Healthy, Resilient, and Sustainable Communities After Disasters Strategies, Opportunities, and Planning for Recovery (2015) / Chapter Skim
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2 Post-Disaster Opportunities to Advance Healthy, Resilient, and Sustainable Communities
2 Post-Disaster Opportunities to Advance Healthy, Resilient, and Sustainable Communities
Pages 47-72
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From page 47... ...
A "not in my backyard" mentality impedes the timely rebuilding of public housing, which was torn down before former residents were allowed to retrieve any remaining belongings. Many former public housing occupants who have been unable to return to the island because of the lack of affordable housing have no voice in the recovery planning process as a result of restrictions that limit participation to current residents.
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Disasters, although unquestionably tragic, create new resources and opportunities to advance the design and realization of healthy communities. One such opportunity is the synchronization of strategic planning across multiple disciplines and sectors that occurs during disaster recovery (Nolen, 2014)
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WHAT IS A HEALTHY COMMUNITY? Leveraging the disaster recovery process to advance the health of a community necessitates an understanding of the diverse determinants that influence health and specific healthy community elements relevant to the post-disaster period.
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To increase awareness among stakeholders regarding their role in shaping the conditions that affect health, a better understanding of what makes a healthy community is needed. The committee found a wealth of sources that describe elements of healthy communities, with significant overlap.
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indoor and outdoor environments, including air, soil, surfaces, and water • Affordable and sustainable energy use • Parks and green spaces, including a healthy tree canopy and agricultural lands • regional transportation grid featuring street connectivity and safe, sustainable, accessible, and A affordable active and public transportation options • acilities and recreational areas for safe, affordable physical activity and policies that promote F equitable access to those areas • Accessible locations at which to obtain affordable and nutritious foods • Affordable, high-quality, and location-efficient housing that meets national healthy housing criteria • uilding construction that incorporates universal design principles to support access for all com B munity members • Land use policies that help mitigate against known hazards • Safe, functional, and resilient critical infrastructure An inclusive, supportive social environment, including: • whole-community approach to strategic planning and problem solving, involving robust civic par A ticipation by empowered residents and leadership from community organizations and public officials • n emphasis on data-driven decision making and ongoing quality improvement in all sectors A • nclusive, supportive, respectful community social bonds, from the neighborhood to the regional I level • Resiliency to adapt to changing environments and emergencies • Quality educational opportunities accessible to all residents • Living-wage, safe, and healthy job opportunities for all residents and a thriving economy • Safe communities, free of violence, crime, bullying, racism, and discrimination • ntegrated and accessible social and community services to address the spectrum of human needs I efficiently and effectively • Support for healthy development of children and adolescents • Opportunities for engagement with arts, music, and culture A high-quality, comprehensive health system, including: • Affordable, accessible, high-quality, and patient-centered preventive health services and health care • Emphasis on individual and family health literacy, capacity building, and empowerment • A robust public health system that provides the essential public health services SOURCE: Adapted from California Health in All Policies Task Force, 2010. From the list in Box 2-2, several cross-cutting themes for healthy communities emerge: • Equity -- The World Health Organization defines equity as "the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically" (WHO, 2014a)
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. In effect, the social determinants of health are also the determinants of social vulnerability (see Box 2-3)
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is increasingly being acknowledged, the connection between efforts to address social vulnerability and activities aimed at reducing disparities in social determinants of health has not been widely recognized (Few, 2007; Lindsay, 2003) , and this represents a missed opportunity to achieve synergy among different professional sectors with shared goals.
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At the same time, however, actions that can be taken to make communities less vulnerable, and thus more resilient, also benefit the community in the everyday context through improvements in community health and well-being -- for example, by addressing social determinants of health that create social vulnerability. This point is of paramount importance because in a fiscally constrained environment, investment in resilience (i.e., the future)
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. Sustainability Disaster recovery can be viewed as a special case of the ongoing sustainable community development process, with the benefit of linking recovery to existing sustainability planning activities in many communities5 (Natural Hazards Center, 2005)
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. Bottom-Up Approaches to Building Social Capital San Francisco, California In recognition of the value of strong community bonds and social networks to a region, a collaborative was formed in 2007 in San Francisco, California.
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Nonetheless, the committee strongly believes there is still a critical need for both health and non-health sectors to include an explicit focus on health in recovery planning to ensure that recovery activities do not have unintended negative impacts on health, that opportunities to create healthier communities are not lost, and that health outcomes are tracked and used as measures of program success. At the same time, however, it is also critical that a healthy community approach to recovery not be presented as an alternative to post-disaster resilience and sustainability initiatives.
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. Disaster management professionals from a variety of sectors (e.g., emergency management, urban planning)
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• timulate economic vitality -- Beyond health care–related costs, unhealthy communities are bad S business more generally. Failure to attend to the social determinants of health (employment, educa tion, food access)
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. The health sector can work to reduce the vulnerability of its own facilities and programs, and it can advocate for measures that reduce the vulnerability of communities and their residents by strengthening community systems and addressing social determinants of health.
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The social services sector offers early childhood interventions and food access programs. Public health agencies may offer health services to the most vulnerable members of communities through a safety net system.
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A Health in All Policies Approach to Disaster Recovery As discussed earlier in this chapter, intentional consideration of health, including health equity, is necessary during recovery to mitigate the negative effects of a disaster and seize opportunities to advance population health and well-being. Although disasters have direct impacts on health in the short term, negative effects on health also arise in the long term through the impacts of the disaster on social determinants of health, often exacerbating preexisting health inequities.
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. The Health and Human Services Transformation Plan, accepted by the Council in 2013, charts a course for improving health and well-being by shifting "from a costly, crisis-oriented response to health and social problems, to one that focuses on prevention, embraces recovery, and eliminates disparities by providing access to services that people need to realize their full potential" (King County, 2013, p.
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. Motivation for a HiAP approach comes from understanding that "good health is fundamental for a strong economy and vibrant society, and that health outcomes are largely dependent on the social determinants of health, which in turn are shaped primarily by decisions outside the health sector" (Rudolph et al., 2013b, p.
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. The Galveston case study demonstrates the challenges of applying a HiAP approach to disaster recovery without adequate pre-disaster investment in building cross-sector relationships (such as that illustrated by the King County and Thurston County examples described in Boxes 2-8 and 2-9, respectively)
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Funded by two grants beginning in October 2009, Dr. Nolen and her center sought to increase the evidence base for post-disaster recovery planning through informed policy making related to the social determinants of health.
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In the course of future disaster recovery efforts, it will be important to measure impacts on health outcomes. A HiAP approach is ideally suited to ensuring that health considerations are incorporated into the recovery decision-making process across all sectors.
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Despite a growing healthy community movement outside of the disaster context, the committee noted only a handful of communities taking this forward-looking and synergistic approach to recovery. There are a number of reasons why the committee believes this approach should be adopted in a far more systematic way.
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Although there are a number of challenges to wider adoption of this healthy community approach, the committee believes the first step is simply to put health on the radar for recovery. In this chapter, the committee has presented its rationale for using the recovery period, and the resources that will necessarily be allocated to the recovery process, to synergistically improve health and social well-being.
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Paper presented at IOM Committee on Post-Disaster Recovery of a Community's Public Health, Medical, and Social Services: Meeting Four, June 13, Washington, DC. CSDH (Commission on Social Determinants of Health)
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2004. Social capital: A missing link to disaster recovery.
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2014b. Social determinants of health: Key concepts.
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