The 6th Global Conference of the Alliance for Healthy Cities (AFHC)

29 October – 1 November 2014, Hong Kong SAR, China

Mr Alex Ross

Director, WHO Kobe Centre

“Prevention and preparedness

is the heart of public health.

Risk management is our bread

and butter."

“Our greatest concern

must always rest with

disadvantaged and

vulnerable groups.”

Dr Margaret Chan WHO Director-General

Public health emergencies:

Every year, one out of 5 WHO Member States

experiences a crisis endangering the health and lives of its people

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Haiti

Pakistan Tunisia-Libya Border

Broad range of public health emergencies

resulting from various hazards.

• Influenza A (H7N9) in China

• Dhaka(Savar) building collapse

• Boston marathon bombing

• Hurricane Sandy

• Haiti earthquake

• Syria conflict

• Bangkok floods

• TC Ketsana in the Philippines

Risks: Many Types

• Biological

• Chemical

• Radiological

• Conflict

IHR (rev 2005)

DRM: A Paradigm Shift

From

disasters’ preparedness & response

to

disaster risk management

9

Emerging and communicable diseases

• Influenza

• MERS-Cov

• Dengue

• Chikungunya

• Food borne diseases

• Ebola

Public health sequelae of disasters

• Communicable diseases

• NCDs

• Continuity of care

• Psycho-social

In 2011...

Humanitarian Health Action

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http://www.who.int/entity/hac/crises/afg/en/index.htmlhttp://www.euro.who.int/en/health-topics/environment-and-health/Climate-change/news/news/2014/05/public-health-advice-on-floodinghttp://www.who.int/entity/hac/crises/caf/en/index.htmlhttp://www.who.int/entity/hac/crises/chn/en/index.htmlhttp://www.who.int/entity/hac/crises/cod/en/index.htmlhttp://www.who.int/entity/hac/crises/gin/en/index.htmlhttp://www.who.int/entity/hac/crises/hti/en/index.htmlhttp://www.who.int/entity/hac/crises/idn/en/index.htmlhttp://www.who.int/entity/hac/crises/irq/en/index.htmlhttp://www.who.int/entity/hac/crises/lbr/en/index.htmlhttp://www.who.int/entity/hac/crises/mli/en/index.htmlhttp://www.who.int/entity/hac/crises/mmr/en/index.htmlhttp://www.who.int/entity/hac/crises/nga/en/index.htmlhttp://www.who.int/entity/hac/crises/phl/en/index.htmlhttp://www.euro.who.int/en/health-topics/environment-and-health/Climate-change/news/news/2014/05/public-health-advice-on-floodinghttp://www.who.int/entity/hac/crises/sle/en/index.htmlhttp://www.who.int/entity/hac/crises/som/en/index.htmlhttp://www.who.int/entity/hac/crises/ssd/en/index.htmlhttp://www.who.int/entity/hac/crises/syr/en/index.htmlhttp://www.who.int/entity/hac/crises/ukr/en/index.htmlhttp://www.who.int/entity/hac/crises/yem/en/index.htmlhttp://www.who.int/entity/hac/crises/bdi/en/index.htmlhttp://www.who.int/entity/hac/crises/tcd/en/index.htmlhttp://www.who.int/entity/hac/crises/chl/en/index.htmlhttp://www.who.int/entity/hac/crises/cog/en/index.htmlhttp://www.who.int/entity/hac/crises/lbn/en/index.htmlhttp://www.who.int/entity/hac/crises/mli/en/index.htmlhttp://www.who.int/entity/hac/crises/international/wbgs/en/index.htmlhttp://www.who.int/entity/hac/crises/pak/en/index.htmlhttp://www.who.int/entity/hac/crises/slb/en/index.htmlhttp://www.who.int/entity/hac/crises/sdn/en/index.htmlhttp://www.who.int/entity/hac/crises/zwe/en/index.html

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Disaster risk reduction, preparedness, response and recovery

(DRR-PRR) is key.

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54% of the world is now urban. (World Urbanization Prospects 2014)

60% by 2030.

66% by 2050.

Urban Health is now recognized as a global public health issue.

Urbanization in numbers

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

1950

2010

2050

YEAR

COUNTRY 1950 2010 2050

Australia 77.0% 88.7% 92.9%

Cambodia 10.2% 19.0% 30.6%

China 11.8% 49.2% 75.8%

Japan 53.4% 90.5% 97.7%

Korea 21.4% 81.9% 87.6%

Malaysia 20.4% 70.9% 85.9%

Mongolia 20.0% 67.6% 84.8%

Philippines 27.1% 45.3% 56.3%

Vietnam 11.6% 30.4% 53.8%

Source: World Urbanization Prospects 2014 (UN); World Population Prospects 2013 (UN); WHO Global Health Observatory

3.3 Billion

in urban areas

1 Billion

in urban slums

3.3 Billion

in rural areas

6.4 Billion

2 Billion

2.9 Billion

2008

2050

(United Nations projections)

Urban residents -- Slums

Source: World Urbanization Prospects 2014 (UN); World Population Prospects 2013 (UN); World Economic Outlook 2014 (IMF)

10 Largest Cities 1960-2020

Rapid, Unplanned Urbanization • Irreversible transition from rural to urban with concentration of opportunities

• Concentration of hazards,

vulnerabilities; increased health risks

• Driving forces: ageing, urbanization,

environmental change and technological

change

• 651 million lived in slums (2009)

• Public health emergencies

• Need for an appropriate governance

mechanism to be proactive

• What’s the role of city officials, city

planners, etc and citizens themselves?

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Public health emergencies

Urban • Poverty (“urban poor”) • Overcrowding • Inadequate infrastructure

• Insufficient land for

resettlement

• Complex political scenario • Quality health services but

poor access—economic, social-cultural

• Greater disaster response efforts but less coordinated

Rural • Poverty also present

• No overcrowding

• Infrastructure – very inadequate

• Sufficient land for resettlement; affected individuals can live with relatives

• Less complex politics

• Limited availability of health services—geographic access

• Response easier to organize

WPRO Regional Health Cluster

http://www.wpro.who.int/emergencies_disa

sters/en/

http://www.wpro.who.int/emergencies_disasters/en/http://www.wpro.who.int/emergencies_disasters/en/http://www.wpro.who.int/emergencies_disasters/en/

Asia Pacific Strategy for Emerging Diseases

(2010)

Securing Regional Health through APSED

Building sustainable capacity for managing

emerging diseases and public health events

DSE Securing our Region's Health

Western Pacific Regional

Food Safety Strategy 2011-

2015

The Great East Japan Earthquake

A story of a devastating natural disaster, a

tale of human compassion

dse@wpro.who.int

WHO WPRO

Safe Hospitals

mailto:dse@wpro.who.int

• Systems approach

- Health governance - Health care financing - Health workforce - Service delivery - Logistics - Health information - Cross-cutting issues

Aligned with and guided by the

“Hyogo Framework for Action (HFA): 2005-2015:

Building the resilience of nations and communities to disasters”

Disaster Resilient Cities

Actualizing the “Hyogo Framework for

Action” at the city-level

Preparedness (phase for

DRR)

Response

Recovery

(with reconstruction

and development)

• Temporal approach

• Policy, leadership, organization

• Coordination, partnerships, accountability, etc. Health governance

• Financial risk protection, efficiency

• Resource mobilization, etc. Health financing

• Management, type, deployment

• Capacity building, reserve force, etc. Health workforce

• Individual health services

• Population health services, etc. Service delivery

• Essential medicines and supplies, rational drug use

• Vaccines, laboratory, blood bank, etc. Logistics

• Monitoring of needs, resources and activities

• Disease surveillance and early warning system, etc. Health information

• Equity, availability, access, human rights, gender

• Community participation, privacy, etc. Cross-cutting issues

Urban Health Emergency Management | 12 November 2013 31 |

Strategic directions on UHEM (2012-2015)

Topic of concern

Enhancing resilience, risk reduction, preparedness, response and recovery among national and local health authorities in urban areas

RESILIENCE

Building technical surge capacity and urban health emergency management expertise WKC initiative: Project City LHITE with grant support from HEM21

HEALTH AND GOVERNANCE

Strengthening health systems to support urban health emergency management

HEALTH SYSTEMS

Ensuring the protection of the health of vulnerable urban populations

HEALTH EQUITY and SECURITY

Improving sector coordination for health by strengthening multi-sectoral partnership and community ownership

INTERSECTORAL COLLABORATION

Developing and adapting tools to urban contexts, including city health risk assessment and city plans WKC initiative: City Health Emergency Kit (CHEK)

RISK IDENTIFICATION AND MANAGEMENT

32 WHO WPRO, 2014

Urban planning

NCD risk factors; environmental

health

Health outcomes Emergency

preparedness, response, recovery

Strengthened resilience, health

systems

…WHO leads the Health

Cluster

Inter Agency Standing

Committee

http://www.who.int/hac/global_health_cluster/en/

http://www.who.int/hac/global_health_cluster/en/http://www.who.int/hac/global_health_cluster/en/

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WHO's role in emergencies

Ministry of Health

WHO Operational

Plan

Health

secto

r/clu

ste

r

resp

on

se s

trate

gy

an

d o

pera

tion

al p

lan

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Performance standards

Mental and Psychosocial Health

Think globally, act locally!

For more information:

• Mr Alex Ross, Director, WKC: rossa@who.int

• Dr Jostacio Moreno Lapitan, Technical Officer,

WKC: lapitanj@who.int

URL: http://www.who.int/kobe_centre/en/

mailto:rossa@who.intmailto:lapitanj@who.inthttp://www.who.int/kobe_centre/en/http://www.who.int/kobe_centre/en/http://www.who.int/kobe_centre/en/

Information and Knowledge

management

Health and

related service

Resources (Human,

drugs & supplies, financial)

Governance, policy, planning

and coordination

MISSION:

Strengthen regional, national and subnational capacities to address

the health aspect of disaster risk management, thus enhancing

health and human security.

VISION:

Attain overall good health of populations at risk of, or affected by disasters

of any hazard, and minimize the related death, injury, disease and

disability.

Regional Framework for Action for Disaster Risk

Management for Health

Scope of the Regional Framework

for Action • Multiple hazards

• Multi-level

• Multi-sectorial

• Common language

• Leverages existing national and regional

• Promotes synergies

Guiding principles

• Adopt a whole of society multi-sectorial

approach

• Apply an all-hazards approach

• Building common capacities to manage

risks of many hazards

• Adopt a comprehensive approach across

the DRM cycle

Guiding principles (2)

• Rely on country ownership, commitment and investment

• Consider community empowerment and resilience as the driving forces of DRM-H

• Ensure planning, action and resource management are based on risk assessments of geological, hydrometeorological and technological hazards

• Strengthen national and local health system functions, and promote equity

Guiding principles (3)

• Position DRM-H as one of the pillars of

health security, which is a core component

of human security

Criteria to link specific health

issues to human security

5

1

• Scale how many people are affected

• Urgency for action

• Intensity depth and impact on society

• Externalities spill over effect beyond

particular areas or locations.

Health as a Human Security Priority for the 21st Century

Chen, 2004

May’s life history

Health as a Human Security Priority for the 21st Century Chen, 2004

Governance, Policy, Planning &

Coordination

Priority 1: Ensure health sector contribution in the shift from disaster management to disaster risk management, and its representation on the relevant governing bodies

Priority 2: Develop and revise relevant national health policies across the four phases of the DRM-H cycle

Priority 3: Strengthening of ministry of health unit(s) responsible for planning and coordinating DRM-H activities across the four phases of DRM

Information and Knowledge

Management Priority 4: Contribute to multisectoral risk assessments at national, subnational and local levels

Priority 5: Establish procedures for the management and utilization of information and knowledge from risk assessments among partners of health and other sectors

Priority 6: Develop policies, mechanisms and procedures for risk communication for public, media and responders

Health and related services

Priority 7: Match available health programme and services with hazards and risk assessment at the national and subnational level

Priority 8: Define or revise existing health services packages for routine activities and disaster response

Priority 9: Develop health service delivery strategies and mechanisms for response and recovery operations as part of national health preparedness plans

Priority 10: Develop or enhance the Safe Hospital Initiative

Resources (Human resources, Drugs & Supplies, Finance)

Priority 11: Review and develop disaster risk management for health skills and experiences available at national, subnational and local levels

Priority 12: Develop national and subnational plans and mechanisms to meet staffing needs for surge requirements

Priority 13: Identify critical medical supplies and equipment through risk assessment and analysis to ensure a minimum stocking level in appropriate locations

Priority 14: Develop procedures for emergency contracting of health supplies and services

Priority 15: Ensure policies for funding mechanism(s) to cover all components of the disaster risk management for health cycle

Priority 16: Establish or enhance contingency funding for disasters

Next steps

• Identify the priority recommendations that

are relevant within the national context on

which developing/revising ‘National Plan

on Disaster Risk Management for Health’.

Next steps (2)

• from regional perspective:

– Base lines mapped against hazards:

• health system

• health status/functioning

• Coverage of key health services

– Safe Hospitals

– Foreign Medical Teams

HEALTH IMPACTS OF A

DISASTER

• Complex managerial

issues

• Governance: breakdown

• Coordination:

– National/regional/local

– External assistance

• System intra-operability

and continuity

– Referral systems

– Medical records and Health Information

• Epidemiology systems

• Roles and Responsibilities

– Health care workers

– Regulation and licensing

– Coordination

• Basic needs:

communication, power,

shelter

• Evacuation, displacement,

return

Public Health Considerations for

the Recovery Process

• Know the epidemiology:

– Underlying community history

– Acute risks: epidemic diseases

vs. chronic/endemic diseases

– Injuries?

• Psycho-social and Mental health:

psychological, behavioral,

emotional, anxiety issues

• Food and water safety; sanitation

• Environmental health – reduction of

risks

• Morbidity/mortality risks:

immediate and longer term

– Immediate reductions in

health levels

• Decline in nutritional status

• Destruction of health

facilities and loss of

personnel, supply chains

• Destruction of health

records

Health Considerations for the

Recovery Process

Health Distinguish:

• Public health – Leadership, governance, communication

– Epidemiology, public health laboratories

– Community based systems (outreach, evacuation, etc)

– Pscyho-social, mental health

– Health care workers: all categories

– Water, sanitation; food safety

– Medical waste/hazardous materials

• Medical/clinical care systems – Institutions, referral patterns

– Health care workers

– Health informatics

– Acute and chronic conditions: treatment

Needs of the individual

• Post disaster, by: – Population group: aged, women, children

– Disease risk: chronic, acute

– Rehabilitation needs

– Health literacy; language; hearing/vision aids

– Evacuation status, family status

– Psycho-social, mental health

– Cultural issues: e.g., ability to accept aid

• Longer term: – Return to stricken area?

– Socio-economic issues

– Availability of health services (including water/sanitation)

HEALTH - a Systems approach

It is crucial to consider ‘health’ in recovery and reconstruction as a system, operating in

collaboration with other systems.

A systems approach to health draws attention to:

– Facilities and infrastructure: safe hospitals/clinics

– Human resources

– Supply chains (drugs, PPEs, supplies, etc)

– Financial resources

– Health information and its use

– Coordination: policy, planning, communication

HEALTH - Systems Approach A systems approach to health enables:

1. Adequate strategies – Understanding and enhancement of capacity of health system to

meet the health needs of population

– Understanding of and mitigation of system’s main vulnerabilities

– Understanding and filling of gaps in system - for instance, inclusion of surge capacity considerations

2. Appropriate allocation of resources throughout the health care system

3. Lessons learned from disaster in own or other countries to be incorporated into health system recovery and reconstruction