Public health in emergencies;
Basic concepts
Ragnar Andersson
Basic concepts
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•
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Accident (Disaster/Crisis/Emergency)
Injury (Lesion/Damage/Harm/Loss)
Risk/Hazard (Danger/Threat/Vulnerability)
Safety (Security/Resilience/Robustness)
Two main sets of terminologies
in safety research
• Injury-centered fields: Occupational,
traffic, home & leisure safety (with
competing views between engineering and
public health circles)
• Disaster/crisis/emergency management
“Accident” - types of definitions
• By consequence
(injury, harm)
• By event (loss of
control)
• By intention
(unintentional)
Examples
• Public health: An unintentional injury
• Engineering: A deviation beyond a system’s
inherent stability limits
• Law: An event that nobody should be
blamed for
Accidents or not?
•
•
•
•
•
Boxing injuries?
Car crashes?
Railway suicides?
Heart attacs?
Nuclear reactor meltdowns?
Controversy on the term
”accident”
• ”Injuries have traditionally been regarded as random, unavoidable
’accidents’. Within the last few decades, however, a better
understanding of the nature of injuries has changed these old attitudes,
and today both unintentional and intentional injuries are viewed as
largely preventable events.” (WHO, 2002)
• “Experts in the field of injury prevention avoid use of the term
'accident' to describe events that cause injury in an attempt to highlight
the predictable and preventable nature of most injuries. Such incidents
are viewed from the perspective of epidemiology - predictable and
preventable. Preferred words are more descriptive of the event itself,
rather than of its unintended nature (e.g., collision, drowning, fall,
etc.)” (Wikipedia, 2010)
BMJ bans "accidents"
Accidents are not unpredictable
For many years safety officials and public health authorities have
discouraged use of the word "accident" when it refers to injuries or the
events that produce them. An accident is often understood to be
unpredictable - a chance occurrence or an "act of God“ - and therefore
unavoidable. However, most injuries and their precipitating events are
predictable and preventable.1-3 That is why the BMJ has decided to ban
the word accident. Davies & Pless, BMJ 2001;322:1320-1321
1.
Doege TC. An injury is no accident. N Engl J Med 1978; 298: 509-510.
2.
Loimer H, Driur M, Guarnieri M. Accidents and acts of God: a history of the
terms. Am J Public Health 1996; 86: 101-107.
3.
Doege TC. Eschewing accidents. JAMA 1999; 282: 427.
“Injury”
• Defined as a bodily lesion at the organic level
resulting from acute exposure to energy (or
insufficiency of heat/oxygene) in amounts or rates
that exceeds the threshold of physiological
tolerance.
• Operationalized as categories under chapter 19,
“injury and poisoning” or chapter 20 “external
causes” in International Classification of Diseases
Operational problems
• Definitions of injury may differ between
classifications, sectors and countries
• Comparisons must be done with caution
“Normal accidents”
”The odd term normal accident is meant to signal
that, given the system characteristics, multiple and
unexpected interactions of failures are inevitable.”
Perrow C. Normal Accidents – Living with
high risk technologies, Basic Books, 1984
Disasters as “normal accidents”
“Disasters… are all too often regarded as unusual events, not
part of “normal life.” In reality, however, the opposite is true.
Disasters and emergencies are a fundamental part of normal
life. They are consequences of the ways societies structure
themselves, economically and socially; the ways that societies
and states interact; and the ways that relationships between
the decision makers are sustained.”
International Humanitarian Law. The International
Committee of the Red Cross. Geneva, Switzerland. 1993
Disaster
”The term disaster is reserved for the actual
occurrence of events that produce casualties
and damage at levels exceeding a
community’s ability to cope”
Lindell et al. Fundamentals of emergency
Management. Washington DC: FEMA, 2006
Disaster (cont.)
• A serious disruption of the functioning of a community or
a society causing widespread human, material, economic
or environmental losses which exceed the ability of the
affected community or society to cope using its own
resources.
• A disaster is a function of the risk process. It results from
the combination of hazards, conditions of vulnerability and
insufficient capacity or measures to reduce the potential
negative consequences of risk.
UN-ISDR (International Strategy
for Disaster Reduction)
Disaster (”bad star” in Greek)
“In contemporary academia, disasters are seen as the
consequence of inappropriately managed risk. These risks
are the product of hazards and vulnerability. Hazards that
strike in areas with low vulnerability are not considered a
disaster, as is the case in uninhabited regions.”
(Wikipedia 2010, with reference to: Quarantelli E.L. (1998). Where We Have Been and Where We
Might Go. In: Quarantelli E.L. (ed). What Is A Disaster? London: Routledge. pp146-159)
Classification of disasters
Abdallah S, Burnham G (2000). The Johns Hopkins and
Red Cross / Red Crescent Public Health Guide for Emergencies
Other classifications
• Natural
• Man-made
– Technological
– Sociological
“all disasters can be seen as being human-made ... All disasters are …
the result of human failure to introduce appropriate disaster
management measures”.
(Wikipedia 2010, with reference to: B. Wisner, P. Blaikie, T. Cannon, and I. Davis (2004).
At Risk - Natural hazards, people's vulnerability and disasters. Wiltshire: Routledge)
Emergency, two notions:
• ”an event involving minor consequences for a
community – perhaps a few casualties and a
limited amount of property damage … and can be
managed successfully with local resources”
• ”the imminence of an event rather than the
severity of its consequences … a situation in
which there is higher than normal probability of an
extreme event occurring”
Lindell et al. Fundamentals of emergency
Management. Washington DC: FEMA, 2006
Relationships among hazards,
emergencies and disasters
Time/probability
Demand compared to
communtiy capacity
Uncertain
Imminent
Occurred
Less than
Hazard
Emergency
Emergency
Greater than
Hazard
Emergency
Disaster
Lindell et al. Fundamentals of emergency
Management. Washington DC: FEMA, 2006
Crisis
• An unstable situation of extreme danger or difficulty: "they went
bankrupt during the economic crisis“ (WordNet)
• A crucial stage or turning point in the course of something: "after the
crisis the patient either dies or gets better“ (WordNet)
• A crucial or decisive point or situation; a turning point. (Wiktionary)
• An unstable situation, in political, social, economic or military affairs,
especially one involving an impending abrupt change. (Wiktionary)
• A sudden change in the course of a disease, usually at which the
patient is expected to recover or die. (Wiktionary)
• A traumatic or stressful change in a person's life. (Wiktionary)
”Risk”- Different meanings
• Probability of a certain outcome, e.g. death
• A combination of probability and
consequence, usually R = P x C
• Conditions associated with danger, e.g. a
slippery spot, a spinning wheel, a sharp
object (“hazards”)
• Perceived risk (perceptions of insecurity)
Risk (in disaster management)
“the probability of harmful consequences, or
expected losses (deaths, injuries, property,
livelihoods, economic activity disrupted or
environment damaged) resulting from
interactions between natural or humaninduced hazards and vulnerable conditions”
UN-ISDR (International Strategy
for Disaster Reduction)
Hazard vs. risk
• Hazard is the potential to cause harm
• Risk on the other hand is the likelihood of harm (in
defined circumstances, and usually qualified by some
statement of the severity of the harm).
• The relationship between hazard and risk must be treated
very cautiously. If all other factors are equal - especially
the exposures and the people subject to them, then the risk
is proportional to the hazard. However all other factors are
very rarely equal.
The Concise Oxford Dictionary
Hazard, vulnerability, barriers and risk
Barriers
Hazard
Vulnerability
Risk
Vulnerability (in disaster
management)
“the conditions determined by physical,
social, economic and environmental factors
or processes, which increase the
susceptibility of a community to the impact
of hazards”
UN-ISDR (International Strategy
for Disaster Reduction)
Resilience (in disaster
management)
“The ability of a system, community or
society exposed to hazards to resist, absorb,
accommodate to and recover from the
effects of a hazard in a timely and efficient
manner.”
UN-ISDR (International Strategy
for Disaster Reduction)
Safety
• The opposite to risk
• Systematic control of conditions associated
to risk
Definitions of ”safety” and “safety
promotion” (Maurice et al. 2001)
• Safety: a state in which hazards and conditions
leading to physical, psychological or material harm
are controlled in order to preserve the health and
well-being of individuals and the community.
• Safety promotion: The process applied to develop
and sustain the basic conditions for safety at a local,
national and international level by individuals,
communities, governments and others, including
enterprises and non-governmental organizations.
Security vs. safety
• Security: antagonistic threats with
significant impact on societal functions
• Safety: non-antagonsitic threats with limited
impact on societal functions
(Swedish ministry of defense)
Other meanings of security
• Social security
• Job security
• Financial security
Conclusion
• Terminologies vary between sectors and
professions
• Clear definitions are essential for correct
understanding