Population Vulnerabilities, Preconditions, and the Consequences of Disasters

Irwin Redlener Population Vulnerabilities, Preconditions, and the Consequences of Disasters HAVING SPENT MORE THAN THREE DECADES WORKING ON THE FRONT lines of public health, prim arily providing direct m edical care or developing programs for medically underserved children in rural and urban environm ents in the United States, I came to the field of disaster preparedness and response sporadically and hesitantly. After leading international disaster response team s and deploying mobile medical units in response to US disasters, my familiarity w ith respect to these challenges was purely program m atic and technical. W hat has been surprising and, to a large extent, disconcerting, has been an apprecia­ tion developed since 2001 o f the complexity and inadequacy of soci­ etal preparation for, m itigation of, and recoveiy from very large-scale disasters. In a perfect illustration of our nation’s proclivity for postevent crisis response and our resistance to longer-term planning and system investm ent, the nation p u t a rush order on developing a massive bureaucracy designed to fast track new systems for preventing and responding to terrorism and large scale natural disasters. FEMA and m any other agencies were incorporated into the new D epartm ent of Homeland Security, billions of dollars were appropriated and, seem­ ingly, a substantial focus on disaster prevention and m anagem ent was emerging in the afterm ath of the attacks on the World Trade Center in New York City. W hat actually m aterialized, however, in the frantic push to create new systems, has, so far, failed to provide credible, cost-effecsocial research Vol 75 : No 3 : Fall 2008 785 tive, evidence-based systems of disaster preparedness and response. Overall, I suspect th at th e governm ent efforts spurred on by the attacks of 9/11 represent not only an extraordinary level of spending, bu t also a lack of accountability th at is virtually unprecedented in recent US history. In fact, after w atching—and w orking am ong—th e efforts to respond effectively to the disasters precipitated by Hurricanes Katrina and Rita, and the subsequent flooding of New Orleans, it is clear that m uch needs to be done in all aspects of this field. But perhaps no chal­ lenge is m ore pressing th an coming to grips w ith the realities facing families whose “disaster risk profile” is exacerbated by vulnerabili­ ties that include long-term income fragility, social marginalization, or chronic illness. PRECONDITIONS AND PUBLIC HEALTH Questions around preconditions and disaster consequence vulnerabili­ ties among affected populations may be seen from the broad perspec­ tives of public health. And in a certain sense, “all roads lead to public health implications.” Fragile buildings and infrastructure, poor roads, insufficient transportation systems, reduced access to clean w ater and food, or limited availability o f good medical care are am ong the precon­ ditions that, even prior to a disaster, create ongoing public health conse­ quences. W hen disaster affects such populations, however, the im pact is far greater and the response and recovery more complex than is the case for populations w ith greater resources. Any num ber of examples can effectively illustrate this point. Resource-rich communities have the ability and capacity to construct buildings that are relatively earthquake resistant, including advanced m aterials and construction strategies such as diagonally trussed skeletons. Such buildings may sustain m uch higher earthquake force levels than less sophisticated construction in developing countries. An example of the latter was the 1976 earth­ quake that struck Guatemala at a Richter force of 7.6, killing as m any as 25,000 people, injuring 80,000 and leaving nearly 1.5 million homeless. Buildings made from sim ple stone and adobe simply could not w ith­ 786 social research stand a quake that m ight have shaken—but not destroyed—buildings constructed w ith earthquake-resistant materials and designs. Similar dem onstrations of the relationships betw een precondi­ tions and disaster consequences have been consistently seen after the recent earthquakes in Pakistan and China, the cyclone th at struck M yanmar (Burma), and num erous other catastrophic events. The form ula rem ains the same: preconditions related to a...