Health Emergency and Disaster Risk Management (Health-EDRM): Developing the Research Field within the Sendai Framework Paradigm
Health Emergency and Disaster Risk Management (Health-EDRM): Developing the Research Field within the Sendai Framework Paradigm
Sharon Tsoon Ting Lo 0 1 3 4 5 6 7 8 9 10
Emily Ying Yang Chan 0 1 3 4 5 6 7 8 9 10
Gloria Kwong Wai Chan 0 1 3 4 5 6 7 8 9 10
Virginia Murray 0 1 3 4 5 6 7 8 9 10
Jonathan Abrahams 0 1 3 4 5 6 7 8 9 10
Ali Ardalan 0 1 3 4 5 6 7 8 9 10
Ryoma Kayano 0 1 3 4 5 6 7 8 9 10
Johnny Chung Wai Yau 0 1 2 3 4 5 6 7 8 9 10
0 Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong , China
1 & Sharon Tsoon Ting Lo
2 Faculty of Medicine, The Chinese University of Hong Kong , Hong Kong , China
3 With contributions from: Alistair Humphrey (Canterbury District Health Board, New Zealand), Olivier Hagon (Geneva University Hospitals), Diana Wong (Monash University), and Ada Fong (The Chinese University of Hong Kong)
4 World Health Organization Kobe Centre for Health Development , Kobe 651-0073 , Japan
5 Tehran University of Medical Sciences , Tehran 1416753955 , Iran
6 Integrated Research on Disaster Risk (IRDR) Scientific Committee , Beijing 100094 , China
7 The United Nations International Strategy for Disaster Reduction (UNISDR) Scientific and Technical Advisory Group , CH1202 Geneva , Switzerland
8 Public Health England , London SEI 8UG , UK
9 Franc ̧ois-Xavier Bagnoud Center for Health & Human Rights, Harvard University , Boston, MA 02115 , USA
10 Nuffield Department of Medicine, University of Oxford , Oxford OX3 7BN , UK
The intersection of health and disaster risk reduction (DRR) has emerged in recent years as a field of critical inquiry. Health is recognized as an outcome and a goal of DRR, and the integration of both fields is essential to ensure the implementation of the Sendai Framework for Disaster Risk Reduction 2015-2030. Health Emergency and Disaster Risk Management (Health-EDRM) has emerged as an umbrella field that encompasses emergency and disaster medicine, DRR, humanitarian response, community health resilience, and health systems resilience. In September 2016, an international group of experts met in Hong Kong to assess the current status and potential of the Health-EDRM research field, a research area that these scholars characterized as underdeveloped and fragmented. Key challenges identified include research overlap, lack of strategic research agenda, absence of consensus regarding terminology, and limited coordination between stakeholders. The Sendai Framework provides a useful paradigm within which to shape the research field's strategic development. The WHO Thematic Platform for Health-EDRM Research Group was established to coordinate activities, promote information-sharing, develop partnerships, and provide technical advice to strengthen the Health-EDRM research field. This group will promote the generation of robust and scientific health research to support the meaningful implementation of the Sendai Framework. The intersection of health and disaster risk reduction (DRR) is a field of critical inquiry (Aitsi-Selmi et al. 2015) that is essential to ensure the comprehensive implementation of
Health disaster risk reduction; Health emergency and disaster risk management; Health-; EDRM; Sendai Framework
World Health Organization, 1211 Geneva 27, Switzerland
the Sendai Framework and the achievement of its seven
global targets, four of which are directly health-related. The
need to ‘‘strengthen the evidence-base’’ and ‘‘enhance the
scientific and technical work on disaster risk reduction’’
(UNISDR 2015, Paragraph 25) is highlighted in the Sendai
Framework’s text, with the health and DRR nexus identified
as a research field that requires further development by
actors such as the World Health Organization (WHO). On
23 September 2016, a workshop, entitled Emergency and
Disaster Risk Management for Health: New Frontiers for
Public Health Science, was held at The Chinese University
of Hong Kong. Five presentations from international
scholars and practitioners reviewed emerging trends,
identified gaps, and provided recommendations for the health
and DRR research field. This meeting was followed by
closed-door roundtable discussions, which formulated
action points to address the challenges raised. Out of these
discussions, the WHO Thematic Platform for Health
Emergency and Disaster Risk Management Research Group
was established to guide future research work. This article
presents a summary of the outcomes of these meetings,
identifies recommendations for the future development of
this research field, and advocates the prioritization of the
health and DRR nexus among researchers and practitioners.
The human health impact is precisely what makes
disasters so devastating. In addition to causing personal
tragedy and suffering, high levels of mortality and morbidity
have an important indirect impact on political, social, and
economic progress. In addition to causing disease and
infirmity, the shock and experience of hazards and their
consequences have a complex impact on physical, mental,
and social well-being (Marx et al. 2012). Good health and
wellbeing is therefore an outcome of all disaster risk
reduction activities. Despite notable developments in
countries around the world, the centrality of health to
mainstream DRR policies and practices has often not been
recognized. Efforts to integrate health into such programs
are notably scarce and frequently hidden within social,
economic, and environmental outcomes or limited to
references to ‘‘saving lives’’ (Murray 2014). Meanwhile, the
health sector has tended to retain a narrower focus on
infectious diseases (Waring and Brown 2005) and
emergency preparedness and response.
Health researchers over the past half century have
addressed various aspects of the intersection of health and
disasters. This literature highlights the diverse clinical and
public health impacts of disasters (Lechat 1979; Korteweg
et al. 2010), the application of disaster epidemiology
(Malilay et al. 2014), the synergies between emergency
management and public health (Clements and Casani
2016), and the role of public health in mitigating disaster
risks (Shoaf and Rottman 2000). However, this body of
literature has some limitations: a scoping review of the
evidence for emergency planning identified the tendency of
most articles to focus on preparedness and response, while
only a few texts relate to hazard analysis, mitigation, and
capability assessment. Moreover, a substantial proportion
of the literature reviewed consisted of anecdotal event
reports that omitted intervention evaluation or follow up
(Challen et al. 2012). Other concerns have highlighted a
‘‘fragmented and response-oriented approach,’’ with
related literature dispersed across various scientific disciplines
in a somewhat piecemeal manner (Tekeli-Yes¸il 2006,
p. 317). Overall, the systematic integration of disaster risk
reduction into the health sector and the health sciences
research fields requires acceleration and further
development (Aitsi-Selmi and Murray 2015).
Health Emergency and Disaster Risk Management
(Health-EDRM) is an umbrella term described by the
WHO that captures the broad intersection of health and
disaster risk management (DRM). Encompassing areas
such as emergency and disaster medicine, health systems
strengthening and resilience, disaster risk reduction,
humanitarian response, and community health resilience,
Health-EDRM refers to the ‘‘systematic analysis and
management of health risks, posed by emergencies and
disasters, through a combination of (1) hazard and
vulnerability reduction to prevent and mitigate risks, (2)
preparedness, (3) response and (4) recovery measures’’ (WHO
2011). Health-EDRM provides an effective policy
framework to unite diverse stakeholders to comprehensively and
effectively address this complex field, from strengthening
health and DRR efforts to building health resilience across
populations. Health-EDRM is therefore multidisciplinary,
multisectoral, and collaborative in nature (WHO 2011),
and recognizes the holistic approach required to reduce the
negative health outcomes from all hazards.
Recent years have seen health issues gain increasing
recognition and advocacy within international policy
circles (Aitsi-Selmi, Murray, et al. 2016). As a result, health is
a clear cross-cutting theme in the 2030 Agenda for
Sustainable Development, particularly within the Sendai
Framework for Disaster Risk Reduction 2015–2030
(UNISDR 2015), Sustainable Development Goals (United
Nations 2015a), Paris Agreement on Climate Change
(United Nations 2015b), and New Urban Agenda (United
The difference is particularly striking in the Sendai
Framework, which contains over 30 explicit references to
health, compared to 3 references in its predecessor, the
Hyogo Framework for Action 2005–2015 (UNISDR 2005).
Throughout the Sendai Framework, health is highlighted as
both an outcome and a goal, with health-focused measures
cited as a means to reduce disaster losses. Four out of the
seven global targets are directly related to health; the other
three are indirectly linked. The critical need to ‘‘enhance
resilience of national health systems by integrating disaster
risk management into primary, secondary and tertiary care,
developing the capacity of health workers to understand
disaster risk and applying DRR approaches in health work’’
has been highlighted (UNISDR 2015, Paragraph 30).
Health sector authorities and workers are identified as
contributing stakeholders to managing disaster risk and to
building community resilience.
As discussions have shifted to the implementation of the
Sendai Framework, health has continued to be advocated at
various meetings. At the UNISDR Science and Technology
Conference (Geneva, January 2016), health as a scientific
discipline was highlighted with regard to the need to build
the scientific evidence-base for DRR, in addition to
including public health emergencies into discussions
surrounding disasters (UNISDR 2016a; Aitsi-Selmi, Murray,
et al. 2016). The International Conference on the
Implementation of the Health Aspects of the Sendai Framework
(Bangkok, March 2016) promoted the Bangkok Principles,
identifying seven areas for mainstreaming of DRR within
health systems and the health sector, from the systematic
integration of health into DRR programs, building resilient
health systems, and stimulating public and private
investment to building the DRR capacity of health workers,
incorporating disaster-related health data into early
warning systems and indicators, fostering transboundary
information-sharing for all hazards, and promoting policy
coherence at all levels (UNISDR 2016b).
Thematic gaps of Health-EDRM research identified
included inquiry into invisible health needs (mental health,
psychosocial support and well-being, and sexual and
reproductive health), in addition to the risks faced by
subpopulations (children, people with disabilities, and the
elderly) and their respective needs and capacities to
manage risks to themselves and their communities before,
during, and after disasters (Khan et al. 2015). Practical
challenges identified included overlap in research
activities, lack of strategic research agenda, absence of
consensus about terminology, limited ability to develop
multisectoral and interdisciplinary approaches, challenges
in bridging the science-policy-practice nexus, limited
platforms to enable effective knowledge-transfer and
experience-sharing across transnational boundaries
(requiring translation of research into English), limited
coordination mechanisms between stakeholders, and lack of
funding (Aitsi-Selmi, Blanchard, et al. 2016). Overall, the
Health-EDRM research field remains underdeveloped and
fragmented, and requires strategic direction to maximize its
contributions to reduce disaster losses meaningfully in
terms of health, lives, and livelihoods.
The Sendai Framework can provide a powerful tool to
develop and strengthen the Health-EDRM research paradigm.
As the primary document shaping the DRR policy and
practice of Member States and other stakeholders over the
next 15 years, it can provide suggestions for the strategic
development of this research field, and add impetus for
funding and other resources that need to be directed to these
All four priorities for action in the Sendai Framework are
relevant to the Health-EDRM field. Scientific risk
assessments should be facilitated to understand the complex nature
of direct and indirect health risks from a diversity of hazards
that impact individuals and populations. Systems science
may shed light on the best way to strengthen health and DRR
governance to manage disaster risk. Improved management
can be attained through proactive measures for prevention
and preparedness, as well as timely, effective, and efficient
response, recovery, rehabilitation, and reconstruction. Public
and private resources should be invested to support
HealthEDRM initiatives, with a view to translate that research into
pragmatic and scalable disaster risk reduction activities. The
research field should be action oriented, and enhance all
aspects of Health-EDRM.
Other guiding principles of the Sendai Framework
(UNISDR 2015, Paragraph 19) may be applied to the
DRR is a ‘‘shared responsibility by central
Governments and relevant national authorities, sectors and
stakeholders’’; Health-EDRM research should similarly
be multisectoral in nature;
DRR requires an ‘‘all-of-society engagement and
partnership’’; Health-EDRM research should empower
populations to identify their disaster risks and take
action to mitigate these risks and build resilience;
DRR and DRM depend on ‘‘coordination mechanisms
within and across sectors and with relevant
stakeholders at all levels’’; one outcome of the Health-EDRM
meetings is recognition of the need for cross-sector
stakeholder coordination mechanisms to strengthen the
evidence-based approach to health-DRR;
DRR needs a ‘‘multi-hazard approach’’ and ‘‘easily
accessible, up-to-date, comprehensible, science-based
and non-sensitive risk information’’; obtaining key
information related to direct and indirect health risks
should be prioritized in the Health-EDRM research
DRR works best when ‘‘an effective and meaningful
global partnership and the further strengthening of
international cooperation […] are essential for effective
disaster risk management’’; the Health-EDRM research
field can only be fully developed through international
partnerships and cooperation, and should be prioritized as
Overall, the Sendai Framework highlights the critical
role of ‘‘academia, scientific and research entities and
networks’’ to identify disaster risk factors and emerging
disaster risks; ‘‘increase research for regional, national and
local application; support action by local communities and
authorities; and support the interface between policy and
science for decision-making’’ (UNISDR 2015, Paragraph
36). Research—when done well and focused in the right
areas—has the potential to empower stakeholders to
provide the evidence-based practices to implement the Sendai
Framework and meet the global targets relating to
reductions in disaster-related mortality and morbidity.
Recommendations for the Health-EDRM research field
The focus of Health-EDRM research should expand
its scope to encompass:
an all-hazards approach that incorporates the full
spectrum of hazards;
a holistic all-needs approach, including physical,
mental, and psycho-social health and wellbeing;
research and interventions facilitated during all
phases of a disaster (not purely in the acute
disaster risk identification for populations with
specific health needs such as children, people
with disabilities, and the elderly; and
research on and the building of health resilience
in all communities;
Health-EDRM research should develop a
multidisciplinary and multisectoral approach to ensure a truly
holistic perspective that addresses health needs in
Health-EDRM terminology should be developed and
agreed upon by key stakeholders;
Needs assessments, evaluation methodologies, and
reporting systems for cases should be developed and
standardized at an international level, particularly to
measure all dimensions of health before, during, and
after disaster settings;
Evidence-based guidelines should be developed to
build population preparedness and community health
Health-EDRM research should be facilitated with a
view to impacting DRR policy and practice;
Past research in this field should be reviewed and
assessed for better policy suggestion;
Funding mechanisms should allocate more funding to
prioritize the Health-EDRM research agenda; and
Multistakeholder partnerships should be developed to
spearhead research in this field, in accordance with
the Sendai Framework.
The Health-EDRM research field has the potential to
build the scientific evidence base and meaningfully guide
the implementation of the health aspects of the Sendai
Framework (Pearson and Pelling 2015). The Health-EDRM
field requires strengthening and support to unite diverse
stakeholders (Murray 2014). This would enable and
enhance rigorous research of previously understudied
issues that relate to health, disaster risk, and
resiliencebuilding provided that research uses a holistic and truly
Consisting of scholars and practitioners from the
HealthEDRM field, the WHO Thematic Platform for
HealthEDRM Research Group will provide an international
multistakeholder and interdisciplinary platform to
coordinate activities, promote information-sharing, develop
partnerships, and provide technical advice to United
Nations agencies and other stakeholders to strengthen and
develop the field of Health-EDRM research. Overall, it is
hoped that this group—through continued advocacy for
greater prioritization and focus on Health-EDRM—will
accelerate the development of this critical research field.
The knowledge developed by such research can provide the
evidence-base that will enable effective implementation of
the Sendai Framework.
For those who would like to engage in the development
of this WHO Thematic Platform for Health-EDRM
Research Group, please contact the current co-chairs Emily
Ying Yang Chan at and Virginia
Murray at .
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