Transcript Document

Long term planning for
recovery after disasters
SSPA Research Workshop
2 June 2011
Request
• Health begins where we live, learn, work,
and play
• Rebuilding may either:
– be used to create more sustainable, equitable society
– or can exacerbate existing inequalities
• Guide for long term planning decisions
drawn from international lessons
• Ensure health in all policies approach
backed by evidence
Methods
• Search of international medical/health databases by Ministry
of Health information service
– mainly looked at impact assessment, natural disasters
• Supplementary searches of social science literature
– recovery, planning, resilience, rebuilding
• Web browsing for relevant documents
• New Zealand thesis with case study of Napier earthquake
• Limitations
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Does not include acute health care needs post disaster
Limited New Zealand information - time and resource constraints
Brief overview of many large areas – not comprehensive
Internally peer reviewed only
Definitions
• Recovery brings the post disaster situation to some
level of acceptability which may or may not be the same
as the pre-impact level
• Restoration/reconstruction/recovery used
interchangeably in the literature
• Recovery phases
• emergency response
• restoration of basic services and housing – patched
enough to function
• reconstruction/rebuilding/replacement
• long term betterment for sustainable and improved
city
Sequence and timing of reconstruction after Hurricane Katrina in New Orleans
Jacob et al (2008)
Reproduced with permission of American Society of Public Health
The Napier earthquake
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Critical infrastructure restored in days
Temporary housing set up
Business/shopping area (Tin Town)
Debris cleared – dumped on beach (no RMA)
Citizen’s committees quickly formed – next day
– had much input
Commissioner appointed by Borough Council
Community consultation on recovery and rebuilding
Compensation for property owners
Catalyst for building codes, Civil Defence
Society less dependent on technology and more used to hard
times
• Social impact (including on Maori) has been little studied
Immediate response
• Core public health functions
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water, sanitation, food safety, vector control
issue health advisories
immunisations
assess needs of vulnerable populations
ensure continuity of health care
injury prevention
• Surveillance
– rates of injury, notifiable diseases, infectious disease,
drinking water
– use and distribution of health services
– gathering data informs immediate recovery and supports
long term planning but is often difficult in crisis
Integrating short and long
term planning
• Phases of recovery overlap
• Some recover more quickly than others
– less affected; more resources
• Tension between need to act quickly and
taking time to plan well
• Short term decisions have impact on long
term recovery
• Best approach is pre-disaster planning and
forward planning to mitigate future disasters
Health in all policies
• Long term planning in all fields has an
opportunity to improve (or worsen) population
health
– housing, environmental protection, sustainability, transport,
parks and recreation, urban redevelopment
• Seldom recognised as “health” even by acute
health services
• Message needs simple language with focus
on solutions not problems
– warm homes, clean environments, access to services,
transport, supporting neighbourhood networks
Equity
• Those with more resources (physical,
financial, intellectual) recover more quickly
• Most vulnerable: very old, very young,
disabled, poor, low literacy, new immigrants
• Macro-level statistics do not always show
difference
• Vigilance needed in rebuilding especially
letting of contracts
• History of protections being waived in the
rush to get recovery started
• Population growth may be socially and
spatially uneven
Housing
• Displaced populations suffer worst impacts of disasters
• Temporary housing needs:
– as close as possible to original area – minimal relocation
– water, electricity, sewerage
– jobs, schools, transport, food supply, services
• Cultural and social factors are important in decisions to
leave/return
• Downstream effects on nearby communities
– rent rises, housing shortages, need for more infrastructure
• If relocating entire communities
– technically and economically feasible options
– income support and employment
Mental health
• Most people recover without any
psychological help
• Fostering self-efficacy and coping skills is
best approach
• Small percentage have serious and
continuing problems
• Displaced populations are more at risk
– children: disruptive behaviour, learning problems, anxiety,
depression, stress
– adults: addiction, mood disorders, co-occuring traumatic
stress and substance abuse
• Domestic violence, substance abuse, PTSD,
suicide rates may rise in displaced people
There is no evidence that psychological
debriefing is a useful treatment for the
prevention of PTSD (Rose et al 2009).
No psychological intervention can be
recommended for routine use following
traumatic events. Psychological
interventions may have an adverse effect
on some individuals (Roberts et al 2009).
Community resilience
• Extended family and community networks buffer
stress
• Major source of assistance in disasters
– separation may be more damaging than the actual disaster
• People without this social capital are more vulnerable
• Community networks
– more flexible than large organisations
– respond more quickly
• Disasters may increase community attachment and
solidarity
• Relationship between official agencies and
community groups is often uneasy
– autonomy vs need to accept funding/reimbursement
Community participation
• Accepted in principle that public participation
in recovery is essential
• Should be anticipated – work with, not
against the community
• Community groups cannot work alone
• One official agency needs to take overall
responsibility (sometimes for hard decisions)
• Community participation:
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different forms at different levels
depends on the social, political, and economic context
“community” does not speak with one voice
initiatives on a local scale are often successful
Economic recovery
• Economic recovery and community wellbeing are
linked
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workforce needed
economic base for retailers
restoration of employment
access to services needed for all community
• Economic recovery takes longer in poorer areas
• Roller coaster trajectory – downward plunge then
intense upward surge before flattening
• Need to build stronger and less vulnerable economy
– diversification (esp. if tourism dependent)
– incorporate mitigation efforts for future
– protect local and regional tax base
• Priorities: tourist facilities vs local community needs
Heritage buildings
• Important part of city identity
• Low priority in immediate aftermath
• Damage from disaster may be less than
actions taken afterwards
• Heritage interests should:
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pre-disaster: take initiative to link with emergency services
post disaster: immediate collaboration with S&R
have teams of own experts ready for advice
separate/distinct placard for damage assessment
• Deconstruction/recycling/disposal of materials
handed to community with emotional
attachment to particular buildings
Sustainability
• Underlying social, economic, environmental factors
give rise to vulnerability
– exposure/sensitivity/resilience
• Merges with environmental management, poverty,
reduction, climate change fields
• Single stressor responses (stop banks, building
codes) not enough
• Improve (not just rebuild, replace)
• Reduce burden of disease
• Build social capital
• Strengthen resilience
– energy efficiency, diversify economic base, sustainability principles
Limitations of evidence
• Very limited epidemological data
– health care utilisation
– demographic data on population change
– aggregated data may conceal poor recovery of some sectors
• Social cohesion, community participation etc
difficult to measure
• Available literature mostly US-based
• Little New Zealand literature
• Nothing specifically related to Maori
• But consistent messages likely to be
generalisable for Christchurch
Lessons for Christchurch
• Seek membership on committees
• Advocate
– for health and wellbeing in all policies using simple language
(health starts in our homes, schools, and jobs)
– at interface between official and community groups
• Develop existing partnerships and pursue
new ones with like-minded organisations
– be watchful for policies and proposals that disadvantage
vulnerable groups (housing, relocation, letting of contracts)
– resist getting bogged down in drawn out planning
– ensure genuine community participation