Public health can be threatened by all manner of natural and human-generated emergencies, from explosions, fires, and industrial accidents involving hazardous materials, to storms and
earthquakes. As well, there is the potential for terrorist acts to occur, which could involve highly toxic or infectious agents. Public health plays an important role in the process of comprehensive health emergency management, while the powers granted to medical health officers are
important in managing the consequences of community emergencies.
In discussing disaster, vulnerability, and mitigation from a population health perspective, Lindsay (2003) suggests that “through health promotion, health protection and personal health services, it is possible that [prevention] may successfully prevent negative health impacts” of disasters, thus situating health emergency management squarely within the Core Public Health Function Framework (Figure 3) as a program that employs the full range of public health strategies.
Health Emergency Management Core Programs include prevention and mitigation; preparedness; and response and recovery.
8.5.1 Prevention and Mitigation
The first stage of health emergency management is prevention and mitigation. The prevention of a disaster ever happening (primary prevention) is the ideal, but failing that, mitigation (reducing ahead of time the health impact of the event) is still a form of prevention and thus a public health function. Primary prevention of disasters involves the environmental health functions of ensuring high air and water quality and safe food; identifying potential environmental health threats and working to reduce or eliminate them; and providing input and advice to land-use and
environmental planning. Also important is public health’s role in drawing attention to larger scale and less specific threats to health such as climate change or resource depletion. Preventing their occurrence, if it can be achieved, is primary prevention.
If primary prevention is not possible, the second level of disaster prevention is mitigation. In terms of the public health function of a health authority, this has two aspects: mitigation of the impacts of a disaster on the health of the public, and mitigation of the impact on the health care infrastructure (Lindsay, 2003).
In the first case, the task of public health is to participate in the identification of populations at risk and work to reduce their risk. If climate change is going to happen, or an earthquake, volcanic eruption, flood, or fire is probable at some time in the future, steps need to be taken to reduce the likely extent and severity of the event’s impact on the public. This may involve either taking steps to reduce the number of people at risk (e.g. by moving people away from vulnerable areas such as low-lying land or land susceptible to earthquake damage) or putting in place protective measures (e.g. sea walls, lava berms, strengthening buildings against earthquakes) to reduce the harm to health if an emergency or disaster does arise. It also includes structural
improvement of vital public health infrastructure such as water supply or sewage treatment systems so that, in the event of a disaster, there would be less likelihood of damage, which would reduce the likelihood of infectious disease outbreaks.
The second aspect of mitigation is concerned with the health care system itself. Public health needs to be part of the health care system’s health emergency management program, helping to ensure the system is prepared to respond effectively to disasters of all kinds. Mitigation overlaps with the second stage of health emergency management, namely emergency preparedness.
8.5.2 Preparedness
An important way to limit the harm resulting from a disaster is to have prepared for it and to have in place a rehearsed disaster plan for all the most likely events that may affect the
community. This planning needs to encompass the community as a whole, and not just the health sector. While health authorities need to plan for the continued provision of emergency services, evacuation of facilities, response to epidemics and other issues, the public health sector also needs to plan for its role in preventing or controlling communicable disease outbreaks (which may constitute emergencies in themselves, or may be secondary to other disasters), as well as its role in monitoring food, water, air, land, and buildings for health hazards during and after the disaster. Plans for continuity of service, including the provision of safe water and food in the event of an emergency, are key, and are an obvious area in which public health plays an important role.
8.5.3 Response and Recovery
The third stage of health emergency management is the response to an emergency, and this will likely include a range of public health staff, depending on the nature of the emergency. As was seen in the SARS outbreak in Toronto in 2003, an emergency—particularly an infectious disease emergency—can quickly overwhelm public health capacity even in the largest city in the
country. Planning and preparation, including the effective management of “system surge” at the provincial and national levels is important.
In the final stage of health emergency management, recovery from the disaster, public health will continue to play an important role in any cleanup and in monitoring and certifying the safety of the water supply, food supply, and other key infrastructure elements as they are restored. Interestingly, Lindsay (2003) suggests that the broad strategy of population health improvement can also contribute to the ability of a community to cope with and respond to a disaster, by increasing personal coping skills and strengthening social support networks; this community resilience can also be important in the post-disaster recovery phase. It appears that this discussion of core programs has come full circle; effective health emergency management depends to a significant degree on overall population health improvement and the creation of safe and healthy communities.