Medical and Public Health Resilience

Shinichi Egawa, MD, PhD, FACS
IRIDeS, Tohoku University

Division of International Cooperation for Disaster Medicine

SFDRR

Health in Sendai Framework

Similarity of disease and disaster

Vulnerability &Capacity

Hazards

Disaster••••

Life, HealthProperties
FamilyCommunity

Division of International Cooperation for Disaster Medicine

Disaster Risk Reduction•••

Know your risk
Reduce your risk
Prepared to act

To reduce the disaster risk,Risk
Risk
Risk

=Hazard xx
Vulnerability
HazardVulnerability

Capacities
Capacities

Division of International Cooperation for Disaster MedicineSendai Framework
Four Priorities

Priority 1: Understanding Disaster Risk
Priority 2: Disaster Risk Governance
Priority 3: Investment in Disaster Risk Reduction
Priority 4: Enhance preparedness for effective
response and “Build Back Better” in recovery,
rehabilitation and reconstruction

Seven Global Targets
Outcomes
Implementationsc) direct economic lossd) infrastructureb) affectede) national andlocal strategiesa)mortalityf) International
cooperationg) multi-hazard
EWS

Division of International Cooperation for Disaster Medicine

Prof. Kimio Takeya
JICA and TU

Health in DRR framework
350"health"
300

314

"disaster"Sendai Framework described forthe first time that disaster affects
health of the people.

280

250
200

SFDRR aims to reduce “disasterslosses with a significant economic,social, health, cultural andenvironmental impact”

153
150
100
500Why?

3403

Yokohama
Hyogo
Sendai
Strategy 1995 Framework for Framework forAction 2005 Disaster Risk
Reduction
2015

Egawa (2018) J Disaster Res 13(6): 1049-1061

Division of International Cooperation for Disaster Medicine

Know your risk

Change of Health Risks in disaster

1923 Great Kanto Earthquake
September 1, 1923
11:58:32
M7.9
Cause of Death
Asphyxia
11%

Unknown
2%

Drowning
1%

Fire86%The buildings should be fire-resistantEvery Sept. 1 is the Disaster Drill Day

Division of International Cooperation for Disaster Medicine

1995 Great Hanshin Awaji Earthquake
January 17, 1995
05:46
M7.3
Cause of Death
Unknown
4%

Fire
13%

Asphyxia
83%

The buildings should be quake-proof
Japanese Association for Disaster
Medicine was established

Division of International Cooperation for Disaster Medicine

2011 Great East Japan Earthquake
Mar. 11, 2011, 14:46 M9.0
Fire1%

AsphyxUnknoiawn

4%2%Drowning93%

2011 White pages,Japan Gov.

Division of International Cooperation for Disaster Medicine

Change of health risks in Great East Japan Earthquake
InjuredDead and lost

Displaced

Hanshin-Awaji
Earthquake 1995

43,800

6,433

307,200

Great EastJapanEarthquake 2011

5,942

19,582

488,000

•
•
•
•
•
•

Less injuries, but different medical needs lasted longer
Disruption of traffic and communication made health sector paralyzed
Complicated radiological disaster
Mental health of affected people was devastatedHealth facilities were also destroyed by disaster
Education of disaster medicine was not generalized in health professionals

Division of International Cooperation for Disaster Medicine

Disaster related deaths
Ministry of Reconstruction, Mar. 31, 2014
Total 3, 089
Total
Fukushima
Miyagi
Iwate

800
600
400

Division of International Cooperation for Disaster Medicine>3Y〜3 Y〜2.5 Y

Total
Miyagi〜2 Y〜１.5 Y〜１year〜6M

〜3M

〜1…

0〜1…

200

2018 Japan Floods
Jun. 28-Jul. 9, 2018
Flood
Land
SlidesLandSlides
Flood

Total 222 deaths withunconfirmed missing(Police Department as of Jul. 17,2018)
Total number of evacuees;
23,000 (Fire Department as ofJul. 8, 2018)
Division of International Cooperation for Disaster Medicine

Reduce your risk

Capacity building of disaster medicinein Japan

Disaster Base Hospital•725 DBHs in Japan– 1 National Disaster Medical Center– 788 DMAT providing DBH– 271 Emergency Center– 54 Radiological DBH
ICUSupportHQER

DMATWater

Division of International Cooperation for Disaster Medicine

Emergency
infrastructure
O2PowerDisaster Base Hospitals in Japan

Division of International Cooperation for Disaster Medicine

J-DMAT: Japan Disaster Medical Assistance Team on Training

Staging CareUnit

DMAT not only provide medical care, but alsoassists the local HQ and Staging Care Unit(SCU) in medical coordination.

Confined Space
Division of International Cooperation
Medicine for Disaster Medicine

Wide Area
Transportation

Medical Management System
Ministry of Health, Labor and Welfare

Disaster Base
Hospital

DMAT HQ

DMAT

DMAT

Emergency Medical Information System (EMIS)

Division of International Cooperation for Disaster Medicine

Disaster Base
Hospital

DMATEMIS Emergency Medical Information System

Division of International Cooperation for Disaster Medicine

Building Back Better of National Disaster Medical System in Japan

Wide Area
Transportation

Staging
Care Unit SCU

Distant
DBH

Disaster Medical
Coordinators
Improved EMIS
SCU
Affected Area
DBH

Confined SpaceMedicine
DamagedSite

Local Hp

Division of International Cooperation for Disaster Medicine

Support ofDBH

Health Cluster Liaison
DPAT
DHEAT
JRATetc.

NearbyDBHKnow your risk

Health Resilience of the SocietyStructure of INFORM risk index

INFORM risk
Dimensions

Hazard & Exposure

Categories

NaturalHuman

Socio-economic

Vulnerable groups

Institutional

Infrastructure

Components

Earthquake

Current conflictintensity

Development anddeprivation (50%)

Uprooted people

DRR

Communication

TsunamiProjected conflictrisk

Inequality (50%)

Other vulnerable
groupsGovernancePhysicalinfrastructure

Drought

Vulnerability

Aid dependency(25%)

Lack of Coping Capacity

Access to healthsystem

FloodTropical cyclone

With more than 50 indicators

Egawa (2018) J Disaster Res 13(6): 1049-1061

LACK OF COPING CAPACITY

VULNERABILITY

INFORM RISKHAZARD & EXPOSURE

LE negatively correlates with INFORM risk

Japan
LELE

LE

LE

Egawa (2018) J Disaster Res 13(6): 1049-1061

Natural hazard risk and LE

LE
P=0.005LE
P=0.0033

LE
N.S.

FLOOD

DROUGHTTROPICAL CYCLONETSUNAMIEARTHQUAKE

Japan

LEp<0.0001

LE
P=0.0003

Egawa (2018) J Disaster Res 13(6): 1049-1061

LE•••••

Lack of ACCESS TOHEALTHCARECHILDREN U5Socio-Economic Vulnerability

Health related categories of INFORM Risk and LEJapan

Human Development Index
Poverty Index
GINI Index
Gender Inequality
Aid Dependency

LELE• Children U5 Mortality• Children U5 Malnutrition• Physicians density• Health expenditure per capita• Measles immunization coverage
Egawa (2018) J Disaster Res 13(6): 1049-1061

Cluster dendrogram by risk dimensions and LE
Cluster 4Japan

Cluster

1234

13

51

45

74

Hazard & Exposure

7.7

3.5

5.5

2.0

Vulnerability

7.2

4.7

3.5

1.8

Lack of Coping Capacity

7.6

6.44.5

2.8Life Expectancy

61.2

62.8

73.2

77.8

N

Cluster 3

Cluster 1

Cluster 2

Egawa (2018) J Disaster Res 13(6): 1049-1061

From GEJE to all hazard

Conclusion

Change the concept of Risk Reduction
Needs

Paradigm ShiftTop 3 priorities for communities (UN Survey)
1. A good education
2. Better healthcare
3. An honest and responsive government

Climate Change
Rapid urbanization
PovertyLack of resource
Loss of biodiversity

Change of Risk
Better accessResilientCommunity

Safe Hospital
Safe School
Mental andPhysical

Effective
Response

Qualityof Life

Communication Funding andDevelopment

Division of International Cooperation for Disaster Medicine

InjuryIllness
disability

Hazard-proof
Structure
Early Warning