Who Is Most at Risk in Disasters?

Imagine that one of the steps to your front porch is broken. Do you wait until someone falls and gets hurt to repair it, or do you fix it before that happens? How about smoke alarms? Do you wait until you have a fire in your home before you install one, or do you install one because you want to prevent a fire?

Of course, the logical choice is to remove safety hazards before injuries happen, or to install devices to warn your family of danger before that danger occurs. If eliminating hazards is effective in keeping homes safe, wouldn’t the same principle apply to natural and man-made disasters?

As an emergency physician and disaster medical specialist with CDC, Dr. Mark Keim has responded frequently to the needs of disaster victims. He says, however, that “in terms of total lives lost, most deaths in disasters occur before anyone can arrive to help. For example, in Hurricane Katrina, most of the 1300 deaths were caused by the water rushing ashore during the impact of the storm when no one could reach the affected areas.”

A New Perspective: Disaster Risk Management

For many years, response was the only means of dealing with a disaster. Cities and states at risk for such events as hurricanes and flooding prepared their responders so that they were ready when these events happened.

However, Dr. Keim and other risk management experts had a better idea. Rather than focusing only on expensive response and recovery following hurricanes, earthquakes, or other disasters, why not also try to prevent injury and death by addressing the vulnerability of people most at risk?

Not everyone has the same level of exposure to disasters. Some locations are more exposed to certain types of disasters than others. In addition, some population groups are more vulnerable to any environmental hazard—including the poor, the elderly, single parents, the very young, and people with chronic diseases.

The ability to recover after a disaster is another factor determining vulnerability. Can these populations afford to move or repair their homes? Where can they find affordable medical or mental health care?

Mapping vulnerable populations

In 2005, Dr. Keim came up with a way to estimate this vulnerability by creating a vulnerability map. He worked with ATSDR’s Geospatial Research, Analysis, and Services Program (GRASP) to create maps indicating the locations where residents were most vulnerable to disasters. GRASP now uses census information to map areas according to social indicators of vulnerability. These include indicators of poverty as well as areas where the elderly and single parents live. Other indicators of vulnerability could include dialysis patients, people with disabilities, or people who use oxygen at home. These maps can help local and state health and disaster programs know the areas in danger of injury or death during a hurricane or other disaster.

Around 30 states are now taking advantage of this CDC/ATSDR collaboration to determine risk before a disaster happens.

CDC/Medical Reserve Corps Partnership

In 2013, CDC partnered with the Office of the Surgeon General, Medical Reserve Corps to conduct a webinar for doctors and public health practitioners, successfully reaching 300–500 participants at a time. In 2014, CDC continued this partnership to train community volunteers in five cities to help health departments begin the process of reducing risk in vulnerable areas.

In February 2013, CDC joined the Office of the Surgeon General, Medical Reserve Corps, and the Pacific Island Health Officers Association to host a Pacific regional workshop held in Honolulu. During this workshop, a set of 15 project proposals was developed at a grass-roots level, aided by international and island health officials, educators, and experts in disaster hazards and risk reduction. These proposed projects were designed to reduce the risk of disasters, including those caused by climate change.

CDC is using vulnerability maps, partnerships, and workshops to provide public health officials the information and skills needed to address the root causes of disaster-related illness and injury. While CDC cannot prevent hurricanes or other disasters, we can help keep people safe and healthy by taking steps to prevent illness and injuries that often result from them.