Disaster Preparedness in the Health Sector: Policy in Latin America

Disaster preparedness is a pertinent topic for any region, but especially for the Americas. In 2017, one-fourth of all natural disasters took place on this continent (PAHO, 2017). There were three Category 5 hurricanes, affecting 19 countries and territories, two earthquakes in Mexico, three severe floods in Peru and Chile, and a landslide in Colombia. Hydrometeorological events are also a constant concern as El Niño and La Niña events occur frequently (USAID, 2017). It is important to note that the Latin American region is more prone to environmental hazards due to the geography of the region (World Bank, 2012). The fault lines that surround the Pacific Basin, aptly named the “ring of fire,” result in recurrent earthquakes and volcanic eruptions, and major cities such as Santiago, Chile and Lima, Peru are easily within reach of these disasters. Mexico, the Caribbean, and parts of Central America are also at constant risk for hurricanes. This is why disaster preparedness is essential in this area, as catastrophic natural disasters have the ability to threaten development and reverse crucial socioeconomic gains from recent years. The health sector is at risk not only to infrastructural damage to hospitals, but also an influx of health concerns such as waterborne infectious diseases due to disruptions in water and sanitation systems (Watson et al., 2007). Climate change has the ability to further exacerbate risk and cause even more damage. With 80% of Latin America’s population residing in cities, and poor urban settlements expanding into disaster-prone areas such as steep hillsides, the risk of environmental hazards is always present (Watanabe, 2012). The region as a whole is thus shifting away from emergency response plans to long-term preparedness plans, to build resilience in the face of geohazards.

Strengthening Latin American countries’ responses to the risk of damage from environmental hazards in the health sector at the regional public health policy level began in the 1970s, specifically when PAHO created the Emergency Preparedness and Disaster Relief Coordination program (PED) in 1976 (Ugarte et al., 2018). This was in part a response to the massive casualties as a result of multiple devastating disasters in the early 1970s, including the 1970 Ancash earthquake in Peru, which killed an estimated 70,000 people. Earthquakes in Nicaragua in 1972 and Guatemala in 1976 raised the death toll from these disasters to over 100,000 people (Gilbert, 2017). In the case of Guatemala, while emergency field hospitals were set up within a few days by organizations such as the Costa Rican Red Cross, drug shortages and miscommunications led to supply deliveries of materials weeks after they were requested (de Ville de Goyet et al., 1976), and analyses of this case ultimately mobilized the PAHO to create the PED (PAHO, 1994). Thus, experiences of past disasters shaped policy implementation.

The United Nations was also working to foster inter-governmental efforts at disaster management during this time. These efforts, as well as others, culminated in the declaration of the 1990s as the international decade for natural disaster reduction. The first World Conference on Disaster Risk Reduction (WCDRR) in 1994 resulted in the International Strategy for Disaster Reduction. The second WCDRR, in 2005, culminated in the UN General Assembly endorsing the Hyogo Framework for Action 2005-2015: Building the Resilience of Nations and Communities to Disasters (United Nations Office for Disaster Risk Reduction, 2015). The countries within this region that have achieved the most progress in risk reduction, according to the Hyogo Framework, include Ecuador, Brazil, Costa Rica, Cuba, and Mexico (World Bank, 2019). This is evidenced in the lower mortality rates of earthquakes in Ecuador in 2016 and Mexico in 2017, with each disaster numbering less than 1,000 casualties (Guererro, 2018). While the 2010 Haitian earthquake is a clear example of the work still needed in disaster risk mitigation for the region, with a death toll of over 300,000, most recent natural disasters in the region have had a much smaller impact than disasters in the late 20^th century. The most recent WCDRR in 2015 was a discussion of the plan leading up to 2030, and resulted in the creation of the Sendai Framework. This document also acknowledges that high-risk groups, such as women, children, the elderly, ill and disabled persons need to be prioritized within disaster risk reduction planning (PAHO, 2018). Overall, efforts to prioritize policy implementation at the regional level in the Latin American region for environmental hazard mitigation began in the 1970s but scaled up in the 1990s.

The ability for countries to not just react to natural disasters, but to actually have the infrastructure to respond quickly and efficiently, is an integral part of reducing the impacts of a natural disaster. An example of capacity-building is the creation of the Central American Probabilistic Risk Assessment Initiative (CAPRA) in 2008 (PAHO, 2018). These are open-source prediction models that are designed to aid in the development of risk mitigation strategies and predict future disasters. All Central American countries are using this model, and a few South American countries as well. In fact, this system has been so successful that India, Bangladesh, and Pakistan modeled their environmental hazards risk assessment system after CAPRA (World Bank, 2019). Thus, the efforts in this region are having far-reaching effects around the world.

Another way Latin American countries are addressing disaster risk in the health sector is building up infrastructure in hospitals. This is especially pertinent in the sector of public health because hospitals in Latin America account for 70 percent of public health expenses (PAHO, 2018). The Safe Hospitals Initiative began in 1986 in response to the devastating earthquake in Mexico. The damage was so severe to the hospitals that 25.2 percent of hospital beds were destroyed (4,387 out of 17,406) (Ugarte et al., 2018). The Safe Hospitals Initiative developed into a Hospital Safety Index (see graphic). A specific risk mitigation strategy within this program is priority mobilization of health teams to areas where hospitals are likely to stop working (PAHO, 2012). Mexico used this framework to conduct a large-scale simulation of an earthquake in 2011, which involved the Mexican Government, hospitals, civil defense forces and the public (PAHO, 2012). A milestone to acknowledge is by 2015, 31 of 35 Ministries of Health in Latin America had a national risk management program. The Safe Hospitals Initiative was tested in Mexico in 2017 by an earthquake, and all hospitals remained operational, thus a reflection of the improvement in health sector disaster risk management (Ugarte et al., 2018).

In September 2016, the Pan-American Health Organization (PAHO) developed a new Health Emergencies Department (PHE) in response to the World Health Organization’s (WHO) creation of its Health Emergencies Program (WHE) (PAHO, 2017). PHE’s regional headquarters are in Washington, DC, but there are also three sub-regional offices in the following locations: Barbados, Panama City, and Lima. Specific initiatives to highlight include USAID’s funding of DRR courses for the Central American University Higher Council (CSUCA) (USAID, 2015). This is an excellent use of humanitarian aid money as it is going towards educating the next generation on risk mitigation strategies, thus providing citizens with the tools necessary to protect their country, rather than promoting the reliance on foreign aid. For more information on up-to-date country-specific programs, refer to the USAID’s Latin American and the Caribbean: Disaster Risk Reduction Fact Sheet (FY 2017). Therefore, there have been efforts in the last few decades to strengthen country responses to natural disasters, in an effort to prevent the damage through early warning systems and training programs.

Related Articles

• Climate Change and Health in Latin America
• Pan American Health Organization

Additional Resources

Alcántara-Ayala, I. (2019). Time in a bottle: Challenges to disaster studies in latin america and the caribbean. Disasters, 43, 27.

Degg, M. R., & Chester, D. K. (2005). Seismic and volcanic hazards in Peru: changing attitudes to disaster mitigation. Geographical Journal, 171(2), 125-145

Maskrey, A. (2011). Revisiting community-based disaster risk management. Environmental Hazards, 10(1), 42-52.

References

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Emergency Preparedness and Disaster Relief Coordination Program (PED), with emphasis on PAHO's experience in humanitarian assistance. (n.d.). Retrieved May 9, 2019, from http://iris.paho.org/xmlui/bitstream/handle/123456789/18996/SPP23_6_ENG.pdf?sequence=1&isAllowed=y

Gilbert, K. (2017, November 13). Timeline: World's 14 deadliest earthquakes of last decade. Retrieved May 9, 2019, from https://www.reuters.com/article/us-iran-quake-global/timeline-worlds-14-deadliest-earthquakes-of-last-decade-idUSKBN1DD257

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Latin America: Putting disaster preparedness on the radar screen. (2012, October 9). Retrieved April 23, 2019, from http://www.worldbank.org/en/news/feature/2012/10/09/desastres-naturales-america-latina-crecimiento-riesgo

Latin America and the Caribbean - Disaster Risk Reduction Fact Sheet, Fiscal Year (FY) 2017 - World. (2017, September 30). Retrieved April 24, 2019, from https://reliefweb.int/report/world/latin-america-and-caribbean-disaster-risk-reduction-fact-sheet-fiscal-year-fy-2017

PAHO Annual Report 2017 Health Emergencies Department. (n.d.). Retrieved April 21, 2019, from https://www.paho.org/disasters/index.php?option=com_docman&view=download&slug=phe-annual-report-2017-printable-version&Itemid=1179&lang=en

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Ugarte, C., Mauvernay, J., & Alcala, P. A. (2018, June 25). Political Will, Coordination, and Planning: Key Components for Strengthening National Response to Public Health Emergencies and Disasters in Latin America and the Caribbean Countries. Retrieved May 1, 2019, from https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2018.304639

de Ville de Goyet, C., del Cid Peralta, E., Romero, A., Jeannee, E., & Lechat, M. (1976). Earthquake in Guatemala: epidemiologic evaluation of the relief effort. PAHO Bulletin.

Watanabe, M. Urban Disaster Risk Management in Latin American Cities. (n.d.). Retrieved May 9, 2019, from http://ella.practicalaction.org/wp-content/uploads/files/130617_ENV_DisRisManCit_GUIDE.pdf

Watson, J. T., Gayer, M., & Connolly, M. A. (2007). Epidemics after natural disasters. Emerging infectious diseases, 13(1), 1–5.