A Health in All Policies response to disaster recovery.

Abstract

The Helsinki Statement on Health in All Policies (HiAP) released after the 8th Global Conference on Health Promotion, held in June 2013, noted that 'Health for all is a major societal goal of governments and the cornerstone of sustainable development'. The writers explained that 'Health in All Policies is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity'.1,2Health in All Policies (HiAP) is an approach to public health work that builds on the determinants of health and wellbeing. The Canterbury District Health Board (CDHB) in New Zealand has been leading a programme of work in this area for several years, beginning with a major policy-level health impact assessment on an urban development strategy.3,4 Other significant projects have included joint appointments across agencies, the development of guidelines on working with determinants for local government5,6 and the formation of the Canterbury Health in All Policies Partnership (CHIAPP),7 which has enabled joined up organisational work plans across agencies. Towards the end of 2010, senior management and team leaders at Community and Public Health (CPH) had begun regular training together, learning about HiAP and how it might apply to the work of the public health unit (PHU).The DisasterA series of earthquakes struck Canterbury, New Zealand, starting on Saturday 4th September 2010 at 4.35 a.m. when the Greendale fault line ruptured for the first time in 16,000 years. There was no loss of life resulting from the first earthquake, of magnitude 7.1. However, there was considerable property damage both initially and in the subsequent aftershocks, of which there were more than 10,000. These aftershocks still continue, though with less frequency, at the time of writing in early 2014 and continue to cause anxiety among many local residents.The most serious aftershock was on 22nd February 2011 at 12:51 p.m. when a 6.3 magnitude earthquake with its epicentre in Christchurch City struck. Although of lower magnitude than the original fault rupture, the peak ground acceleration (2.24 G) was one of the highest ever recorded, and some areas of the city recorded a maximum modified Mercalli magnitude of 10. The violence of this earthquake, combined with the time of day it struck, when the city was full of workers enjoying their lunch break, contributed to the massive destruction of the central city and ultimately led to the deaths of 185 citizens and over 65,000 injuries. The central city area remained cordoned offto the public for over a year, and it is estimated that some 80% of its building stock has or will be demolished. Outside the central city, entire suburbs have had to be abandoned leading to the displacement of communities, with more than 6,000 residential properties to be demolished.Under extremely difficult circumstances, the local acute hospitals and many primary care facilities kept running. The clinical response of the local health system has been documented elsewhere.9,10Stafffrom the local PHU were deployed in the immediate response to deal with water and sanitary health (WASH) issues, infection control, food hygiene and the implementation of emergency health legislation invoked by New Zealand's first and only declaration of a national disaster on 23rd February 2011. In addition, public health staffcollected and analysed population-based health data - an essential component of intelligence gathering for the national incident controller. The response of the CDHB has been praised internationally along with many of the other acute responders.11A Health in all Policies UNITThe PHU leadership team recognised that this was an opportunity to 'leapfrog' to the HiAP approach and consequently, immediately after the February earthquake, the unit was restructured in order to prioritise HiAP and support staffto utilise a determinants framework in all areas of their work. …