This course introduces a set of public health problems experienced by people affected by natural disasters and/or conflict. It discusses the many changes in people’s lives when they are uprooted by a disaster, ranging from changes in disease patterns, access to health care, livelihoods, shelter, sanitary conditions, nutritional status, etc. We will explore what humanitarian interventions could look like if we want to mitigate the effects of disasters. The course content is a mix of theoretical knowledge and many practical examples from recent disasters. We think this course is unique because it contains so many practical ‘real-life’ examples and is taught be instructors and guest lecturers who together have over 200 years of experience in this field. The course consists of 10 modules totaling approximately 9-10 hours of delivered content with an additional 2-3 hours of self-work (quizzes and writing and evaluating a short peer-review assignment) as well as lively discussions forums. The course has been designed in a way that each module builds on the lessons of previous modules. However, modules can be accessed in any order and some can stand alone. You do not have to pay for this course if you choose to enroll without a certificate. Sometimes referred to as auditing, enrolling without a certificate means that you will have access to all of the videos, quizzes, assignments, and discussions. The only difference is that you will not receive a certificate upon completion. Click the Enroll Without A Certificate link to sign up and begin the course. Even if you enroll in a session that has yet to begin, you may access most of the course materials right away by clicking the Preview Course Materials link. However, you will have to wait for the session to begin before posting on the discussion forum or accessing the final peer-reviewed assessment. Visit the Learner Help Center for details about session schedules.
Introduction
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來自 Johns Hopkins University 的課程
Public Health in Humanitarian Crises
157 個評分
從本節課中
Module 1: Humanitarian Disasters and Public Health
In this module we will define what we mean by disasters, hazards, risks and vulnerabilities. We look at patterns and trends and understand the role of public health in disasters.
與講師見面
Gilbert Burnham, MDProfessor
International Health
Mija VerversSenior Associate
Health Systems
[MUSIC]
Welcome to the first module, and
here we're going to be talking about humanitarian disasters and public health.
This will give you an overview of the entire course, and
will bring into focus some of the definitions and
some of the concepts that we'll revisit as we go through the course.
In this module, we will discuss the various definitions of disasters,
how it affects populations and groups of people.
We'll talk about the various issues related to risks,
vulnerability, and how do we manage disasters?
We'll talk about the components of the disaster cycle, or the humanitarian cycle.
And we'll discuss about how populations can prepare themselves
to face the consequences of disasters.
Now, disasters are affecting increasing numbers of people for various reasons.
And disasters can be looked at from several standpoints.
They can be looked at from the event themselves,
whether they're an engineering catastrophe.
And on the right hand side we can see a photograph of the prime minister's
residence in Haiti that collapsed after the earthquake.
They can be looked at from a weather standpoint, or
they can be looked at from other phenomenal standpoints.
But in this course, we're going to look at things from a public health standpoint.
So, we want to look at the health of a population.
How do events affect these populations?
And most importantly, what can be done to reduce the impact of the disasters,
not only on the populations, but also on individuals themselves.
Let's start off with definitions, and
let's talk a little bit about what are possible definitions of disasters.
So we might ask the question, if there's a tropical storm, or
earthquake, or a flood, or a conflict, is that a disaster?
Or what happens if a certain number of people are killed?
Does it have to be 10, or 20, or 50, or how many people are injured?
How many people must be displaced for it to be a disaster?
Or we could look at a disaster from the standpoint of diseases.
Many people believe that whenever we have a disaster,
there will be an outbreak of some kind of disease.
Is that true, is that a valid definition?
If you're the insurance people, you'll look at the amount of property damage or
the economic disruption.
Is that the only definition of a disaster?
Can it be a rapid onset, or can it be a slow onset disaster?
Can it be a disaster or an event which requires no external assistance?
Or only when we have Doctors Without Borders or
other groups arriving, is that when it's a disaster?
And finally the question about the media.
Are there disasters that are not covered by media?
Or if it's a disaster, does it have to be covered by the media?
So these are all questions that come up, and
they affect the way that various people look at disasters.
So let's talk about definitions.
What defines a disaster?
And among the many different definitions,
they all contain some element of the following, a sudden or a calamitous event.
Although we could argue that there are slow onset disasters like droughts, so
there are some exceptions.
We can talk about something that seriously disrupts the functioning of a community or
a society.
We would include things such as losses of human, material, or economic,
or environmental natures, and we also have to say, these might be direct.
They could be through cause of death, or injury, or property damage.
They could also be indirect through the loss of access.
Access to food, access to services, security,
and most importantly, now we're talking about livelihoods.
Have people lost access to their livelihoods,
their traditional forms of support?
We also would include the fact that to be a disaster, it must exceed
a community's or a society's ability to cope using its own resources.
So right away you can see that some societies might have more resources than
others, so this definition might be a sliding definition,
depending on the amount of resources.
The basis of disaster management,
whenever we look at the systems that are in place to assist society, is one,
being able to call for assistance when this event exceeds your capacity to cope.
And secondly, knowing that there will be assistance there to assist you
when you call for this.
We also need to be reminded that disasters are often caused by nature,
commonly the natural disasters.
However, even in these natural disasters,
humans contribute to the risks and to the vulnerabilities.
And later in this lecture, we'll talk about some of these vulnerabilities, and
some of the ways that we mitigate or
reduce the nature of these vulnerabilities.
I've put here a standard definition that comes from the International Federation of
Red Cross and Red Crescent Societies.
This is a definition that's widely used.
Doesn't have all of those components that we talked about previously, but
it's fairly comprehensive.
And here it says, a sudden, calamitous event that seriously disrupts
the functioning of a community or society and causes human, material,
and economic or environmental loss that exceeds the community's or
the society's ability to cope using its own resources.
Though often caused by nature, disasters can have human origins as well.
So of all the disaster definitions out here, this is one I like the best.
I think it covers things very nicely.
Now let's look at how disasters come about.
Here we see a list of hazards.
Now we should not confuse hazards with disasters.
Hazards are events that occur.
They can be earthquakes.
They can some type of technological event.
They can be political in nature, or they can be compound,
which contains a number of these different elements.
But in themselves, they are not disastrous unless they affect human life and
human economy in some way.
But disasters cause a release of energy, and
the energy is where we see the impact on populations.
And this energy may be released in the form of storms.
It may be released in the form of earthquakes.
It may be released in the form of political turmoil, and
consequently conflict, or it may be a combination of these elements
releasing energy that has an impact on the population.
Now this impact can cause human losses.
These can be economic losses, they can be injuries, and they can be death, or in
many cases, they can also be displacement of populations into other locations.
And when a population is displaced, as we'll talk about later on, this population
is at increasing risk, increasing vulnerability from multiple hazards.
It can cause a structural damage to buildings, and this commonly is associated
with earthquakes, but more importantly it can cause functional damage.
So things may be in place,
but they're not functioning in the way that will benefit the society.
It will not be functioning in a way that will alleviate some of
the problems that have been caused by this release of energy.
These events then create needs, and these needs may be for items such as food, and
may be needs for items such as relief from injuries, or it may be a need for shelter.
So multiple needs may be created.
If a community is able to meet these needs with its own resources,
then it might be an emergency, but
it would probably not fulfill our standard definition of a disaster,
which needs external resources to cope with the consequences.
We can look at this through the lens of risks.
Now right away, you can see that this slide was probably written by
an insurance company, because insurance companies are always talking about risks,
and how much it's necessary to insure these potential risks.
But if we were in public health we would probably say this is
probability of loss to a population.
And this could be a number of forms of loss.
So the three items I put here are the components that go into our
standard definition of disaster.
The risks, which is a calculation, hazard, which is an event, and
we saw the list of those, and then vulnerabilities.
And much of the rest of this talk is going to be about vulnerabilities.
Now we can these three items, and we can put them into a formula,
and the formula looks like this.
Risk is a calculation that occurs from the interaction of the hazard
with the vulnerabilities of a specific population.
Now this may look a little conceptual.
However, you can actually assign values to these items,
such as hazards and vulnerabilities.
Hazards for instance, we commonly associate with different measurements.
We have Richter scales.
We have the size of tropical storms.
We have a number of things we can give a number to, and
if we're creative, we can also give numbers to vulnerabilities as well.
Let's talk a little bit about hazards.
Now, some of the hazards can be modified.
And an example of that is the hazards that come from transportation events,
or industrial events, or even conflicts.
Perhaps later in the course, you'll have a chance to hear about
some of the modifications that we've done for conflicts.
Many of you have heard the Geneva Conventions.
That's an attempt to modify conflict, or the consequences of conflict.
The Hague Law that governed war dating from 17th century also covers that.
Some hazards can be made worse.
So climate change is a situation that definitely can be made worse, and
there are risks that this is occurring.
War can certainly be made worse if the standard conventions and
the standard rules of war are not followed appropriately.
And then we have the issues of vulnerability,
and this is where our greatest successes have occurred in being able to modify
the risks by reducing vulnerabilities.
There's a photograph on the right of the famous Winslow Homer painting in the Gulf
called Be Calmed.
And this is a favorite of mine from childhood, and
I used to look at this picture and meditate on the many hazards and
vulnerabilities that were present in this picture.
If we have that same kind of eye for society, we can look around us and
identify many of the vulnerabilities that are occurring around us every day.
These vulnerabilities maybe additive or they may be multiplicative.
So one vulnerability may greatly increase another vulnerability.
Now, if we're going to classify these vulnerabilities, there are many different
classifications, but here's one that I like particularly well.
We can look at the underlying causes.
What are the ideologies or
belief systems that make people prone to certain vulnerabilities and
certain events in which they would be otherwise not so vulnerable?
We can look at cultural events or factors.
We can look at economic factors that might make a population more vulnerable, and
we'll come back to some of the economic ones here in a bit.
We can also look at dynamic pressures.
What's happening in a society?
If a society does not have strong institutions,
if there are low levels of education, if the social fabric is being torn apart,
if local markets are not functioning well, if there's an absence of press freedoms,
then the dynamic pressures create vulnerabilities.
The same thing can be said of the macro forces, such as population growth.
Areas that are experiencing rapid population growth in locations
that are vulnerable to storms or flooding have increasing risks.
Urbanization has some risks involved, and increasingly we're
concerned about environmental degradation and the consequences of that.
And if you live in Baltimore like some of us, we've dealt with the fact
that the ground in many areas where there's been a loss of industrial
activity in the past has been heavily contaminated by lead and by heavy metal.
So that's just one of the the kind of environmental
degradations that we're seeing.
In Latin America, we're seeing increasing problems with deforestation and
landslides following heavy storms, another example of this.
And then we have to think about the unsafe conditions
that people find themselves in, people living in fragile physical environments.
When we see the continuing rapid movement of populations from rural areas to
urban areas, when they arrive in urban areas, many of these populations live in
very fragile locations that are subject to flooding, or to other problems.
People living in dangerous buildings, fragile economies, low income.
The poverty is always one of the major unsafe conditions for populations.
And then there may be government policies that either make things more unsafe or
maybe make things safer.
So government policies can have a very positive effect, but
they may have a negative effect as well.
Then we come back to our formula again, and we see our vulnerabilities, those that
we've just gone through, and we see that they can be modified by capacities.
What is the capacity of a community, of a province,
of a state, of a city, to be able to modify these vulnerabilities?
And in many ways, that's the responsibility of government,
is to protect its population by reducing its vulnerabilities.
Now we can look at examples of these capacities at several levels.
We can look at the national level, where a well designed and
functioning disaster management program can ensure that there's appropriate
legislations, there are appropriate training, there are appropriate resources
to cope with the disasters that might occur in that particular country.
These resources can coordinate the preparedness activities.
And increasingly, I might add, we're looking more at how do we prepare for
disasters, rather than how to be really clever and
be really quick to respond to disasters.
So national disaster preparedness is an increasingly important activity.
In a disaster, the national level resources should be
coordinate both national and international assistance.
If you follow the news over the last how many years,
you can see many examples of countries that
have been able to coordinate international response very well.
An example of this have been the earthquakes and tsunamis in Japan.
The Japanese government has managed this very well.
An example many of you may remember was the earthquake in Haiti,
in which the government was not strong enough to really coordinate
the international assistance, and we had a lot of confusion as a consequence.
And finally, the national level needs to be able to provide the resources,
technical and financial, not only to respond,
but to rebuild after the disaster.
And those of you who followed the situation in Syria, the conflict there,
I know what you're wondering, like the rest of us,
is where will there ever be the resources to rebuild that country?
Now, that's a question that's still a very open question.
Then at the state or provincial level, we look at disaster management
capacities to support lower level strata in the society.
Whether it's county or municipal governments, can the planners be trained,
can civil defense responders be appropriately identified and
given the skills?
Are there the resources to mobilize for all phases of disaster management,
not just immediate response, but that recovery, and
in fact, that preparation for the next disaster?
Now this is the point where I need to emphasize that the most important response
always comes from the community.
And building that community capacity, particularly through organizations such as
Red Crescent or Red Cross Society, and other groups, is a primary way that
we have been able to build capacity and reduce vulnerabilities in populations.
Now I want to say a little about looking at disaster risk reduction.
This has been a big push in the last probably 15 or 20 years, and
this started with the Hyogo Framework, which was adopted in 2002.
And this followed the Great Hanshin Awaji earthquake, or
other people know this as the Kobe earthquake of Japan.
And this started out by stressing how important it was to look at the risks
in society, to identify these,
then to develop strategies to lessen the impact of natural hazards.
So if you live in Japan, if you live in Kobe, it's just a matter of time,
maybe centuries, maybe decades, until you have another earthquake, so
what can be done to lessen the impact of that?
And then finally, building on that last point about the community, how do we build
a community based framework to address the consequences of these natural hazards?
Then this was followed in 2015 by the Sendai Framework.
Now, this came about following the great Tohoku earthquake,
and then the tsunami which followed that.
And this put a shift in emphasis more on understanding what
the disaster risks were.
So identifying the existing risks as we did with Hyogo is fine, and
that was very important, but then we need to take a step back from that and
see what's underlying that.
And what can be done to improve governance?
So what's the government's role in managing disasters?
Many parts of the world,
now this is felt to be extremely important, and how do we strengthen that?
And then finally, investing in building resilience, so
buildings do not automatically collapse after a earthquake, and
storms do not automatically result in heavy flooding.
