A disaster public health education framework to strengthen … · 2011. 7. 7. · Prof Emily YY...
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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
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
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.
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
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
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
Background 1
Asia
Prof E YY Chan, A disaster education framework to bridge natural disaster medical response and primary care development in
Background 2
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
Urban versus Rural disaster responseBackground 3
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
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
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
Challenges in urban health in Asia (1a) �Potential impact on large population (megacities)
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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
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)
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
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
Source: Hong Kong Census & Statistics Department
Challenges in urban health in Asia (3a) � Demographic transition
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
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
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
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
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
Sources: CRED Crunch Issue No. 13 � �Disaster Data: A Balanced Perspective�, July 2008
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
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
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
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
Challenges in urban health in Asia (7) �Skills: Data collection, interpretation
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
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.
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
Analysis
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
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
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
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
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
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
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
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
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
The SPHERE Project.
http://www.sphereproject.org/content/view/114/84/lang,English
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
Disaster Medicine
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
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
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
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
Disaster public health education framework
A two-dimensional, three-tier education training framework
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
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
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
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
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
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
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
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
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
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.
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
Thank you
Q&A
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