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Despite a longstanding focus on examining acute health impacts in disaster research, only limited systematic information is available today to further our understanding of chronic physical health risks of disaster exposure. Heterogeneity of studies and disaster events of varying type and scale compounding this challenge highlight the merit of a consistent approach to examining nationally representative population data to understand distinctive profiles of chronic disaster health risks.
This epidemiological study examined the full spectrum and national profile of chronic physical health risks associated with natural and man-made disaster exposure in Australia.
Nationally-representative population survey data (N=8841) were analyzed through multivariate logistic regression, controlling for sociodemographic variables, exposure to natural and man-made disasters, and other traumatic events. Key outcomes included lifetime national chronic health priority conditions (asthma, cancer, stroke, rheumatism/arthritis, diabetes, heart/circulatory) and other conditions of 6 month or more duration (based on the World Health Organization’s WMH-CIDI chronic conditions module).
Natural disaster exposure primarily increased the lifetime risk of stroke (AOR 2.06, 95%CI 1.54-2.74). Man-made disaster exposure increased the lifetime risk of stomach ulcer (AOR 2.21, 95%CI 1.14-4.31), migraine (AOR 1.61, 95%CI 1.02-2.56), and heart/circulatory conditions (AOR 2.01, 95%CI 1.07-3.75). Multiple man-made disaster exposure heightened the risk of migraine (AOR 2.98, 95%CI 1.28-6.92) and chronic back or neck conditions (AOR 1.63, 95%CI 1.02-2.62), while multiple natural disaster exposure heightened the risk of stroke (AOR 3.28, 95%CI 1.90-5.67). No other chronic health risks were elevated. Despite the relatively greater chronic health risks linked to man-made disasters, natural disasters were associated overall with more cases of chronic health conditions.
The analysis of nationally-representative population data provides a consistent method to examine the unique national imprint of disaster exposure and distinct profile of disaster health risks to inform future detection, prevention measures, disaster health preparedness, and response planning.
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.
Previous research has identified a vulnerability paradox in global mental health: contrary to positive associations at the individual level, lower vulnerability at the country level is accompanied by a higher prevalence in a variety of mental health problems in national populations. However, the validity of the paradox has been challenged, specifically for bias from modest sample sizes and reliance on a survey methodology not designed for cross-national comparisons.
To verify whether the paradox applies to suicide, using data from a sizable country sample and an entirely different data source.
We combined data from the World Health Organization 2014 suicide report and the country vulnerability index from the 2016 World Risk Report. Suicide was predicted in different steps based on gender, vulnerability and their interaction, World Bank income categories, and suicide data quality.
A negative association between country vulnerability and suicide prevalence in both women and men was found. Suicide rates were higher for men, regardless of country vulnerability. The model predicting suicide in 96 countries based on gender, vulnerability, income and data quality had the best goodness-of-fit compared with other models. The vulnerability paradox is not accounted for by income or data quality, and exists across and within income categories.
The study underscores the relevance of country-level factors in the study of mental health problems. The lower mental disorder prevalence in more vulnerable countries implies that living in such countries fosters protective factors that more than compensate for the limitations in professional healthcare capacity.
To examine patterns and predictors of primary mental health care service use following 2 major Australian natural disaster events.
Utilizing data from a national minimum dataset, descriptive and regression analyses were conducted to identify levels and predictors of the use of the Access to Allied Psychological Services (ATAPS) program over a 2-year period following 2 major Australian bushfire and flood/cyclone disasters.
The bushfire disaster resulted in significantly greater and more enduring ATAPS service volume, while service delivery for both disasters peaked in the third quarter. Consumers affected by bushfires (IRR 1.51, 95% CI 1.20–1.89), diagnosed with depression (IRR 2.57, 95% CI 1.60-4.14), anxiety (IRR 2.06, 95% CI 1.21-3.49), or both disorders (IRR 2.15, 95% CI 1.35-3.42) utilized treatment at higher rates.
The substantial demand for primary mental health care services following major natural disasters can vary in magnitude and trajectory with disaster type. Disaster-specific ATAPS services provide a promising model to cater for this demand in primary care settings. Disaster type and need-based variables as drivers of ATAPS use intensity indicate an equitable level of service use in line with the program intention. Established service usage patterns can assist with estimating capacity requirements in similar disaster circumstances. (Disaster Med Public Health Preparedness. 2015;9:275-282)