Health Research Linked to Disasters

and Other Humanitarian Crises

Larissa Avilés-Santa, MD, MPH

Director, Clinical and Health Services Research
National Institute on Minority Health and Health Disparities (NIMHD)

Introduction to Principles and Practice of Clinical Research

National Institutes of Health
Images from Google Clinical Center
Images from Google
Why Health Research in Disasters and
Other Humanitarian Crises?
• Worldwide
• Frequent events
• Immediate effects
• Priceless losses
• Preparedness
• Resilience
• Long-term impact on health, health care
• Vulnerability
• Recovery

Images from Google

Outline
• Brief overview of types of humanitarian crises and the
disaster recovery continuum

• Purpose of health research linked to humanitarian

crises

• Proposed frameworks for disaster recovery and health

research

• Challenges in performing health research linked to

disasters

• Research opportunities
Types of Humanitarian Crises and
the Disaster Recovery Continuum

Images from Google

 Prolonged power outages
Prolonged disruption of
Droughts communication
Snowstorms Extended lack of potable water
Landslides

Famine
Mass displacement
Migration
Refugees
Genocides
Human Trafficking?
Extreme political instability
Civil unrest
and violence
Armed Conflict
Pre-Disaster Recovery Planning Guide for State Governments,
FEMA Publication Number: 104-008-3
 Stafford Disaster Relief and Emergency
Assistance Act (Stafford Act)

• Robert T. Stafford Disaster Relief

and Emergency Assistance Act, PL
100-707, signed into law
November 23, 1988; amended the
Disaster Relief Act of 1974, PL 93-
288.
• “To provide an orderly and
continuing means of assistance by
the Federal Government to State
and local governments in carrying
out their responsibilities to
alleviate the suffering and
damage which result from such
disasters.”
https://www.fema.gov/disasters/stafford-act
Public Health Emergencies and Disasters

• Public Health Emergency

• Federal assistance needed to:
• To protect property and public health and safety
• “Major disaster”
• Any natural catastrophe or, regardless of cause, any fire,
flood, or explosion
• Damage of sufficient magnitude
• Federal assistance to alleviate damage, loss, hardship, or
suffering.

https://www.fema.gov/disasters/stafford-act
Local emergency
management agencies

Local governments and

other agencies

Local health care systems

Individuals

Local and international

organizations (e.g.,
volunteers, medical
professionals, charitable,
faith-based)

Images from Google

Recovery planning Emergency and Interim housing Permanent housing
Community needs public health Infrastructure repair Economic revitalization
assessments services and restoration Reestablish disrupted
Training and Evacuation and Ensure continuity of health care services
capacity relocation care Advanced mitigation
assessments Emotional support Community strategies
Debris engagement to build
Mitigation activities back stronger

National Disaster Recovery Framework, Second Edition, June 2016

U.S. Department of Homeland Security
Question 1

Disaster recovery is a series of phases in a continuum

that:
a. Are distinct, and specific activities are expected
within each one of them.
b. Are interdependent, and with some activities
happening along the continuum.
c. Start after disasters hit.
d. Offer a great opportunity to test new
interventions in topics outside of response or
recovery.
Purpose of Health Research Linked
to Humanitarian Crises or Disasters

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 Benefits from Health Research Linked to Disasters
Short-term benefits
• Accurately characterizing the scope and nature of exposures of concern
• Understanding acute health impacts
• Identifying vulnerable populations
• Improving worker safety
• Determining effectiveness of interventions

Long-term benefits
• Improved understanding of the delayed and chronic health effects from
exposures and other disaster related risk factors
• Increased community resilience
• Expanded knowledge of the effectiveness of medical countermeasures and
other mitigation strategies
• Improved health system preparedness, response, and recovery for future
events

Miller A et al., Intern J Environmental Res Public Health 2016; 13: 676
Social
Vulnerability
Index

https://www.youtube.com/watch?app=desktop&v=u5m0Lb3B4UY&feature=youtu.be
https://www.youtube.com/watch?v=REKFHOryflA

Flanagan BE et al., J Environmental Health 2018; 80: 34-36

https://phys.org/news/2017-11-storms-poorer-people-harder-superstorm.html
www.oxfamamerica.org
Social
Vulnerability
Index

https://www.youtube.com/watch?app=desktop&v=u5m0Lb3B4UY&feature=youtu.be
https://www.youtube.com/watch?v=REKFHOryflA

Flanagan BE et al., J Environmental Health 2018; 80: 34-36

http://puerto-rico-now.c4sr.columbia.edu/2019/04/04/Claramunt-Entrikin-Bone-
Calvesbert.html
https://www.niehs.nih.gov/research/programs/coronavirus/covid19pvi/index.cfm
https://www.niehs.nih.gov/research/programs/coronavirus/covid19pvi/index.cfm
Question 2
Upon designing a health research project linked to
disasters or other humanitarian crises, potential
research outcomes mediators include:
a. Household members’ health status upon first
contact with the research team, household
annual income and access to highways
b. Household or individual health status prior to the
event, health care system’s operational status
and food security
c. Level of preparedness prior to the event
d. All of the above