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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...


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