Professional Documents
Culture Documents
Public Health Impact: of Disasters
Public Health Impact: of Disasters
Public Health Impact: of Disasters
Spring 2000 59
examples of natural hazards which have the earthquake. A study of the fatal are other buildings and people in the area
the potential for both direct and indirect coronary events in Los Angeles found that of a disaster. This damage occurs at a most
acute health consequences. In the United indeed there was an increase in the inopportune time, just as the need for
States in the recent past, increases in number of heart attacks on January 17, emergency health care is greatest.
morbidity and mortality as a direct result 1994 however, a decrease of fatal events
from heat waves have been documented. occurred in the following week (Kloner Damage to the physical infrastructure
In Chicago in the summer of 1995, 465 et al. 1997). Thus, it appears that an acute An example of the direct impact of
people died from heat-related illness disaster such as an earthquake may disasters on the health care system was
when record-breaking temperatures were hasten death from heart attack, however, the damage to hospitals as a result of the
recorded for 8 consecutive days (MMWR the net effect is not a significant increase Northridge earthquake. Eighteen hospitals
1995). Those most at risk were those who in fatal heart attacks. suffered varying degrees of structural and/
were elderly and either did not have, or While disasters may not be associated or non-structural damage as a result of
did not turn on, air conditioning in their with a large increase in fatal acute the earthquake. Several hospitals had to
homes. coronary events, they do appear to result evacuate patients already there and others
At the opposite extreme hypothermia in greater morbidity from chronic were unable to treat individuals seeking
is only one potential acute health problem conditions such as heart disease, hyper- emergency care (Cheu 1995).
associated with extreme cold weather. tension and diabetes. Researchers in The earthquake of January 25, 1999 in
Extreme cold weather events are also Japan found that glycemic control was the coffee region of Colombia had similar
accompanied by two secondary hazards impaired in diabetics following the Kobe devastating impacts on the health care
which carry their own adverse health earthquake (Inui et al. 1998). Similarly, system. The one hospital in the com-
effects. Extreme cold events, especially following Hurricane Iniki on the Island munity of Calarca suffered significant
those that result in ice storms, often result of Kuai in Hawaii, the mortality rate from damage to the building, causing the
in electrical power outages. In response diabetes doubled compared to prior to evacuation of the 30 in-patients to a
to the lack of electricity, residents the Hurricane (Hendrickson and Vogt building next door. Although the damage
commonly resort to using candles for light 1996). Therefore, conditions for which did not affect the integrity of the building,
and kerosene heaters and fireplaces for stress is a risk factor and for which stairwells were impassable and significant
heating. This use of open-flame sources ongoing health care is necessary appear damage to walls in the operating suite
has been associated with residential fires, to be affected by disaster situations. made those areas unusable. The hospital
and fire-related mortality. Power failures continued to provide emergency care in
Psychological effects
also result in residents using gasoline or the portion of the building that had been
The health effects of natural disasters are
kerosene powered generators. The misuse constructed after a previous damaging
not purely of a physical nature. A great
of generators in poorly ventilated settings earthquake. This section fared much
deal of literature deals with the emotional
is associated with an increase in carbon better than the older sections of the
or psychological effects of disasters. Just
monoxide poisoning (MMWR 1998). hospital, which had significant portions
like the physical effects, the emotional
built of unreinforced concrete.
effects of disasters vary greatly from
Chronic illnesses A number of clinics in Armenia also
disaster to disaster. They also tend to range
The consequences of a disaster on the suffered major structural damage. Of the
from very minor emotional distress to
health of the population are not limited 12 public health clinics in the city, four
clinically diagnosable psychological
to acute conditions such as physical collapsed in the original earthquake with
pathology. Again there are a number of
injuries or acute illness. For a long time five others having significant damage to
variables that contribute both to the
there has been speculation that disasters the roof, walls, and equipment. One clinic
severity and extent of the psychological
result in an increase in adverse conse- slowly slipped down the hillside behind
effects. Generally, natural disasters result
quences of chronic illness such as heart it, although it had continued to function
in large numbers of individuals suffering
disease. Anecdotal accounts of disasters in the immediate aftermath of the
from minor emotional distress that tends
often include reports of increased heart earthquake.
to be self-limiting in nature (Bravo et al.
attack deaths, especially in the event of The effects on the health care system
1990). Some portion of the population may
acute onset disasters such as earthquakes. are not only a result of structural damage.
suffer from more severe forms of distress,
Certainly heart attack deaths are often A major cause of damage to hospitals in
especially anxiety and depression, depen-
included in the official numbers of the Northridge, Californian earthquake,
ding on their prior psychological state and
fatalities in disasters. In the Northridge, was breakage of water lines and sprinkler
the impact of the disaster on them and
Californian earthquake, the official pipes. Many hospitals, although struc-
their families (Siegel 1999). While it has
coroners report of the fatalities directly turally sound were unable to operate
generally been believed that victims of
or indirectly associated with the earth- because of the damage caused by water
natural disasters suffer from Post-
quake was 57. Only 33 of those deaths were pipes rupturing and flooding the facility
Traumatic Stress disorder (PTSD), it does
as a result of physical injuries (Peek-Asa causing a loss of medical records, medical
not appear that this is the case. Symptoms
et al. 1999). The other deaths were supplies, computers and other electronic
of PTSD may be expressed by victims of
attributed to heart attacks or other equipment (Cheu 1995). The Sepulveda
natural disasters but community based
medical causes. These numbers, however, Veterans Administration had such exten-
studies do not reflect an increase in
did not include all individuals who died sive damage due to water that they were
diagnosable PTSD (Siegel 2000).
of heart attacks in Los Angeles County on forced to evacuate their patients to other
January 17, 1994, but only those coronary Direct system effects area hospitals in spite of the fact that they
deaths that came to the attention of the Hospitals, clinics, health care centers sustained no structural damage to the
coroner and were determined to be and the personnel that staff them are hospital.
somehow caused or hastened because of subject to the same destructive forces as Other non-structural damage also
Spring 2000 61
downed power and telecommunication A public health sector which conducts Calamity Preparedness, Journal of Contin-
lines, over-turned or cracked transformers, routine surveillance, has good immuni- gencies and Crisis Management, Vol. 3,
and system overloads from earthquakes, sation coverage, maintains adequate No. 4, pp. 228-246.
windstorms, hurricanes, ice storms and environmental control, etc. will be better Corrales Arturo 1999, Hurricane Mitch:
other natural hazards. Underground pipes able to withstand the increase in need A Central American Disaster, Presented
carrying water, sewage, oil, or natural gas following a disaster. The health system, at Natural Hazards Workshop, July 1999,
are at risk for breakage from earthquakes. including the medical care system, Boulder, CO.
Water treatment systems can be over- however must itself be prepared to resist Eguchi R.T., Goltz J.D., Taylor C.E., Chang
whelmed by large amounts of water from the disaster. Buildings and their contents S.E., Flores P.J., Johnson L.A., Seligson H.A.,
hurricanes and other flooding events. must protect the health care professionals & Blais N.C. 1998, Direct Economic Losses
Without these utilities the health care inside and they must be able to continue in the Northridge Earthquake: A Three-
system cannot function. to function in the aftermath of a disaster. Year Post-Event Perspective, Earthquake
Large health care agencies, such as This necessitates that the health sector Spectra, Vol. 14, No. 2, pp. 245-264.
hospitals, often maintain back-up systems undertake major efforts to mitigate Goltz James 1999, The 921 Chi-Chi,
in case of failure of the infrastructure. damages to itself from potential hazards Taiwan Earthquake of September,
Hospitals maintain emergency generators and prepare to function at increased www.eeri.org/Reconn/TaiwanG/TaiwanG.
and have some water storage capabilities. capacity following the impact of a html.
However, these back-up systems do not disaster. Hendrickson L.A. & Vogt R.L. 1996,
always function as expected and are by Mortality of Kauai residents in the
their nature limited resources to be used References 12-month period following Hurricane
for a short period of time. Also, other Bolin Robert 1993, Household and Com- Iniki, American Journal of Epidemiology,
essential components of the health care munity Recovery after Earthquakes, Vol. 144, No. 2, pp. 188-91.
system often do not have such back-up Boulder, University of Colorado. Inui A., Kitaoka H., Majima M., Takamiya
systems. Clinics, pharmacies, doctors Bourque L.B., Peek-Asa C., Mahue M., S., Uemoto M., Yonenaga C., Honda M.,
offices rarely have the capability to Nguyen L.H., Shoaf K.I., Kraus J.F., Weis B., Shirakawa K., Ueno N., Amano K., et al.
provide themselves with power or water Davenport D., Saruwatari M. 1998, Health 1998, Effect of the Kobe earthquake on
in the event of a disaster. Implications of Earthquakes: Physical and stress and glycemic control in patients with
The transportation system is also Emotional Injuries During and After the diabetes mellitus, Archives of Internal
vulnerable to many types of natural Northridge Earthquake, Proceedings of the Medicine, 1998 Feb 9,Vol. 158, No. 3, pp. 274-8.
disaster. In Honduras alone Hurricane International Symposium on Earthquakes Kloner R.A., Leor J., Poole W.K., & Perritt
Mitch destroyed more than 9000 meters and Peoples Health: Vulnerability Reduction, R 1997, Population-Based Analysis of the
of bridges isolating many communities. Preparedness and Rehabilitation, WHO Effect of the Northridge Earthquake on
The combination of destruction to the Centre for Health Development, Jan. 1997, Cardiac Death in Los Angeles County,
transportation and communications Kobe, Japan, pp. 22-31. California, Journal of the American College
sectors had a grave impact on the public Bravo M., Rubio-Stipec M., Caninio G.J., of Cardiology, Vol. 30, No. 5, pp. 1174-1180.
health sectors ability to respond to the Woodbury M.A., & Ribera J.C. 1990, The Melkonian Arthur 1997, Long-term
disaster. Because of the damage surveil- Psychological Sequelae of Disaster Stress Health Implications of Disaster, Procee-
lance efforts were hampered. Instead of Prospectively and Retrospectively Evalua- dings of the International Symposium on
70% of locations providing surveillance ted, American Journal of Community Earthquakes and Peoples Health: Vulnera-
reports on communicable diseases only Psychology, No. 18, pp. 661-680. bility Reduction, Preparedness and Rehabili-
30% of locations provided such reports Centers for Disease Control and Preven- tation, World Health Organization Centre
following the disaster. This hampered the tion 1995, Heat-Related Mortality -- for Health Development, January 27-30,
ability to respond to any public health Chicago, July 1995, Morbidity and Mor- 1997, Kobe, Japan.
emergencies that may have cropped up tality Weekly Review, August 11, 1995, Vol. Noji Eric 1997, The Public Health
and probably contributed to the dengue 44, No. 31, pp. 577-579. Consequences of Disaster, Oxford Univer-
fever outbreak (PAHO 1999). Centers for Disease Control and Preven- sity Press, NewYork, NY.
tion 1998, Community Needs Assessment Pan-American Health Organization
Conclusion and Morbidity Surveillance Following an 1999, Disaster Chronicle: Hurricanes
The public health consequences of natural Ice Storm -- Maine, January 1998, Morbi- Georges and Mitch.
disasters are complex. Disasters directly dity and Mortality Review Weekly, May 08, Peek-Asa C., Kraus J.F., Bourque L.B.,
impact the health of the population Vol. 47, No. 17, pp. 351-354. Vimalachandra D., Yu J., Abrams J.1998,
resulting in physical trauma, acute Centers for Disease Control and Preven- Fatal and hospitalized injuries resulting
disease, and emotional trauma. In ad- tion 1999, ,Community Needs Assessment from the 1994 Northridge earthquake,
dition, disasters may increase the mor- and Morbidity Following an Earthquake- International Journal of Epidemiology, Vol.
bidity and mortality associated with Turkey, August 1999, Morbidity and 27, No. 3, pp. 459-65.
chronic diseases and infectious diseases Mortality Weekly Review, Vol. 48, No. 50, pp. Peek-Asa C., Ramirez M.R., Shoaf K.I.,
through the impact on the health care 1147-1150. Seligson H.A., Kraus J.F. 2000,GIS Mapping
system. How are these ramifications best Cheu Donald 1995, Northridge Earth- of Earthquake-Related Deaths and Hospital
reduced? As the saying goes, an ounce of quake-January 17, 1994: The Hospital Admissions from the 1994 Northridge,
prevention is worth a pound of cure. Response, FEMA, 17 January: 1995, California, Earthquake, Annals of Epide-
Possibly the greatest factor which would pp. 1-15. Northridge Earthquake: One Year miology, Vol. 10, No. 1, pp. 5-13.
lead to reduced morbidity and mortality Later, Universal City, CA. Richman N. 1993, Editorial - After the
as a result of disasters is a strong public Cole Sam 1995,Lifelines and Livelihood: Flood, American Journal of Public Health,
health system. A Social Accounting Matrix Approach to Vol. 83, No. 11, pp. 1522-24.
Spring 2000 63