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Public Health Response in Disasters
2006 National
Health Policy
Conference
Adjunct
Meeting
Feb. 8, 2006
Critical Systems
Challenges for
Chronic Diseases
George A. Mensah, M.D.
Associate Director for Medical Affairs
National Center for Chronic Disease
Prevention and Health Promotion
Disclosure Statements
• No conflicts of interest
• Statements made in
this presentation do
not necessarily
represent the views
of the CDC, DHHS, or
the US Government
Card
Cardiovascular Science
Kaiser Permanente
CDC Foundation
www.who.int
Cardiovascular Science
Katrina and Other Natural Disasters
• Panel 1: Lessons Learned
– Impact on public health systems
– Deployment of mobile hospitals
– System evacuation issues
– Mental health transformations
• Panel 2: Critical System Challenges
– Surge Capacity Issues
– Legal Issues
– Chronic Disease Issues
Cardiovascular Science
Chronic Disease Issues in
Natural Disasters - The Outline
•Triumphs and Successes
•Tradition of Neglect
•Critical Challenges
•Opportunities and Hope
Cardiovascular Science
Triumphs and Successes
•  Civil society response
•  International collaboration
•  Attention to provision of shelter,
food and water for evacuees
•  Fatality from malnutrition
• Control of infectious outbreaks
Cardiovascular Science
Mokdad, Mensah, Posner, Reed, Simoes, Engelgau, and the
Chronic Diseases and Vulnerable Populations in Natural
Disasters Working Group. Prev Chronic Dis 2005 Nov
http://www.cdc.gov/pcd/issues/2005/nov/05_0201.htm
Cardiovascular Science
Persons at Risk from Disasters – 1
• Persons with underlying chronic
diseases; mental illness
• Persons without health insurance
• Persons with low income, SES,
and educational attainment
• Homeless persons
Mokdad, Mensah, Posner, et al. Prev Chronic Dis 2005 Nov
http://www.cdc.gov/pcd/issues/2005/nov/05_0201.htm
Cardiovascular Science
Persons at Risk from Disasters – 2
Other Vulnerable Populations
• The elderly
• Pregnant women and infants
• Children and adolescents
• Mentally impaired
• People living with disabilities
• Prisoners and other
institutionalized persons
Cardiovascular Science
Chronic Diseases and
Vulnerable Population Issues
• Lack of access to routine health
care and medications
• Significant interruption in lifesupporting treatments
– home oxygen use
– renal dialysis
– insulin injections
Mokdad, Mensah, Posner, et al. Prev Chronic Dis 2005 Nov
http://www.cdc.gov/pcd/issues/2005/nov/05_0201.htm
Cardiovascular Science
Selected Observations from
Surveys of Hurricane Evacuees
• Most health care visits were for
chronic health conditions
• Up to 41% had at least one major
chronic health condition.
• Non-traumatic deaths often result
from existing chronic conditions.
Cardiovascular Science
Needs Assessment in Persons
Staying in Evacuation Centers
• Leading the list of top 10
conditions were:
–Hypertension
–Cardiovascular diseases
–Diabetes
–Psychiatric disorders
Cardiovascular Science
Chronic Disease Issues in
Natural Disasters - The Outline
•Triumphs and Successes
•Tradition of Neglect
•Critical Challenges
•Opportunities and Hope
Cardiovascular Science
Cardiovascular Science
Chronic Disease Management
During Disasters and Emergencies
“No generally accepted
guidance on the management
of chronic diseases during
disasters has previously been
established.”
Humanitarian Charter and Minimum Standards; p 294
Cardiovascular Science
Priority Chronic Conditions During
Disasters or Complex Emergencies
Conditions for which an acute
cessation of therapy was likely to
result in death, including:
– Dialysis-dependent chronic
kidney failure
– Insulin-dependent diabetes
– Certain childhood cancers
Humanitarian Charter and Minimum Standards; p 294
Cardiovascular Science
http://www.dhs.gov/interweb/assetlibrary/NRP_FullText.pdf
Cardiovascular Science
Frequency of Selected Terms in
The National Response Plan
TERM
Outbreak
Infection/infectious disease
Cancer
Heart disease
Diabetes
Pregnant/pregnancy
Mental Illness
FREQUENCY
62
18
1
0
0
0
0
http://www.dhs.gov/interweb/assetlibrary/NRP_FullText.pdf
Cardiovascular Science
Chronic Disease Issues in
Natural Disasters - The Outline
•Triumphs and Successes
•Tradition of Neglect
•Critical Challenges
•Opportunities and Hope
Cardiovascular Science
Data to Guide Chronic Disease
Disaster Preparedness
1. Pre-disaster burden data
2. Estimates of immediate needs
3. Surge capacity of local and
neighboring health care systems
4. Ability to rebuild infrastructure
needed to support care
Cardiovascular Science
Surveillance Needs Before,
During, and After a Disaster
1. Size, functional status, and
needs prior to the disaster
2. Ability to assess the needs
and levels of actual response
during the disaster;
3. Ability to monitor the longterm effects of the disaster.
Cardiovascular Science
Chronic Disease Issues in
Natural Disasters - The Outline
•Triumphs and Successes
•Tradition of Neglect
•Critical Challenges
•Opportunities and Hope
Cardiovascular Science
Humanitarian Charter and Minimum
Standards in Disaster Response
Standard 2: Reproductive Health
Guidance Note
1. Minimum Initial Service Package
2. Gender-based violence (GBV)
3. Emergency obstetric care
4. Comprehensive reproductive
health services:
Humanitarian Charter and Minimum Standards; p 290
Cardiovascular Science
Standard 4: Chronic Diseases
Control of Non-Communicable Diseases
Cardiovascular Science
Essential Drugs and Supplies
• Life-threatening conditions
–Acute heart attack & stroke care
–Oxygen in severe lung disease
–Insulin in type 1 diabetics
–Dialysis in kidney failure
–Obstetric complications
–Acute care in certain cancers
• Medications for routine care
Cardiovascular Science
Chronic Disease and Vulnerable
Populations: Research Issues
• Direct morbidity & mechanisms
• Specific preventive strategies
• Determinants of rate of recovery
• Impact on mental health and
overall long-term health status
• Essential medications and supplies
for stockpiles
Cardiovascular Science
Summary & Conclusions
• Previous preparedness efforts often
neglected chronic diseases and
vulnerable populations
• New emphasis offers opportunities
for improved preparedness and
health protection
• Surveillance, policy development,
and assurance remain core functions
Cardiovascular Science
Cardiovascular Science
Chronic Disease and Vulnerable
Populations in Natural Disasters
Working Group at CDC
• Coordinating Center for Health
Promotion
• Coordinating Office for Terrorism
Preparedness and Emergency
Response
• Other CDC Centers, Institutes,
Offices
• Public health partners
Cardiovascular Science
Preventing Chronic Diseases and Adverse
Outcomes in Vulnerable Population
Cardiovascular Science