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The Sendai Framework seeks to substantially reduce disaster risk and losses in lives, livelihoods, health, and other assets including persons, communities, and countries. The framework focuses on reducing mortality while increasing population wellbeing, early warning, and promotion of health systems resilience. The use of scientific evidence to inform policy and formulate effective initiatives and interventions is crucial to disaster risk reduction within health. Different instruments and methodologies are available to guide policy and operations. The potential value of routinely collected patient data from health registers is that they can provide pre-event health and comparison group data without burdening affected populations.
The current contribution aims to illustrate how health registers can help monitor the health impact of natural and human-made disasters.
Patient data from health registers of general practitioners and other health professionals, sometimes combined with other registers and data sources, have been utilized to monitor the health impact of disasters and environmental hazards in the Netherlands, Norway, and Sweden since 2000.
Health registers allowed monitoring of mental health problems, medically unexplained symptoms, chronic health problems, and social problems. These were compared to groups not directly exposed. The health impact and care utilization was tracked after the fireworks explosion in Enschede affecting inhabitants of the neighborhood (2000; data range 1999-2005), children and parents after the Volendam café fire (2001; data range 2000-2006), Swedish survivors of the Tsunami in Southeast Asia (2004; data range 2004-2010), and parents of children affected by the terrorist attack on Utøya (2011; data range 2008-2014).
Health systems with registers have an important advantage when it comes to the potential for monitoring population health, and perhaps offer early warnings of pandemics. However, data generation should be closely connected to policy-making before and during the planning and evaluation of public health intervention.
On June 23 and 24, 2016, a heavy hailstorm in the south of the Netherlands destroyed farms, greenhouses, and crops, and caused severe damage to many residences and cars in multiple communities. The size of the massive hailstones ranged from 3 to 5 centimeters in diameter. The farm damages alone were estimated to be 100 million euros, while total insurance industry losses were expected to exceed half a billion euros. In addition to the storm, the affected region also had its first tropical day of the year, with temperatures reaching 32 degrees Celsius. To date, the psychosocial impact and possible adverse health effects caused by the storm have not been thoroughly investigated.
To explore whether the occurrence of chronic and acute health problems in the affected region increased after the hailstorm compared to “control” areas.
Health data for the time period before (2013-2015) and immediately after the hailstorm (2016-2018) will be collected based on electronic health records (morbidity, psychosocial problems, and prescribed medication) from general practices (GP) located in the affected municipalities. For the same period, health problems in the affected region will also be compared with GP-registered data from different Dutch municipalities with similar urbanization levels, which will be used as a control group. The combination with external datasets (e.g. socioeconomic status, environmental exposures) will also be considered.
Multilevel regression analyses will be carried out to test the health impact of this sudden, onset event. The current study is a work in progress. Final results are expected in February 2019 and are presented during the conference.
The present study illustrates how routinely collected patient health records, recorded by GPs, can be used for epidemiological research in the aftermath of a disaster within the context of climate and weather extremes in Europe.
This chapter summarizes the current state of the literature relating to each of the disaster phases across a wide range of variables, including sociocultural factors and environment and community resources. Social networks among racial/ethnic minority cultures can be a significant protective factor against adverse mental health consequences, and the emphasis on social networks among many racial/ethnic minority cultures appears to also influence evacuation efforts. Differences in risk perception between minority and majority populations contribute to differences in disaster exposure. A variety of cultural beliefs appear to affect individuals in pre- and peridisaster phases. Several factors have an impact on marginalized populations' postdisaster mental health outcomes. Environmental and community resources suggest that limited or lack of resources appears to significantly impact disaster-response in marginalized populations. The chapter further discusses the implications for research, disaster-response efforts, and practice.
This chapter presents an introduction to the physical health problems following disasters as well as disaster studies. The majority of studies after traumatic events such as disasters have focused on psychological problems, such as depression, anxiety, and posttraumatic stress disorder (PTSD), and they have shown a positive relation between exposure to traumatic stress and psychopathology. Several studies have examined the prevalence of specific symptoms among survivors of disasters. The mean number of physical symptoms was compared between survivors of a disaster and a control group. Although risk factors for psychological problems after exposure to traumatic stress have been investigated in many studies after disasters, only a few risk factors for physical symptoms have been examined after several disasters. Risk factors for physical symptoms after disasters can be divided into predisaster factors, disaster-related factors and postdisaster factors.
A broad range of health problems are related to disasters. Insight into these health problems is needed for targeted disaster management. Disaster health outcome assessment can provide insight into the health effects of disasters.
During the 15th World Congress on Disaster and Emergency Medicine in Amsterdam (2007), experts in the field of disaster epidemiology discussed important aspects of disaster health outcome assessment, such as: (1) what is meant by disaster health outcome assessment?; (2) why should one conduct a disaster health outcome assessment, and what are the objectives?, and (3) who benefits from the information obtained by a disaster health outcome assessment?
A disaster health outcome assessment can be defined as a systematic assessment of the current and potential health problems in a population affected by a disaster. Different methods can be used to examine these health problems such as: (1) rapid assessment of health needs; (2) (longitudinal) epidemiological studies using questionnaires; (3) continuous surveillance of health problems using existing registration systems; (4) assessment of the use and distribution of health services; and (5) research into the etiology of the health effects of disasters.
The public health impact of a disaster may not be immediately evident. Disaster health outcome assessment provides insight into the health related consequences of disasters. The information that is obtained by performing a disaster health outcome assessment can be used to initiate and adapt the provision of health care. Besides information for policy-makers, disaster health outcome assessments can contribute to the knowledge and evidence base of disaster health outcomes (scientific objective). Finally, disaster health outcome assessment might serve as a signal of recognition of the problems of the survivors.
Several stakeholders may benefit from the information obtained from a disaster health outcome assessment. Disaster decision-makers and the public health community benefit from performing a disaster health outcome assessment, since it provides information that is useful for the different aspects of disaster management. Also, by providing information about the nature, prevalence, and course of health problems, (mental) health care workers can anticipate the health needs and requirements in the affected population.
It is important to realize that the disaster is not over when the acute care has been provided. Instead, disasters will cause many other health problems and concerns such as infectious diseases and mental health problems. Disaster health outcome assessments provide insight into the public health impact of disasters.
There are few prospective studies on risk factors for health problems
after disasters in which actual pre-disaster health data are
To examine whether survivors' personal characteristics, and pre-disaster
psychological problems, and disaster-related variables, are related to
their post-disaster health.
Two studies were combined: a longitudinal survey using the electronic
medical records of survivors' general practitioners (GPs), from 1 year
before to 1 year after the disaster, and a survey in which questionnaires
were filled in by survivors, 3 weeks and 18 months after the disaster.
Data from both surveys and the electronic medical records were available
for 994 survivors.
After adjustment for demographic and disaster-related variables,
pre-existing psychological problems were significantly associated with
post-disaster self-reported health problems and post-disaster problems
presented to the GP. This association was found for both psychological
and physical post-disaster problems.
In trying to prevent long-term health consequences after disaster, early
attention to survivors with pre-existing psychological problems, and to
those survivors who are forced to relocate or are exposed to many
stressors during the disaster, appears appropriate.
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