Preparedness E-newsletter Archive - 2006

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Public Health Consequences of Disasters

Asian Tsunami

December 26, 2006, marks the second anniversary of the Asian earthquake and tsunami which killed an estimated 150,000+ people and displaced millions more in 12 countries. The cause of the tsunami was a magnitude 9.1 earthquake off the west coast of northern Sumatra, Indonesia -- the third largest earthquake in the world since 1900. The tsunami caused death and destruction as distant as the eastern African coastline (3000 miles away).

Closer to home, we have also recently experienced “flooding” disasters both locally (Hurricane Ivan,,,,) and nationally (Hurricane Katrina). Although the scale of each of these 3 catastrophes is different, they are connected by common themes and by common lessons from which we can learn. In this way, we can help ensure that death, disability and societal disruption are minimized the next time around.

In his 2005 Cutler Lecture at the University of Pittsburgh Graduate School of Public Health, Dr. Eric Noji defined a disaster as “a result of a vast ecological breakdown in the relation between humans and their environment, a serious or sudden event on such a scale that the stricken community needs extraordinary efforts to cope with it, often with outside help or international aid.” He also noted that factors which contribute to disaster severity are:

  • Human vulnerability due to poverty and social inequality
  • Environmental degradation
  • Rapid population growth especially among the poor

These three factors are clearly evident in all of the disasters noted above. Although disasters can affect anyone, without regard for wealth or social position, typically those who are poorest and most vulnerable will suffer heavier consequences. This vulnerability may be related to many factors – location of housing, ability to evacuate, presence or absence of social supports, and much more. Disasters are likely to expose social vulnerabilities within the society it strikes, and both the true and perceived effectiveness of governmental response are critically important to minimizing a disaster’s effects on the most vulnerable.

Another common lesson is that the most effective initial response will always be local. Dr. Noji notes that it is typically a myth that the community is too shocked and helpless after a disaster. In reality, many survivors find new strengths, and cross-cultural dedication to the common good is the most common response. However, as seen in the aftermath of Katrina, these local efforts cannot be sustained for very long. If relief is not available within several days, the risk of social breakdown increases rapidly. A related consideration is that the larger the disaster, the longer the effects will linger. In the case of Katrina, Ivan and the Asian Tsunami, those who survived may feel the effects for a lifetime, and many years will be required to restore the communities which were the most heavily affected.

Another myth noted by Dr. Noji is that external medical volunteers with any kind of medical background are needed. The reality is that the local population almost always covers immediate lifesaving needs, and that few survivors owe their lives to outside teams. Most people are saved by friends, neighbors, and whatever local medical community is immediately available. Or they are saved by really good preparation – an example being the evacuation of the World Trade Center towers in 2001, in which an estimated 13,000 – 15,000 people exited the towers in an orderly fashion in the one hour prior to the final collapse. In the case of Katrina, it is clear that an effective evacuation would have saved many additional lives, and there are additional stories from the Asian tsunami suggesting that those who recognized the receding waters as a precursor to a tsunami moved more successfully to higher ground.

The last myth discussed by Dr. Noji is that epidemics and plagues are inevitable after every disaster. The reality is that epidemics rarely ever occur after a disaster, and that dead bodies will not lead to catastrophic outbreaks of exotic diseases. This reality is supported by post-event analysis of Katrina, Ivan, and the Asian Tsunami. In the case of the tsunami, a follow-up report noted that no significant secondary loss of life occurred, due either to disease, starvation, violence, or other factors. In the case of Katrina, there were an unknown number of deaths could likely have been prevented with a faster response providing food, water, shelter, security, and basic medications. In addition, Dr. Noji notes that proper resumption of basic public health services – immunizations, sanitation, waste disposal, water quality, and food safety - will ensure the public’s safety, with the one caveat that criminal or terror-intent disasters may require special consideration and response.

In conclusion, while knowing the likely threats is important (hazard analysis), understanding how each threat expresses its toll on the health and well-being of communities, in both the near term and long run (vulnerability analysis), is crucial to our preparedness and response. Knowing these, the next steps are to “harden” vulnerable aspects, whether through materials, personnel, or, most importantly, educating and training local communities in what to expect and what to do when it happens.


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LMS Online Education

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The Preparedness Center is pleased to announce the availability of FREE continuing education opportunities on the Pennsylvania Department of Health Learning Management System (LMS). Additional titles coming soon:

  • Vaccine Development for Pandemic and Public Health Use
  • Disaster Nursing
  • Stress Response During Disasters
  • Emergency Preparedness for Pandemics and All-Hazards and lots more!

These modules are typically only one hour in length, and contain the most up-to-date information. The specific accreditations for each module are listed online. Pennsylvania residents can visit to register at no cost. Registered users can log in at



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Avian Influenza Update

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Published: October 2006

Data from the last three years indicate pronounced seasonal variability for human cases of H5N1, with peaks in human cases occurring in the winter/spring (Northern Hemisphere) even in tropical climates. Given the abrupt spread of the virus into Europe and Africa last year, it is very likely that this year will be the worst yet.

Read more



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What is Public Health Preparedness

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A lot of supplies? Well-trained staff? A state of mind? All of these and more. The RAND corporation examines this question by looking at how state and local sites around the nation are integrating preparedness activities into their day-to-day core public health work. The US Senate HELP Committee has just passed a Bill which reauthorizes the Public Health Security and Bioterrorism Preparedness and Response Act; identifies the Secretary of Health and Human Services (HHS) as the lead federal official responsible for public health and medical response to emergencies including a flu pandemic; establishes standard of preparedness from state-to-state; and, requires individual states to meet performance standards developed by the Secretary of HHS. And HHS is reorganizing the office of Public Health Emergency Preparedness.


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Introduction to UPCPHP E-newsletter

Sam Stebbins

Dear Colleagues,

You are invited to subscribe to the e-newsletter from the University of Pittsburgh Center for Public Health Preparedness. It features information and resources regarding preparedness activities, and will be published regularly with special editions for developing situations.

In addition to up-to-date news and information, the e-newsletter will highlight in-person and online training opportunities both at the center and from many other sources.

Please take a minute to examine this preview issue. It’s an illustration of the focused items of interest that will be featured in each e-newsletter. Subscribing takes only a minute.


Sam Stebbins, MD, MPH
Director, University of Pittsburgh Center
for Public Health Preparedness


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