Cause-specific mortality and natural disasters: the urgent need for change. The Humanitarian Leader Working Paper 003
The sixth session of the Global Platform for Disaster Risk Reduction (GP2019) was held in Geneva on the 15th May 2019 providing delegations from 116 signatory nations with the official progress report on seven targets to reduce disaster risk agreed under the Sendai Framework for Disaster Risk Reduction (SFDRR) (UNISDR, 2019a).
Member states formed the SFDRR in Sendai Japan, at the World Conference on Disaster Risk Reduction, as a fifteen-year voluntary non-binding agreement and later endorsed by the UN General Assembly in June 2015 (UNISDR, 2019b). The SFDRR established seven targets and four priority areas to strengthen domestic and global disaster risk reduction efforts and, in particular, reduce mortality, the number of people affected, economic loss and strengthen community resilience to disaster events (UNISDR, 2015).
The GP2019 was the last global meeting prior to the deadline for the fifth SFDRR target to ‘substantially increase the number of countries with national and local disaster risk reduction strategies by 2020’, which presently stands at 92 countries (UNISDR, 2015, p.12,
UNISDR, 2019a). The meeting was significant because it confirmed the urgency to address the increasing threat of disaster hazards faced by communities worldwide.
Impacts caused by disasters over the past three decades are conservatively estimated at 1.3 million lives lost and 4.4 billion people injured, displaced or left in need of emergency assistance (CRED/UNISDR, 2018). The Swiss Re Institute estimated the cost to the global economy caused from disasters in 2018 was $US165 billion, of which only $US85 billion was covered by insurance, and in 2017 the cost was estimated at $US337 billion, of which $US144 billion was insured (Swiss-Re, 2018; Swiss-Re, 2019).
While the toll on communities from disaster events is increasing, the complexity of disaster risk is rapidly changing. Natural hazard disasters are increasing in frequency, intensity and magnitude, at a rate faster than efforts to protect people, the environment and infrastructure (UNDRR, 2019). Extreme weather events alone have doubled within 20 years (UNDRR, 2019) and the biological systems required by communities to sustain health and life are not recovering from prolific environmental stress, natural hazard impacts and climate change effects (IPBES 2019; Myers et al., 2017). In addition, single hazard disaster events are transforming into compounding and cascading emergencies (UNDRR, 2019) and communities at increased risk from natural hazards, are being compromised by pollution, environmental degradation, urbanisation and population growth (Finnigan, 2019; Landrigan et al., 2018; Whitmee et al., 2015). Furthermore, an amalgam of these factors is adding to disaster risk by driving internal displacement and migration within countries (UNDRR, 2019).
As the dynamic of disaster risk changes, the importance of the SFDRR to the humanitarian agenda must be viewed more broadly than simply aiming to reduce disaster risk and improve community resilience. Unlike other international agreements, the success of delivering many Sustainable Development Goals (SDGs) is dependent on reaching the SFDRR targets (Moller, 2019). Reducing the global impact and human lives lost caused by disaster events directly affect: SDG targets: 1.5 in building community resilience to shocks like disasters; 3.2 to end preventable deaths of newborns and children under five years; 3.4 to reduce premature death from NCDs; 3.9 to reduce preventable deaths from air, water and soil contamination; 3C to increase health financing and health workforce; 3D to strengthen capacity for early warning, risk reduction and management of national and global health risks; 11.5 to reduce the number of deaths, people affected and economic loss from disasters; and 11B to increase the number of cities and human settlements adopting and implementing integrated policies and plans for resilience to disasters (United Nations, 2019a). Failure to reach the outcome intended by any SFDRR target will guarantee failure in reaching one or more of these eight SDG targets. In stark contrast, the relationship between the 2030 Agenda and the Sendai framework targets compares with the Paris Accord (UNFCCC, 2015) in which the five SDG targets agreed in Goal 13 on climate action can be met, irrespective of whether the Paris Accord is delivered (United Nations, 2019b).
The first SFDRR target (Target A) is to ‘Substantially reduce global disaster mortality by 2030, aiming to lower the average per 100,000 global mortality rate in the decade 2020–2030 compared to the period 2005-2015’ (UNISDR, 2015, p.12). To reliably measure a reduction in the mortality rate requires an accurate measurement of deaths caused by disaster events.
Typically, considerations around such measurement include the attribution of death from exposure to a hazard and the temporal relationship between the hazard event and death (UNISDR, 2017). The technical guidance developed for measuring the SFDRR targets recommend countries base the attribution consideration on their own methodology and legal considerations (UNISDR, 2017). It also recommends temporal considerations be based on each nations local epidemiology, or four weeks after an earthquake and flood, six months after a drought and a period of ‘no new cases’ for epidemics (UNISDR, 2017).
For many countries, the health and medical sector are responsible for recording and registering death on local data systems (Lopez et al., 2015; WHO 2013), and lead emergency responses for mass casualty and natural hazard disaster events (Couig et al., 2005; WHO, 2007). The health sector relies on specific information, relating to the cause of death and risk of death from exposure to natural hazard disasters, to effectively plan rapid emergency responses that save lives and reduce premature mortality before, during and after disaster events. Evidence-based morbidity and mortality data is the cornerstone of health emergency planning, providing the detail to scale health resources for rapid diagnostic capacity, ambulatory transport, and treatment and care of people injured, ill or at risk, while maintaining existing healthcare services for existing patients (CDC, 2016; Igarashi et al., 2018; Checchi et al, 2017). The same data is needed to prepare communities for disaster events to protect critically ill people, or large vulnerable populations at risk from impending natural hazards, such as for category four or five cyclones and hurricanes (HAI, 2019; King et al., 2016; Little et al., 2012). In addition, the availability of cause-specific mortality information is essential to compare the cost of disaster risk reduction initiatives relative to the yield of mortality reduction. Such comparisons shape health policy outcomes and inform decisions on risk reduction investment options (Kellett and Caravani, 2013; Phillips et al., 2015).
This research was undertaken to contribute to the discussion and practice of global reporting of disaster attributed mortality and improve emergency health responses designed to prevent premature death and protect life. The aim was to examine whether the knowledge of cause-specific mortality risk from natural hazard disasters reported in published medical and scientific literature was translated into global disaster data collection and reporting practice.