CASE BOX 2.5 WHAT MAKES LOW- INCOME COUNTRIES PARTICULARLY VULNERABLE TO DISASTERS?

As highlighted earlier, low- income countries will face the highest burden of hazards and disasters in the 21st century. The following discusses the main reasons for such vulnerabilities.

Frequency of disasters

Globally, the number of natural disasters is increasing and developing coun-tries are usually disproportionately affected. Furthermore, many developing countries are subject to seasonal events such as floods, droughts and tropi-cal storms. With the increasing frequency of meteorologitropi-cal disasters due to climate change, the patterns of large- scale emergency events will leave a smaller window of opportunity between events to prepare for disasters. As a result, the resilience of communities can decrease.

Baseline health and livelihood status of the population Developing countries are usually afflicted by widespread factors that generate a poor baseline health status of the population even during times of non- disaster. Some of the leading factors linked to poor health in these countries include physical factors (inadequate sanitation, water, waste disposal and housing) and behavioural factors (sexual behaviour, alcohol abuse and smok-ing). People in poverty are further exposed to vulnerabilities due to a lack of access to health services, safe environments, proper education and informa-tion. As a result of these factors and the vulnerabilities they create, developing countries are disproportionally affected by the health and economic losses brought about by disasters.

Demographic and epidemiological transitions

In simple terms, the theory of demographic transition states that societies that experience modernisation progress from a pre- modern regime of high fertility and high mortality to a post- modern one in which both are low. An increase in life expectancy and the ageing of populations may also lead to an epide-miological transition that is shifting the disease profile from communicable diseases to non- communicable diseases (NCDs) in many countries. For many low- income countries, this presents a double burden of disease which poses a major public health challenge during disasters. Specifically, in this transi-tion process, there is a period when a country is still being burdened with communicable diseases, while non- communicable, chronic conditions begin to spread. The Sphere standards highlight the need to address the exacerba-tion of chronic health condiexacerba-tions during disasters. However, due to limited resources, many aid agencies overlook this issue and consider it as secondary

to more acute problems. As a result, people do not have access to therapies and medicines that may reduce morbidity and mortality caused by complica-tions of their chronic condicomplica-tions.

The non- communicable disease burden in developing countries

Globally, over 60% of all deaths in 2005 were caused by chronic NCDs such as hypertension and diabetes mellitus. Although these chronic NCDs consti-tuted the most significant disease burden in developed countries, more than 80% of the NCD- related deaths occurred in low- income and middle- income countries. With ageing populations and the increasing behavioural health risk factors associated with rapid urbanisation and lifestyle modernisation in many developing countries, the mortality and disease burden in developing coun-tries will continue to shift from communicable disease–based to predomi-nantly NCD- related in the coming decades.

Health systems

Health systems govern health care accessibility and availability. Well- built health care systems can better absorb the impact of disasters and respond more efficiently and the robustness of a health care system will demonstrate resil-ience in stress/crisis such as natural disasters. Disaster preparedness plans for the health system should include supportive policies, allocated resources, risk analysis and contingency plans. Physical measures such as the reinforcement of health infrastructure and the construction of safer facilities can mitigate the damage during a disaster to ensure that basic services will continue when they are needed most. Unfortunately, in developing contexts, limited resources, inequitable health care the low provision of public health programmes and the low- quality health infrastructure have hampered preparedness.

In addition, the availability of technology and equipment may affect the efficiency and effectiveness of disaster response. For example, post- disaster data collection may need to rely on quick, on- site surveys and surveillance tools. Importantly, data should be collected on both acute and immediate life- saving needs, as well as chronic medical conditions. Historically, information on chronic diseases is not identified as essential data to be collected during needs assessments. This practice essentially rules out resource allocation for chronic disease management service provision.

Health improvement and health promotion

Developing countries often fare poorly in their health promotion and improve-ment programmes as usually more immediate health needs are prioritised due to resource limitations. Most disaster risk reduction and community resil-ience building in these countries are usually fragmented.

What is “risk”?

Risk is the likelihood, or probability, of an event that may result in an adverse out-come. It is a function of the interactions between hazard, exposure and vulnerability ( risk factors ) and the manageability ( coping capacity ) of the affected individual or com-munity. In the context of disaster, risk is defi ned as “ expected losses (of lives, persons injured, property damaged, and economic activity disrupted) due to a particular hazard for a given area and reference period ” (CRED, 2009). People who are made vulnerable from exposure to intense and frequent natural hazards are at higher risk. To reduce such risk, their coping and recovery capacity (also called “manageability” in the formula) from being exposed to the hazard should be increased.

The risk and impact of disaster at the individual and community levels must also be explored and assessed in order to guide effective disaster prevention and response protocol development. Various dimensions of risk and impact include: what (i.e.

type and severity of consequences), who (i.e. socio- demographic characteristics of the people affected) and when (i.e. time and frequency of impact).

A well- managed disaster database could serve the following purposes: (1) assist-ing humanitarian actions at both national and international levels; (2) rationalisassist-ing decision- making for disaster preparedness; and (3) providing an objective basis for vulnerability assessment and priority setting (Guha- Sapir, Below, & Hoyois, n.d.).

Disaster risk formula

The risk formula is a concept that helps us understand the risk of a disaster’s impact.

The risk formula shows the relationships between fi ve components – namely: risk , hazard , exposure , vulnerability and manageability .

In the equation ( Figure 2.9 ), risk is the product of four factors: hazard, expo-sure, vulnerability and manageability. Risk exists only if there is vulnerability and exposure to a hazard, and only if their product is greater than the manageability.

Thus, the same triggering event that results in a disaster in one community may not become a disaster in another. The risk may be different depending on the factors in the equation and how they evolve within a community. This equation is important as it helps justify the need for disaster preparedness programmes and education.

Hazard is a dangerous phenomenon, substance, human activity or condition that may cause loss of life, injury or other health impacts, property damage, loss of livelihoods and services, social and economic disruption or environmental damage.

Exposure describes people, property, systems or other elements present in hazard zones that are thereby subject to potential losses. Vulnerability is determined by

FIGURE 2.9 Risk formula Source: Adapted from Rand (2008).

the characteristics and circumstances of a community, system or asset that make it susceptible to the damaging effects of a hazard. In the foregoing equation it refers to the degree of loss (from 0% to 100%) resulting from a potentially damaging phe-nomenon. Manageability refers to the organisational response to the hazard and the ability of the population to respond to it. Risk is the possibility of damage, loss, injury, death or other negative consequences as a result of the foregoing components (see Case Box 2.6).

This formula can be illustrated by the following example. Both the residents of concrete apartments and the residents of makeshift shelters in an earthquake- prone region are equally exposed to the natural hazard of tectonic movements. However, they are not at equal risk of suffering losses from an earthquake event because con-crete buildings, if built according to stringent building codes, can absorb the shock of an earthquake without collapsing, allowing their inhabitants to survive. On the other hand, the makeshift shelters built of clay and tin may not survive an earth-quake, causing injuries and loss of properties in an earthquake. In this case, the type of shelter and the building material of people’s dwelling place are key risk factors that make people living in apartment buildings more resilient and slum dwellers more vulnerable to the risk of earthquake. In other words, the potential impact of an earth-quake event on apartment dwellers is different from that on slum dwellers.

CASE BOX 2.6 GLACIAL LAKE OUTBURST FLOODS