Disasters are Still Bad for You

Today’s New York Times carries an article reporting that reconstruction in Joplin is bringing in new stimulus to the economy

On the surface my response is “a- duh”. Dig a whole and then fill it in and call the filling “new activity”. Or remember the Broken Window Fallacy, that breaking windows creates work for glaziers (good, if that is where you stop looking) but wastes the shop-owner’s money (ah, there’s more to the story).

But maybe it’s more than that. An article in the New Yorker reviews how disasters in wealthy, developed societies may lead to overall economic growth. James Surowiecki writes in that article that something akin to “accelerated depreciation” may occur: disaster-stricken economies don’t simply replace broken windows, as it were; they upgrade infrastructure and technology, and shift investment away from older, less productive industries.”

This argument was advanced in this 2002 paper by Mark Skidmore of the University of Wisconsin-Whitewater and Hideki Toya of Nagoya City University in Japan.  They said that some disasters can boost GDP by forcing upgrades in technology and infrastructure, and offering the opportunity for critical reappraisal of ingrained modes of economic activity, leading to a higher level of productivity and, eventually, to net gains in growth. They find that this holds for some weather-related disasters, but not for geological disasters. The argument of this paper, which is as strong as the disaster-bonus case gets, is a touchstone for a good deal of later research.

Dive into the question deeper and consensus remains that disasters are bad for you. For those of you who want to read more, Will Wilkinson has a survey and treatment of this question in the Economist.

Just as that Skidmore and Toya study finds that GDP growth rates are resilient only in wealthy, more developed countries and that in poor, less developed countries that disasters have no such positive effect, I believe the same difference can be seen in communities. Communities with wealth, social capital, strong civic structures and participation, leadership, equity, etc. will do well. Those without face a disaster plain and simple. Some people do improve their lot, too; good luck finding a Joplin contractor who has time to fix your house at this point.  But as we know, people, like communities or countries, who are poor, poorly insured, and otherwise without easy access to capital fare rather badly in reconstruction.

The other problem is with the measure.  GDP is simply a measure of the transfer of goods and services.  It has nothing to do with general well-being.  Money is being redistributed from insurance companies to home-owners, from home-owners to construction workers, and from one section of town to another.

Someone needs to do the same economic study of towns in disasters as the economists did with countries. This would go a long way to helping us understand what makes up resilience in a community.

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National Academy of Science Comments

Some of you have asked what I said today to the National Academy of Sciences/National Research Council.  They originally asked Alonzo Plough to speak and he, who was not in town today, asked me to represent him.  Here are my comments to them:

Thank you to the National Academy of Science and the National Research Council for inviting the Los Angeles County Department of Public Health to address this distinguished panel.  Dr. Alonzo Plough, the Director of the Emergency Preparedness and Response Program, regrets he is unable to address the panel today.  It is my honor to represent him today, with the assistance of Ms. Brittney Weissman, Public-Private Partnership Manager for the Emergency Preparedness and Response Program, who sits in the audience.

I am going to describe how our public health department is putting resilience into practice.  By way of background, CDC’s 15 Public Health Preparedness Capabilities are national standards for health departments to plan for resilience.  Two of the 15 Capabilities address community resilience.  Capability One is “Community Preparedness” and Capability 2 is Community Recovery. Los Angeles County Department of Public Health (LACDPH) is directly addressing Capability 1 and Capability 2 in its community resilience efforts.  During the next 5 minutes I will describe how LACDPH is implementing its community resilience plans both externally, in its relations to the community, and internally within the Department of Public Health.

Externally, LACDPH is developing its public-private partnerships.

In the Los Angeles County Community Disaster Resilience Project project (www.laresilience.org), LACDPH aims to engage community-based organizations in providing leadership and partnership to promote community resilience in the face of public health emergencies .  The key goal is to develop an active network of community agencies that work consistently with the Los Angeles County Department of Public Health and the Emergency Network of Los Angeles (ENLA) to develop resilience in communities in the context of public health disasters. ENLA is the Los Angeles County VOAD (Voluntary Organizations Active in Disasters), and is recognized as the networking agency for community based organizations that provide assistance to individuals, families, and organizations following emergencies and disasters.

Through community organization meetings, surveys, and workgroups this project aims to identify what agencies and CBOs are doing, what leadership they could provide, and what it would take to build more resilient communities in Los Angeles County.

Three community resilience workgroups are now working to engage community partners more fully in resilience.  The three workgroups have different and intersecting aims and share the same aim of identifying existing social networks, services and resources that can be dually used for improving resilience or otherwise leveraged to this goal.

For instance, the purpose of the Vulnerable Populations Workgroup is to identify the specific populations in Los Angeles County that are vulnerable to public health emergencies and to identify strategies that will enhance their integration into plans to build community resilience.   Initial workgroup discussion questions:

· What resources can be used for the dual purposes of preparedness and building healthier communities?

· What are new ways to engage all vulnerable populations in building the resilience of a community?

· How can the Los Angeles County Department of Public Health work with community-based organizations including social service organizations, schools, businesses, and faith-based organizations to meet the goals of reduced vulnerability and increased community resilience?

In this context, it is worth mentioning that LACDPH is advising UCLA investigators on a related project the aim of which is to determine how local health departments work effectively with community-based organizations and faith-based organizations to enhance preparedness.  One likely lesson we are learning from these two projects combined is about VOADs generally.  The Voluntary Organizations Active in Disasters (VOAD) model can greatly enhance linkages between health departments and CBO’s.  Also, variations in VOAD effectiveness appear to be related to variations in funding, staffing, membership requirements, and the quality of their relationships with local government counterparts.  Enhancing VOAD effectiveness and linkages to public health departments may be one way that community resilience can be fostered in other communities.

Second, we are very excited about a new media campaign that LACDPH  is rolling out in August that publicly announces the paradigm shift from individual preparedness to community resilience.  Community sufficiency will be the theme.  A focus on “we” is replacing the focus on “me”.  No longer will billboards exhort citizens to get prepared by making a plan or kit, though that’s certainly still important.  At the heart of this campaign is the question of how do you get people to trust each other, to know each other, so that they can work together in the midst of a disaster before government help arrives. LAC DPH will also revamp its website to support the community resilience theme and will encourage community folks and organizations to connect with each other before, during and after disasters.

Third, LACDPH performs regular population assessments that include sections on preparedness and resilience markers; and analysis informs LACDPH programs and campaigns.  These are always random-digit-dialed telephone survey of the Los Angeles County population, conducted in 6 languages English, Spanish, Mandarin, Cantonese, Korean, or Vietnamese.  For instance, my team’s analysis of recent data has lead to the conclusion that low literacy materials will be particularly important and to include multiple languages with saturation in minority communities.  Determining risks to the health of the jurisidiction is a core function of the CDC Capabilities which these population surveys address.

Fourth, is the ROADMAP project.  The UCLA Schools of Medicine and Public Health, Los Angeles County Department of Public Health (LACDPH) and the City of Los Angeles Department of Aging (DOA) are collaborating on this project, a resiliency intervention that aims to build capacities for staff at the City of Los Angeles DOA Senior Centers to work with their senior consumers around safety and preparedness.  This is building new community partnerships to support preparedness by, one, linking across government agencies and, two, linking LACDPH with community resources, in this case the Senior Centers that are privately owned and contract to provide services.

This project is supplementing our understanding of how to convey preparedness messages effectively to various vulnerable communities. Our approach adopts the evidence-based approach of using a train-the-trainer model to disseminate preparedness lessons into the community.  Lay workers and volunteers are provided brief training in preparedness.  They hold community meetings and classes at public venues.  Meetings are participatory and hands-on; for instance everyone walks out with some part of their emergency plan completed.  Seniors leave with their medications written down onto an emergency card.  Social networks are leveraged to improve participation and adoption.  The content and processes are targeted and slightly adapted for different audiences.  For example, promotoras can lead “platicas” at community centers, libraries and churches; peer mentors can assist developmentally disabled adults who are living independently in the community to gather their supplies. Always the core Methods are evidence-based and straight out of the public health playbook.  Understand the whole community.  Engage the community in an authentic manner.  Meet people where they are. Build on what already works on a daily basis. Empower local action.  Evaluate.  Disseminate.

The above are examples of LAC-DPH facing outwards, developing external linkages and partnerships with the community.  All of this is complemented by LAC-DPH’s inward facing efforts to develop linkages and partnerships within the Department that support and maintain the external resilience work.  Indeed, if community resilience is also concerned with the more common adverse events and problems then LAC-DPH is infusing resilience as a fundamental concept into all the programs at DPH – Community Health Services, Health Education Administration, Health Assessment, Organizational Development and Training etc.  Dr. Plough and Brittney Weissman are undergoing a series of “Meet and Greets” with the heads of the other sections of DPH.  With the support of Dr. Fielding, the Commissioner of Public Health, slowly, the internal structure of the DPH is being infused with an understanding of resilience, to support the goal of community resilience, and community coalitions and partners that are currently linked with departments in LAC-DPH will be infused with resilience ideas, training and tools.  In sum, LACDPH will be connecting preparedness activities with other health promotion and public health prevention activities across department programs.

One last example:  LACDPH continues to develop 8 emergency preparedness public health nurses from the Community Health Services Department to engage communities and develop partnerships.  Nurses from the divisions of Maternal Child Health, Substance Abuse Prevention and Control and the Office of AIDS Program and Policy are being trained in emergency preparedness and community resilience work.  Several resilience-related trainings for all staff are slated to occur between now and the end of August including: social media tools for preparedness, response and recovery, and psychological first aid.  These trainings will be part of a broader resilience-related training curriculum implemented in partnership with the DPH training program for staff throughout the Department.

Thank you.

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Zombies Apocalypse–We May be Prepared But are We Resilient?

A sense of humor goes a long way in this business and the CDC shows they have it with their new blog post on zombie preparedness recommendations. (http://emergency.cdc.gov/socialmedia/zombies_blog.asp).

In this post self-sufficiency remains an important component of the resilience framework, but how does the rest of the resilience framework hold up in a zombie apocalypse?

In the zombie apocalypse widespread zombification threatens the very existence of civilization.  A pandemic virus sometimes brings on Z-Day, the day when the transmogrification begins. This sets into play the apocaplyse trope.

The zombies are an unprecedented threat that demonstrates the very lack of resilience in our society. Community, hah!  Community engagement is now a military action. Community disintegrates, that’s the very point.  No one can be trusted.  All our efforts at building capacity of social and volunteer organizations arefor naught. The only collective action that is possible now is hunkering down behind the perimeter and killing zombie onslaughts.  Participatory decision making is challenging with zombies.  Indeed the core components of community resilience are now leveraged against us.  Communication becomes dangerous (it may signal to the zombies where you are safely hiding). Our social networks are also dangerous and social networking is impossible (power is down).  Forget government coming to our aid since long ago the army was beaten. Of course, the vulnerable populations were the first to be eaten–hence all the senior and hospital-gown-clad zombies.

At least individual resilience factors still matter–coping, self-efficacy, optimism.  Funnily, religious faith may be dangerous to your health in the zombie movies—the doomsayer is the first to get it.

Let’s hope that the next National Health Security Strategy deals with the zombie apocalypse more forcefully

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All You Need to Read in the Journals

Hobfoll’s “Limits of Resilience” article in Social Science and Medicine, is  a great study (if you ignore the complicated statistics) because they followed over 1000 Palestinians through the Intifada. Charting depression and PTSD symptom trajectories, they identified factors predicting resilience most important of which was social support and the amount of resources lost.  From this they correctly conclude:

Loss of psychosocial and material resources was associated with the level of distress experienced by participants at each time period, suggesting that resource-based interventions could benefit people exposed to chronic trauma. Such intervention could focus on all levels of resources, including personal resources (e.g., self-efficacy, job skills), social resources (e.g., social support, family relationships), material resources (e.g., housing, transportation), and condition resources (e.g., job avail- ability, fair access to work, open borders) (Norris & Stevens, 2007). Although any meaningful intervention is complex, such a resource model leads to targeted goals that are potentially achievable.

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Will There Be a CBO Backlash?

The ‘resilience movement’ considers partnerships between government and community organizations essential to creating disaster resilient communities. And now some states are going to revoke their tax exemptions and levy new fees on them (http://www.nytimes.com/2010/02/28/us/28charity.html).

I think PREPostrophiles should examine this policy before supporting it.

Nonprofits are hurting as much as the rest of us in this economy. Meanwhile, local and state governments are turning to them to bear more of the brunt of reduced services.  On top of that, resilience advocates are looking to them to provide disaster-related services that governments cannot and will not provide to make us more resilient. Indeed, the CDC has set out an entire set of capabilities around partnerships. The BayPrep program in San Francisco is defining standards and metrics for local community organizations as disaster resilient. In Los Angeles we are engaging community-based and faith-based organizations more actively towards making our communities disaster resilient. More and more, we see nonprofits like churches and community organizations step up and provide response and relief services during disasters.

Every tax dollar taken from nonprofits will be one less dollar they can spend on services.  These are the very services our most vulnerable communities and at-risk populations need to maintain resilience.  Once the tax-man starts knocking on their doors, I fear these same organizations will have less tolerance for partnering with other government agencies (public health, emergency services) to improve disaster resilience.  We will soon be asking too much from them.  We will feel the backlash in our work.

The essential services they deliver provide the foundation for community resilience in vulnerable communities.  I bet that the dollars they spend in the community are often more effectively and efficiently spent than the dollars government spends in the same places. An ounce of their resilience-building may be worth a pound of government relief.

Instead, I’d like to see a mandate that government contracted nonprofits have a business continuity plan that describes how they will prevent interrupting their functions and get back into the work of providing services to their communities in a disaster.  But that’s a topic for another day.

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