Destruction of Health Care Infrastructure Sendai sewage treatment - PowerPoint PPT Presentation

FLOODING & P UBLIC H EALTH IMPACT Paul R Hunter The Norwich Medical School University of East Anglia

D IRECT IMPACTS ON HEALTH ▪ Pre-onset phase ▪ Injuries ▪ Onset phase ▪ Death by drowning ▪ Injuries ▪ Post-onset phase ▪ Faecal oral disease ▪ Vector and rodent-borne disease ▪ Respiratory infections ▪ Skin infections ▪ Mental health Few et al 2004

I NDIRECT IMPACTS ON HEALTH ▪ Damage to health care infrastructure ▪ Chemical contamination of food and water stocks ▪ Damage to water and sanitation infrastructure ▪ Damage to crops and/or disruption of food supplies ▪ Damage/destruction of property (e.g. lack of shelter may lead to increased exposure to vectors) ▪ Population displacement Few et al 2004

Destruction of Health Care Infrastructure

Sendai sewage treatment plant

Onagawa

D EATHS

A NNUAL REPORTS OF FLOODING EVENTS GLOBALLY 250 200 150 100 50 0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 http://www.emdat.be/ Data taken from EM-DAT

A NNUAL REPORTS OF DEATHS FROM FLOODING 40000 Venezuela 1999 35000 Bangladesh 1974 30000 25000 20000 15000 10000 5000 0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Data taken from EMDAT

A NNUAL REPORTS OF DEATHS FROM FLOODING PER EVENT 10000 1000 100 10 1 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Data taken from EMDAT

A NNUAL REPORTS OF N UMBERS AFFECTED BY FLOODING 300.000.000 250.000.000 200.000.000 150.000.000 100.000.000 50.000.000 0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Data taken from EMDAT

D EATHS PER 10000 PEOPLE AFFECTED BY FLOODING 1000 100 10 1 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 0,1 Data taken from EMDAT

D EATHS PER EVENT BY WHO S UB -R EGION 1960-2016 0,6 0,5 0,4 E D 0,3 C B 0,2 A 0,1 0 AFR-D AFR-E AMR-A AMR-B AMR-D EMR-B EMR-D EUR-A EUR-B EUR-C SEAR-B SEAR-D WPR-A WPR-B

D EATHS PER EVENT BY WHO REGION TYPE 1960-2016 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0 ABC DE 60 - 79 80 - 99 2000+

A CUTE MORBIDITY High income vs low income countries

HEALTH IMPACTS POST FLOODING ▪ Infectious dissease ▪ Toxicity ▪ Psychological ▪ Adverse Birth Outcomes

F LOODING IN UK

F LOODING IN DEVELOPING NATIONS

I NFECTIOUS DISEASE RISK POST FLOODING DEVELOPED NATIONS DEVELOPING NATIONS ▪ Common source of anxiety ▪ Enteric disease ▪ Outbreaks infrequent ▪ Diarrhoeal disease ▪ Hepatitis E ▪ Giardiasis in Utah ▪ Outbreaks of waterborne disease ▪ Leptospirosis have been described ▪ Vector-borne disease, e.g.: ▪ Cryptosporidium ▪ Malaria ▪ E. coli O157 ▪ Acanthamoeba keratitis

W ATERBORNE DISEASE & WATER QUALITY

H URRICANE K ATRINA

T HE K ATRINA EXPERIENCE ▪ Flood waters contained high levels of faecal indicator bacteria ▪ Surface water indicator bacteria levels returned to pre-event levels within two months ▪ Bifidobacterium and bacterial diversity analysis suggested that indicator bacteria were of human origin ▪ Vibrio and Legionella concentrations higher post event ▪ Giardia and Cryptosporidium present in flood water Sinigalliano et al. 2007

K ATRINA AND G ROUND WATER ▪ Many wells submerged under 0.6 to 4.5m of water ▪ Associated plumbing damaged ▪ Chemical evidence of saltwater intrusion into wells ▪ Some evidence of indicator organisms Van Biersel et al. 2007

C HOLERA AND DIARRHOEA VISITS TO HOSPITAL POST 1998 FLOOD - B ANGLADESH

R EDUCING THE IMPACT OF FLOODING

R EDUCING THE PUBLIC HEALTH IMPACT OF FLOODING ▪ Mitigation ▪ Warning and preparedness ▪ Needs assessment ▪ Surveillance ▪ Response and recovery ▪ Continuing health education

K ATRINA ▪ Of people who did not evacuate the city prior to the arrival of Hurricane Katrina ▪ 1/3 did not get the message ▪ 1/3 heard the message but did not understand how to evacuate. ▪ People who did not evacuate were predominantly from the poorest and most marginalised sections of society. Brodie et al 2006

T HE 2007 S EVERN FLOODS

D ID PEOPLE COMPLY WITH THE ADVICE ? ▪ During the boil water notice ▪ 42% people used unboiled water for food preparation ▪ 38% people used unboiled water for brushing teeth ▪ 29% people used unboiled water for drinking

S OURCES OF INFORMATION IN A DO NOT DRINK NOTICE ISSUED DURING SEVERE FLOODING Local radio Leaflet Water company Local newspaper TV Friend/neighbour internet 0 10 20 30 40 50 60 70 % reporting use of information source

C ONCLUSIONS ▪ Despite the large number of floods reported annually the quality of the evidence base for public health impacts is still poor. ▪ Not all adverse health effects of flood disasters are unavoidable ▪ By good planning and response many health effects can be eliminated (and appear to have been) or their impact reduced ▪ In a flood emergency use multiple channels of communication.