Health emergencies and disaster risk management (Health-EDRM)

People across the world are faced with the risks associated with health emergencies and disasters. Reducing such risks and their consequences is vital to health security and resilience across communities. Research and knowledge management on Health EDRM is critical in designing policies and programs. 

The importance of sound risk management has been emphasized as part of the implementation of the Sustainable Development Goals (SDGs), including Universal Health Coverage (UHC), the Sendai Framework for Disaster Risk Reduction 2015-2030 (Sendai Framework), International Health Regulations (IHR) (2005), the Paris Agreement on Climate Change (Paris Agreement), and other frameworks.

To improve the scientific evidence base, WHO established the Thematic Platform for Health EDRM Research Network (TPRN). WHO HQ and all six Regional Offices are involved in the operation of TPRN and work together to discuss research needs, facilitate international research collaboration and knowledge management. WHO Kobe Centre (WKC) acts as the secretariat of TPRN.  

To address the need for stronger methods for Health EDRM research, WKC coordinates the development of the WHO Guidance on Research Methods for Health EDRM. The guidance is comprehensive and covers the design, implementation and reporting of research during and after emergencies and disasters.

What is our research focus?

Based on the 2018 Kobe Expert Meeting on Health EDRM Research Needs, WKC focuses on the below research themes. 

To provide effective health support in disaster relief and recovery, accurate and comprehensive data is essential. WKC promotes and coordinates research on methodology and tools for health data collection for use before, during and after emergencies and disasters.

​​Emergencies and disasters can place significant and persistent mental health pressures on those affected, including the responders. Mental health and psychosocial support (MHPSS) is an essential part of Health-EDRM. WKC coordinates research on enhancing health systems for effective MHPSS.

Long-term Psychosocial Impact of Natural Disasters on Survivors in Japan

Development of Specific Care Strategies to Maintain and Recover Survivors’ Health after Disasters

Inclusivity is a key principle of Health-EDRM. This requires understanding the vulnerabilities and capacities of communities and specific vulnerable sub-populations. How communities perceive and manage risks also greatly affects the health consequence of emergencies and disasters. WKC works on research for better understandings and countermeasures on this research theme. 

Health workforce development is an overarching research theme of Health-EDRM WKC supports research to address this gap and including capacity building. 

Why is this important?

These research activities help countries to strengthen their capacities in emergency risk management and will ultimately contribute to one billion more people safe during emergencies.

Related links

Health Emergency and Disaster Risk Management Framework

Health Emergency and Disaster Risk Management Fact Sheets

 

Consult all archived projects here

 

WHO Thematic Platform for Health-EDRM Research Network (TPRN)

Background

The growing recognition of health as a core dimension in disaster risk management has catalyzed the development of Health Emergency and Disaster Risk Management (Health-EDRM), a field which encompasses emergency and disaster medicine, disaster risk reduction, humanitarian response, community health resilience, and health system resilience. In response to the Sendai Framework for Disaster Risk Reduction 2015-2030, WHO has established the “WHO Thematic Platform for Health EDRM Research Network” (TPRN) as a subgroup of the Thematic Platform for Health-EDRM. It aims to strengthen research and promote knowledge and evidence in Health-EDRM. The TPRN aligns with the World Health Organization’s 13th General Programme of Work 2019-23 (GPW13), which is a critical tool for WHO Member States to set and approve the priorities of the Organization, define the targets to be delivered, and to monitor their achievements. The GPW13 is structured around three strategic priorities, and one specifically addresses health emergencies and aims to build and sustain resilient health systems required to keep the world safe from epidemics and other health emergencies.

 

Methods
The TPRN comprises the core group, participants, and the information-sharing network. The core group includes WHO staff at all levels and regions, the Secretariat (WHO Kobe Centre), and other external key stakeholders. The core group facilitates the development of TPRN and coordinates its activities.
The participants consist of global stakeholders who contribute to updating the knowledge and scientific evidence of H-EDRM through active participation in one or more thematic groups. The information sharing network expands the TPRN and includes members who will receive a periodical newsletter from the TPRN Secretariat with information of official WHO meetings, publications, research funding, and information updates from the TPRN. The WHO Kobe Centre has acted as the Secretariat of the TPRN since 2019.

 

Results
The Terms of Reference of the TPRN (1), and its operational plan (2), were developed respectively in 2018 and 2019. Leading experts from the TPRN and other key partners have identified, through a meeting convened by the WHO Kobe Centre in 2018, five research priority areas: health data management; mental health and psychosocial support; addressing specific health needs of subpopulations; health workforce development; and research methods and ethics. A detailed description of the expert meeting and its findings were published in a series of papers (3-6), and on a project page on the WHO Kobe Centre website (7). In 2019, the WHO Kobe Centre launched the first call for proposals on Health-EDRM addressing the first four priority areas, while the WHO Guidance on Research Methods for H-EDRM currently underway specifically addresses the fifth research priority. WHO has also published the WHO Health Emergency and Disaster Risk Management Framework which maximize the contribution of the TPRN to research, policy and practice of Health-EDRM.

 

Conclusions
The TPRN serves as an international, multi-stakeholder and inter-disciplinary platform to exchange information, share views and advise WHO about Health-EDRM research and evidence. It promotes partnerships among stakeholders to enhance the scientific and technical work on Health-EDRM, influence the international Health-EDRM research agenda and advocate greater health input within the wider disaster risk reduction community.

 

Related web articles:

Project page: Kobe Expert Meeting, October 2018: “Scientific Evidence in Health-EDRM” 

WHO Guidance on Research Methods for Health and Disaster Risk Management

Background

Health Emergency and Disaster Risk Management (Health-EDRM) has recently emerged as a critical field for research, policy, and practice as a result of the growing recognition of health as a core dimension in disaster risk management. Global frameworks such as the WHO General Programme of Work 13 (GPW13), the Sendai Framework for Disaster Risk Reduction 2015-2030, the Sustainable Development Goals (SDGs), and the International Health Regulations (IHR) have health-related goals, targets, or indicators aiming to reduce the impacts on health of disasters and emergencies and/or to build resilient health systems and communities. Policies and actions guided by the best possible evidence are therefore critical for managing the health risks of emergencies and disasters. However, the evidence base in Health-EDRM is very limited, reflecting the overall lack of research in this area. To address this gap, the WHO Thematic Platform for Health-EDRM Research Network (TPRN) set out to develop a research methods resource textbook to guide Health-EDRM research.

Methods
In October 2018, the WHO Kobe Centre convened an expert meeting to identify key research needs for Health-EDRM, bringing together leading experts from the TPRN and other key partners. “Research methods and ethics” was identified as one of the five research priorities, and there was an urgent need for a research methods resource textbook to address key issues in research and ethics in Health-EDRM, notably the need to harmonize Health-EDRM research with universal terms; mechanisms to facilitate and speed up ethical review process; increased community participation and stakeholder involvement in generating research ideas and in assessing impact evaluation; and development of reference materials such as consensus statements.

Results
The WHO Guidance on Research Methods for Health-EDRM has 41 chapters by 92 authors from 17 countries around the world, with a wide variety of H-EDRM disciplines. The book is structured around six sections: introduction; identifying and understanding the problem; assessing the problems and developing a scoping study; study design; special topics to demonstrate research processes and benefits; and how to become a researcher. It includes an extensive series of case studies, 26 from individual countries and 33 from more than two countries or of global relevance. The book is edited by six leading experts in Health-EDRM and will be assigned to 59 peer reviewers from 21 countries. It is expected to be published in 2020 on open access via the WHO Kobe Centre website.    

Conclusions
The WHO Guidance on Research Methods for Health-EDRM will facilitate, enable and enhance health-EDRM research to develop evidence to inform policy and practice. The book will be useful for a range of stakeholders including health professionals in Health-EDRM, academia, government agencies and ministries, international organizations, and community groups and civil society organizations.

Development of Specific Care Strategies to Maintain and Recover Survivors’ Health after Disasters

Background

The increasing scale and frequency of disasters has placed a priority on the mitigation of disaster risk and impact. Of special interest is disaster risk management for health, with attention towards vulnerable populations. Older adults are more likely to have physical, cognitive and mental vulnerabilities, such as multiple chronic diseases that can worsen during and after disasters and be complicated by mental health issues such as post-traumatic stress disorder (PTSD) and depression. Healthcare and social service providers affected by disasters are also of concern in terms of the prevention of PTSD and depression, as they are required to keep working under stressful environments.

The current research project was conducted within the context of the 2016 Kumamoto earthquakes that affected over 180,000 people in Japan. It included two studies. The first study aimed to identify the needs and health status of older adults in Town X, one of the most severely damaged areas close to the hypocentre. The second study evaluated the impact of a two-day therapeutic programme among healthcare and social service providers directly affected by the Kumamoto earthquakes. The programme included a psychoeducation intervention, open and individual consultations, and a small-group psychotherapy designed to prevent post-traumatic stress disorder (PTSD) and depression.

Goal

  1. To assess the health status, quality of life, needs for long term care, and changes in lifestyle of people over 65 years affected by the 2016 Kumamoto Earthquakes.

  2. To conduct a therapeutic intervention programme among healthcare and social service providers affected by disasters to evaluate its feasibility, relevance, acceptability and impact on the prevention of PTSD and depression.

Methods

  1. A letter-based questionnaire was sent to all 9,215 citizens over 65 years in Town X three years after the Kumamoto earthquake to collect information about socio-demographic characteristics; disaster effects (e.g. house damage; effect on household finance; requirement of evacuation); lifestyle change after the disaster (e.g. eating habits; daily activities; social activities; and change in health needs before and after the disaster (e.g. long term care,  health-related quality of life (HRQoL) as measured with the Short Form (SF)-8.

  2. To evaluate the impact The Centre for Epidemiologic Studies Depression Scale (CES-D); SF-8; and a sheet of dynamic change for trauma response (DCTR)) before, one month, three months, and six months after the intervention.

Results

A total of 3,692 older adults affected by the earthquake (40% of targeted participants) responded to the letter-based survey. Thirty percent of the participants reported a decrease in the frequency of going out and socialization after the earthquake. The need for long term care and support increased three years after the earthquake, and deterioration of the level of needed care and support was observed in 7% of the respondents. Lastly, respondents’ HRQoL scores were lower compared to the national standards: 48.2 versus 49 in males and 46.4 versus 49.3 in females for the physical component score of HRQoL, and 49.3 versus 51.3 in males and 47.6 versus 50.7 in females for the mental health component score of HRQoL.

The therapeutic intervention programme included 254 participants, of which 92.5% were nurses. Between the baseline and 6 months post intervention, the level of PTSD declined from 39% to 19% (p < 0.01), the CES-D average score decreased from 22.8 to 22.3 (p<0.05); and the DCTR average score declined from 8.3 to -2.4 (p<0.01). However, the change in HRQoL was not statistically significant: the average physical component score declined from 43.5 to 41.1 (p >0.05), while the average mental component score was increased from 40.9 to 42.6 (p >0.05).

Implications

Our sample of older adult survivors of the Kumamoto earthquakes displayed lower levels of HRQoL and experienced increased need for care and support three years after the earthquake. The proportion of healthcare and social providers with PTSD was reduced by half following the intervention; however, the lack of a comparable control group limits the assessment of the effectiveness of this therapeutic intervention.

 

Long-term Psychosocial Impact of Natural Disasters on Survivors in Japan

Over the past few decades, the frequency and severity of natural disasters have increased. Growing population, unplanned urbanization, ageing and related demographic trends have contributed to this change. The 3rd UN World Conference for Disaster Risk Reduction, Sendai Framework for Disaster Risk Reduction 2015-2025 (SFDRR), highlights the fundamental role of health in disaster risk management (DRM) and emphasizes the need for scientific evidence in this area. In practice, the majority of attention to DRM has focused on preparedness and response. However, the long-term psychosocial impact and needs of survivors during the recovery phase have not been well documented nor have there been many studies about possible interventions.

Research Background

In cooperation with NCNP Japan (the institute leading this research), Hyogo Institute for Traumatic Stress and the WHO Kobe Centre Working Group for this project (including 21 Japanese experts) will conduct a comprehensive review of DRM in Japan with a focus on psychosocial interventions.

Research Outline

  1. Develop a review paper on policy and social innovations for disaster mental health in Japan based on gaps and needs for important natural
    disasters.
  2. Convene an expert consultation meeting to identify fundamental gaps in knowledge and required actions for better long-term mental health
    management for disaster survivors.
  3. Conduct a systematic literature review to understand global research gaps.
  4. Conduct a nationwide comprehensive survey of researchers, local/national government officers and NGO and community workers to
    complement and strengthen the key findings of the expert consultation.
  5. Integrate the results of the survey into the results of the consultation meeting and literature review to develop evidence-based policy
    suggestions.​

Goals

The project will

  1. Identify fundamental gaps in knowledge and required actions in long-term psychosocial management for disaster survivors.
  2. Contribute to evidence-based policy options for better long-term psychosocial management after disasters.
  3. Provide scientific evidence for health emergency and disaster risk management by sharing lessons and evidence from Japan.