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Does Health Promotion has a role in disaster management?Does Health Promotion has a role in disaster management?
LABENESE EPIDEMIOLOGICAL ASSOCIATION 12th ANNUAL CONFERENCE, BIERUT
18 November 2006
Dr Syed Jaffar HussainDr Syed Jaffar HussainRegionalRegional AdvisorAdvisor
Healthy Lifestyle Promotion/Injuries & Violence Healthy Lifestyle Promotion/Injuries & Violence PreventionPrevention
Outline of the presentationOutline of the presentation
The concept of health promotion
The public health consequences of emergencies/disasters
The public health challenges witnessed in Lebanon
Public Health Response to emergencies/disasters
The role of health promotion and health promotion professionals
Health PromotionHealth Promotion
“Health promotion is the process of enabling people to increase control over, and to improve, their health” (Ottawa Charter 1986).
Five Key Action Areas:
Build Healthy Public Policy
Create Supportive Environments
Strengthen Community Actions
Develop Personal Skills
Reorient Health Services
The fundamental conditions and resources for health are:
Peace,
Shelter,
Education,
Food,
Income,
A stable eco-system,
Sustainable resources,
Social justice, and equity
The Bangkok CharterThe Bangkok Charter
The Bangkok Charter identifies actions, commitments and pledges required to address the determinants of health in a globalized world through health promotion.
Four Key Commitments•Central to the global development agenda
•A core responsibility for all of government
•A key focus of communities and civil society
•A requirement for good corporate practice.
Make health promotion centralto Global Development Agenda
Health promotion must become an integral part of , foreign policy and international relationsdomestic and
war and conflictincluding in situations of
Make health promotion a key focus of communities and civil society
Communities and civil society often lead in initiating, shaping and undertaking health promotion.
They need to have the rights, resources and opportunities to enable their contributions to be amplified and sustained
What happens in a Emergency-Man made or NaturalWhat happens in a Emergency-Man made or Natural
Five Major Outcomes:
Human Loss, Injuries
Massive damage to infrastructure
Population Displacement and dismemberment of the family fabric
Economic hardships
Intense Bereavement and Anger
Loss of human lives/injuriesLoss of human lives/injuries
Immediate social and health needs.
Psychological trauma
Injuries (or injured) are not receiving quality treatment
Loss of Human lives due to secondary causes of injuries
Long-term disabilities
Damage to infrastructureDamage to infrastructure
Not only health facilities but infrastructure having tremendous impact on human health (water, housing, sanitation, etc)
Existing mechanism of care is disrupted (family care, etc)
Greater risk of epidemics
Limited access of the relief agencies to affected population (damaged roads, insecurity, etc)
Population DisplacementPopulation Displacement
New habitats
Strain on existing civic amenities
Patients with chronic diseases become more vulnerable
Sense of insecurity
Loss of self esteem
Refugees
Economic HardshipsEconomic Hardships
Loss of entrepreneurships
Reliance on aid
Increased dependency
Vulnerability to ill-health and new diseases
May lead to nonsocial behaviors and events
Bereavement and/or angerBereavement and/or anger
Psychologically and emotionally vulnerable
May resort to bizarre behaviors
May become unhappy with the response of the government and agencies
Partly may be misinformation received through local media or other sources
Public Health impact of War in Lebanon Public Health impact of War in Lebanon
More than 1200 dead due to war
More than 4000 injured due to war
974 184 displaced before ceasefire and still 255 986 after ceasefire (as of 3 September)
Public Health impact Lebanon Health infrastructure
Public Health impact Lebanon Health infrastructure
Graph 1: Status of health facilities assessed in total numbers (total = 410)(total number of health facilities per district is mentioned between brackets)
Source: MOH/WHO assessment
Graph 2: Status of all health facilitiesin percentage (n=410)
01020304050607080
Beirut S
uburbs (50)
Bent Jbeil (33)
Hasbaya (20)
Marjayoun (28)
Qada of N
abatieh (53)
Beirut (78)
Jezzine (31)
Sour (59)
Herm
el (8)
Baalbeck (50)
No Information Functioning
Partially functioning Not Functioning
Functioning51%
Not Functioning26%
Partiallfunctioni
6%
No Information17%
What happened during the war n Lebanon?
What happened during the war n Lebanon?
33 days of conflict
Massive population displacement
Significant damage to infrastructure
Oil spill contaminating 150 kilometers of coastline
Sea, air and road blockade
Occupation in several areas of south Lebanon
US$ ??3.6 billion estimated damage
Estimated more than1 million people displaced in and outside Lebanon
230 000 fled to neighboring
countries
735 000displaced in
Lebanon
Population displacementPopulation displacement
Roads and at least 77 bridgesMore than 15 000 homes Power plants and fuel stations
Infrastructure damage Limited access due to:
Infrastructure damage Limited access due to:
2. Sea and air embargo
1. Destruction of civil infrastructure
Growing public health concernAssessed UXOs and mines in South Lebanon (estimated numbers)
Growing public health concernAssessed UXOs and mines in South Lebanon (estimated numbers)
Source: OCHA
cluster bombs101 760
air delivered
bombs825
artillery (naval)4950
artillery13 200
air delivered missiles
825
The Role of Health Promotion & Public Health Professionals
The Role of Health Promotion & Public Health Professionals
Organizing and Informing the community
The phases of an emergency/disasterThe phases of an emergency/disaster
Preparedness Response
Recovery Rehabilitation
Com
mun
ity p
artic
ipat
ion
and
empo
wer
men
t
Unfortunately Emergencies/Disaster do not follow a linear course
Emergency/DisasterAcute Phase
Adaptation
Recovery
Rehabilitation
Importance of Health Promotion in Emergencies/Disasters
Importance of Health Promotion in Emergencies/Disasters
Emphasizing the public health impact of the issue.
In the context of emergency/disasters management, HP involves working with people to prevent, prepare for, and respond to disasters to reduce risks, increase resilience and mitigate the impact of disaster on health.
Community participation, therefore, is the basis of successful HP in such disaster situation
The Importance of Community Participation in HP in aemergency/disaster situation
The Importance of Community Participation in HP in aemergency/disaster situation
Emergency Prevention and Preparedness: Community participation in assessing risks and vulnerability; promoting awareness of environmental hazards and safety consciousness; strengthening community resilience and organization. Awareness raising and training are the cornerstones.
Emergency response and recovery: community participation in the response phase in the immediate aftermath of disaster; ensuring sustainable and incremental improvements in environmental health
Summary of the Role of Health Promotion Professionals in various phasesSummary of the Role of Health Promotion Professionals in various phases
Focus on disaster preparedness and prevention
Provide training and guidance in performing action
Promoting good health practices in community development
Psychological rehabilitation and long term support
Identification of specific messages and communication methods appropriate to the situation
Adaptation of methodologies to actual and potential needs
Use of messages based on problems/practices associatedwith recovery phase
Need to deal with psychosocial problems of the situation
Help the individual develop her/his own perception of risk
Ensuring that the rebuildingprocess is ‘health focused’
Adjustments of health promotion activities to prevailing health conditions and scarcities
Tailor risk information based on an individual’s characteristics
Assessment of individuals/ groups who may require long term care
Specify the consequences of the condition and recommended action
Define pop at risk and their evel of risk
Gradual blending into more stable condition
Provide “how to” information, promote awareness
Organize community for making them health and safety conscious
RecoveryResponsePreparedness
Its all about assessing and mitigating risksWhich specific practices are placing health at risks?
Which is the most vulnerable group of population?
What could motivate the adoption of safe practices?
Who should be targeted by the program?
How can one communicate with these groups?
Coordination-the real challenge? Coordination-the real challenge?
Duplication and wastage of scarce resources.
Often community needs are not assessed-they receive the support we perceive they need not what their real needs are.
Non-synthesis of information
Donors’ driven agenda?
Government’s “over-reliance” on relief agencies.
Some Critical Public Health Areas where healthpromotion professionals can play a critical roleSome Critical Public Health Areas where healthpromotion professionals can play a critical role
Generating data and information on the effectiveness of interventions
Environmental Hygiene (water, sanitation, housing, etc)
Mental health promotion
Immunization-Maternal and Child Care
Prevention of epidemics
Care of patients with chronic illnesses
Calculating trends
Engaging media as an active partner
Source: Smedley BD, Syme SL (eds.), Institute of Medicine. Promoting Health: Strategies from Social and Behavioral Research. Washington, D.C.:, National Academies Press, 2000.
A Multilevel Approach to Epidemiology of CommunityParticipation in Health Promotion
A Multilevel Approach to Epidemiology of CommunityParticipation in Health Promotion
Future challenges Lebanon
Future challenges Lebanon
Transition relief to recovery
Medium- to long-term rehabilitation
Ensuring that reconstruction and rehabilitation policies are health
driven rather than only health system driven
THANK YOUTHANK YOU