| Environmental health management after natural disasters |
Health sector representatives repeatedly have expressed their commitment to improving the environmental health conditions of the population they serve, as a vital part of the primary care approach that stresses prevention of disease over cure of avoidable illness. Despite long-standing recognition of the essential link between the environment in which people live and work and their enjoyment of good health, much progress has yet to be made in this regard. Gastroenteritis and diarrhea! diseases take a heavy toll in the region of the Americas, especially on infant life; and water-borne and water-related diseases are still major causes of morbidity and early mortality.
The importance of environmental health was underscored by an extraordinary session of the United Nations General Assembly, which in 1980 declared the decade ending in 1990 as the International Drinking Water Supply and Sanitation Decade. Providing healthful environmental conditions for an expanding, increasingly urbanized population is a task that cannot be accomplished by the health sector alone. It requires the commitment of governments to a broad intersectoral approach-including education and housing-within the framework of economic and social development plans.
Yet it falls upon the health sector to provide leadership in determining environmental health needs and planning and executing measures to meet them. PAHO has developed a comprehensive plan of action for health strategies in the region of the Americas. High priority is given to the provision of drinking water and basic sanitation services. In the spirit of the International Drinking Water Supply and Sanitation Decade, PAHO's Member Governments have set 1990 as the target date to "provide safe drinking water and adequate sanitation services to the greatest possible number of inhabitants." Within the overall strategy of achieving Health for All by the Year 200O, that year has been set as the date to extend this coverage to all persons.
Natural disasters, to which many countries in the region of the Americas are prone, can seriously jeopardize progress made in the area of environmental health. Physical disruption of infrastructure and services is aggravated by the displacement of large sectors of the population. The consequent alteration in their daily environment has potentially hazardous health consequences. Too often, it has been necessary to spend scarce resources on emergency measures just to reestablish previously existing environmental health services. Progress in such circumstances is severely hampered.
The series of manuals on disaster preparedness being issued by the Pan American Health Organization is designed to respond to the call from member countries to "disseminate the appropriate guidelines and manuals" in order to assist health workers in the Americas in developing disaster preparedness plans and training the necessary human resources. Given the suddenness of their occurrence and the importance of speedy measures to prevent potential morbidity and mortality, natural disasters demand that a nation use appropriate technology and its own human resources during the immediate emergency. Dependence on outside resources can create a time lag that may have serious consequences for the health and well-being of the affected population.
This manual is intended to provide a framework to assist planners in the health and other sectors to incorporate in their action strategies measures to protect the population from the deleterious effects of natural disasters. If not taken into account ahead of time, disasters may wreak unnecessary havoc with environmental health services that were established at tremendous cost where resources are scarce. This will occur even in areas where clean water and adequate sanitary facilities have existed for a long enough time to be taken for granted. The manual also addresses measures that should be taken once a disaster strikes to diminish its long-term effects on the health of the population and to speed up the recovery process.
If the potential effects of natural disasters are considered and provided for in advance, serious health aftereffects may be averted, costly repairs may be reduced, and progress toward Health for All by the Year 2000 may be maintained despite adverse natural circumstances.
HÃ©ctor R. AcuÃ±a, M.D., M.P.H.