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

Transcription

1 2011 Hospital Authority Convention Collaborative Healthcare A disaster public health education framework to strengthen disaster medical response in Asian Urban Communities Prof Emily YY Chan Director, CERT-CUHK-Oxford University Centre of Disaster and Medical Humanitarian Response School of Public Health and Primary Care, Faculty of Medicine, CUHK 8 st June 2011

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

3 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.

4 Disaster Background 1 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

5 Background 2 Asia

6 Urban versus Rural disaster response Disaster Response System Technical and Human response capacity Urban Usually organized or at least exist in some sort More concentrated Rural Background 3 Non-exist or fragmented 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

7 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 transition 4. Types of disasters ( silence disaster: eg temperature) 5. Political issues: complex and fragmented system 6. Media pressure 7. Skills: Data collection, interpretation Background 4

8 Challenges in urban health in Asia (1a) Potential impact on large population (megacities) Photo from: Photo from: Apple Daily

9 Challenges in urban health in Asia (1b) Potential impact on large population (living density) No. of persons (As at mid-2010) Source: Hong Kong Census & Statistics Department

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

11 Challenges in urban health in Asia (3a) Demographic transition Source: Hong Kong Census & Statistics Department

12 Challenges in urban health in Asia (3b) Epidemiological transition 75 % Main causes of death, WHO region, 2000 Chronic diseases Injuries Communicable diseases, maternal & perinatal conditions, & nutritional deficiencies Africa Eastern Mediterranean South- East Asia Western Pacific AmericasEurope Source: WHO report

13 Challenges in urban health in Asia (3b) Epidemiological transition Country Burden of chronic disease and natural disasters in selected Asian developing countries ( ) Total number of natural disasters % deaths by chronic disease caused in the country % chronic Cardiovascular disease Cancer Chronic respiratory disease Other chronic diseases Diabetes disease deaths (among total reported deaths) China* India* Indonesia* Pakistan** Sources: WHO, Preventing Chronic Disease: A Vital Investment, World Health Organization Global Report, 2005, _disease_report/en/; Centre of Research on Epidemiology of Disaster (EMDAT), and * As projected in 2005 ** As projected in 2002

14 Challenges in urban health in Asia (4) Types of disasters ( silence disaster: temperature) Sources: CRED Crunch Issue No. 13 Disaster Data: A Balanced Perspective, July 2008

15 Challenges in urban health in Asia (5) Political issues: complex and fragmented system Source: Wen Wei Po Source: Oriental Daily.

16 Challenges in urban health in Asia (6) Media pressure Source:

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

18 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.

19 Analysis

20 Principles of health response in disaster Fundamental Goal: Analysis 1 1. Securing the basics that all humans require to maintain health 2. 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 nd Edition Oxford University Press.

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

22 Application of Public Health principles in disaster response Analysis 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.

23 Environmental health International health 国际健康 Psychosocial aspects of health 心理因素 Health Education 健康教育 Impact of wider determinants & international perspectives 更广阔的影响因素 环境健康 Three domains of public health Health improvement 健康促进 Occupational health 职业健康 Health Protection 健康保护 Infectious diseases HealthService s 健康服务 传染病 Epidemiology, biostatistics, clinical trials, law & ethics 流行病学, 生物统计, 临床研究, 法律及道德 Analysis Primary care 初级保健 Health economics Prof. Emily YY Chan Lecture 1. Lecture 1 Overview PBHT 5801 Disaster and Humanitarian Crisis, July 7 th 2010 健康经济学 Care groups 关注组织 Healthcare management 卫生管理 Global health 环球健康 Healthcare systems &policy 健康系统 Evidence based medicine 循证医学

24 Public Health Methods and Tools for dealing with Disasters A. Epidemiology and Biostatistics -Assessment and Evaluation: Disaster epidemiology B. Health Service -Policy analysis and planning -Service emergency Preparedness and training -Disaster response management C. Health Protection -Infection control -Environmental health -Mental health -Nutrition D. Health Improvement -Coordination -Risk communication -Resource mobilization Analysis Three domains of Public Health -Capacity building (e.g. HR development and disaster response team building)

25 Disaster Medicine The SPHERE Project. ent/view/114/84/lang,english

26 Low cost activities to address chronic medical needs in disaster Hierarchy of Prevention Analysis Tertiary Prevention 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 2 : Identify and assess risk, screening, patient management plans, chronic medical service during relief 1 : Educate about disease prevention (dietary habit, smoking, alcohol, injury prevention) 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

27 Provision of medical service Pathway of Care Concept: Analysis Protection 保护 Most post-disaster medical relief service: Acute condition Prevention 预防 Diagnosis 诊断 Treatment 治疗 Rehabilitation 康复 Palliative 缓解 Promotion 促进 Acute care: Life saving procedures, clinical conditions (infections), MCH services Thrope A, Griffiths S et al: Primary health care and Public Health. Oxford University Press(2007 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 31 st May 2011

28 What is needed to address disaster response training? Policy Change Public Health Environmental Change System Change Professional Behavior Change Individual Behavior Change Primary Care Thrope A, Griffiths S et al: Primary health care and Public Health. Oxford University Press(2007) 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 31 st May 2011

29 Developing a training framework

30 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 Entrant Professional Expert Certificate UG area concentration/focus Post graduate Diploma Graduate Taught program (MSc) Graduate Research based Program (MPhil/ PhD)

31 Entrant Level: General Public General Public 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 Public Health relevance Population focus Evidence based Prevention approach Cost-effectiveness Life-course Community empowerment Proactive public risk communication Community engagement to co-share responsibility

32 Entrant Level Clinical Non Clinical Public Health Epidemiology of Disaster and Humanitarian Crisis Principles in Health, Human Rights and Humanitarian Law Basic Epidemiological and biostatistics Skills 1. Principles of Disaster Medicine 1. Field based health project/program management 2. Principles of Disaster Nursing 3. Principles of Disaster Mental Health 4. 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 Sanitation 5. Disaster: Food and Nutrition 6. Infection control 7. Development and Health 8. Risk literacy and communication 9. Research methodology 10. Emergency Rescue Competency 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 -

33 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 1. 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 planning 4. Skill based Training (PFA, Practicum Placement) 5. Updates in disaster responses, policy and systems Evidence based response and practice Practical clinical, Service Management Research Skills

34 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

35 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 strengthen mitigation and response capacities, share responsibility and community empowerment

36 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 nd Edition Oxford University Press.

37 Thank you Q&A