Environmental Resilience and Public Health

Bernard D. Goldstein, MDUniversity of Pittsburgh

U.S. Environmental Protection Agency

SUSTAINABILITYand

the

THE NATIONAL ACADEMIES

What is the Relation Between Public Health; Prevention; Resilience and

Sustainability?• Definitions are primarily important because

they can impact on actions. – Planning is the mediator between definitions and

actions– Definitions impact on both the geographical and

the temporal dimensions of disaster planning

Public Health

Sustainability

Prevention

Resilience

Relation Between Sustainability and Resilience(Joseph Fiksel – Ohio State University)

• Sustainability is the capacity for long-term realization of health & well being, economic prosperity, & environmental protection– However, unforeseen conditions can lead to unintended

and/or undesired consequences• Resilience is the capacity to survive, adapt, and

flourish in the face of changing conditions and potential disruptions

• In a complex and turbulent world, resilience is a prerequisite for achieving sustainability

Resilience Concepts• Robustness: the ability to withstand a given level of stress or

demand without suffering loss of function.• Redundancy: the extent to which systems are substitutable.• Resourcefulness: capacity to identify problems, establish

priorities, and mobilize resources when conditions exist that threaten to disrupt.

• Rapidity: the capacity to meet priorities and achieve goals in a timely manner in order to contain losses, recover functionality, and avoid future disruption.

Bruneau and Reinhorn. (2007). Exploring the concept of seismic resilience for acute care facilities. Earthquake Spectra, Volume 23, No. 1, pages 41-62.

Definitions• “Health is a state of complete physical, mental and

social well-being and not merely the absence of disease or infirmity.”– World Health Organization

• “Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs.”– Brundtland Commission of the United Nations, 1987

Attributes of Sustainability that Public Health does well (or should do well)

• Multi-disciplinary approaches to problem solving • Developing models and metrics that facilitate trade-off

analyses and synergies among the three sustainability pillars of the environment, the economy, and the social/health aspects of society

• Incorporating a temporal, multi-generational dimension that should lead to a focus on maternal / child health and wellbeing

• Incorporating a global dimension. • Anticipating disasters, including considering disaster relief as

a means to lessen the impact of the next disaster

Role of Resilience in SustainabilitySustainability Targets Key Challenges Trajectory

Adult Humans Aging Downhill (Death Inevitable)

Terrestrial Biomes Human Activities Downhill, but Potentially Reversible

Communities Social Capital Multi-Directional

Social Capital

Community Organizations

Health

EconomyNatural Environment

Built Environment

Gulf State Health Indicator Rankings

Gulf Region Health Outreach Program($105 million/5 years)

Gulf Region Health Outreach Program

Talking PointsJune 12, 2013

• GRHOP is a series of four integrated, five-year projects to strengthen healthcare in specified Gulf Coast communities in Louisiana, Mississippi, Alabama, and Florida.

• GRHOP was developed jointly by BP and the Plaintiffs’ Steering Committee as part of the Deepwater Horizon Medical Benefits Class Action Settlement, approved by the U.S. District Court in New Orleans on Jan. 11, 2013 and is now on appeal. The Outreach Program is supervised by the court, and is funded with $105 million from the Medical Settlement. As of June 2013, $53.9 million has been paid to the four projects

• The target beneficiaries of the Outreach Program are residents, especially the uninsured and medically underserved, of 17 coastal counties and parishes in Alabama, Florida, Louisiana and Mississippi.

Summary and Background Facts

• inform residents about their own health and provide access to skilled frontline providers supported by networks of specialists who can address physical, environmental, behavioral and mental health needs,

• improve the resilience of the targeted communities to future health challenges.

• be embedded in and complement existing efforts being undertaken by the public health community.

• involve local communities, seek input from the community, and build capacity tailored to their special needs.

• focus on activities that produce sustainable benefits to the communities lasting beyond its five year duration

The Outreach Program will:

• The program consists of four projects to:– build the capacity of primary care

community health clinics in the region, – increase the mental and behavioral

health expertise of health professionals in the targeted communities and increase awareness by local communities of mental and behavioral health issues,

– increase the environmental health expertise of health professionals in the targeted communities and the health literacy of local communities,

– train community health workers who will help residents navigate the healthcare system and access needed care.

Four Integrated Projects

Four Integrated Projects

• The Outreach Program is a collaboration among:– Alliance Institute,– Louisiana Public Health Institute

(“LPHI”), – Louisiana State University Health

Sciences Center (“LSUHSC”),– Tulane University, – University of South Alabama,– University of Southern Mississippi,

and– University of West Florida.

Two Recent Ongoing Disasters

• 100,000-200,000 deaths• 1.5 million homeless