrastructure-related public health issues for all urban residents on a day-to-day basis: Under non-disaster conditions transportation is the single largest contrib utor to emissions of several air quality pollutants, and similarly, the generation of electric power is a key contributor to several air quality pollutant emissions (Wright, 2005: 580, based on U.S.
From page 25...
... As communities move from a small population density to a much higher population density, there is, for example, an evolution in the provision of water supply services, from wells to community water supply systems to urban water treatment plants. Similarly, the natural evolution of wastewater treat
From page 26...
... With electric power, individual stoves have given way to electric heating capacity provided via overhead electric power lines followed by underground lines, and from smaller electric power plants to larger ones based on energy sources such as coal or nuclear power, noted Zimmerman. Society is also becoming increasingly reliant upon infrastructure networks that often span large distances, stated Zimmerman, noting that the United States has almost 4 million miles of highway, 10,000 miles of track for city and regional rail, 22,000 miles of track for long distance passenger travel, and 170,000 miles of freight railroads (summarized in National Research Council, 2002)
From page 27...
... Infrastructure: Choices and Trade-Offs Difficult choices often have to be made regarding risks and benefits when considering the effects of infrastructure options upon the health of a population, such as the use of diesel fuel for emergency power back-up to generators versus the health effects that may result from diesel fuel emissions. Decisions made by government and industry must involve the decoupling of infrastructure and shift our dependency from centralized energy sources to renewable energy sources such as solar, waste, wind, and other relatively newer technologies that can operate in a decentralized manner, stated Zimmerman.
From page 28...
... For example, in Bosnia, the mortality of traumas in 1992 increased dramatically within the time-span of a few months, from 22 percent mortality of trauma cases to 78 percent mortality, an increase that was directly linked to the civil war and international intervention. Hospitals and the Red Cross Society emblems were previously considered to be safe harbors even during a complex emergency; however, over the last 510 years there has been an increasing trend towards targeting the health
From page 29...
... They vary in origin, including: long-term interruption of health services due to impairments in access or security the need for provisional housing interruption of infrastructure, such as water systems, electricity, transpor tation general insecurity and psychological impact of events on population and staff limited access to food due to lack of income, lack of adequate stores, destruction of crops, etc. Poncelet observed that the disrup We prefer to see victims attended by tion of basic needs and supplies can hospital physicians, but what will save often prove far more devastating than the largest number of lives is the fixing the direct impact of the disaster itself.
From page 30...
... However, this view is changing with an accumulation of research on long-term coping and functioning Mental health has traditionally been skills of affected populations, noted overlooked as a priority need for Poncelet. Depression and post-trauproviding assistance in the case of matic stress disorder (PTSD)
From page 31...
... This allows for technical cooperation between local and international officials with an independent assessment of specific needs in the current situation and the ability to mobilize international resources to complement the local and national response, if necessary. If You Don't Know, Don't Go In summary, Poncelet put forth three major points regarding complex disasters and their impact on public health: the need for quality information, protection of public health services, and availability of appropriate and timely expertise.
From page 32...
... Poncelet suggested that the best method of alleviating some of the strain on public health posed by a complex emergency is to help the remaining local structure to respond and prepare for a crisis as poorly coordinated international intervention can prove more dangerous than effective.


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