Transcript Health and Extreme Events: vulnerability pathways and

VULNERABILITY & RESPONSE
TO THE HEALTH IMPACTS OF
FLOODING
Roger Few
School of Development Studies
University of East Anglia
Environmental Inequalities Seminar 3: Inequalities, Flooding and Water Resources.
University of Surrey, 24/25 October 2006
Floods and health impacts
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Drowning
Physical injury
Increased exposure to
infectious disease
Respiratory disease
Exposure to chemical hazards
Food security/malnutrition
Stress and mental health
outcomes
Floods - pathways of health impact/vulnerability
land use control,
flood defences,
warning &
evacuation
Flood
Hazard
avoidance:
modify dwelling
improve latrines,
mosquito control
Flood
Proximity
protection:
hygiene behaviour,
water treatment,
emotional support
access to care,
emergency planning,
strategic supplies,
support networks
Health Risk
Effect
Health
Outcome
contact with
floodwater
drowning, injury
increased
exposure to
pathogens
disruption of
food supply
disruption of
health systems,
water/sanitation
disruption of
livelihood,
assets
displacement
respiratory
disease
waterborne
disease
mosquito-borne
disease
nutritional
disease
mental health
outcomes
chronic disease
Recovery
Flood Hazard
Flood Proximity
Health Risk Effect
contact with
floodwater
increased exposure
to pathogens
disruption of food
supply
disruption of health
systems,
water/sanitation
disruption of
livelihood, assets
displacement
Health Risk Effect
Health Outcome
contact with
floodwater
drowning, injury
respiratory disease
increased exposure
to pathogens
waterborne disease
disruption of food
supply
mosquito-borne
disease
nutritional disease
disruption of
livelihood, assets
displacement
mental health
outcomes
disruption of health
systems,
water/sanitation
chronic disease
flood defences,
land use control,
warning &
evacuation etc
Flood
Hazard
avoidance:
modify dwelling,
improve latrines,
mosquito control
etc
Flood
Proximity
protection:
hygiene behaviour,
water treatment,
emotional support
etc
Health Risk
Effect
Health
Outcome
access to care,
emergency plans,
strategic supplies,
support networks
etc
Recovery
social-economic-political-cultural
context
Flood
Hazard
Flood
Proximity
Health Risk
Effect
Health
Outcome
environmental change
hazard intensity/range
disease distribution
Recovery
Contextual factors that may shape health-related response
examples
Social/cultural
social networks
gender relations
beliefs, customs
attitudes to risk
education system
access to psychosocial support
mobility during emergencies
approaches to water supply and sanitation
emergency preparedness planning in health facilities
understanding of hazards and health protection
Economic
economic structure
markets and supply systems
access to insurance/credit
access to technology
infrastructure investment
alternative income opportunities
importation of food during crises
willingness to evacuate home
reliability of early warning systems
physical access to health facilities
Political/Institutional
policies and regulations
institutional structures
civil society
community participation
state-citizen relations
external intervention
risk management practices in public health
coordination between health-related sectors
coordination of health volunteer networks
community-based emergency health training
public trust in warnings
activity of medical relief agencies
Environmental
land distribution
access to natural resources
environmental degradation
endemicity of disease
feasibility of latrine improvement on marginal land
alternative income or subsistence opportunities
pollution of alternative water sources
ongoing health status
Vietnam: Mekong Delta
Annual floods – extremes in 2000, 2001,
(2002)
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16 million people (40,000 sq km)
Urban and rural areas prone to flooding
Income inequalities: poverty line for state
benefits is c$16 per month
Research with University of Social
Sciences and Humanities, Ho Chi
Minh City
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Interviews with local government, health
facilities, community leaders, mass
organisations (urban areas: Cao Lanh and
Long Xuyen)
Interviews on risk perception, health
behaviour, flood response with 24
households in 4 sites
Health impacts
‘Flood-adapted’ but health hazards common,
especially for the poor – injury, infection, stress
“During September and October my house is flooded two times
per day at high tide and the water level is this much [c20cm]
from the floor. Because the environment is polluted, each time
the water comes up waste drifts into the home.”
(resident, Ward My long, Long Xuyen)
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Draw on specific examples from studies to illustrate the
multiple factors shaping vulnerability/coping capacity
Local flood management and livelihoods
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Establishment of dyke systems
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small-scale dykes/roadways
50% resident contribution
houses of poor often remain
inundated
prioritization of access/transport
Loss of income
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floods affect many income
activities of the poor e.g. fishing,
casual labour, motorcycle, lottery
tickets
less able to diversify income
options
less money for food/medicine +
anxiety, stress
“We became poor after the
flood of 2000. The flood
totally destroyed our
shrimp pond and we had no
income. Now, in each flood,
we feel stress and worry
about being jobless and not
having enough food – this
causes sleeplessness,
strain and quarrel between
family members.”
(resident, My Ngai commne, Cao
Lanh)
Water, sanitation and hygiene
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Fishpond latrines
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traditional ‘rural’ sanitation in urban
areas
health risk especially during floods
official intolerance – but is it cultural
conservatism or lack of resources ?
Drinking water
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common use of river water from
creeks
incomplete treatment, especially
during flood
hygiene education uneven
risk perception
Health protection services
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Health sector preparedness
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tiered network of preparedness
committees including health sector
emergency planning – e.g. medical
boats, drug supplies
volunteers (education, monitoring,
first aid, boat transport to HFs)
variation in extent and access to
these services
“We prepare an emergency medical boat and 4 teams for assisting people,
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Floodvolunteers”
kindergartens
including Red Cross members and
(head of health
My Hoa Hungin
commune,
 station,
child drownings
2000 Long Xuyen)
unattended young children
“Access in floods can only be by boat, and so poor people without boats
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special kindergarten scheme for
cannot get access to the health station. We have no resources to organize
poor families
mobile health teams”
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sustainability?
(head of health
My Ngai commune, Cao Lanh)
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Ongoing analysis….
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Factors closely, but not solely, related to
livelihoods/poverty, e.g.
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policy/planning process
access to health education
social/cultural norms
support networks
physical location
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For health risk, additional consideration is an individual’s
ongoing health status
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Many opportunities for in-depth research on specific
aspects of vulnerability and/or coping capacity re. health
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along the health impact pathway from hazard -> outcome
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For further information, see:
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Few, R. (2007) ‘Health and climatic hazards: framing
social research on vulnerability, response and
adaptation’, Global Environmental Change 17, 281295.
Pham Gia Tran and Few, R. (2006) ‘Local responses
to floods in the Mekong Delta, Viet Nam’. In Few, R.
and Matthies, F. (eds) Flood hazards and health:
responding to present and future risks, Earthscan,
London, pp.128-144
http://www1.uea.ac.uk/cm/home/schools/ssf/dev/people/academic
/Few/hazardshealth