1 Introduction
2 Disaster Risk Management and Health
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Paragraph 18: Inclusion of health targets and indicators for monitoring and reporting on disaster risk management;
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Paragraph 22(n): Establishing a mechanism of case registry and a database of mortality caused by disaster in order to improve the prevention of morbidity and mortality;
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Paragraph 30(i): Enhancing the resilience of national health systems through training and capacity development; Supporting the implementation of the International Health Regulations (WHO 2005);
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Paragraph 30(j): Strengthening the design and implementation of inclusive policies and social safety-net mechanisms, such as supporting access to basic health-care services, including maternal, newborn, and child health, sexual and reproductive health;
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Paragraph 33(c): Improving the resilience of critical infrastructure to ensure new and existing health facilities remain operational in emergencies and disasters;
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Paragraph 33(o): Enhancing recovery schemes to provide psychosocial support and mental health services, and assisting those disproportionately affected by disasters including those with life threatening and chronic disease.
3 Sendai Global Targets and Indicators
4 Measuring the Sendai Framework Health-Related Indicators: Challenges and Opportunities
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The International Health Regulations (IHR)—Designed to assist the global community in preventing and responding to acute public health risks that have the potential to cross borders and threaten people worldwide (WHO 2005). The regulations mandate countries to assess their capacities for disease surveillance and response and report whether these are sufficient to meet their obligations.
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The Global Health Security Agenda (GHSA)—Initiated in 2014 by the Obama administration, a non-binding coalition of countries, nongovernmental organizations, and international organizations working together to help build country capacity to respond to infectious disease threats, elevate global health security as a national and global priority, and ultimately spur progress on implementing the IHR (GHSA 2016).
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The Joint External Evaluation (JEE) Alliance—A voluntary, collaborative process to assess a country’s capacity to adhere to IHR requirements to prevent, detect, and rapidly respond to public health threats (WHO 2016a). The JEE is a tool that has been developed by the World Health Organization in collaboration with other initiatives such as the GHSA, and assesses 19 technical areas. It allows countries (the United Kingdom was one of the initial volunteer countries) to identify and prioritize the most urgent needs within their health security systems, and to engage with donors and partners to target resources effectively (WHO 2016b).
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The WHO R&D Blueprint for Action to Prevent Epidemics—A global strategy and preparedness plan published in May 2016, sparked by the Ebola crisis that allows the rapid activation of research and development activities during epidemics. Its aim is to fast-track the availability of effective tests, vaccines, and medicines that can be used to save lives and avert large-scale crises (WHO 2016c). However, disaster risk reduction also requires ongoing, steady, and continual research and development, including horizon scanning and scenario testing.
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The Paris-based World Organization for Animal Health (OIE)—Founded in 1924 as the Office International des Epizooties (OIE), coordinates global animal disease control, and has created the Performance of Veterinary Services tool, used to evaluate veterinary capacity in countries around the world (OIE 2013).
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The Lancet Countdown—An international research collaboration identifying the health benefits in responding to climate change. It is currently engaged in a consultation process to develop indicators that will give a global overview on the relationship between health and climate (Watts et al. 2017).
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Temporality Deaths attributable to a disaster can occur during a slow-onset and protracted event or months, sometimes years after the initial impact of a sudden-onset event, and may differ according to the hazard. Temporal dimensions need to be specified in relation to recording a death associated with a hazardous event or disaster.
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Attribution Linking mortality and morbidity to events or disasters can be problematic. With certain hazards, the cause of death may be obvious, for example drowning as a result of a flood. However, particularly with slow-onset hazards, the causes are often indirect. For example, in the case of droughts, some of the indirect causes of morbidity and mortality have included communicable diseases, malnutrition, and disruption to basic health care (Stanke et al. 2013).
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Baselines Progress and change can only be monitored if there is a baseline. In the Sendai targets, countries will report on loss data for the period 2005–2015 to enable comparison with data from 2015 to 2030 per 100,000 population. However, the collection of historic loss data will require an investment of time and resources. One possibility with the health-related indicators of the Sendai Framework is to explore using resources such as the Global Burden of Disease study (an open, collaborative, independent study) to comprehensively model and, where possible, measure epidemiological levels and trends of disease and risk factor burden worldwide. The study has already been used to generate comparable, valid, and consistent baseline measurements for the health-related Sustainable Development Goals (Lim et al. 2016).
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Classification of hazards Paragraph 24(j) of the Sendai Framework calls for the strengthening of “technical and scientific capacity to capitalize on and consolidate existing knowledge and to develop and apply methodologies and models to assess disaster risks, vulnerabilities and exposure to all hazards”(UNISDR 2015, p. 15). So far as can be determined, there does not appear to be a single established universal taxonomy or set of classifications for use in disasters. A number of taxonomies have been put together by individual organizations, yet none are approved international standards. These include the Peril Classification and Hazard Glossary developed by the Integrated Research on Disaster Risk (IRDR 2014) and the one used by the Centre for Risk Studies at the Cambridge University Judge Business School (Cambridge Centre for Risk Studies 2017). It will be essential to ensure that all hazards identified within the scope of the Sendai Framework are represented to avoid bias (Gall et al. 2009). However, it should be acknowledged that disasters are caused by vulnerability that is contextual; therefore, creating a single taxonomy may oversimplify the diverse characteristics displayed by disasters.
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Thresholds Disasters encapsulate events of all scales and have no minimum threshold. However, some disaster databases such as EM-DAT (CRED 2017) define threshold criteria (events are only reported, for example, if 10 or more people died) that do not capture all disasters.