“COVID-19 provides a compelling case for an all-hazards approach”

On the International Day for Disaster Reduction, IANPHI talks to Dr. Stella Chungong, director of Health Security Preparedness at the World Health Organization (WHO), and Prof. Virginia Murray, head of Global Disaster Risk Reduction at Public Health England, about the recent Hazard Definition and Classification Review technical report, published in July 2020 by the United Nations Office for Disaster Risk Reduction and the International Science Council. The UN secretary general's special representative for Disaster Risk Reduction Mami Mizutori describes the report as a “timely milestone in the actions that have been taken over the last five years to accelerate implementation of the Sendai Framework for Disaster Risk Reduction”.

Dr. Chungong and Prof. Murray, who led the technical working group leading up to the report, talk about the report’s significance and potential applications for national public health institutes (NPHIs) against the backdrop of COVID-19 and the health risks of many other emergencies.

This interview was conducted by email. It was slightly edited for length and clarity.

IANPHI: Before we dive in to the newly released technical report, can you take us back five years and talk a bit about the UN landmark Sendai Framework for Disaster Risk Reduction 2015-2030?

Adopted by 187 Member States on 18 March 2015 at the Third World Conference for Disaster Risk Reduction in Sendai, Japan, the framework aims at “the substantial reduction of disaster risk and losses in lives, livelihoods and health and in the economic, physical, social, cultural and environmental assets of persons, businesses, communities and countries.”

What are the health aspects of the Sendai framework? In your opinion, what makes the Sendai Framework a critical tool for public health stakeholders, such as NPHIs? How is health central to disaster risk management?

Prof. Virginia Murray: The Sendai Framework provides UN member states with concrete actions to protect development gains from the risk of disasters, including those due to natural, biological and technological hazards. The Sendai Framework works hand-in-hand with the other agreements which form the 2030 Agenda for Sustainable Development, including the Paris Agreement on Climate Change, the New Urban Agenda, and ultimately the Sustainable Development Goals (SDG). 

Prof. Virginia Murray

The Sendai Framework is a significant advance in the way the global and national multisectoral disaster risk management community, as represented by the Member States who adopted the Framework, have increased their recognition and understanding of the critical role of public health in disaster risk management. The Sendai Framework gives far more prominence to public health than its predecessor agreements. From the three references to health in the Hyogo Framework for Action (2005-2015), the Sendai Framework refers to the many dimensions of health on 38 occasions, so it is a prime example of “health in all policies” and makes specific reference to the International Health Regulations (IHR) (2005). The achievement was due to the key roles played by Ministries of Health from many countries in the negotiations to advocate strongly for the inclusion of health throughout the Sendai Framework.

Dr. Stella Chungong: The Sendai Framework is indeed a significant agreement for public health. It recognizes that the IHR (2005) is an important global framework that countries can use to strengthen health security preparedness. The Sendai Framework provides a bridge between disaster risk reduction, the IHR (2005) and other sectors by supporting countries to advance whole-of-society and all-hazard emergency and disaster risk management approaches in terms of strengthening country preparedness capacities. The Sendai Framework also supports countries to progress towards the health-related SDGs. Therefore, the Sendai Framework and the IHR (2005) together provide a basis for coherent action to reduce health emergency risks and impacts and to facilitate resilience and recovery. In light of that, we have published the WHO Health Emergency and Disaster Risk Management (EDRM) Framework to capture and consolidate country experiences into global guidance for disaster risk management that can be shared with all countries across the world. 

Dr. Stella Chungong

Health permeates all aspects of the Sendai Framework – the goal, the outcome, the principles, the targets, the priority actions and the roles of all stakeholders. The Framework not only refers to saving lives and reducing mortality, more broadly it recognizes the need to reduce the risks and impacts of emergencies on people’s physical and mental health and well-being, and to prioritize whole-of-society action and investments accordingly from the national to local levels. 

The Sendai Framework also reinforces the inclusion of biological hazards, such as infectious disease outbreaks, along with other natural and human-induced hazards, in the scope of all-hazards disaster risk management, such that the principles and actions described in the Sendai Framework are universally applicable to disaster risk management, including emergency preparedness, for the range of risks that communities and countries face. In light of the need for robust governance mechanisms to achieve effective disaster risk reduction and emergency preparedness, the Sendai Framework calls for all sectors to take action to reduce risks to health and other socioeconomic assets in the community. 

The Sendai Framework also highlights priority actions directly aimed at reducing health risks or strengthening the capacity of the health sector, such as “enhancing the resilience of health systems, integrating disaster risk management into primary, secondary and tertiary health care; developing the capacity of health workers; ensuring health facilities remain safe and operational during and after disasters, and enhancing training capacities in disaster medicine; supporting community health groups in disaster risk reduction … with other sectors, and implementation of the International Health Regulations (2005).” 

I can give an example here. WHO’s ‘safe hospital program’ implements this particular priority action by supporting countries in making national health facilities resilient and better prepared for emergencies through capacity assessments and development. During the COVID-19 pandemic, WHO published a rapid readiness checklist for hospitals to scale up capacities required to manage COVID-19 cases. Over 3,000 hospitals across the globe already assessed their preparedness and readiness and took actions to improve the capacity to serve communities in times of great need.    

IANPHI: How is the Sendai Framework helpful to NPHIs and what can NPHIs do to advance its goal? What is the role of NPHIs in disaster risk management and how can NPHI be more engaged? 

Prof. Murray: The relevance of the Sendai Framework to health has been reflected in global, regional and national health policies and guidance. The references to health in the Sendai Framework have been amplified by WHO in the Health EDRM Framework, which guides countries and their respective stakeholders on putting in place the capacities needed to prevent, prepare for, respond and recover from emergencies.  The combination of the Health EDRM Framework and Sendai Framework have provided the foundation for linking health and multisectoral actions, including national strategies for disaster risk reduction. 

In the time of COVID-19 these frameworks provide guidance on generic actions to be taken with and across all sectors, and also refer to specific actions for particular aspects of public health. It is the collaboration between stakeholders to apply the WHO Health EDRM Framework and support the implementation of the IHR (2005) and the Sendai Framework that will make a very good way to progress for all the NPHIs associated with IANPHI.

In the Sendai Framework, the generic actions, such as risk assessments, strengthening governance arrangements, emergency preparedness, recovery and building back better, demonstrate the need for health actors, including NPHIs, to implement these measures with their health sector partners, and also to bring health risks, needs and actors to the multisectoral and whole-of-society forums and decision-making processes. This will ensure that all sectors can work together to address the determinants of health and manage the critical interdependencies that produce better health outcomes for people at risk, including those with the highest levels of vulnerability. 

IANPHI: The Hazard Definition and Classification Review technical report offers a new, extended hazard list comprised of over 300 hazards grouped into eight clusters: meteorological and hydrological hazards, extraterrestrial hazards, geohazards, environmental hazards, chemical hazards, biological hazards, technological hazards, and societal hazards. Why was this identification and classification work needed? What are its potential applications?

Prof. Murray: The COVID-19 pandemic is a timely reminder of how hazards within the complex and changing global risk landscape can affect lives, livelihoods and health. It provides a compelling case for an all-hazards approach to achieve risk reduction as a basis for sustainable development. The broad range of hazards of relevance to risk reduction and resilience building, and the increasingly interconnected, cascading and complex nature of natural and man-made hazards, including their potential impact on health, social, economic, financial, political and other systems, are all interlinked in the discussions on sustainable development and climate change adaptation. 

Although understanding of hazards and their related impacts has evolved over recent decades, and lists of hazards are available at many levels from many organisations, a single overview that provides a full picture of hazards to help inform the policy, practice and reporting of disaster risk reduction and management within and across all sectors was not available. The need for a more systematic approach and standardised characterisation of hazards was highlighted by both the policy and scientific communities.

This lack of a coherent view of hazards hampered disaster risk management in several ways: it compromised effective reporting by countries on aspects such as mortality, morbidity, economic loss, damage to basic infrastructure and disruption of basic services; it was a barrier to implementing a comprehensive and inclusive approach to the development of national and local disaster risk reduction strategies and related financing and regulatory frameworks; and it affected the capacity to develop and use multi-hazard early warning systems effectively and forecast events in the future.

In May 2019, the UN Office for Disaster Risk Reduction (UNDRR) and the International Science Council (ISC) jointly established a technical working group to identify the full scope of hazards relevant to the Sendai Framework as a basis for countries to review and strengthen their risk reduction policies and operational risk management practices. This report presents the first results of this international collaborative effort.

As a scientific undertaking, the technical working group was guided by the definition of ‘hazard’ adopted by the United Nations General Assembly (UNGA) in February 2017; namely, “a process, phenomenon or human activity that may cause loss of life, injury or other health impacts, property damage, social and economic disruption or environmental degradation”. This definition covers a broader scope of hazards than has traditionally been the case in the field of disaster risk reduction and expands the definition of hazard to include processes and activities. 

The initial hazard list was compiled from existing hazard glossaries and terminologies. To limit the potentially infinite scope of hazards addressed, a hazard was only included if it fulfilled each of three criteria: has the potential to impact a community; has measurable spatial and temporal components; proactive and reactive measures are available. The hazard list currently excludes complex human activities and processes where it was difficult to identify a single or limited set of hazards, compound and cascading hazards, and underlying disaster risk drivers (such as climate change).

The technical working group used an iterative process of developing and reviewing the hazards listed through extensive consultation with over 500 technical experts from relevant science groups, UN organisations, the private sector and other partners. The hazard list comprises 302 hazards grouped according to the eight clusters you mentioned. Although this hazard list is considered to be the most useful at the present time, it is not a definitive list and needs regular review and updating. 

Hazard definitions are sourced from the highest possible authority (such as the UN agency responsible for providing guidance on the hazard), reflect scientific consensus on the issues addressed, and are of broad international relevance. To help compile consistent definitions and descriptions for the hazards listed, the technical working group developed a common template to be applied to all hazards. A hazard information profile (‘HIP’) for each hazard has been completed for most of the hazards. The finalization of all HIPs will continue in the coming months. 

Further development or prioritisation of hazards should be made in the context of the risk management objectives of each stakeholder, and the hazard list developed as part of this project can serve as a tool to help countries and communities investigate the potential sources of risk in their own context. 

As hazards are expected to intensify with the effects of complex challenges, such as climate change and in the current COVID-19 global pandemic, enhancing resilience to hazards is key for disaster risk reduction. This requires robust hazard and risk information as well as strengthening the science-policy-society interface to achieve better risk informed public and private decision-making and investment for long-term resilience. This UNDRR/ISC Sendai Hazard Definition and Classification Review will support and enhance this interaction. Given its scope and complexity, this report raises important opportunities for further work. These are presented in a series of recommendations for consideration by the UN system, individual countries, the scientific community and other actors constituting the disaster risk reduction community. Ultimately, this report takes stock of how our understanding of hazards is shifting as we move from managing disasters as events to managing risks.

Dr. Chungong: Health risks are associated with many different types of hazards – disease outbreaks, natural, technological and societal hazards. The WHO Classification of Hazards which was published as an Annex to the WHO Health EDRM Framework was a key reference for the UNDRR/ISC Hazard Definition and Classification Review. 

From the traditional focus of disaster risk reduction on natural, technological and other hazards, the health sector’s influence was to ensure that a wide range of hazards that have the potential to cause emergencies and disasters and have implications for public health were included in the new extensive set of hazards.  

An understanding of the range of hazards that may affect communities is central to emergency and disaster risk management for heath and other sectors. The interaction of different hazards with the range of diverse vulnerabilities that many communities face can amplify health risks considerably and it is important to understand these.

Health policy makers, practitioners and stakeholders including NPHIs and academia can use this report as a core reference for:  

• Supporting all-hazard risk assessments
• Capacity development for national disaster risk reduction
• Design and implementation of national plans and strategies for emergency and disaster risk prevention, preparedness, response and recovery 
• Monitoring and reporting progress toward the reduction of health risks and impacts of emergencies and disasters on communities 
• Decreasing exposure and vulnerability to hazards 

IANPHI: One of the recommendations of the report is to “use this hazard list to actively engage policymakers and scientists in evidence-based national risk assessment processes, disaster risk reduction and risk-informed sustainable development, and other actions aimed at managing risks of emergencies and disasters.” How can NPHIs contribute to these processes?

Prof. Murray: Engagement with a range of users, such as NPHIs, working in disaster risk reduction, emergency management, climate change, and increasingly sectoral actors pursuing sustainable development is needed to further develop hazard definitions. These users are likely to be representatives of Sendai Framework Focal Points and National Platforms for disaster risk reduction, regional economic and social commissions, policymakers, communities and practitioners within and across all sectors. 

By socialising this report, it will be possible to assess the value of the hazard terminology report and tool by users and sectors. The Hazard Information Profiles (HIPs) could also be used by the United Nations Statistics Division and the National Statistical Offices to ensure interoperability and standardisation of statistically relevant definitions of hazards across the Sendai Framework, Paris Agreement and the SDGs for use at local, national and international levels. This will ensure synchronisation among global and national statistical mechanisms and processes. 

Dr. Chungong: NPHIs play an important role in risk assessment processes, disaster risk reduction and risk-informed sustainable development. NPHIs can use the hazard list to better engage and advocate the principles of disaster risk management to key national and international stakeholders involved in emergency risk reduction and national preparedness assessments. NPHIs can also provide significant support in institutionalising disaster risk management approaches and ensuring their sustainable application toward health security preparedness.  

NPHIs can also use their role to further expand national training and education programmes to better reflect disaster risk management practices and principles given that these remain under represented. This can also extend to facilitating the inclusion of disaster risk management in national research and development programmes.

IANPHI: The WHO Health Emergency and Disaster Risk Management (EDRM) Framework, which offers a comprehensive approach for all who are working to reduce health risks and consequences of emergencies and disasters, and build the resilience of health systems, communities and countries, celebrates its first anniversary this month. Can you give us an update on the progress made for the implementation of this framework? 

Prof. Murray*: The WHO Health EDRM Framework is a major breakthrough for the way in which States approach the management of emergencies and disasters. The Health EDRM Framework provides guidance to Member States and multisectoral actors on the wide of range of key functions that are needed to effectively reduce the risks and impacts of emergencies and disasters. The Health EDRM Framework is built on good practice and experience from countries and the fields of disaster medicine, epidemic preparedness and response, health system strengthening, humanitarian action and multisectoral sectoral disaster risk management. It is important to note that WHO has also published a Glossary of Health Emergency and Disaster Risk Management Terminology to support the common use of terms for the implementation of Health EDRM.

A key aspect of the Health EDRM Framework is the focus on applying a risk management approach that involves all stakeholders in health and other sectors from community to national to global levels. The principles and practice of health emergency and disaster risk management are being used by a wide range of actors in many aspects of public health policies, guidance and action on emergencies and disasters, and also the multisectoral and UN system.

Dr. Chungong: At WHO, the health EDRM Framework has been integrated in the 13th WHO General Programme of Work. WHO and UN system guidance on topics such as strategic risk assessment and national emergency response planning and improving reporting on health aspects of the Sendai Framework reporting are drawing on the Health EDRM Framework to strengthen them. Countries are also applying risk management approaches to sustain capacities and strengthen emergency preparedness by integrating health plans in multisectoral national strategies, policies and planning for disaster risk reduction. Health EDRM is everybody’s business – countries, partners, WHO and, of course, communities. 

In the context of the COVID-19 pandemic, whole-of-society approaches to manage risks are being advanced in countries in line with the principles of the Health EDRM Framework. The WHO director general has called for global solidarity and national unity under the leadership of governments, as the key to successful action, which is epitomized by the principles of the Sendai Framework and the functions identified in the Health EDRM Framework. In a recent webinar that was jointly organized by WHO, UNDRR and the Inter-Parliamentary Union, the WHO director general reiterated this call with over 400 parliamentarians across the world to enhance the engagement of policy makers to reduce the COVID-19 risks in the communities. 

A key aspect of next steps for Health EDRM can be seen in WHO’s work with countries and partners to continue development of the WHO Thematic Platform for Health EDRM and its associated research network. The Health EDRM Research Network (Health EDRM RN) has been influential in bringing health research into global disaster risk reduction research, and it has also been used to strengthen evidence for national health EDRM strengthening. This includes the recent publication of Guidance on Research for Health EDRM. Based on the advice from the Health EDRM RN, the WHO Centre for Health Development has launched calls for proposal for research in Health EDRM as well as for the context of the COVID-19 pandemic. The research network will consolidate its work around a Knowledge Health Information Hub and the elaboration of a Health EDRM Research Agenda.

* Prof. Murray is also co-chair of the WHO Thematic Platform for Health-EDRM Research Network.