All communities are at risk of emergencies and disasters including those associated with infectious disease outbreaks, conflicts, and natural, technological and other hazards. The health, economic, political and societal consequences of these events can be devastating. Climate change, unplanned urbanization, population growth and displacement, antimicrobial resistance and state fragility are contributing to the increasing frequency, severity and impacts of many types of hazardous events that may lead to emergencies and disasters without effective risk management.
Reducing the health risks and consequences of emergencies is vital to local, national and global health security and to build the resilience of communities, countries and health systems. Sound risk management is essential to safeguard development and implementation of the Sustainable Development Goals (SDGs), including the pathway to universal health coverage (UHC), the Sendai Framework for Disaster Risk Reduction 2015–2030 (Sendai Framework),
International Health Regulations (IHR) (2005), Paris Agreement on Climate Change (Paris Agreement) and other related global, regional and national frameworks.
While countries are have strengthened capacities to reduce the health risks and consequences of emergencies and disasters through the implementation of multi-hazard disaster risk management, the IHR (2005), and health system strengthening, many communities remain highly vulnerable to a wide range of hazardous events. Fragmented approaches to different types of hazards, including over-emphasis on reacting to, instead of preventing events and preparing properly to be ready for response, and gaps in coordination across the entire health system, and between health and other sectors, have hindered the ability of communities and countries to achieve optimal development outcomes including for public health.
Large-scale events due to natural and technological hazards in the Caribbean, Japan, Mozambique and Nepal, disease outbreaks in the Democratic Republic of the Congo, Republic of Korea and Saudi Arabia, and protracted crises in many countries have highlighted that no country is immune from emergencies and disasters. While these events may have the greatest impact, the cumulative effect of smaller-scale events also has a significant impact on communities worldwide. All of these events demonstrate the public health imperative to scale up risk-informed actions to reduce hazards, exposures and vulnerabilities, and build capacities to protect public health from emergencies and disasters.
In order to address current and emerging risks to public health and the need for effective utilization and management of resources, the conceptual frame or paradigm of “health emergency and disaster risk management” (Health EDRM) has been developed to consolidate contemporary approaches and practice.
The Health EDRM Framework provides a common language and a comprehensive approach that can be adapted and applied by all actors in health and other sectors who are working to reduce health risks and consequences of emergencies and disasters. The Framework also focuses on improving health outcomes and well-being for communities at risk in different contexts, including in fragile, low- and high-resource settings.
Health EDRM emphasizes assessing, communicating and reducing risks across the continuum of prevention, preparedness, readiness, response and recovery, and building the resilience of communities, countries and health systems. Drawing on the expertise and field experience of many experts who contributed to the development of this Framework, Health EDRM is derived from the disciplines of risk management, emergency management, epidemic preparedness and response, and health systems strengthening. It is fully consistent with and helps to align policies and actions for health security, disaster risk reduction, humanitarian action, climate change and sustainable development. Effective implementation of Health EDRM is therefore critical to achieve UHC in all country contexts.
The vision of Health EDRM is the “highest possible standard of health and well-being for all people who are at risk of emergencies, and stronger community and country resilience, health security, universal health coverage and sustainable development”. The expected outcome of Health EDRM is that “countries and communities have stronger capacities and systems across health and other sectors resulting in the reduction of the health risks and consequences associated with all types of emergencies and disasters”.
Health EDRM is founded on the following set of core principles and approaches that guide policy and practice:
- risk-based approach;
- comprehensive emergency management (across prevention, preparedness, readiness, response and recovery);
- all-hazards approach;
- inclusive, people- and community-centred approach;
- multisectoral and multidisciplinary collaboration;
- whole-of-health system-based;
- ethical considerations.
Health EDRM comprises a set of functions and components that are drawn from multisectoral emergency and disaster management, capacities for implementing the IHR (2005), health system building blocks, and good practices from regions, countries and communities. The Framework focuses mainly on the health sector, noting the need for collaboration with many other sectors that make substantial contributions to reducing health risks and consequences.
Health EDRM functions are organized under the following components.
- P O L I C I E S , S T R AT E G I E S A N D LEGISLATION: Defines the structures, roles and responsibilities of governments and other actors for Health EDRM; includes strategies for strengthening Health EDRM capacities.
- PLANNING AND COORDINATION:
Emphasizes effective coordination mechanisms for planning and operations for Health EDRM. - HUMAN RESOURCES: Includes planning for staffing, education and training across the spectrum of Health EDRM capacities at all levels, and the occupational health and safety of personnel. - FINANCIAL RESOURCES: Supports implementation of Health EDRM activities, capacity development and contingency funding for emergency response and recovery. - INFORMATION AND KNOWLEDGE MANAGEMENT: Includes risk assessment, surveillance, early warning, information management, technical guidance and research. - RISK COMMUNICATIONS: Recognizes that communicating effectively is critical for health and other sectors, government authorities, the media, and the general public. - HEALTH INFRASTRUCTURE AND LOGISTICS: Focuses on safe, sustainable, secure and prepared health facilities, critical infrastructure (e.g. water, power), and logistics and supply systems to support Health EDRM. - HEALTH AND RELATED SERVICES:
Recognizes the wide range of health-care services and related measures for Health EDRM.
- COMMUNITY CAPACITIES FOR HEALTH EDRM: Focuses on strengthening local health workforce capacities and inclusive community-centred planning and action.
- MONITORING AND EVALUATION: Includes processes to monitor progress towards meeting Health EDRM objectives, including monitoring risks and capacities and evaluating the implementation of strategies, related programmes and activities.
The success of Health EDRM relies on joint planning and action by ministries of health and other government ministries, the national disaster management agency, the private sector, communities and communitybased organizations, assisted by the international community. At the core of effective Health EDRM are efforts to strengthen a country’s health system with a strong emphasis on community participation and action to build resilience and establish the foundation for effective prevention, preparedness, response and recovery from all types of hazardous events including emergencies and disasters.
All countries require multidisciplinary and multisectoral policies, strategies and related programmes to reduce health risks of emergencies and disasters and their associated consequences. The design of Health EDRM strategies requires a systemic approach that takes account of the risks, capacities and the availability of resources to implement risk management measures at local, subnational and national levels. Strategic health emergency risk assessments, assessments of capacity across Health EDRM components and functions, and reviews of existing plans and past experience can assist the development of comprehensive strategies and identification of priorities for action.
The Framework proposes the following areas for action that could be considered by the health sector as the foundation of a comprehensive strategy: surveillance, early warning and alert systems; emergency preparedness for response across all hazards, the health system and all sectors, including operational readiness and mass casualty management systems; and resilient hospitals and health facilities that are safe, secure and sustainable, and that can continue to function in emergency or disaster situations. Strong advocacy and participation by the health sector in international and national forums, including through the National Disaster Management Agency (NDMA), is needed to ensure that the health of the populations remains central to multisectoral policy, planning, and resource allocation dialogues, and in operational coordination at local, subnational and national levels.
WHO is committed to working with Member States and partners to support implementation of the IHR (2005), the Sendai Framework, the SDGs and the Paris Agreement. Effective management of the risks of emergencies and disasters by all stakeholders will make a substantial contribution to strengthen community and country resilience, health security, UHC and sustainable development. It will also enable all communities at risk of emergencies and disasters to attain the highest possible standard of health and well-being. Implementation of the Health EDRM Framework provides a solid foundation for all stakeholders to work together and achieve these objectives.