AmeriCares is an emergency response and global health organization committed to saving lives and building healthier futures for people in crisis in the United States and around the world.
AmeriCares is addressing community-based disaster risk reduction and public health gaps through a Public Health-Inclusive Community Risk Framework across preparedness, response and recovery operations. AmeriCares is working with local and international NGO partners to support long-term community disaster risk reduction projects in El Salvador, Myanmar, the Philippines among other countries, supporting participatory prevention, preparedness, mitigation, risk reduction activities and broader community organizational capacities. Through extensive local and international NGO partners, we are also engaged in health institutional risk reduction by increasing institutional preparedness through capacity-building trainings and pre-positioning disaster supplies, as well as mitigation through improved infrastructure post-disaster recovery projects.
The health and well-being of the individual, family, neighborhood, community and region is dynamic and interdependent upon a multitude of factors, both internal (e.g. psycho-social health, allostasis or the ability to manage stability and stress amidst change, genetic pre-disposition to disease, nutrition and physical fitness) and external (e.g. socio-cultural influences, environmental exposure) (Antonovsky, 1979; IOM, 2001). The interdependency and interconnections between humans and the environment has long been recognized, with human and environmental health and well-being often being a focus of understanding this relationship (ibid). This dynamic linkage is even clearer in times of emergency, disaster and increased stressors due to impacts from climate variability and climate change (Almedom & Tumwine, 2007; deFur et al., 2007; Marks, 2006; Perrin, 1996).
However, significant disconnect continues between the fields of public health, socio-ecological resilience, disaster risk reduction and climate change adaptation. Most adaptation, resilience, risk and vulnerability frameworks and policies fail to include adequate (if any) measures of health, be they mental, environmental, reproductive, individual or public health, often focusing instead on physical safety and injury prevention measures through building of safe infrastructure (UNISDR 2005, 2008). Conscientious inclusion of public health into scientific and practical disaster risk frameworks and policies is essential to understand, and adequately address, the interconnected causal influences between (and outcomes from) health and risk, extending from the individual to international scales. In this paper, we build on identified gaps in the bodies of literature, and propose a new Public Health-Inclusive Community Risk Framework (Framework) within AmeriCares Preparedness, Risk Reduction, Response and Recovery operations, in order to address scientific, applied and policy gaps.
The AmeriCares Public Health-Inclusive Community Risk Framework and associated Public Health Disaster Preparedness, Risk Reduction, Response and Recovery operations will inform best practices and policy-making at the local to international scales through case studies and cross-sector programmatic integration.
The Framework is useful as a theoretical, practical and policy-oriented tool, which carries international policy implications to broadening the resilience and adaptation discussion to be health-inclusive and community-centric. Increased awareness of, and importance paid to, public health and the interconnectedness with disaster risk, offers critical opportunities to improve the fields of disaster risk reduction, resilience and climate change adaptation and related international frameworks and policies.
This includes, in particular, the timely opportunity to inform the improvement of the current public health gaps in the post-2015 HFA. Building on best practices and driven by collaborative, community-based solutions to risk identification, mapping and comprehensive risk reduction prioritization, the Public Health-Inclusive Disaster Risk Framework presents a new archetype to understand, and address, comprehensive risks, adaptable and scalable to diverse communities and partners around the globe.
The AmeriCares Public Health-Inclusive Community Risk Framework and associated Public Health Disaster Preparedness, Risk Reduction, Response and Recovery operations include development and support of EWS that integrate public health emergencies within the early warning constructs, including, but not limited to: monitoring and response mechanisms for infectious disease outbreaks; malnutrition crises; maternal and child health trends; and, environmental health threats.
The AmeriCares Public Health-Inclusive Community Risk Framework and associated Public Health Disaster Preparedness, Risk Reduction, Response and Recovery operations include integration of education and raising awareness of diverse hazard- and non-hazard-related threats, identification of resources and capacities, and promotion of long-term risk reduction measures at the community and public health institutional levels.
The Hyogo Framework for Action includes only one reference to public health within Priority for Action 4, Reduce the underlying factors, Section (ii)(e): “Integrate disaster risk reduction planning into the health sector, promote the goal of ‘hospitals safe from disaster’ by ensuring that all new hospitals are built with a level of resilience that strengthens their capacity to remain in disaster situations and implement mitigation measures to reinforce existing health facilities, particularly those providing primary health care” (UNISDR 2005, pp. 11). The Mid-term Review noted that as of 2011, there were “still very few countries reporting on risk assessments for schools and health facilities” (UNISDR 2011, pp., 23), such that the Chair’s Summary of the 2009 Global Platform questioned this target and ability of government and organizations to implement these national health facility assessments by 2011 (pp. 61). Despite the establishment of the Scientific and Technical Committee in 2008 to address science and technical policy matters including health sciences and incorporation of “knowledge of the wide health impacts of disasters” (HFA Midterm pp. 35), the HFA Suggestions for Post-2015 focus solely again on “Reduc(ing) disaster damage to…health facilities by a given percentage by 2-25” (UN 2014, pp. 8). The Post-2015 Section E.18.f. language does offer a suggested measure for implementation around International Health Regulations (ibid).
The AmeriCares Public Health-Inclusive Community Risk Framework and associated Public Health Disaster Preparedness, Risk Reduction, Response and Recovery operations, offers theoretical and applied case study lessons that challenge current gaps and improve the current paradigm of the HFA, which focuses primarily on reducing loss of life and injuries through improved health facility infrastructure.
The Post-2015 HFA Priorities could be improved by including following public health priorities, each of which are addressed in the Public Health Community Risk Framework: preventive health; health education; environmental health; reproductive health; nutrition; livelihood security; psycho-social health; injury and loss of life prevention through first aid and CPR training, and early warning and evacuation systems and infrastructure; and, improved medical and public health service capacity extending outside of the traditional health facility (i.e. public health outreach workers and rural health programs, disaster triage and medical treatment trainings for remote communities, etc.).
The AmeriCares Public Health-Inclusive Community Risk Framework and associated Public Health Disaster Preparedness, Risk Reduction, Response and Recovery operations support community-based and public health institutional preparedness, risk reduction, response and recovery capacities internationally, through close partnership with local and international NGO’s, government agencies, and community stakeholders.