Top of PageEvents such as the attacks of September 11, 2001, Hurricane Katrina, the 1998 Eastern Canadian ice storm, SARS and the continuing threat of infectious disease pandemics have highlighted the need to be prepared to respond to disasters from a wide range of threats. This issue of the Health Policy Research Bulletin focuses on the public health impacts of disasters and draws upon a growing body of research that is helping to strengthen emergency management's capacity to reduce those impacts. In particular, this issue:
Finally, this issue explores the benefits and challenges of strengthening the research connections between disciplines and sectors, including disaster studies, emergency management, and health and social services. In so doing, it suggests 12 areas for future research and identifies opportunities for collaboration.
While several of these terms have relevance to many professions, the definitions below reflect their use in the field of emergency management.1 Nevertheless, these terms may be subject to some interpretation.
Accidents, emergencies and disasters - a continuum:
Coping resources - the individual and community skills, material, equipment or services that can be used to meet the demands created by an incident.
Disaster threshold - the point at which the consequences of an event exceed the level of a community's coping resources, and an emergency becomes a disaster.
Emergency management - the professional discipline and process of dealing with extreme, harmful events. Emergency management involves managing the community's vulnerability, resources and environment as a means of making the community safer.
Extreme event - an occurrence that can cause severe damage within the community, including personal injuries and property destruction (e.g., a hurricane).
Hazard - the potential for a negative interaction between an extreme event and the vulnerable parts of the population that is not addressed by the community's coping resources (e.g., a mudslide resulting from a hurricane).
Resilience - the ability of a community to resist the harm of an impact and quickly return to normal.
Risk - the product of two components: the likelihood of an event occurring and the potential consequences of the event.
Vulnerability - the relationship between the common social and economic characteristics of the population, individually and collectively, and their ability to cope with the hazards they face.
Health Canada's Health Policy Research Bulletin is published twice yearly with the aim of strengthening the evidence base for health policy decision making. The Bulletin features research from across Health Canada, the Public Health Agency of Canada (PHAC), other federal departments and academia. A Steering Committee composed of representatives from Health Canada and PHAC recommends policy research themes to be featured and reviews the text for each issue. The Committee is supported by the Bulletin Secretariat within the Data Development and Research Dissemination Division of the Applied Research and Analysis Directorate, Strategic Policy Branch, Health Canada, which coordinates all aspects of the Bulletin's development, production, release and dissemination.
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In this issue, Nancy Hamilton, Managing Editor of the Health Policy Research Bulletin, speaks with Dr. Theresa Tam (TT), Director General of the Centre for Emergency Preparedness and Response, Public Health Agency of Canada, and Dr. Ronald St. John (RSJ), St. John Public Health Consulting International, and former Director General, Centre for Emergency Preparedness and Response, Public Health Agency of Canada.
Q. Over the past few years, many countries have placed an increased focus on emergency management. What are the reasons for this?
TT: The Public Health Agency of Canada was formed following the SARS outbreak, so our focus is on public health emergencies as well as other types of emergencies that have a health impact. SARS was a stark reminder that infectious diseases continue to be a threat and that with global travel they can spread around the world within hours. There is also the heightened risk of terrorism and bio-terrorism, as well as climate change and the increasing frequency of weather-related natural disasters.
Most of these threats have international relevance so countries now recognize the need for a coordinated, global approach to emergency management. Moreover, international health regulations require countries to detect, report and respond to events within short time lines. They take a risk assessment approach where you decide whether something is unusual, serious, can spread to other people, or has economic and trade impacts. And, as SARS has demonstrated, infectious disease outbreaks can have serious economic consequences.
RSJ: We've also learned from experience that there are often patterns to how disasters unfold. We began to recognize that we could manage what was happening and take a systematic approach to emergency management.
Q. What does the term emergency management mean and what types of activities are involved?
RSJ: Emergency management is a form of risk management. It involves taking steps to avoid destructive events or, if you can't avoid them, you minimize their impacts once they occur. We talk about the four pillars -- prevention, preparedness, response and recovery. It's not just about the event and the response to it; it's also about mitigating the impact of the event or preventing it altogether. When you build a canal around Winnipeg to contain the annual flood, you're working to prevent a disaster. When you prepare for an event, you plan, train and exercise. Then, when an event does happen, you have a set of operational procedures to deal with it. Your response then gradually moves into the recovery phase.
TT: I agree. We're not just dealing with the response or even preparedness. We're expected to be one step ahead. We do real-time risk assessments and scan a variety of intelligence so we can detect a possible event as it evolves or stop it from occurring or spreading before it becomes an emergency or disaster.
Q. When does an emergency become a disaster?
RSJ: While there is no hard-and-fast rule, many in the field use this rule of thumb -- an emergency becomes a disaster when a community's capacity to cope is exceeded. Knowing a community's coping capacity is critical as it determines the threshold at which an emergency becomes a disaster (see article on page 8). The threshold depends on many factors such as the level of individual preparedness, the capacity of the voluntary sector to help and the capacity of community members to come together to help each other (see article on page 34).
TT: We tend to use the term "disaster" loosely. Often, it depends on your social context, where you come from and how you are affected. On the legal front, there are declarations or states of emergencies that can apply, whereby financial assistance is made available. For example, when provinces and territories have undergone a substantial event, the federal government can provide support through the Disaster Financial Assistance Agreement.
Q. How has emergency management evolved and what has influenced our thinking and action?
RSJ: What has emerged is the concept of an integrated emergency management system that allows you to link activities together. When an event happens, you know who is responsible for doing what, when, where and how. Actually, much of the approach was first developed by California firefighters.
TT: While the early systems may have been intuitive to front-line firefighters, they weren't necessarily so for health professionals. So, it's been important to look at different models and adapt them to our needs. The key is interoperability -- the ability to link activities across jurisdictions to achieve coordination and to increase "surge capacity" (see article page 37).
RSJ: Many influences have shaped our thinking. Case studies of real-life incidents have pointed out where we have gaps (see article on page 18). These are tough ways to learn so we've also used exercises, scenarios and role- playing to identify where improvements are needed. Research on vulnerable groups has also helped to show how we can strengthen a community's resilience and coping capacity (see articles on pages 23 and 29).
TT: Emergency management requires the involvement of many players. Ten years ago, it was difficult to bring together the public health side and the emergency side. The two spoke very different languages. However, this has begun to change and increasing collaboration is contributing to the field's evolution.
Q. What role does the federal government play and how does it work to protect the health of Canadians during an emergency?
TT: In Canada, emergency management begins with a local level response. The federal government is not at the front line initially -- that's not our role. When a community is unable to cope with an event, it will call upon its provincial or territorial government which, in turn, may call upon the federal government. Public Safety Canada has overall federal responsibility, with different departments taking the lead on specific functions. For example, the Public Health Agency of Canada and Health Canada have the lead on health functions. The Agency and the Department collaborate when responding to emergencies, notably in the Health Portfolio Emergency Operations Centre.
RSJ: Although the Agency and Health Canada may have different responsibilities, as federal partners they have some roles in common. Both offer leadership and national coordination, and deal with issues of interoperability and surge capacity. They also both set guidelines and provide tools to help other jurisdictions respond.
TT: For example, the Agency is about to release the Pan-Canadian Health Emergency Management System and federal/provincial/territorial governments have approved two agreements -- one on mutual aid and one on information sharing during a public health emergency. We also conduct surveillance and outbreak investigations, and we provide surge support in the form of epidemiologists and other professionals, mobile labs, the National Emergency Stockpile System and our health emergency response teams. Health Canada, on the other hand, addresses a broad range of emergency situations, including emergencies in First Nations communities. It is also the federal lead for radiological/nuclear events and provides support and reach-back for chemical incidents, while the Public Health Agency of Canada is the lead for biological emergencies and natural disasters.
Q. They say that disasters don't discriminate, yet certain population groups appear to suffer more health impacts than others. Why are some groups more at risk than others?
RSJ: Disasters can happen almost anywhere. The impacts, however, are not homogeneously distributed. A population has many subgroups and, depending on their characteristics, some may be more or less vulnerable to the impacts of a particular event. For example, during the 2003 European heat wave, approximately 70,000 died -- mostly older persons living alone without family and support, so they did not have the capacity to escape the heat. However, it's not just a matter of age or physical functioning. Research is showing that anyone who is marginalized -- economically or socially -- may be more at risk (see article on page 23).
Q. What are some of the key challenges confronting the emergency management field from the health perspective?
TT: While we are dealing with many challenges, such as the gap in surge capacities and a review of the stockpile system, there is an overriding challenge that relates to how we plan. Because emergencies have many things in common, public health professionals are beginning to recognize the need for an all-hazards approach (see article on page 14) where you develop generic preparedness and response plans, regardless of the threat. However, there will always be something driving the need for more specific risk-based planning. For example, since SARS, we've been strengthening pandemic plans. With the Vancouver 2010 Olympics coming up we're now creating plans for emergencies during mass gatherings. What we recognize is that preparing for different types of hazards may allow us to leverage resources that will contribute to our overall preparedness.
RSJ: This relates to what needs to be done "when it's not happening" -- in other words, when there is no emergency. This is one of the most important times to invest in planning, training and exercising. Although we need long-term and sustainable investments, unfortunately, they tend to be knee-jerk infusions tied to specific events. And after the event, once the pressure is off, we tend to shift funds to other priorities.
Q. Knowing this, what types of re search are needed and how will the results be used in decision making?
TT: Having a solid research base is critical to our work. We can only put forward a major piece of policy if we have the evidence. This includes threat-risk assessments, analyses of vulnerable populations as well as the potential impacts of an event, including the health and the economic burdens. We also consider the legal context, the political environment and what other countries are doing. Recently, we've been looking at it from the perspective of the public and have had some interesting feedback about what Canadians believe is important. All of these elements need to be in place and supported by the research. When they are, it will help us move our policies forward and secure the investments we need.
RSJ: I'll add to that by pointing readers to the closing article (page 43) prepared by John Lindsay of Brandon University. He takes an overarching look at the research in the field and identifies 12 areas where further work is needed -- for example, people at risk, disaster impact investigations, volunteers, community preparedness, changing attitudes and integration of disciplines. These draw on multidisciplinary approaches and will help strengthen the connections between emergency management and health sector research.
Below is a sampling of non-intentional Canadian disasters selected for their human, physical or economic impact, or their historical significance. Unless otherwise noted, all data for this Timeline appear in the Canadian Disaster Database.1
1916 Cochrane and Matheson Forest Fire Ontario |
1917 Halifax Harbour Explosion |
1918 Spanish Influenza Pandemic |
1936 Heat Wave |
1950 Red River Flood |
|---|---|---|---|---|
The Cochrane and Matheson fire resulted from small blazes started by lightning and locomotive sparks, which combined to become a firestorm. |
The freighter Mont-Blanc, loaded with ammunition, collided with a coal freighter. The resulting explosion was the largest pre-atomic explosion in history. |
Spanish Influenza hit Canadians hard, affecting more than one quarter of the population. It was the deadliest disaster to affect Canadians. |
A two-week heat wave across Canada resulted in temperatures as high as 44.4° centigrade. |
A combination of heavy snow cover and rainfall caused the Red River to stay above flood level for 51 days. |
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1953 Polio Epidemic |
1954 Hurricane Hazel |
1979 Train Derailment |
1979-1980 Drought |
1985 Plane Crash |
1996 Flood |
|---|---|---|---|---|---|
Polio affected more than 8,000 Canadians across the country. |
Hurricane Hazel struck south-central Ontario and dumped more than 210 millimeters of rain over two days. |
A CPR train
carrying |
Poor wheat yield due to a cereal crop drought that occurred in parts of the Prairies. It was the most expensive disaster in Canadian history. |
A chartered DC-8 carrying 256 passengers crashed after takeoff, killing all on board. |
290 millimeters of rainfall in less than 36 hours washed out homes, roads and bridges, and downed power lines. |
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1997 Flooding Southern Manitoba |
1998 Ice Storm Ontario, Québec and New Brunswick |
1998 Swissair Plane Crash Peggy's Cove, Nova Scotia |
2000 Contaminated Water Supply Walkerton, Ontario |
2003 SARS Outbreak Toronto, Ontario |
|---|---|---|---|---|
Due to flooding of the Assiniboine, Red and Winnipeg Rivers, over 7,000 military personnel were employed for 36 days to assist evacuees and to prevent flood damage. |
Freezing rain fell on a corridor from Ontario to New Brunswick, resulting in power outages for approximately 3.5 million people. It resulted in the largest evacuation in Canadian history. |
Swissair Flight 111 flying from New York to Zurich plummeted into the Atlantic Ocean, 10 kilometers from Peggy's Cove, Nova Scotia. |
The water supply of the town of Walkerton, Ontario, became contaminated with a highly dangerous strain of E. coli. |
Toronto had the largest SARS outbreak outside of Asia. More than 27,000 people in and around the city were forced into quarantine. |
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2003 Northeast Blackout |
2003 Wildfires |
2003 Hurricane Juan |
2004 Hailstorm |
|---|---|---|---|
On August 14, Ontario and eight northeastern U.S. states were hit by the largest blackout in North American history. Electricity was cut to 50 million people. |
Dozens of communities were evacuated due to wildfires started by lightning and human actions, mostly in the interior of the province. |
One of the most powerful hurricanes to ever affect Canada. The category 2 hurricane packed winds reaching up to 174 kilometers per hour. |
Severe hail and rain battered parts of Edmonton, forcing the evacuation of 30,000 people from the West Edmonton Mall. |
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2005 Extreme Rain |
2006 Rain and Windstorm |
|---|---|
More than 150 millimeters |
One of the most intense weather systems to impact south coastal BC in several decades resulted in a precautionary boil water advisory and widespread power outages. |
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International Classification of Natural and Technological Disasters (Centre for Research on the Epidemiology of Disasters).2
Dr. Ronald St. John, St. John Public Health Consulting International and former Director General, Centre for Emergency Preparedness and Response, Public Health Agency of Canada; Peter Berry, PhD, Climate Change and Health Office, Healthy Environments and Consumer Safety Branch, Health Canada; Don Shropshire, National Director, Disaster Management, Canadian Red Cross; and John Lindsay, Department of Applied Disaster and Emergency Studies, Brandon University.
The authors acknowledge Stéphane L. Paré, Applied Research and Analysis Directorate, Strategic Policy Branch, Health Canada, for help with data analysis and graphs.
Whether precipitated by natural or technological triggers, disasters can lead to human suffering, damage and destruction. This article looks at disaster trends and explores some of the underlying factors contributing to their increasing frequency and severity around the world and in Canada. The article also discusses the importance of a community's coping capacity in determining whether an emergency becomes a disaster and, in so doing, sets the stage for subsequent articles on emergency management.
Over the past decade, many regions and cities in North America and around the world have suffered the effects of large-scale emergencies and disasters. With 24-hour news coverage, the immediate impacts of these disasters -- physical destruction and, in many cases, injury, illness and death -- are all too familiar. The longer term impacts, such as infrastructure damage, economic disruptions and population displacements, often garner less attention but may nevertheless have indirect, but profound, public health impacts (see page 12).
International Classification of Natural and Technological Disasters
| Natural | Technological |
|---|---|
| Hydrometeorological |
Industrial |
Geophysical |
Transport |
Biological |
Miscellaneous |
Source: Adapted from the EM-DAT Disaster Category Classification for Operational Databases, developed by the Centre for Research on the Epidemiology of Disasters and its partners.2
Although the terms "emergency" and "disaster" are often used interchangeably in the literature, their definitions differ. An emergency rises to the level of a disaster when its magnitude exceeds the capacity of the community to cope with the consequences1 (see Figure 1). As a result, a certain event may result in an emergency in one community but a disaster in another.
Throughout history, disaster classification has evolved as we have learned more about disasters and their characteristics. Disasters are classified as either "natural" or "technological." Technological disasters are those with a non-natural trigger; they can be either accidental or intentional (e.g., terrorism caused by chemical, biological, radio-nuclear or explosive devices). Although there are many subcategories under each, natural disasters include hydrometeorological (including climatological), geophysical and biological events, while technological disasters include industrial, transport and miscellaneous events.2 As the Disaster Timeline reveals (page 6), Canada has experienced disaster events in most major categories.
Figure 1: When Does an Emergency Become a Disaster?
Source: Federal/Provincial/Territorial Network on Emergency Preparedness and Response, 2004.1
Disaster data have presented a number of challenges, including the lack of standardized collection and definition methodologies (see Using Canada's Health Data, on page 47). Disaster databases, however, have improved over the past 25 years; this has facilitated the study of disaster patterns and trends at the global and country levels.
Over the past century, the greatest number of disasters has occurred in Asia (see Figure 2). While Asia's larger land mass may provide part of the explanation, other factors may also explain this:
It is also interesting to look at the proportion of different types of disasters across continents (see Figure 2). While hydrometeorological disasters make up the greatest proportion in the Americas (61%) and Oceania (79%), technological disasters comprise the greatest proportion in Africa (55%). Geophysical disasters, on the other hand, make up the smallest proportion in all continents, but are among the deadliest of all disaster types.5
Figure 2: Global Distribution of Disasters, by Continent and by Class, 1900-2008
Note: Percentages may not total 100% due to rounding.
Data source: Centre for Research on the Epidemiology of Disasters.5
In looking at the frequency of disasters and their impacts over the past 60 years, some interesting trends emerge (see Figure 3). Of the two major categories of natural disasters, the number of hydrometeorological disasters has increased significantly in recent decades, driven by an increase in extreme weather events.5 In comparison, the number of geophysical disasters has remained low, with only minor increases in the past three decades. Not surprisingly, the number of technological disasters remained low and relatively constant until the "post-war" boom in the 1960s and 1970s.
Figure 3: Disaster Impacts Throughout the World, 1950-2007
*Sum of injured, homeless and people requiring immediate assistance
during an emergency; it can also include displaced or evacuated people.
Data source: Centre for Research on the Epidemiology of Disasters.5
In terms of impacts from all disaster types, we see increasing trends in both the total number of people affected and the economic damages, but a modest decline in the number of deaths up until the last decade. The earlier decreases were encouraging and were probably accounted for by the decrease in famine deaths in Africa as a result of better food security measures and the construction of water reservoirs; reduced earthquake fatalities due to more rapid local disaster responses; and decreased deaths as a result of improved cyclone-warning measures.6 On the other hand, the past decade has seen disaster deaths rise, with approximately 600,000 deaths from the 1995 to 2002 famine in the Democratic People's Republic of Korea; 226,000 deaths from the 2004 Indian Ocean Tsunami; 75,000 deaths from the 2005 South Asia earthquake; and 70,000 deaths from the 2003 European heat wave.7
The magnitude of an event does not solely account for the harm created by a disaster; the social and economic contexts as well as the level of response capacity are also important. For example, the 1989 Loma Prieta earthquake in California registered a magnitude of 6.9 and killed 63 people,8 whereas the 1993 earthquake in Latur, India, measured 6.4 and killed approximately 9,000 people.9 In 1998, Hurricane Mitch brought havoc to Honduras and Nicaragua, killing over 10,000 people in landslides and floods. Mitch was both a natural and a human disaster, where extreme weather collided with poverty, environmental degradation and social inequality10 (see sidebar on page 10).
"Anywhere it struck, Mitch would have been deadly. But, only poverty can explain why it was so deadly in Nicaragua. In poor countries, people crowd onto marginal land, in flood plains or on the slopes of menacing volcanoes. They denude the hills, making mudslides more likely. The flimsy houses have no basements or foundations. Upriver, dams are old, poorly built, infrequently inspected. Poor countries lack the technology to track storms, the communication systems to send alarms, the resources to stage large-scale evacuations."
Washington Post, November 4, 1998
Windstorms, floods and forest fires are the predominant disaster types in the Americas.4 In Canada, as elsewhere, the risk of a disaster occurring varies from place to place. Geographic and geologic features are important risk factors for natural disasters, as evidenced by the storm paths along the Great Lakes-St. Lawrence corridor; the rock, mud and landslides in mountain regions; the droughts in the southern Prairies; and the storm surges in coastal regions and flooding of many river basins.11
In Canada, the frequency of both natural and technological disasters has been increasing over the past century (see Figure 4). The increase is largely driven by the increasing frequency of hydrometeorological disasters, particularly floods, which are the most commonly reported disaster. Flood disasters along Canadian rivers are on the rise -- almost three quarters (70%) of the river floods of the past century have occurred since 1959.12
Figure 4: Frequency of Disasters in Canada, by Selected Classes and Sub-Classes of Disasters, 1900-1999
Data source: Canadian Disaster Database.21
Table 1 provides a snapshot of deaths, the number of people affected and the direct economic costs associated with natural disasters in Canada since 1900. While analysis shows an increase in the number of people affected as well as in direct costs, mortality appears to be on the decline.
The impacts of floods have helped shape the overall impact trends. For example, there have been few flood-related deaths in Canada and relatively few injuries, perhaps due to preventive measures and the number of safe evacuations. Since 1900, several large-scale floods (e.g., 1950 Red River flood, 1996 Saguenay flood) have led to the evacuation of more than 200,000 people.13 Moreover, given the extensive economic costs associated with flooding, the psychological impacts can be substantial as affected families cope with longer term recovery issues.14
The Public Health Impacts of Disasters
Simone Powell, Division of Aging and Seniors, Centre for Health Promotion, Public Health Agency of Canada
Natural and technological disasters have both short - and long-term public health impacts, which fall into four categories:16
Table 1 : Mortality, Number of People Affected and Damages Associated with Natural Disasters in Canada, 1900-2002
| 1900-1969 | 1970-1979 | 1980-1989 | 1990-1999 | 2000-2002 | |
|---|---|---|---|---|---|
| Estimated number of disasters | 160 | 2 | 114 | 151 | 29 |
| Estimated number of deathsa | 3,010 | 114 | 283 | 179 | 18 |
| Estimated number of people affectedb | 162,462 | 25,4779 | 50,285 | 712,625 | 154 |
| Estimated direct damage costsc (Canadian $ billions) |
$4.882 | $9.712 | $17.617 | $13.710 | $0.203 |
Source: Canadian Disaster Database, Public Safety and Emergency Preparedness Canada, 2005 data.21
Notes: Data compiled using natural disaster information
about meteorological events.
a Health data not available/could not
be confirmed for some disasters.
b Number of people affected reflects the
number of people injured and evacuated during a disaster event.
c Disaster damages based on 1999 Canadian
dollars for those disasters occurring between 1915 and 2002. Total
disaster damage is based on cost data for 76 of 160 disasters occurring
between 1900 and 1969, and for 324 of 388 disasters occurring between
1970 and 2002. Estimates are conservative and include direct costs
only (excluding uninsured and indirect costs, such as hospitalization).
To understand these patterns and trends, one must examine the underlying factors that affect the risk profile of the world in which we live. Risk is considered to be the product of the likelihood of an event happening and the severity of the associated impacts.1 Hence, a number of factors often drive these patterns and trends, either by increasing the probability of the event occurring or by increasing the severity of the resulting consequences. Some of the drivers include:
Climate Change: A key factor underlying these changing risk patterns is global climate change. The Intergovernmental Panel on Climate Change15concludes that warming of the climate system is "unequivocal" and that it is "virtually certain" that there will be further temperature increases. The rate of surface water evaporation and precipitation will also increase, contributing to more frequent and unpredictable droughts, heavy precipitation, heat waves and intense hurricane activity.15
Climate change can also affect the ecological balance, creating conditions that make a disaster more likely. For example, a warmer climate led to an increasing population of the bark beetle population in British Columbia's interior forests, which in turn led to large-scale forest die-offs and an increased risk of forest fires.22 Abnormally hot, dry weather in 2003 resulted in over 2,500 wildfires, consuming over 250,000 hectares of forest, destroying over 334 homes and many businesses, and forcing the evacuation of over 45,000 people -- at an estimated cost of $700 million.23
Large-Scale Urbanization: As of 2005, half (49%) of the world's population lived in urban centres, up from 13% in 1900. The United Nations projects that this trend will continue.24 Such concentration of people and assets can magnify the impacts of disasters. The Kobe earthquake of 1995 represented the first time in history that an earthquake took place directly beneath the centre of a densely populated urban area -- and the impacts were devastating in human (more than 6,000 deaths) and economic losses (exceeding $100 billion [United States dollars] in 1995 value).25 Furthermore, the rapid growth of slums in which millions of people reside in areas lacking basic sanitation, electricity and potable water, create a fertile setting for the introduction and rapid spread of infectious diseases, increasing both the frequency of infectious disease outbreaks and the number of people infected.
Globalization: The Severe Acute Respiratory Syndrome (SARS) epidemic of 2003 demonstrates the important role that increased global trade and travel can play in the rapid spread of infectious diseases. SARS began in the wild animal meat markets of southern China where the virus was harboured by the wild civet cat that was being slaughtered and sold. Within days of the first outbreak, SARS had spread to affect people thousands of miles from its source, including Canada. While the mortality and morbidity associated with SARS did not compare with those of outbreaks such as malaria or tuberculosis, the disruptions to the global economy related to interruptions in trade and travel had an estimated global cost of $30 - $100 billion (United States dollars).26
Disasters have an uneven impact on our communities. While impacts relate to the level of exposure, they also depend upon the vulnerability of populations (see article on page 23). Disasters are on the rise in Canada and many of their impacts are increasing. This snapshot of disaster trends and their underlying factors sets the stage for discussions in the next articles about the increasing importance of emergency management in protecting the health of communities and individual Canadians -- and the need for long-term investments to reduce the risk of disasters and to prepare for, respond to and recover from them.