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Editorial| Volume 5, ISSUE 4, P95-97, October 2007

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Disasters and Poverty

DOI:https://doi.org/10.1016/j.dmr.2007.09.001
Disasters and Poverty
Next ArticleSeeking Participants for Study of Hurricanes Katrina and Rita Responders
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      Disaster Management & Response is one of many health-related journals participating in a world-wide effort to bring attention to poverty and its impact on health. The facts regarding poverty and disaster are very clear and disconcerting: Poverty and disasters are inextricably linked, both in the United States and other countries. The overwhelming number of disaster-related deaths due to natural or human-made causes occur in underdeveloped countries.

      United Nations Development Programme, Bureau for Crisis Prevention and Recovery, Disaster Reduction Unit. Poverty, sustainable development and disaster reduction. Available at: http://www.undp.org/bcpr/disred/. Accessed July 14, 2007.

      In more developed countries, the poor also are most affected, as evidenced by the New Orleans residents who experienced the impact of hurricanes Katrina and Rita. Many factors influence both the occurrence of disasters as well as their consequences, including geography/climate change, personal resources, infrastructure, and political instability.

      Factors Affecting Disaster Vulnerability

      Geography and Environment

      Ninety percent of the disaster-related deaths worldwide result from natural disasters.

      Disaster Control Priorities Project. Natural disasters: coping with the health impact. July 2007. Available at: http://www.dep2.org. Accessed September 9, 2007.

      Lacking resources, the poor often live where the work is, such as fishermen living on the beach, predisposing them to tidal waves, tsunamis, and flooding, or where the land is more affordable because it is less desirable, such as at the base of volcanoes, in flood planes, or in seismically active areas. Out of necessity for economic survival, the environment also may be exploited, predisposing areas to disaster, such as landslides and flooding.

      Limited Personal Resources

      Impoverished individuals are focused on day-to-day survival, with limited reserves for emergencies. Having extra food, fuel, medications, and money stored away in the event of a disaster may be unrealistic. Despite warnings to leave an impending disaster area, they may lack the means to do so. For example, one of the reasons why some New Orleans citizens did not evacuate the city as directed prior to Hurricane Katrina making landfall was that many did not have a vehicle. Using 2000 U.S. Census data, it was projected that more than 50% of poor households in New Orleans did not have a car, truck, or van.

      Sherman A, Shapiro I. Essential facts about the victims of Hurricane Katrina. Center on Budget and Policy Priorities. Available at: http://www.cbpp.org. Accessed September 1, 2007.

      For some, who had no family outside the area to stay with, there was simply no money to stay in a motel or hotel. If they own a home, the poor may have no or insufficient insurance to rebuild, especially because the cost of property insurance in disaster-prone areas is usually prohibitive.

      Infrastructure

      Poor communities have few resources for sturdy construction, disaster warning systems, communications technology, or disaster response. Roads and bridges may be unable to withstand earthquakes or floods. Buildings often are constructed of the most economical materials, predisposing them to collapse and fire, as noted in the article by Satapathy and colleagues in this issue. Building codes associated with an increased likelihood of structures surviving major natural disasters, such as earthquakes, often are nonexistent or not enforced. In countries experiencing repeated disasters, the economies are seriously affected, leaving little tax base to support the building efforts. In addition, funds targeted for infrastructure development must be used for disaster relief activities. Poverty is further propagated because of low educational levels related to the absence of school facilities, cost of education, or because children are needed to work to support the family. Individuals who are able to receive advanced education often leave their homeland for jobs in more developed countries. Hence, the cycle of poverty continues.
      Access to adequate health care and nutrition is minimal in impoverished communities, resulting in chronically ill, inadequately immunized persons who are more vulnerable to endemic diseases and who may be physically unable to work, causing the proliferation of poverty and despair. In Africa, for example, an estimated one third of the malaria deaths occur in countries affected by serious conflict, war, or natural disaster.

      World Health Organization. Third of African malaria deaths due to conflict or natural disaster. Partnership plan to improve emergency response to prevent malaria. Available at: http://www.who.int/inf-pr-2000/en/pr2000-46.htm. Accessed September 9, 2007.

      Health care facilities are stressed in trying to meet daily needs, let alone disaster situations. Mental health resources are largely unavailable. Finally, in many countries that have experienced repeated or protracted disasters, such as droughts and famine, individual initiative may be quashed. Some countries have been reliant on external aid for so long that a relief-oriented mentality has taken hold.

      Large T. Case study—Bangladesh takes on poverty and disaster. Routers Foundation AlertNet. Available at: http://www.alertnet.org/printable.htm?URL=/thefacts/reliefresources/110604657337.htm. Accessed July 14, 2007.

      Political Instability

      A number of impoverished countries are politically unstable; civil and ethnic warfare are not uncommon. Large groups of citizens may be displaced because of the fighting, encamped in areas where they cannot work and escape the poverty. Girls and women are particularly vulnerable to sexual assault and exploitation in these situations, predisposing them to pregnancy, AIDS, and other sexually transmitted diseases.
      • Seaman J.
      • Maguire S.
      ABC of conflict and disaster. The special needs of women and children.
      Br Med J. 2005; 331: 34-36
      Cultural norms may be such that the victims suffer in silence for fear of stigmatization.

      Solutions

      Global commitment to reducing disaster-related death and disability was formalized by the Yokohama Strategy for a Safer World: Guidelines for Natural Disaster Prevention, Preparedness and Mitigation, adopted by the United Nations at the World Conference on Natural Disaster Reduction, in Yokohama, Japan, in 1994 (known as the Yokohama Strategy).

      United Nations International Strategy for Disaster Reduction, Yokohama Strategy and Plan of Action for a Safer World. Guidelines for National Disaster Prevention, Preparedness and Mitigation. World Conference on Natural Disaster Reduction, Yokohama, Japan, May 23-27, 1994. Available at: http://www.unisdr.org/eng/about_isdr/bd-yokohama-strat-eng.htm. Accessed July 9, 2007.

      It was affirmed that those most affected by natural and other disasters are the poor and socially disadvantaged. The Yokohama Strategy was a 10-year plan with the following key elements: include disaster risk reduction in community development; enhance resilience of individuals and communities to prevent and deal with disasters; and actively engage individuals and communities in disaster risk reduction.
      The results of the strategy were reviewed at the World Conference on Disaster Reduction in Kobe, Hyogo, Japan, in January 2005. The outcome of that conference was the Hyogo Framework for Action 2005-2015: Building the Resilience of Nations and Communities to Disaster, generally referred to as the “Framework for Action.” It was acknowledged that initiatives for development and poverty reduction must include efforts to reduce disaster risk. The expected outcome by 2015 is a “substantial reduction of disaster losses, in lives, and in the social, economic, and environmental assets of communities and countries.”

      United Nations International Strategy for Disaster Reduction. Hyogo Framework for Action 2005-2015: Building the Resilience of Nations and Communities to Disasters. Available at: http://www.unisdr.org/wcdr. Accessed July 9, 2007.

      The goals are “to integrate disaster risk reduction into sustainable development policies and planning, to strengthen capacities to build resilience, and to incorporate risk reduction into the implementation of emergency preparedness, response, and recovery. The priorities for action are: to make disaster risk reduction a national and local priority; to identify, assess, and monitor disaster risks and enhance early warning; use knowledge, innovation, and education to build a culture of safety and resilience at all levels; reduce underlying risk factors; and strengthen disaster preparedness for effective response at all levels.”

      Hyogo. Framework for action 2005–2015: building the resilience of nations and communities to disasters. Available at: http://www.unisdr.org/wcdr. Accessed July 9, 2007.

      Many of us witness the effects of poverty on health status on a daily basis in our emergency departments and can easily understand how they are magnified even more when disaster strikes. Achievement of the Hyogo Framework for Action outcome is a massive undertaking requiring commitment by an enormous number of individuals and organizations. Considering the enormity of the challenge, it is difficult to identify how one individual can make much of an impact. Here are a few ideas. We can start by making sure that as citizens and health care providers, we are as prepared as we can be so that we are part of the solution and not part of the problem. This means having and exercising a solid emergency plan and provisions for family and animals and perhaps for our neighbors who may be physically or economically challenged. It requires that we have the education necessary to respond if disaster strikes. We can consider volunteering for a community response program, a disaster relief organization, or a Disaster Medical Assistance Team. We can speak up when institutions or officials are making budget decisions related to emergency preparedness or infrastructure stability, for example, bridge inspection and repair and warning systems. Because literacy and poverty are linked, we can become literacy volunteers or donors. Donations can be directed to programs that support community development and teaching people new skills so that they become more self-reliant. We can provide community education on emergency preparedness by formal presentations or by having educational materials, available free at http://www.ready.gov, in our reception and treatment areas. In light of growing evidence that global warming is a major factor in the increased frequency of natural disasters,

      Planet Ark. Insurers see more disasters due to climate change. November 2, 2001. Available at: http://www.planetare.org/dailynewsstory.cfm/newsid/13100/story.htm. Accessed September 10, 2007.

      we can “think green” and implement environmentally prudent strategies both at home and work. Finally, we may volunteer to serve in disadvantaged communities, at home or abroad. The incidence of disasters is increasing each year, with global impact regardless of where they occur. Our challenge is to promote efforts to reduce disaster risk and to advocate for those who are most vulnerable.
      One final note: ENA was a pioneer in recognizing the importance of disaster preparedness to emergency nurses when it established Disaster Management & Response (DMR) 4 years ago. In order to utilize Association resources effectively, last year DMR became an on-line publication for ENA members while remaining a print journal for subscribers. Our recent reader survey, however, revealed that more than 80% of respondents do not read on-line journals, preferring to receive information in print form. Accordingly, it is been determined that the most effective way to make disaster information readily available to our constituents is to move disaster-related content to the Journal of Emergency Nursing, effective in 2008. This is the last edition of DMR. Serving as the editor for the past 2 years has been a rich and rewarding experience. I am indebted to our authors, reviewers, readers, Editorial Board, Elsevier, former DMR Editor Judy Stoner Halpern, AtlantiCare Health Systems staff and leadership, and the ENA Board of Directors for their trust and support.

      References

      1. United Nations Development Programme, Bureau for Crisis Prevention and Recovery, Disaster Reduction Unit. Poverty, sustainable development and disaster reduction. Available at: http://www.undp.org/bcpr/disred/. Accessed July 14, 2007.

        View in Article

      2. Disaster Control Priorities Project. Natural disasters: coping with the health impact. July 2007. Available at: http://www.dep2.org. Accessed September 9, 2007.

        View in Article

      3. Sherman A, Shapiro I. Essential facts about the victims of Hurricane Katrina. Center on Budget and Policy Priorities. Available at: http://www.cbpp.org. Accessed September 1, 2007.

        View in Article

      4. World Health Organization. Third of African malaria deaths due to conflict or natural disaster. Partnership plan to improve emergency response to prevent malaria. Available at: http://www.who.int/inf-pr-2000/en/pr2000-46.htm. Accessed September 9, 2007.

        View in Article

      5. Large T. Case study—Bangladesh takes on poverty and disaster. Routers Foundation AlertNet. Available at: http://www.alertnet.org/printable.htm?URL=/thefacts/reliefresources/110604657337.htm. Accessed July 14, 2007.

        View in Article
        • Seaman J.
        • Maguire S.
        ABC of conflict and disaster. The special needs of women and children.
        Br Med J. 2005; 331: 34-36
        View in Article

      7. United Nations International Strategy for Disaster Reduction, Yokohama Strategy and Plan of Action for a Safer World. Guidelines for National Disaster Prevention, Preparedness and Mitigation. World Conference on Natural Disaster Reduction, Yokohama, Japan, May 23-27, 1994. Available at: http://www.unisdr.org/eng/about_isdr/bd-yokohama-strat-eng.htm. Accessed July 9, 2007.

        View in Article

      8. United Nations International Strategy for Disaster Reduction. Hyogo Framework for Action 2005-2015: Building the Resilience of Nations and Communities to Disasters. Available at: http://www.unisdr.org/wcdr. Accessed July 9, 2007.

        View in Article

      9. Hyogo. Framework for action 2005–2015: building the resilience of nations and communities to disasters. Available at: http://www.unisdr.org/wcdr. Accessed July 9, 2007.

        View in Article

      10. Planet Ark. Insurers see more disasters due to climate change. November 2, 2001. Available at: http://www.planetare.org/dailynewsstory.cfm/newsid/13100/story.htm. Accessed September 10, 2007.

        View in Article

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      DOI: https://doi.org/10.1016/j.dmr.2007.09.001

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      © 2007 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

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