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Natural disasters and the challenge of extreme events: risk management from an insurance perspective.

Loss statistics for natural disasters demonstrate, also after correction for inflation, a dramatic increase of the loss burden since 1950. This increase is driven by a concentration of population and values in urban areas, the development of highly exposed coastal and valley regions, the complexity of modern societies and technologies and probably, also by the beginning consequences of global warming. This process will continue unless remedial action will be taken. Managing the risk from natural disasters starts with identification of the hazards. The next step is the evaluation of the risk, where risk is a function of hazard, exposed values or human lives and the vulnerability of the exposed objects. Probabilistic computer models have been developed for the proper assessment of risks since the late 1980s. The final steps are controlling and financing future losses. Natural disaster insurance plays a key role in this context, but also private parties and governments have to share a part of the risk. A main responsibility of governments is to formulate regulations for building construction and land use. The insurance sector and the state have to act together in order to create incentives for building and business owners to take loss prevention measures. A further challenge for the insurance sector is to transfer a portion of the risk to the capital markets, and to serve better the needs of the poor. Catastrophe bonds and microinsurance are the answer to such challenges. The mechanisms described above have been developed to cope with well-known disasters like earthquakes, windstorms and floods. They can be applied, in principle, also to less well investigated and less frequent extreme disasters: submarine slides, great volcanic eruptions, meteorite impacts and tsunamis which may arise from all these hazards. But there is an urgent need to improve the state of knowledge on these more exotic hazards in order to reduce the high uncertainty in actual risk evaluation to an acceptable level. Due to the rarity of such extreme events, specific risk prevention measures are hardly justified with exception of attempts to divert earth-orbit crossing meteorites from their dangerous path. For the industry it is particularly important to achieve full transparency as regards covered and non-covered risks and to define in a systematic manner the limits of insurability for super-disasters.

Disaster Planning↗

Managing extreme natural disasters in coastal areas.

Extreme natural hazards, particularly the hydro-meteorological disasters, are emerging as a cause of major concern in the coastal regions of India and a few other developing countries. These have become more frequent in the recent past, and are taking a heavy toll of life and livelihoods. Low level of technology development in the rural areas together with social, economic and gender inequities enhance the vulnerability of the largely illiterate, unskilled, and resource-poor fishing, farming and landless labour communities. Their resilience to bounce back to pre-disaster level of normality is highly limited. For the planet Earth at crossroads, the imminent threat, however, is from a vicious spiral among environmental degradation, poverty and climate change-related natural disasters interacting in a mutually reinforcing manner. These, in turn, retard sustainable development, and also wipe out any small gains made thereof. To counter this unacceptable trend, the M.S. Swaminathan Research Foundation has developed a biovillage paradigm and rural knowledge centres for ecotechnological and knowledge empowerment of the coastal communities at risk. Frontier science and technologies blended with traditional knowledge and ecological prudence result in ecotechnologies with pro-nature, pro-poor and pro-women orientation. The rural communities are given training and helped to develop capacity to adopt ecotechnologies for market-driven eco-enterprises. The modern information and communication-based rural knowledge centres largely operated by trained semi-literate young women provide time- and locale-specific information on weather, crop and animal husbandry, market trends and prices for local communities, healthcare, transport, education, etc. to the local communities. The ecotechnologies and time- and locale-specific information content development are need-based and chosen in a 'bottom-up' manner. The use of recombinant DNA technology for genetic shielding of agricultural crops for coastal regions against abiotic stress (induced by the water- and weather-related natural disasters), strengthens the foundations of sustainable agriculture undertaken by the resource-poor small farm families.

Disaster Planning↗

[Natural disasters].

The attempt is made to illustrate the role played by natural disasters in the history of the earth and mankind by examples of past catastrophes. Subsequently, the earthquake of Tangshan/China in 1976 and the hypothetical scenario of a repeat of the 1906 San Francisco earthquake in a modern setting serve as a basis for discussion of the significance of natural disasters in modern times.

Disasters↗

Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster.

A population of the fire fighters who had been exposed to a natural disaster were screened using the General Health Questionnaire 4, 11, and 29 months after a natural disaster. On the basis of these data, a high-risk group of subjects who had scored as cases and probable cases and a symptom-free comparison group were interviewed using the Diagnostic Interview Schedule 42 months after the disaster. The prevalence of posttraumatic stress disorder (PTSD), affective disorders, and anxiety disorders was examined. Only 23% of the 70 subjects who had developed a PTSD did not attract a further diagnosis, with major depression being the most common concurrent disorder. Comorbidity appeared to be an important predictor of chronic PTSD, especially with panic disorder and phobic disorders. The subjects who had only a PTSD appeared to have had the highest exposure to the disaster. Adversity experienced both before and after the disaster influenced the onset of both anxiety and affective disorders.

Adult↗

Natural disasters and service delivery to individuals with severe mental illness--ice storm 1998.

OBJECTIVE: To review the literature on the responses of individuals with severe mental illness (SMI) to natural disasters, to describe the impact of the 1998 Ice Storm on a group of SMI patients, and to describe the steps taken at a Canadian university teaching hospital to ensure the ongoing provision of mental health services throughout the crisis. METHOD: Published articles describing the impact of natural disasters on SMI populations, as well as service provision to these patients, are reviewed. Service use at the Montreal General Hospital (MGH) Department of Psychiatry is described. A questionnaire about the impact of the ice storm was administered to a group of patients in an assertive community treatment program. RESULTS: Service use during this natural disaster was consistent with that described in the literature, in that these patients were no more likely to be admitted or to visit the emergency room during the crisis. Continuous mental health service delivery may have contributed to this positive outcome. This service delivery was provided by ensuring staff access to information, by securing the physical safety of both staff and patients, and by taking a flexible, outreach-oriented approach to service delivery. CONCLUSIONS: SMI patients who have ongoing access to psychiatric services in disaster situations tend to cope well. A flexible, proactive, assertive approach to service delivery during the crisis situation will help to ensure that needs for care will be met.

Adaptation, Psychological↗

The veterinary surgeon in natural disasters: Italian legislation in force.

Law No. 225/1992 established a National Service of Civil Protection, with the important role of 'safeguarding life, goods, settlements and the environment from damage deriving from natural disasters, catastrophes and calamities' (art. 1). This law arranges civil protection as a co-ordinated system of responsibilities administrated by the state, local and public authorities, the world of science, charitable organisations, the professional orders and other institutions, and the private sector (art. 6). The President of the Republic's Decree No. 66/1981 'Regulation for the application of Law No. 996/1970, containing norms for relief and assistance to populations hit by natural disasters--Civil Protection' mentions veterinary surgeons among the people that are called upon to intervene. In fact, in natural disasters the intervention of the veterinary surgeon is of great importance. The authors examine these laws and other legislation relating to the National Service of Civil Protection.

Animals↗

Evaluation of a multistate faith-based program for children affected by natural disaster.

OBJECTIVES: To systematically evaluate Camp Noah, a faith-based intervention for children affected by natural disaster: to assess the extent to which the camps were carried out according to the program design, to describe how the Camp Noah program was implemented, and to explore Camp Noah program effects on children. DESIGN: Qualitative survey. SAMPLE: Twenty-eight local, state, and national stakeholders. MEASUREMENT: Open-ended interviews. RESULTS: Although camps adhered to the curriculum, many implementation weaknesses resulted from a lack of clear program structure and written procedures. Stakeholders observed that children generally were able to process their disaster experiences in the camp, and some children exhibited increased understanding of God's role in their disaster experience. Stakeholders also described parent reports of increased coping skills related to weather among some children. Lastly, stakeholders both observed positive effects of Camp Noah on children's behaviors and symptoms and described changes reported to them by parents. CONCLUSIONS: Every year, thousands of children suffer emotionally as a result of natural disaster in the United States. With public health nursing support and improvements in infrastructure, Camp Noah may be a promising intervention to address this important public health problem.

Adaptation, Psychological↗

Global climate changes, natural disasters, and travel health risks.

Whether the result of cyclical atmospheric changes, anthropogenic activities, or combinations of both, authorities now agree that the earth is warming from a variety of climatic effects, including the cascading effects of greenhouse gas emissions to support human activities. To date, most reports of the public health outcomes of global warming have been anecdotal and retrospective in design and have focused on heat stroke deaths following heat waves, drowning deaths in floods and tsunamis, and mosquito-borne infectious disease outbreaks following tropical storms and cyclones. Accurate predictions of the true public health outcomes of global climate change are confounded by several effect modifiers including human acclimatization and adaptation, the contributions of natural climatic changes, and many conflicting atmospheric models of climate change. Nevertheless, temporal relationships between environmental factors and human health outcomes have been identified and may be used as criteria to judge the causality of associations between the human health outcomes of climate changes and climate-driven natural disasters. Travel medicine physicians are obligated to educate their patients about the known public health outcomes of climate changes, about the disease and injury risk factors their patients may face from climate-spawned natural disasters, and about the best preventive measures to reduce infectious diseases and injuries following natural disasters throughout the world.

Disasters↗

Infectious disease risks from dead bodies following natural disasters.

OBJECTIVE: To review existing literature to assess the risks of infection from dead bodies after a natural disaster occurs, including who is most at risk, what precautions should be taken, and how to safely dispose of the bodies. METHODS: Disease transmission requires the presence of an infectious agent, exposure to that agent, and a susceptible host. These elements were considered to characterize the infectious disease risk from dead bodies. Using the PubMed on-line databases of the National Library of Medicine of the United States of America, searching was done for relevant literature on the infection risks for public safety workers and funeral workers as well as for guidelines for the management of the dead and prevention of infection. A small but significant literature was also reviewed regarding the disposal of the dead and the contamination of groundwater by cemeteries. RESULTS: Victims of natural disasters usually die from trauma and are unlikely to have acute or "epidemic-causing" infections. This indicates that the risk that dead bodies pose for the public is extremely small. However, persons who are involved in close contact with the dead-such as military personnel, rescue workers, volunteers, and others-may be exposed to chronic infectious hazards, including hepatitis B virus, hepatitis C virus, HIV, enteric pathogens, and Mycobacterium tuberculosis. Suitable precautions for these persons include training, use of body bags and disposable gloves, good hygiene practice, and vaccination for hepatitis B and tuberculosis. Disposal of bodies should respect local custom and practice where possible. When there are large numbers of victims, burial is likely to be the most appropriate method of disposal. There is little evidence of microbiological contamination of groundwater from burial. CONCLUSIONS: Concern that dead bodies are infectious can be considered a "natural" reaction by persons wanting to protect themselves from disease. However, clear information about the risks is needed so that responsible local authorities ensure that the bodies of disaster victims are handled appropriately and with due respect. This paper provides a source of information for those who are in the unfortunate position of managing those bodies.

Cadaver↗

The response of an assertive community treatment program following a natural disaster.

A newly forming model treatment program for seriously mentally ill adults was dramatically affected by a natural disaster in September 1989. Hurricane Hugo rendered the offices of the Assertive Community Treatment Program uninhabitable, its vehicles marginally driveable, and its resources virtually nonexistent. In the three months following the storm, however, not a single psychiatric rehospitalization took place. Although the authors cannot claim that the program model was solely responsible for this outcome, this paper illustrates the service system elements that contributed to the program's effectiveness in the wake of one of the nation's most severe natural disasters.

Adolescent↗

Infectious diseases of severe weather-related and flood-related natural disasters.

PURPOSE OF REVIEW: The present review will focus on some of the possible infectious disease consequences of disastrous natural phenomena and severe weather, with a particular emphasis on infections associated with floods and the destruction of infrastructure. RECENT FINDINGS: The risk of infectious diseases after weather or flood-related natural disasters is often specific to the event itself and is dependent on a number of factors, including the endemicity of specific pathogens in the affected region before the disaster, the type of disaster itself, the impact of the disaster on water and sanitation systems, the availability of shelter, the congregating of displaced persons, the functionality of the surviving public health infrastructure, the availability of healthcare services, and the rapidity, extent, and sustainability of the response after the disaster. Weather events and floods may also impact disease vectors and animal hosts in a complex system. SUMMARY: Weather or flood-related natural disasters may be associated with an increased risk of soft tissue, respiratory, diarrheal, and vector-borne infectious diseases among survivors and responders.

Communicable Disease Control↗

Infectious diseases that pose specific challenges after natural disasters: a review.

In a time span of less than one year, December 2004 to October 2005, several natural disasters of extreme proportions struck different areas of the world, causing unparalleled destruction and loss of lives and property. In each of these instances, the potential existed for acquisition of infectious diseases caused by bacteria, viruses, mold, and mildew and demonstrated that such disasters represent a public health concern, which is exacerbated by the fact that many factors may work synergistically to increase the risk of morbidity and mortality caused by communicable diseases. This article reviews causes, symptoms, and treatments of various infectious diseases that pose a threat in the event of a natural disaster.

Child↗

Changes in reports and incidence of child abuse following natural disasters.

OBJECTIVE: The aim of this research was to investigate if there is a higher incidence of child abuse following major natural disasters. METHODOLOGY: Child abuse reports and substantiations were analyzed, by county, for 1 year before and after Hurricane Hugo, the Loma Prieta Earthquake. and Hurricane Andrew. Counties were included if damage was widespread, the county was part of a presidential disaster declaration, and if there was a stable data collection system in place. RESULTS: Based on analyses of numbers, rates, and proportions, child abuse reports were disproportionately higher in the quarter and half year following two of the three disaster events (Hurricane Hugo and Loma Prieta Earthquake). CONCLUSIONS: Most, but not all, of the evidence presented indicates that child abuse escalates after major disasters. Conceptual and methodological issues need to be resolved to more conclusively answer the question about whether or not child abuse increases in the wake of natural disasters. Replications of this research are needed based on more recent disaster events.

Child↗

The role of the veterinarian in hurricanes and other natural disasters.

Hurricanes create a multiplicity of complicated problems and hazards ranging from outbreaks of infectious disease to animal control problems precipitated by destruction of property. A multidisciplinary response is required to solve such problems. The pool of knowledge derived from various professionals interacting with multiple levels of government agencies (federal, state, and local) will provide the expertise needed. Because the veterinarian is trained to deal with disease involving populations of animals (e.g., herds or flocks) as well as individuals, and because of his/her intensive clinical training, the veterinarian is uniquely qualified to deal with the disaster situation. The veterinarian possesses extensive knowledge in disease and disease processes and has the capability of disease and injury management in affected populations, which qualifies him/her for an essential role, with unlimited potential as a member of any disaster relief team. There is considerable potential for veterinarians to play a role in responding to natural disasters. The areas of disease control, animal care, animal control, protection of the food supply, disinfection/sterilization, and planning are all areas where veterinarians can take an active part. Inclusion of the veterinarian in the process of planning for and responding to natural disasters will yield significant public health benefits.

Animal Welfare↗

Natural disasters.

This presentation covers the various types of natural disasters which are faced by investigators throughout the world. Each geophysical substance is discussed, including earth, air and water, and secondary effects including fire. Additionally, four myths associated with disasters are reviewed.

Atmosphere↗

[Aviation support of measures for rendering medical care to the victims of natural disasters, accidents and catastrophes].

The unpredictable character of natural calamities and technological accidents makes some specific demands on the organization and planning of the wide range complex of social measures to abolish their awful and tragic consequences. Analysing and summarizing the reviews and reports of international congresses on the emergency and catastrophic medicine and their own experience, the authors accentuate attention on the advantages and capabilities of aerial transport in delivering of medical personnel, all necessary equipment to the zones of mass sanitary losses and its really essential role in rapid aeromedical evacuation of injured. The authors scrutinize in details the structural scheme of organization of patient's search-and-rescue work and suggest, that main principles of planning and management of search-and-rescue operations in aviation could be applied in a decision of problems, which arise in medical assistance to the victims of the natural disasters and accidents.

Accidents↗

Demographic effects of natural disasters: a case study of Hurricane Andrew.

Many studies have considered the economic, social, and psychological effects of hurricanes, earthquakes, floods, tornadoes, and other natural disasters, but few have considered their demographic effects. In this paper we describe and evaluate a method for measuring the effects of Hurricane Andrew on the housing stock and population distribution in Dade County, Florida. Using information collected through sample surveys and from other data sources, we investigate the extent of housing damages, the number of people forced out of their homes, where they went, how long they stayed, and whether they returned to their prehurricane residences. We conclude that more than half the housing units in Dade County were damaged by Hurricane Andrew; that more than 353,000 people were forced to leave their homes, at least temporarily; and that almost 40,000 people left the county permanently as a direct result of the hurricane. We believe that this study will provide methodological guidance to analysts studying the demographic effects of other large-scale natural disasters.

Data Collection↗

Suicide after natural disasters.

BACKGROUND: Among the victims of floods, earthquakes, and hurricanes, there is an increased prevalence of post-traumatic stress disorder and depression, which are risk factors for suicidal thinking. We conducted this study to determine whether natural disasters affect suicide rates. METHODS: From a list of all the events declared by the U.S. government to be federal disasters between 1982 and 1989, we selected the 377 counties that had each been affected by a single natural disaster during that period. We collected data on suicides during the 36 months before and the 48 months after the disaster and aligned the data around the month of the disaster. Pooled rates were calculated according to the type of disaster. Comparisons were made between the suicide rates before and those after disasters in the affected counties and in the entire United States. RESULTS: Suicide rates increased in the four years after floods by 13.8 percent, from 12.1 to 13.8 per 100,000 (P<0.001), in the two years after hurricanes by 31.0 percent, from 12.0 to 15.7 per 100,000 (P<0.001), and in the first year after earthquakes by 62.9 percent, from 19.2 to 31.3 per 100,000 (P<0.001). The four-year increase of 19.7 percent after earthquakes was not statistically significant. Rates computed in a similar manner for the entire United States were stable. The increases in suicide rates were found for both sexes and for all age groups. The suicide rates did not change significantly after tornadoes or severe storms. CONCLUSIONS: Our study shows that suicide rates increase after severe earthquakes, floods, and hurricanes and confirms the need for mental health support after severe disasters.

Adolescent↗