Academic journal article Journal of Environmental Health

The Role of Environmental Health in Understanding and Mitigating Postdisaster Noncommunicable Diseases: The Critical Need for Improved Interdisciplinary Solutions

Academic journal article Journal of Environmental Health

The Role of Environmental Health in Understanding and Mitigating Postdisaster Noncommunicable Diseases: The Critical Need for Improved Interdisciplinary Solutions

Article excerpt

Introduction

The frequency, intensity, and severity of natural disasters across the globe have increased in recent decades (Aitsi-Selmi et al., 2015; Burkle, 2010; Hogan & Burstein, 2007; Intergovernmental Panel on Climate Change, 2014; Ryan et al., 2015a, 2015b). The majority (88%) of these natural disasters have been the result of cyclones, hurricanes, typhoons, floods, tsunamis, or storms (United Nations International Strategy for Disaster Reduction [UNISDR], 2012). During the last 20 years, the exposure of people and infrastructure to risk in all countries has increased faster than vulnerability has decreased (Aitsi-Selmi et al., 2015; Ryan et al., 2016a; UNISDR, 2015). This increasing vulnerability highlights the need to focus resources on assisting the most vulnerable people affected--both directly and indirectly--by a disaster (Ryan et al., 2015a).

Traditionally the focus of public health before, during, and after a disaster has been on communicable diseases. The actual risk of communicable diseases, however, is low, particularly in developed countries (Watson, Gayer, & Connolly, 2007). A combination of population aging, increasing obesity and overweight, decreasing physical activity, environmental change, and reduction in communicable disease in populations across the world has contributed to a "disease transition" to noncommunicable diseases (NCDs) (Demaio, Jamieson, Horn, de Courten, & Tellier, 2013; The Sphere Project, 2011; World Health Organization [WHO], 2017a, 2017b). This transition poses a new challenge for disaster management and health systems (Connell & Lea, 2002; Murray et al., 2012).

Any disruption to public health infrastructure (PHI) such as medical access or availability, lack or quality of water, or poor sanitation can result in an exacerbation of NCDs or even death (Aldrich & Benson, 2008; Chan & Kim, 2011; Demaio et al., 2013; Jhung et al., 2007; Kjellstrom & McMichael, 2013; Martine & Guzman, 2002; Rath et al., 2007; Ryan et al., 2015a). Arguably, this risk was first highlighted by the 47% increase in mortality one year after Hurricane Katrina, which can be attributed to NCDs (Burkle, 2010). People at greatest risk are those with cancer, cardiovascular diseases, diabetes, respiratory conditions, and renal diseases (Arrieta, Foreman, Crook, & Icenogle, 2009; Evans, 2010; Hendrickson, Vogt, Goebert, & Pon, 1997; Loehn et al., 2011; McKinney, Houser, & Meyer-Arendt, 2011; Ryan et al., 2015b; Swerdel, Janevic, Cosgrove, Kostis, & Myocardial Infarction Data Acquisition System Study Group, 2014).

This challenge has been recognized globally by the United Nations in the Sendai Framework for Disaster Risk Reduction 2015-2030. Item 30(k) suggests that NCDs should be included in the design of policies and plans to manage risks before, during, and after disasters, including having access to life-saving services (UNISDR, 2015).

In Australia, NCDs cause approximately 90% of all deaths, account for 88% of the burden of disease, and are responsible for 83% of recurrent health expenditure (Australian Government Department of Health, 2017; Queensland Government, 2014). The challenge of managing NCDs stems from a lack of initial understanding of the problem and a shortage of appropriate mitigation strategies (Lim, Chan, Alsagoff, & Ha, 2014). Healthcare providers typically focus on the treatment aspects of NCDs with a tendency to be response oriented, which alone will not either mitigate or solve the problems NCDs have exposed on society (Sabate, 2003; Tinetti, Fried, & Boyd, 2012). The challenges posed by NCDs encompass a range of disciplines, and for this reason requires an interdisciplinary approach (Burkle, 2012; Burkle, 2014; Paans, Wijkamp, Wiltens, & Wolfensberger, 2013; Wessely, 2014).

The environmental health (EH) discipline takes an interdisciplinary approach to providing a strong basis for good public health outcomes for individuals and communities (WHO, 2017c). …

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