a disaster public health education framework to strengthen … · 2011. 7. 7. · prof emily yy...

A disaster public health education framework to strengthen disaster medical response in Asian

Urban Communities

Prof Emily YY ChanDirector, CERT-CUHK-Oxford University

Centre of Disaster and Medical Humanitarian ResponseSchool of Public Health and Primary Care, Faculty of Medicine, CUHK

8st June 2011

2011 Hospital Authority Convention �Collaborative Healthcare�

Prof E YY Chan, A disaster public health education framework to strengthen disaster medical response in Asian Urban Communities, presented at 2011 Hospital Authority Convention Collaborative Healthcare on 8st June 2011

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� Introduction of the topic� Challenges of urban health in Asia� Analysis� Proposed Framework


Introduction

Disasters cannot be prevented but their human impact can be mitigated.

Evidence indicates that effective medical and public health mitigation and responses require multidisciplinary efforts and appropriate training.


Disaster

WHO (CRED,2010) 3 major types of disasters:

� Natural (earthquake, floods, etc.)� Man-made (Nuclear accidents, de-railed of trains,

aircraft accidents, fire, etc.)� Conflicts and war


Background 1

Asia

Prof E YY Chan, A disaster education framework to bridge natural disaster medical response and primary care development in

Background 2


Urban versus Rural disaster responseBackground 3


Urban Rural

Disaster Response System

Usually organized or at least exist in some sort

Non-exist or fragmented

Technical and Human response capacity

More concentrated Limited/non-exist

Experiences Depends Likely to have some experience (in disaster prone locations

Resource More concentrated Limited

Risk communication/risk literacy

Uncertain Uncertain

International Visibility Media focus Scare/forgotten

Challenges in urban health in Asia

�Developed settings� in developing communities:1. Potential impact on large population (megacities, living

density)2. Cannot assume 100% local epidemiological pattern

(population movement)3. Epidemiological and demographic transition4. Types of disasters ( �silence� disaster: eg temperature)5. Political issues: complex and fragmented system6. Media pressure7. Skills: Data collection, interpretation

Background 4


Challenges in urban health in Asia (1a) �Potential impact on large population (megacities)

Photo from: Apple Daily http://hk.apple.nextmedia.com/i

Photo from: http://www.traveltohongkong.info/


http://hk.apple.nextmedia.com/i

http://www.traveltohongkong.info/

No. of persons (As at mid-2010)

Source: Hong Kong Census & Statistics Department

http://www.censtatd.gov.hk/hong_kong_statistics/dashboard/index_en_GHS.htmlProf E YY Chan, A disaster public health education framework to strengthen disaster medical response in Asian Urban Communities,

presented at 2011 Hospital Authority Convention Collaborative Healthcare on 8st June 2011

Challenges in urban health in Asia (1b) �Potential impact on large population (living density)

http://www.censtatd.gov.hk/hong_kong_statistics/dashboard/index_en_GHS.html

Challenges in urban health in Asia (2) �Cannot assume 100% local epidemiological pattern (population movement)

Sources: http://wps.ablongman.com/wps/media/objects/419/429222/thumbs/ch28_669.html


http://wps.ablongman.com/wps/media/objects/419/429222/thumbs/ch28_669.html

Source: Hong Kong Census & Statistics Department

Challenges in urban health in Asia (3a) � Demographic transition


Main causes of death, WHO region, 2000

Africa Eastern Medi-

terranean

EuropeSouth-EastAsia

WesternPacific

Americas

25

50

75

%

Source: WHO report 2001

Chronic diseases

Injuries

Communicable diseases, maternal & perinatal conditions, & nutritional deficiencies

12

Challenges in urban health in Asia (3b) � Epidemiological transition


Burden of chronic disease and natural disasters in selected Asian developing countries (2000-2008)

Country Total number of natural disasters 2000-2008

% deaths by chronic disease caused in the country % chronic disease deaths (among

total reported deaths)

Cardiovascular disease

Cancer Chronic respiratory disease

Other chronic diseases

Diabetes

China* 235 33 20 17 8 1 79

India* 160 28 8 7 8 2 53

Indonesia* 133 28 12 7 11 3 61

Pakistan** 61 22 6 5 8 1 42

Sources: WHO, Preventing Chronic Disease: A Vital Investment, World Health Organization Global Report, 2005, http://www.who.int/chp/chronic _disease_report/en/; Centre of Research on Epidemiology of Disaster (EMDAT), http://www.unisdr.org/disaster-statistic/pdf/isdr-disaster-statistics-50top-countries.pdf and http://www.emdat.be/Database/Trends/trends.html. * As projected in 2005 ** As projected in 2002

Challenges in urban health in Asia (3b) � Epidemiological transition


http://www.who.int/chp/chronic

http://www.unisdr.org/disaster-statistic/pdf/isdr-disaster-statistics-50top-countries.pdf

http://www.emdat.be/Database/Trends/trends.html

Sources: CRED Crunch Issue No. 13 � �Disaster Data: A Balanced Perspective�, July 2008


Challenges in urban health in Asia (4) �Types of disasters ( �silence� disaster: temperature)

Challenges in urban health in Asia (5) �Political issues: complex and fragmented system

Source: Oriental Daily. http://orientaldaily.on.cc/

Source: Wen Wei Po http://paper.wenweipo.com/2010/12/27/NS1012270002.htm


http://orientaldaily.on.cc/

http://paper.wenweipo.com/2010/12/27/NS1012270002.htm

Challenges in urban health in Asia (6) �Media pressure

Source: http://www.time.com/time/arts/article/0,8599,1885349,00.htmlProf E YY Chan, A disaster public health education framework to strengthen disaster medical response in Asian Urban Communities,

presented at 2011 Hospital Authority Convention Collaborative Healthcare on 8st June 2011

http://www.time.com/time/arts/article/0,8599,1885349,00.html

Challenges in urban health in Asia (7) �Skills: Data collection, interpretation


Objectives

Based on principles of academic training in public health, emergency & disaster medicine and primary care, this presentation reviews the current response needs in gaps in developing countries in Asia.

-to identify and map out the training and knowledge gaps in disaster mitigation and response for frontline practitioners and academic researchers.


Analysis


Principles of health response in disaster

Fundamental Goal:1. Securing the basics that all humans require to maintain

health2. Determining the current and likely health threats to the

affected community, given the local environment and community�s resources, knowledge and behavior

3. Finding and providing the resources to address points (1) and (2).

Bolton, P. Chapter 3.5 Part 3. Direct Action. Managing disasters and other public health crises. Oxford Handbook of Public Health practice. Pg 249. 2nd Edition Oxford University Press.

Analysis 1


Public Health Approach

- Population based- Evidence based- Prevention focus- Life-course approach- Prioritize cost effectiveness - Focus on equity and reduce inequality- Multidisciplinary- Engagement and collaboration with community


Hill, Griffiths & Gillam. Chapter 4. Essential Public Health Toolkit. Public health and Primary Care: Partners in population and Health. Pg 83.Oxford University Press.

Analysis

Application of Public Health principles in disaster response

� Three domains of public health practice� Balancing individual and population interventions

(Disaster medicine) � The hierarchy of prevention (Primary Care)� Pathway of care and integrating vertical and horizontal

approaches (primary care)

Hill, Griffiths & Gillam. Chapter 4. Essential Public Health Toolkit. Public health and Primary Care: Partners in population and Health. Pg 83.Oxford University Press.

Analysis


Epidemiology, biostatistics, clinical trials,law & ethics流行病学,生物统计,临床研究,法律及道德

Health Health ProtectionProtection

健康健康保护保护

Environmental health

环境健康

Infectious diseases

传染病

Occupational health

职业健康

Impact of wider determinants &

international perspectives

更广阔的影响因素

Psychosocial aspects of health

心理因素

Health Health improvementimprovement

健康促进健康促进

International health国际健康

Health Education健康教育

Healthcare management卫生管理

Healthcare systems &policy健康系统

HealthServiceHealthServicess

健康服务健康服务

Care groups

关注组织

Evidence based medicine循证医学

Health economics

健康经济学

Global health环球健康

Primary care 初级保健

Three domains of public health

Prof. Emily YY Chan Lecture 1. Lecture 1 Overview PBHT 5801 Disaster and Humanitarian Crisis, July 7th 2010

Analysis

Public Health Methods and Tools for dealing with Disasters

A. Epidemiology and Biostatistics-Assessment and Evaluation: Disaster epidemiologyB. Health Service-Policy analysis and planning-Service emergency Preparedness and training-Disaster response management C. Health Protection-Infection control-Environmental health-Mental health-NutritionD. Health Improvement-Coordination-Risk communication-Resource mobilization-Capacity building (e.g. HR development and disaster response team

building)

Analysis

Three domains of Public Health


The SPHERE Project.

http://www.sphereproject.org/content/view/114/84/lang,English


Disaster Medicine

http://www.sphereproject.org/cont

Low cost activities to address chronic medical needs in disaster

TertiaryPrevention三级预防

Secondary Prevention二级预防

Primary Prevention初级预防

3�: Train staff to detect and prevent NCD complication(Develop multidisciplinary service(, disease target monitoring; support development of surveillance

system

1� : Educate about disease prevention (dietary habit, smoking, alcohol, injury

prevention)

2� : Identify and assess risk, screening, patient management plans, chronic medical

service during relief

Chan EYY & Sondorp E(2007) Medical Intervention following Natural Disaster: Missing out on Chronic Medical Needs. Asia Pacific Journal of Public Health Vol 19 Special Issue 2007 pg 45-51

Hierarchy of Prevention Analysis


Provision of medical service

�Pathway of Care� Concept:

Prevention预防

Protection保护

Promotion促进

Diagnosis诊断

Treatment治疗

Rehabilitation康复

Palliative缓解

Most post-disaster medical relief service:

Acute condition

Thrope A, Griffiths S et al: Primary health care and Public Health. Oxford University Press(2007

Acute care: Life saving procedures, clinicalconditions (infections), MCH services

Prof E YY Chan, A disaster education framework to bridge natural disaster medical response and primary care development in developing countries, presented at The 17th World Congress of Disaster and Emergency Medicine on 31st May 2011

Analysis

What is needed to address disaster response training?

� Policy Change

� Environmental Change

� System Change

� Professional Behavior Change

� Individual Behavior Change

Prof E YY Chan, A disaster education framework to bridge natural disaster medical response and primary care development in developing countries, presented at The 17th World Congress of Disaster and Emergency Medicine on 31st May 2011

Thrope A, Griffiths S et al: Primary health care and Public Health. Oxford University Press(2007)

Public Health

Primary Care

Developing a training framework


Disaster public health education framework

A two-dimensional, three-tier education training framework


2 dimensional 3 tier Training Accreditation Level

Clinical

Non-Clinical

General Public Certificate

Entrant UG area concentration/Focus

Professional Post graduate Diploma

Graduate Taught program (MSc)

Expert Graduate Research based Program (MPhil/ PhD)

Entrant Level: General Public

General Public Public Health relevance

1. General concepts of disasters and related health risk

2. Disaster preparedness at individual and household level

3. Support community disaster preparedness and planning in �settings� (school, workplace, industrial etc)

4. Communication/Risk communication platform

�Population focus�Evidence based�Prevention approach�Cost-effectiveness�Life-course �Community empowerment�Proactive public risk communication�Community engagement to co-share responsibility


Entrant Level Clinical Non Clinical Public Health

Competency�Epidemiology of Disaster and Humanitarian Crisis �Principles in Health, Human Rights and Humanitarian Law�Basic Epidemiological and biostatistics Skills

�3 Domains of Public health�Principles of Primary Care Delivery�Principle of clinical practices in disaster settings�Skills required to plan, analyze, evaluate field based activities

-

1. Principles of Disaster Medicine 1. Field based health project/program management

2 . Principles of Disaster Nursing3. Principles of Disaster Mental Health4. Management of Infectious disease

and Environmental Health in Disaster setting

5. Clinical medicine and primary care delivery in resources deficit setting(disaster, rural community)

6. Diagnostic and Laboratory techniques in disaster and resources deficit settings

2. Logistic and supply chain in disaster

3. Resilience, mitigation and preparedness

4. Water and Sanitation5. Disaster: Food and

Nutrition6. Infection control7. Development and Health8. Risk literacy and

communication9. Research methodology10. Emergency Rescue

TrainingProf E YY Chan, A disaster public health education framework to strengthen disaster medical response in Asian Urban Communities,

Professional Level

Clinical Non Clinical Public Health Competency Addressed

� Ethics and legal implication of disaster related actions� Disaster response system and resources awareness in the

community� Disaster epidemiology and biostatistics skills

�Evidence based response and practice�Practical clinical, Service Management� Research Skills1. Update Clinical medicine

practices in resources deficit setting

2. Research Skills in disaster and humanitarian medicine

1. Health need assessments and Program Evaluation

2. Disaster response management

3. Disaster contingency planning4. Skill based Training (PFA,

Practicum Placement)5. Updates in disaster responses,

policy and systems


Expert Level

Clinical Non Clinical Public health Competency Addressed

�Target clinical research topic in the management of disaster affected population (MPhil/PhD)

�Target research subject(MPhil/PhD): -Post disaster Need Assessments-Social Health issues (rural community resilience ; Training evaluation)-Evaluation impact of humanitarian response

�Evidence Based solution�Prevention


Conclusion

� The proposed framework identifies areas for comprehensive training for medical and public health practitioners who are interested to engage in medical disaster relief.

� The proposed framework also aims to strengthenmitigation and response capacities, share responsibility and community empowerment


Reference

� Hill, Griffiths & Gillam. Chapter 4. Essential Public Health Toolkit. Public health and Primary Care: Partners in population and Health. Pg 83.Oxford University Press.

� Bolton, P. Chapter 3.5 Part 3. Direct Action. Managing disasters and other public health crises. Oxford Handbook of Public Health practice. Pg 249. 2nd Edition Oxford University Press.


Thank you

Q&A


a disaster public health education framework to strengthen … · 2011. 7. 7. · prof emily yy...

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