Research Gaps in Strengthening Resilience of Communities ...acdpr.hkjcdpri.org.hk/pdf/ppt/14Emily_Chan.pdf · Thematic Research Network for Health Emergency and Disaster Risk Management

HKDPRI Annual Conference on Disaster Preparedness and Response 2019: Reduce Risk, Build Resilience

Prof Emily YY Chan MD, SMPIH(Harvard), FHKAM, FFPH(UK)

Professor and Director CCOUC, Faculty of Medicine, Chinese University of Hong Kong

Co-Chair, WHO Thematic Research Network, Health-Emergency Disaster Risk Management.

Knowledge and Research Gaps Strengthening Resilience of Communities, Countries, and

Health Systems Under Health- EDRM Framework

Thematic Research Network for Health Emergency and Disaster Risk

Management (H-EDRM)

Health EDRM: the systematic analysis and management of health risks surrounding emergencies and disasters by reducing the hazards and vulnerability along with extending preparedness, response, and recovery measures.

Health-EDRM and Global Policies

• Build coherence across different global polices• Sendai Framework• Sustainable Development

Goals (SDGs)• Paris Agreement• New Urban Agenda (Habitat

III)• Sendai Framework

• Alleviate impact of disasters across all disaster phases

• Account for exposure, vulnerability, capacity building

What are the health research needs for the Sendai Framework (2017)

Chan EYY et al (2019). What are the Health research needs for Sendai Framework? Lancet 2017

• Health-EDRM is a new multidisciplinary academic field that use health both as an outcomes and determinants to address disaster risks and impact.

• It encompasses(but not limited to):

public health, emergency, disaster and humanitarian medicine,

Physical science subjects that address disaster risk reduction(DRR),

Social science subjects that enhance community and system resilience, risk communication science, Evidence based programs and policy

“health sciences should be more involved in the disaster risk management community, advancing their understanding of outbreaks and pandemics, health impacts of all hazards, but also advances in data collection”

– EU Report Science for Disaster Risk Management 2017

Health-EDRM as an academic field of studies

PRIMARY: to prevent health risk beforethe disaster

EXAMPLE: childhood vaccination programmes, and early warning systems, TSPM, Community Impact driven Warning

SECONDARY: to prevent health risks afterthe disaster

EXAMPLE: emergency vaccination campaigns, knowing how to prepare ORS; Injuryprevention, Health-EDRM related behavior

TERTIARY: to reduce the impact afterdisaster

EXAMPLE: using ORS, provide first aid (physical and psychological), and healthcare staff specifically trained for disaster-related injury/disease outbreak; Service arrangements

Interventions can be divided by when they should be implemented:

Health-EDRM: Health-Emergency and Disaster Risk: Health Protection

Some key Health research issues:

Working epidemiological definitions should include:

– concerns about how thresholds relating to temporality (slow-onset/protracted events),

– attribution (direct vs indirect causes of morbidity and mortality), and

– baseline data should also be accounted for


– Acute impact assessments

– Long term mental and social health, and well-being

– Profiles by subgroup with vulnerabilities who are often not recognized in national local policies, plans, and practices

• Extreme of age

• People with disabilities

• Patients with chronic conditions


Xiuxi Village (2019), Photo by CCOUC

• Health Risk Profile, what about?

• How to built evidence-based disaster Resilience should built at all levels:

– Individual

– Household

– Community-based


Health-EDRM Research community must provide relevant research evidence to support the global DRR effort

Global emergency

research system

caregivers Local governments

Local authorities

Families

fundersResearch institutes

Journals and publishers

Users of relevant research results

Health-EDRM and research (2019): Major stakeholders

And others!!!

Health-emergency disaster risk management and research ethics (2019)

Infrastructure and platform

• Emphasis on prevention can provide for research infrastructure in normal times to support any emergency-related research attempts

Evidence based science

• Medical care and health response in emergency contexts often rely on best-fit interventions rather than best practices

Chan EYY et al (2019). Health EDRM and research ethics. Lancet 2019

• Current hotly debated topics in the bioethics community

– Research participation (Passive participation, stigmatization, Discrimination, Exclusion)

– Determination of duties and roles at the research and intervention(treatment) interface

– Management of expectations on the frontline (Individual versus Population)

Health-EDRM Research: Ethics

“Health-EDRM research needs to go beyond guidelines, codes, and approval process. An insistence on ideal rules, methods, and principles might cause more harm than pursuing the least-worst options in emergencies. This is not to suggest that time pressures justify unethical practices or no ethical reflection.”

• A huge challenge: implementation of research plans in global health emergencies– Existing research ethic systems are designed for non-emergency circumstances, and

may not be flexible

– Scientific rigor is heavily dependent on i) knowledge of dynamic local context ii) knowledge, awareness, and understanding of the latest research methodology and technology

– How to engage the community throughout research in the i) design ii) implementation iii) reporting phases

– Practical ethical issues in emergency research are often poorly addressed by ethics review systems

– Pre-assessed generic protocols often do not account for the changes and sensitivesinherent to disasters

– What are the specified roles & responsibilities of funders to oversee the integrity of research implementation

Health-EDRM (2019) Research: Implementation

Case 1: CCOUC Health –EDRM program in Health Risk Communication in Rural China

CCOUC’s Mission - to serve as a platform for research, education, and community knowledge transfer in the areas of disaster and medical humanitarian crisis policy development, planning and response

• Disaster-prone, poverty, ethnic minority villages in China

• Train a cadre of professionals in public health and disaster management

• Community capacity and resilience building

China: Ethnic Minority Health ProjectGeographical Scope of CCOUC Projects

Ethnic Minority Health Project, China (as of 2019)

18,000+ villagers reached

Dong Hui Manchu Miao Dai Yi Zhuang Tibetan Korean

Lisu Jingpo Kunge Bulang Inner MongolianAchang Jiang

Integrate science into evidence-based policy and practice of Health Emergency and Disaster Risk Management (H-EDRM)

Written language to be used:• Simplified Chinese • English

Components:• 10 H-EDRM topics (Animated

Videos)• Games• Quiz (Pre- and Post- videos)• Supplementary infomation

Animated Videos:• 3-4 minutes long• Context specific, e.g. diet

preferences differ among ethnic communities

• Voice-over in 5 spoken languages/dialects: Mandarin, English, Lisu, Tibetan and Korean

Health-EDRM Scale up program in Health risk communication

Platform

• WeChat (China) has 1.08 billion monthly active WeChat users (Q3 2018)

• WeChat the 5th most-used messager app in the world

Source: http://www.businessofapps.com/data/wechat-statistics/, accessed on 9 May 2019)

Program supported by Kadoorie Foundation (2018-2021)

10 Topics on H-EDRM • Location-specific emergency

preparedness bag

• Home-made oral rehydration solution (ORS)

• Prevention of non-communicable diseases

• Prevention of communicable diseases

• Water and health

• Diet and health

• Food and drug safety

• Indoor environmental health hazards

• Household waste management

• Injury prevention and management

10 H-EDRM Topics

International Frameworks

Community

Stakeholders (e.g. village head,

village doctor)

Provincial

CDC, Academic

Institutions

National

China CDC, National Health

Commission

Ethnic Minority Health Project

Impact measure: RCT, 360 degree evaluation

Program supported by Kadoorie Foundation (2018-2021)Project Partners: CCOUC(CUHK)/China National Centre of Disease

Control/WHO Kobe Centre

Case 2: Local Health-EDRM evidence for Reduce Risk, Build Resilience

• Typhoons, also known as cyclones or hurricanes

– Name is dependent on its Location and Strength

• The most common natural hazards in the Asia-Pacific and Southeast Asia Region

Fallen tree (Causeway Bay, HK), Anthony Ivanoff, CC0 1.0

• Past 70 years: overall mortality decreased but have increased in frequency

• 2018, Hurricanes Florence (14 billion USD), Michael (16 billion USD) and typhoon Jebi (12.5 billion USD), are the costliest type of disaster [1]

• Approximately 466 million people were affected by cyclones in the world (1977-2009) [2]

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https://commons.wikimedia.org/wiki/File:Yee_Wo_Street_in_Hong_Kong_-_Fallen_Trees_due_to_Typhoon_Mangkhut_2018.jpg

Typhoon Specific Preparedness Measures (TSPM)

• People are knowledgeable

But

• Not adhere to government/early warning signals

• Low perception on health-risks associated with typhoons:

– 75% of Hong Kong residents have some form of household emergency preparedness items (first-aid kit, basic aid supplies, emergency food and drinking water, basic medication, fire extinguishing equipment) [4]

– 69% did not take any precautions when a severe warning signal was hoisted and did not have adequate first-aid knowledge [5]

– 82.3% did not perceive HK to be a city susceptible to disasters [6]

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Typhoons in Hong Kong

• Mangkhut (T10) was the strongest

storm in 30 years

– T10 was from 09:40am – 19:40pm

– 458 people injured

– 46,000 fallen trees

– 5,000 broken windows

– around 40,000 homes had no electricity for over 24 hours

• An average of 5-6 typhoons per year

– Only sixteen T10 typhoons since 1946

(when records started)

People walking over trees to work (Wanchai, HK), Anthony Ivanoff, CC0 1.0

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https://commons.wikimedia.org/wiki/File:People_climb_over_trees_to_go_to_work_the_morning_after_Typhoon_Mangkhut_near_Immigration_Tower_in_Wan_Chai.jpg

2018 Typhoon Mangkhut in Hong Kong [7]

A population based cross-sectional survey study immediately after Typhoon Mangkhut in Hong Kong [7]

– Impact on Sept 16 2018 (Survey period Sept 17- Oct 02 2018)

– Telephone interviews with standardized tool (7 sections with 39 questions)

– Computerized Random Digit Dialing and Last Birthday

– Inclusion criteria: Age 18 or above, understood Cantonese, holds a valid HKID

Ethics approval

– Ethics approval was sought from the Survey and Behavioural Research Committee at The Chinese University of Hong Kong

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Chan EYY, Man AYT, Lam HCY, Chan GKW, Hall BJ, Hung KKC. Is urban household emergency preparedness associated with short-term impact reduction after a super typhoon in subtropical city? Int J Environ Res Public Health. 2019;16(4):596.

Descriptive analysis of perception, preparedness, and impact

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes No Yes No Yes No Yes No

Perceived home to be at high riskduring typhoons

Impact from Typhoon Mangkhut Practiced at least 1 typhoon-specific preparedness

Went out when typhoon signalwas T8 or above

Only 9.4% perceived their home to be at high risk of danger during typhoons, findings not associated with sociodemographic factors

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Results(1): Impact of the Typhoon Mangkhut

Impact

• 33.4% reported experiencing short-term impact

• Self reported injury rate of 0.77%*

Risk perception and Impact

• Perceived home to be high risk during typhoons were positively associated with household damage* (OR=5.16; 95%CI:2.63–10.14; p-value=<0.001)

– Adjusted for: gender, age, education, income, floor level, and TSPM practice

70.70%

14.90% 13.80%

1.00%

0%

10%

20%

30%

40%

50%

60%

70%

80%

road or trafficblockages^

had poweroutages

had homedamages*

Injured

^road or traffic blockages which prevented/affected respondents from going to work or school*household damage = power outages, home damage, item loss

What are the impacts

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Results(2a): weather information acquisition

• All respondents reported checking the weather information during the typhoon

• 87.9% felt the HK Government provided enough information for respondents to prepare and respond to Mangkhut

65%

11%

16%

0%

50%

7%

1%

32%

53%

14%

1%

25%

0%

10%

20%

30%

40%

50%

60%

70%

TV internet newspaper/ magazine smartphone/ apps

H7N9

Cold spell

Mangkhut

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Results(2b): Warning

• 16.0% respondents reported leaving their homes when the storm was the strongest (T8+)– Of which, 74.7% were for non-occupational and non-emergency

reasons (e.g. for meals/cinema)

• Men (OR=1.98; 95%CI=1.22-3.22)

• Younger age group (18-24 vs. ≥65: OR=3.40; 95%CI= 1.29-8.93)

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Results(3a): Uptake of Typhoon Specific Preparedness Measures

(TSPM)

• 74.3% has reported of at least one TSPM

– Taped windows

– Collect or tied down items that can be blown away

– Anti-flooding/leaking/seeping measures

• People who engaged certain routine preparedness measures were three times more likely to prepare for Typhoon Mangkhut, adjusting for other potential confounders

• Uptake of TSPM was, however, not associated with lessof household impacts

Taped windows (Wanchai, Bay, HK), Anthony Ivanoff, CC0 1.0

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https://commons.wikimedia.org/wiki/File:HK_Central_%E9%A6%99%E6%B8%AF%E5%A4%A7%E6%9C%83%E5%A0%82_City_Hall_view_%E5%92%8C%E8%A8%98%E5%A4%A7%E5%BB%88_Hutchison_Hose_before_storm_%E8%B6%85%E5%BC%B7%E9%A2%B1%E9%A2%A8%E5%B1%B1%E7%AB%B9_Typhoon_Mangkhut_Sept_2018_SSG.jpg

Discussion (1): Health Impact

• Official report = no deaths

• Limited literature exists for typhoon-related injuries; most are based on public hospital records

• Our study found injury rate of 0.77%

– if applied to the HK population of 7 million, over 50,000 unreported injury cases of varying severity (Versus: Official reported 458 people injured)

– More research is needed for injury epidemiology to provide tailored preparedness and response advocacy to the public

• Lack of research on health-risks specific to high-rise urban cities e.g. Impact of falling air conditioners and glass shards, feeling dizzy from swaying buildings

Broken Windows (Hung Hom, HK), Wpcpey, CC0 4.0

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https://commons.wikimedia.org/wiki/File:HK_Central_%E9%A6%99%E6%B8%AF%E5%A4%A7%E6%9C%83%E5%A0%82_City_Hall_view_%E5%92%8C%E8%A8%98%E5%A4%A7%E5%BB%88_Hutchison_Hose_before_storm_%E8%B6%85%E5%BC%B7%E9%A2%B1%E9%A2%A8%E5%B1%B1%E7%AB%B9_Typhoon_Mangkhut_Sept_2018_SSG.jpg

Discussion (2): Weather information and warning• Overall community information patterns are similar across a number of

natural hazards in Hong Kong.

• Although television holds its dominance in public communication, Internet-based channels are increasing more important in Hong Kong for information seeking. with their convenience, flexibility, and timeliness

• 16.0% respondents ventured out for non-emergency reasons, particularly males and the young

– Education and intervention efforts should be invested to prevent people from venturing outside as it could add extra burden to the emergency response system and may delay rescue for more pertinent needs

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Discussion (3): Preparedness

• Proportion of routine household preparedness decreased in five years from 75.1% (2012)[4] to 70.6% (2018)

– Not statistically significant but the decrease suggested DRR awareness should be reinforced

• Consistency in the uptake of routine household preparedness and disaster-specific preparedness

– which may be reinforced by the higher awareness and risk perception among this group

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Discussion: Research gap and Limitations

• Limitation

– Cross-sectional meant inferences are limited to association, not causations;

– telephone survey excludes those without a landline (89.0% penetration);

– cannot ascertain actual household risk; greater proportion of higher education and income may also bias the results

• Research gap

– Natech disasters (Natural disaster-triggered technological disasters) in urban context

– What are effective typhoon-specific preparedness measures (TSPM) on a household level?

• TSPM were not associated with lowering impact on household

• Many household impacts are also hardly preventable through applying preparedness measures mentioned in this study

• Road blocks from fallen trees was the most prevalent impact, less is known how it affect the daily routine of local residents and mid-long term recovery

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Implications

• Health impact awareness raising with climate change that may bring more meterological events and severe typhoons

• More proactive Health-EDRM measures to target non-compliant individuals (Primary, Secondary, Tertiary health community)

• Gaps in NaTECH related health research high-rise urban cities

• Patterns and channel use of of risk communications

• Long term follow-up studies in health and related impact.

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Conclusion

• Health-EDRM is the latest multidisciplinary research and academic paradigm for health stakeholders to engage in DRR

• Evidence based science and research outcomes are urgently needed to support DRR efforts to reduce risks and build resilience

• Global gaps in academic and infrastructure platform to support research and academic training

• Lessons learnt in implementation and policy development should also be documented and disseminated to benefit wider audiences.

References

1. CRED (Centre for Research on the Epidemiology of Disaster and the United Nations International Strategy for Disaster Reduction). 2019. 2018 Review of Disaster Events.

2. Chan, E.Y.Y.; Yue, J.; Lee, P.;Wang, S.S. Socio-demographic predictors for urban community disaster health risk perception and household based preparedness in a Chinese urban city. PLoS Curr. 2016, 8, 1–11.

3. Chan, E.Y.Y.; Man, A.Y.T.; Lam, H.C.Y. Scientific evidence on natural disasters and health emergency and disaster risk management in Asian rural-based area. Br. Med. Bull. 2019.

4. Chan, E.Y.Y.; Yue, J.; Lee, P.;Wang, S.S. Socio-demographic predictors for urban community disaster health risk perception and household based preparedness in a Chinese urban city. PLoS Curr. 2016, 8, 1–11.

5. Wong, T.F.; Yan, Y.Y. Perceptions of severe weather warnings in Hong Kong. Meteorol. Appl. 2002, 9, 377–382.

6. Chan, E.Y.Y.; Yeung, M.P.; Lo, S.T. Hong Kong’s Emergency and Disaster Response System Policy Brief ; The Hong Kong Jockey Club Charities Trust: Hong Kong, China, 2015.

7. Chan, E.Y.Y.; Man, A.Y.T.; Lam, H.C.Y.; Chan, G.K.W.; Hall, B.J.; Hung, K.K.C. Is urban household emergency preparedness associated with short-term impact reduction after a super typhoon in subtropical city? Int J Environ Res Public Health. 2019;16(4):596.

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Documents

Research Gaps in Strengthening Resilience of Communities ...acdpr.hkjcdpri.org.hk/pdf/ppt/14Emily_Chan.pdf · Thematic Research Network for Health Emergency and Disaster Risk Management