Disaster Epidemiology

Methods and Applications

Jennifer Horney, Jennifer A. Horney

• Publisher: Academic Press
• Year: 2017
• ISBN:
  9780128095072
• Topic: Medicina
• Subtopic: Epidemiología

Disaster Epidemiology: Methods and Applications applies the core methods of epidemiological research and practice to the assessment of the short- and long-term health effects of disasters. The persistent movement of people and economic development to regions vulnerable to natural disasters, as well as new vulnerabilities related to environmental, technological, and terrorism incidents, means that in spite of large global efforts to reduce the impacts and costs of disasters, average annual expenditures to fund rebuilding from catastrophic losses is rising faster than either population or the gross world product. Improving the resilience of individuals and communities to these natural and technological disasters, climate change, and other natural and manmade stressors is one of the grand challenges of the 21st century. This book provides a guide to disaster epidemiology methods, supported with applications from practice. It helps researchers, public health practitioners, and governmental policy makers to better quantify the impacts of disaster on the health of individuals and communities to enhance resilience to future disasters.

Disaster Epidemiology: Methods and Applications explains how public health surveillance, rapid assessments, and other epidemiologic studies can be conducted in the post-disaster setting to prevent injury, illness, or death; provide accurate and timely information for decisions makers; and improve prevention and mitigation strategies for future disasters. These methods can also be applied to the study of other types of public health emergencies, such as infectious outbreaks, emerging and re-emerging diseases, and refugee health. This book gives both the public health practitioner and researcher the tools they need to conduct epidemiological studies in a disaster setting and can be used as a reference or as part of a course.

• Provides a holistic perspective to epidemiology with an integration of academic and practical approaches
• Showcases the use of hands-on techniques and principles to solve real-world problems
• Includes contributions from both established and emerging scholars in the field of disaster epidemiology

Chapter 1

History of Disaster Epidemiology

1960–2015

Jennifer A. Horney Texas A&M University, College Station, TX, United States

Abstract

Disaster epidemiology is not a new field, and the methods utilized to conduct disaster epidemiology studies are no different than the methods used in everyday applied public health research and investigations. The only difference is the circumstances under which the methods are employed. The challenges of conducting epidemiologic studies during a disaster are many—limited access to study sites and populations; access to reliable electricity, connectivity, and communication systems; and typically a short time frame in which to gather, analyze, and report data to decision-makers so that it can be utilized to prevent morbidity and mortality. However, many innovations have been developed by disaster epidemiologists to meet these challenges. Rapid needs assessments, innovative surveillance and tracking systems, and adapted epidemiologic study designs are some of the innovations that will be discussed in this chapter.

Keywords

Epidemiologic methods; Public health surveillance; Rapid needs assessment; Study design

Background

Studies of the impacts of natural and man-made disasters have been undertaken since the 1950s and 1960s, growing out of the study of evacuation planning and research on wartime relocation following World War II, and later, concerns about nuclear attacks or accidents (Tierney, 2007). Early studies were primarily descriptive and based mostly on survey data collected following disasters. Surveys tended to rely on self-reported impacts and the time frames in which data were collected varied from immediately postdisaster to months after the event (Adams & Adams, 1984). These early studies were wide-ranging with regard to disaster type, including both acute (e.g., hurricanes, flash floods, and earthquakes) and more chronic types of emergencies (winter storms, droughts, and volcanic activity) (Adams & Adams, 1984; Erikson, 1976; Glass, O'Hare, & Conrad, 1979; Killian, 1954; Spencer, Romero, & Feldman, 1977).

From the beginning of disaster research, the methods used were “hardly distinguishable” from the methods used in everyday public health and social science research (Mileti, 1987, p. 69). However, the circumstances, under which the methods were employed, were very different and varied depending on the phase of the disaster process that was being studied. For example, immediately after a disaster, it may be more difficult to develop hypotheses, design reliable studies, recruit appropriate controls, or locate subjects (Killian, 1956). Delays associated with obtaining Institutional Review Board approval of research protocols may hinder the immediate collection of data in the postdisaster period (National Institutes of Health, n.d.). Research, particularly by those from outside the affected area who did not experience the disaster firsthand, can place perceived or actual burdens on individual respondents, communities, or systems during disaster response and recovery (Korteweg, van Bokhoven, Yzermans, & Grievink, 2010; Laska & Peterson, 2011).

For these and other reasons, disaster epidemiology has historically been somewhat marginalized from the broader discipline of epidemiology. However, the role of epidemiologists in responding to disasters has expanded dramatically in the last two decades. Rapid Needs Assessment (RNA) methods, adapted from the World Health Organization's Expanded Program on Immunization (EPI) method of estimating immunization coverage, began to be implemented regularly after humanitarian emergencies, beginning with the famines in Somalia (Boss, Toole, & Yip, 1994), and after disasters, beginning with Hurricane Andrew (CDC, 1992; Hlady et al., 1994; Malilay, Flanders, & Brogan, 1996). Emergency department surveillance systems were implemented to capture illness, injury, and mortality data to quantify the health impacts of disasters such as floods in Louisiana (Ogden, Gibbs-Scharf, Kohn, & Malilay, 2001) and Hurricane Floyd in North Carolina (CDC, 2000). Other types of epidemiologic investigations, such as retrospective and prospective cohort studies, began to be implemented to study the long-term effects of disasters such as the terrorist attacks of September 11, 2001 (Savitz et al., 2008), the Indian Ocean Tsunami (Nishikiori et al., 2006), and the Deepwater Horizon oil spill (Stewart et al., 2011). The systematic use of the term “disaster epidemiology” since the 1990s has helped to establish the discipline as a formal subset of epidemiology and encourage its ongoing development (Malilay et al., 2014).

Disasters continue to be a major cause of morbidity and mortality. In spite of large efforts to reduce the impacts and costs of natural disasters, in the United States, average annual federal expenditures to fund rebuilding from catastrophic and chronic losses have been rising faster than either population or gross domestic product (GDP) (Gall, Borden, Emrich, & Cutter, 2011). Globally, the number of people at risk continues to grow along with the populations of megacities located in vulnerable coastal areas, as does the cost of disasters relative to real global GDP (Bouwer, Crompton, Faust, Höppe, & Pielke, 2007). These trends will likely accelerate along with the destructive potential of natural disasters due to climate change and sea-level rise. The following sections present a review of the development in the field of disaster epidemiology and provide examples of disaster epidemiology investigations.

1960s–1980s

Rapid Needs Assessments

Postdisaster RNAs are an important way to mitigate adverse health effects of a disaster among a population. The RNA cluster sampling methods, initially developed by the World Health Organization's EPI in the 1970s, were initially used to obtain data about vaccine coverage and ensure availability of vaccines to all children globally by 1990 (Lemeshow & Robinson, 1985). Since data on immunization coverage and the burden of vaccine-preventable diseases (e.g., tetanus, diphtheria, measle...