Public Health Preparedness Environmental Health is Critical Environmental

Public Health Preparedness: Environmental Health is Critical! Environmental Health Australia Conference 9 December 2016 Kristine M. Gebbie, Dr. PH, RN Flinders University

Presentation goals • Brief overview of the importance of environmental health in disasters • Key areas of environmental concern – Drinking water – Sanitation and Waste (general/hazardous) – Food safety – Communicable diseases and vectors – Evacuation centres and shelters Public Health & Disasters 2

Where you are matters! • Environment is a key contributor to the health of the public • Action on environment of historic importance to public health • Protection has become more complex – Population density – Increased technology – Conflicting attitudes and expectations Public Health & Disasters 3

Is there a difference? • Environmental health emergency or disaster or • Environmental health in emergencies and disasters? • It’s a distinction without a difference for the core concerns! Public Health & Disasters 4

Safe water: a challenge when • The established system for safe delivery of water is contaminated • The established system for safe delivery of water and removal of waste is damaged/disrupted • A population is moved to an area that lacks adequate safe water Public Health & Disasters 5

Priorities for water • Drinking, cooking, personal hygiene (handwashing!) use: 7 -15 litres/person (3 -5 for drinking/cooking) • Livestock or crops (may be critical to reestablishment of livelihoods) • Health facilities/hospitals (should be planned for separately; 40 -60 litres/day/person) 5 August 2015 6

Within Australia • If system is intact but contaminated, boiling is good measure • Delivery of safe water can generally be arranged within a short time • Depending on packaging, may add to the waste disposal challenge! • Resilience development suggests family storage of 2 -3 day supply Public Health & Disasters 7

Contaminated system • Cut off distribution of contaminated water • Alert population to institute protective actions (e. g. , boiling/filtration) – Be alert to cost of chemicals or fuel • Flush or otherwise clean the system • If repair will take extended time, arrange alternate water supply Public Health & Disasters 8

The terrorist threat • Deliberate contamination of a major drinking water system • Security measures have been dramatically increased in recent decades • Reasonable suspicion of contamination may lead to temporary shutdown, decontamination Public Health & Disasters 9

Post earthquake, Costa Rica • Town of 40, 000 with no water system • Soft drink company in capitol bottled water and began supplying within 18 hours • New dam brought water to treatment plant; trucks then delivered to town • Within 60 days, service available 6 hours/day Public Health & Disasters 10

Sanitation and Waste • Human waste management is a priority if usual systems are disrupted • Temporary measures may be essential – Photo: New Zealand • Handwashing essential! Public Health & Disasters 11

Other waste • Solid waste from food/water/other packaging • Medical waste if care is being given on site • Hazardous materials, depending on nature of emergency Public Health & Disasters 12

One non-issue • 1 -2 bodies generally well-handled, but some emergencies lead to hundreds • Panicked disposal of human remains is not appropriate! • Respectful storage of bodies away from water and food supply and protected from insects/animals is correct • Given climate, cooling (often in refrigerated trucks) is a best choice Public Health & Disasters 13

Food safety • Household preparedness education always includes food recommendation • Logistics for emergency response teams includes food supply • Challenges – Disrupted supply chain for longer events – Overly eager volunteer food suppliers Public Health & Disasters 14

Communicable diseases and vectors • Large groups in small spaces increase the opportunities for spread of disease • Poor arrangements for food storage or waste disposal invite vectors of disease (flies, rodents, other) • A well-supported vaccine program is protective and an emergency may provide an opportunity for increasing uptake of basic vaccines (measles, polio, DTP) Public Health & Disasters 15

Cholera- a frequent concern • Not reported recently in Australia, but. . • One reason for taking great care with human waste Public Health & Disasters 16

Displaced or relocated population • Numbers of displaced rising steadily – Weather-related events (flood, tsunami, typhoon) – Internationally, civil unrest/war • Large numbers of refugees/displaced persons require emergency supports – Internally displaced may be more difficult to help than those who cross borders Public Health & Disasters 17

Phases of response • Immediate measures (to sustain life) • Intermediate measures (from about 2 to 6 weeks after the disaster, or the arrival of refugees in a camp) • Long-term solutions (from about 6 weeks) – Generally not a problem in Australia, though some families are still in ‘temporary’ situations several years after major fires Public Health & Disasters 18

Safe places for defecation and handwashing • Must be provided quickly • Should be clearly marked and separated from drinking water and food sources • Should take into account cultural expectations (e. g. , extent of gender/age separation) Public Health & Disasters 19

Evacuation centres and shelters • Pre-selected, pre-supplied locations are the best! • Short-term use rarely a challenge • Longer term use (48 hours or more) requires attention to – Adequate water -- Rest/sleep space – Waste disposal -- Child safety – Food supply -- Health care – Usual use of the facility Public Health & Disasters 20

ENVIRONMENTAL HEALTH ASSESSMENT FORM FOR SHELTERS For Rapid Assessment of Shelter Conditions during Disasters (https: //emergency. cdc. gov/shelterassessment/pdf/shelter-tool-form. pdf) • Major categories for assessment – – – – – Facility itself Food supply Water & ice Health Sanitation & solid waste Child care Sleeping Companion animals Handicapped access Public Health & Disasters 21

One final area • Communication! – You will be asked for information by the public or by your family and friends – You are responsible to be a part of the planned response, not a spreader of rumor or guesswork – Think before you speak – Be where rumours go to die Public Health & Disasters 22

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Useful Resources • Environmental Health Training in Emergency Response (EHTER) – http: //www. cdc. gov/nceh/ehs/ETP. • World Health Organization – http: //www. who. int/environmental_health_e mergencies/en/ – http: //apps. who. int/iris/bitstream/10665/425 61/1/9241545410_eng. pdf? ua=1 Public Health & Disasters 24

Thank you! Public Health & Disasters 25