Community Participation in Health Emergency and Disaster Risk Management: A Scoping Review Protocol

Bottom-up citizen engagement for health emergency and disaster risk management: directions since COVID-19

Disasters are considered one of the major threats to the health of communities. Given the global spread of disasters, there has been a renewed emphasis in recent years on using community participation approaches in disaster risk management. Community participation in field of emergency and disaster health in Low and Middle-income countries faces a lot of challenges. The objective of this study is to explore the specific challenges faced by communities in Iran concerning their participation in health emergency and disaster risk management. In this study, a qualitative content analysis as research methodology was employed. Purposeful sampling was conducted from June 2023 to May 2024 among community members who were willing to participate and had experience collaborating during disasters. Data were collected through semi-structured in-depth interviews and analyzed using Graneheim and Lundman's method. The rigor of the study was ensured using Lincoln and Guba's criteria. Each interview was recorded, transcribed into a word document, and then uploaded into MAXQDA (2020). A total of 23 interviews were conducted with 20 participants. There were 15 males and five females participating in the study including healthcare managers, academic people, and laypeople. Data analysis revealed nine distinct categories, which were grouped into three overarching themes based on their similarities. These themes addressed issues of insufficient risk perception, community traumatization, and poor social capital. This study sheds light on the multifaceted challenges that hinder effective community participation in health emergency and disaster risk management in Iran. Addressing these barriers is essential for enhancing community resilience and ensuring effective disaster preparedness. To overcome these challenges, it is imperative for policymakers, healthcare managers, and community leaders to collaborate and implement comprehensive strategies that foster community participation.

The COVID-19 pandemic, which has affected the entire world, has not only created a number of emerging issues for each country, especially in the field of public health, but has also provided a number of opportunities for risk management, alternative strategies and completely new ways of looking at challenges. This brief report examines the COVID-19 pandemic response in Türkiye and the possible implications of the experience for future responses to other health emergencies and disaster risk management, based on the lessons learned. This study uses publicly available literature from government, private sector and academic sources to analyse the conflicts, changes and lessons learned during the COVID-19 pandemic, which are components of the World Health Organization (WHO) Health Emergency and Disaster Risk Management (Health EDRM) framework. The COVID-19 experience in Türkiye has several aspects, including the significant role of healthcare workers, the existence of an effective health system accustomed to emergencies, applications based on information technologies, the partial transparency of public authorities in providing information and a socio-cultural environment related to cooperation on prevention strategies, including wearing masks and vaccination. Challenges in Türkiye include distance learning in schools, lockdowns that particularly affect the elderly, ensuring environmental sustainability, hesitation about the effectiveness of social/financial support programs, the socio-cultural trivialisation of pandemics after a while and the relaxation of prevention strategies. Lessons learned from the COVID-19 pandemic include the value of transparency in public health/healthcare information, the strengthening of all aspects of the health system in terms of health workers and the importance of a balanced economy prepared for foreseeable risks.

Among the impacts of the Coronavirus Disease 2019 (COVID-19) pandemic on the public health system in the United States has been a reevaluation of emergency response systems and procedures. This study uses publicly available literature from government, private sector, and academic sources to identify changes and lessons learned during the COVID-19 pandemic in specific aspects of emergency response, namely human resources, health service delivery, and logistics, determined based on the World Health Organization Health Emergency and Disaster Risk Management (WHO Health EDRM) Framework. Major themes of changes implemented include those intended to increase mobility and flexibility of workforce and resources, integration of various parts of the health system, and effective communication, and are anticipated to be incorporated into response systems going forward.

The widespread impact of the COVID-19 pandemic and other emergencies and disasters on people’s health and well-being has necessitated an increasingly recognized role of health systems in preventing, preparing for, responding to, and recovering from all types of emergencies. The growing appreciation of the nature of cascading and compound systemic risks has led to the adoption of a set of principles and approaches to disaster risk management, emphasizing the development and sustainability of capacities and systems that apply an all-hazards approach and a whole-of-society collaboration across various disciplines and sciences, including public health. The cause to bring a stronger focus to health in multisectoral disaster risk management has been reflected in the Sendai Framework for Disaster Risk Reduction 2015–2030, which was one of the landmark agreements adopted by the United Nations in 2015 that form the 2030 Agenda for Sustainable Development. (The other frameworks include the Sustainable Development Goals, the Paris Agreement on Climate Change, and the Addis Ababa Action Agenda on Financing for Development.) The Sendai Framework also reinforced the inclusion of natural, biological, human-induced, and other hazards within the scope of disaster risk reduction and stated the need “to strengthen technical and scientific capacity to capitalize on and consolidate existing knowledge and to develop and apply methodologies and models to assess disaster risks, vulnerabilities and exposure to all hazards.” The management of systemic health risks associated with these hazards requires the performance of many functions in health and other sectors that are brought together in the form of systems, programs, and plans that facilitate a series of joint actions within and across disciplines and sectors, and these are described in the World Health Organization (WHO) Health Emergency and Disaster Risk Management (EDRM) Framework published in 2019. As a driver for managing these risks and building these partnerships and networks between health and the wider sciences, the UNDRR-ISC Sendai Hazard Definition and Classification Review provides a globally newly agreed resource. This report and its 302 Hazard Information Profiles describe terminologies that can be used by a range of users working in disaster risk reduction, emergency management, climate change, and, increasingly, sectoral actors, including the health sector, who are pursuing sustainable development. The application of common terminology with a shared understanding of the definitions and descriptions of hazards will provide a strong foundation for the engagement of the interdisciplinary and multidisciplinary partnerships and networks needed to advance risk knowledge and joint action for the management of compound and complex risks. As another driver, United Nations agreements on specific hazards such as the Minamata Convention on Mercury, a multilateral environmental agreement that addresses specific human activities that are contributing to widespread mercury pollution, provide globally adopted approaches that aim to reduce harm at all levels across society. In the negotiation of the Sendai Framework and through other initiatives, such as in One Health, the International Health Regulations, published in 2015 and the development of the WHO Health EDRM Framework, public health has collaborated with the multisectoral and multidisciplinary disaster risk reduction community to shape global policy and guidance. The participation of the health sector in producing agreed-on definitions and descriptions of hazards in the Hazard Information Profiles has facilitated knowledge sharing on health implications of hazards including biological hazards that can benefit wider disaster risk management science. Building on this work, there are also opportunities to strengthen partnerships and the public health understanding of these terminologies and the wider range of hazards that can affect health and enable the application of health EDRM. By applying public health knowledge and skills and common approaches across sectors, based on shared terminology, the bridges between public health and the science relating to the all-hazards approach can be strengthened. These partnerships will help reduce health risks and wider socioeconomic impacts of emergencies and disasters, aligned with Winslow’s description of public health in 1920 as “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of [the whole of] society”.

A wide range of natural and man-made hazards increases the health risks at mass gatherings (MGs). Building on the Sendai Framework for Disaster Risk Reduction 2015-2030, the World Health Organization (WHO) developed the Health Emergency and Disaster Risk Management (H-EDRM) framework to strengthen preparedness, response, and recovery from health emergencies in the communities and emergency-prone settings, such as MGs. The Jeddah tool is derived from the H-EDRM framework as an all-hazard MG risk assessment tool, which provides a benchmark for monitoring progress made in capacity strengthening over a given period for recurrent MGs. Additionally, it introduces a reputational risk assessment domain to complement vulnerability and capacity assessment matrixes. This paper describes the key elements of the Jeddah tool to improve the understanding of health risk assessment at MGs in the overarching contexts of health emergencies and disaster risk reduction, in line with international goals.

With environmental degradation and rapid urbanisation, China is one of the most severely affected countries in terms of the number of disasters, human causalities and economic losses. As one of the most important indicators of disaster risk reduction, disaster-related death has been reduced in recent years due to the improvement of capacity on disaster management. As key components of primary prevention under the Health Emergency and Disaster Risk Management (Health-EDRM) framework, the emergency medical and public health response and disease surveillance system have been largely strengthened. However, the health sector in China was often only involved in the later stage of disaster response. As highlighted in the Sendai Framework for Disaster Risk Reduction 2015–2030, the international community of disaster risk reduction is calling for a widened emphasis for the health sector to employ a more proactive approach in future disaster risk reduction-related affairs. Although the newly established Ministry of Disaster Management of China has integrated the duties previously scattered in many government departments, the health sector remains not directly included in its structure. Preventive measures including primary care resilience, health infrastructure safety code and hospital emergency plan are still not in place in many areas of the country. There is an urgent need to build a framework and mechanism to ensure a better involvement of health into new China disaster management system, as highlighted in the Health-EDRM framework.

Disasters disrupt communication channels, infrastructure, and overburden health systems. This creates unique challenges to the functionality of surveillance tools, data collection systems, and information sharing platforms. The WHO Health Emergency and Disaster Risk Management (Health-EDRM) framework highlights the need for appropriate data collection, data interpretation, and data use from individual, community, and global levels. The COVID-19 crisis has evolved the way hazards and risks are viewed. No longer as a linear event but as a protracted hazard, with cascading and compound risks that affect communities facing complex risks such as climate-related disasters or urban growth. The large-scale disruptions of COVID-19 show that disaster data must evolve beyond mortality and frequency of events, in order to encompass the impact on the livelihood of communities, differentiated between population groups. This includes relative economic losses and psychosocial damage. COVID-19 has created a global opportunity to review how the scientific community classifies data, and how comparable indicators are selected to inform evidence-based resilience building and emergency preparedness. A shift into microlevel data, and regional-level information sharing is necessary to tailor community-level interventions for risk mitigation and disaster preparedness. Real-time data sharing, open governance, cross-organisational, and inter-platform collaboration are necessary not just in Health-EDRM and control of biological hazards, but for all natural hazards and man-made disasters.

IntroductionNon-pharmaceutical measures to facilitate a response to the COVID-19 pandemic, a disease caused by novel coronavirus SARS-CoV-2, are urgently needed. Using the World Health Organization (WHO) health emergency and disaster risk management (health-EDRM) framework, behavioural measures for droplet-borne communicable diseases and their enabling and limiting factors at various implementation levels were evaluated.Sources of dataKeyword search was conducted in PubMed, Google Scholar, Embase, Medline, Science Direct, WHO and CDC online publication databases. Using the Oxford Centre for Evidence-Based Medicine review criteria, 10 bottom-up, non-pharmaceutical prevention measures from 104 English-language articles, which published between January 2000 and May 2020, were identified and examined.Areas of agreementEvidence-guided behavioural measures against transmission of COVID-19 in global at-risk communities were identified, including regular handwashing, wearing face masks and avoiding crowds and gatherings.Areas of concernStrong evidence-based systematic behavioural studies for COVID-19 prevention are lacking.Growing pointsVery limited research publications are available for non-pharmaceutical measures to facilitate pandemic response.Areas timely for researchResearch with strong implementation feasibility that targets resource-poor settings with low baseline health-EDRM capacity is urgently needed.

Climate change is expanding the global at-risk population for vector-borne diseases (VBDs). The World Health Organization (WHO) health emergency and disaster risk management (health-EDRM) framework emphasises the importance of primary prevention of biological hazards and its value in protecting against VBDs. The framework encourages stakeholder coordination and information sharing, though there is still a need to reinforce prevention and recovery within disaster management. This keyword-search based narrative literature review searched databases PubMed, Google Scholar, Embase and Medline between January 2000 and May 2020, and identified 134 publications. In total, 10 health-EDRM primary prevention measures are summarised at three levels (personal, environmental and household). Enabling factor, limiting factors, co-benefits and strength of evidence were identified. Current studies on primary prevention measures for VBDs focus on health risk-reduction, with minimal evaluation of actual disease reduction. Although prevention against mosquito-borne diseases, notably malaria, has been well-studied, research on other vectors and VBDs remains limited. Other gaps included the limited evidence pertaining to prevention in resource-poor settings and the efficacy of alternatives, discrepancies amongst agencies’ recommendations, and limited studies on the impact of technological advancements and habitat change on VBD prevalence. Health-EDRM primary prevention measures for VBDs require high-priority research to facilitate multifaceted, multi-sectoral, coordinated responses that will enable effective risk mitigation.

Introduction:Vulnerable populations were the most impacted by the COVID-19 pandemic. This included those with underlying health conditions, self-employed, low-income, people with limited access to health care, and the elderly. To capture these lessons and identify resilience actions, the Health Emergency and Disaster Risk Management (Health EDRM) Framework was used to guide the application of the Public Health System Resilience Scorecard (Scorecard).Method:This study was conducted in Australia, Bangladesh, Japan, Slovenia, Turkey, and the United States. Participants included emergency professionals, doctors, nurses, environmental health specialists, researchers, and government officials. The Scorecard was used to rank the level of preparedness from 0-5 (5 the highest) for the public health system resilience indicators. Following the individual workshops, recommendations were collated and interpreted to develop consolidated priority actions.Results:The priority actions related to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. To address surge capacity issues, determining whether existing disaster structures have the capacity to provide support for hospitals during patient surges. This could include services that enable telehealth and primary health care to support hospitals during a crisis. Mental health services at the local government level should be evaluated and awareness of ecosystem risks in urban and rural areas needs to increase. Strategies for achieving reciprocal trust are required to enable uptake of public health information, and the extent at which pre-existing chronic health issues are likely to exacerbate needs to be understood and addressed.Conclusion:This study revealed several areas for strengthening public health system resilience. Priority actions relate to addressing needs relating to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. This serves as a framework for transforming public health systems to become more adaptive, flexible, and focused on enabling societies to function at the highest possible level when responding to a disaster or pandemics.

Background The COVID-19 pandemic has profoundly impacted societies, influencing countries’ Health Emergency and Disaster Risk Management (H-EDRM) systems. By taking Italy as a case study, this research aimed to investigate the response to the pandemic focusing on challenges, response strategies, lessons learned and implications for H-EDRM, with an emphasis on health workforce, health services delivery and logistics. Methods This was a retrospective observational study using qualitative methodology. Data was collected via semi-structured interviews and analyzed according to the H-EDRM framework. Multiple interviewees were selected to obtain a holistic perspective on the Italian pandemic response. Stakeholders from five sectors (policymaking, hospital, primary care, third sector, lay community) from three of the most impacted Italian regions (Piemonte, Lombardia, Veneto) were interviewed, reaching 15 interviewees in total. Results With regard to human resources, the main themes concerned the shortage of personnel, inadequate training, poor occupational health, and lack of multidisciplinarity. Regarding health services delivery, interviewees reported weakness of public health, hospital, and primary care systems. With regard to logistics, the following themes emerged: inadequate infrastructures, shortage of supplies, issues with transportation systems, and weak communication channels. Lessons learned stressed the importance of considering pragmatic disaster preparedness and the need for cultural and structural reforms. Conclusions Implications that emerged from this study can inform advancements in disaster management in Italy. Acknowledgments: This study was conducted in collaboration with the Department of Public Health and Health Policy, Hiroshima University, Japan and funded by the World Health Organization Kobe Centre for Health Development (WKC-HEDRM-K21001). *ALC and EP are both first authors Key messages • Findings show that great interconnection of sectors is key in overcoming challenges and for future disaster preparedness. • Lessons learned contribute to translating the H-EDRM precepts into practice.

BackgroundThe COVID-19 pandemic has profoundly impacted societies, influencing countries' Health Emergency and Disaster Risk Management (H-EDRM) systems. By taking Italy as a case study, this research aimed to investigate the response to the COVID-19 pandemic, focusing on the changes made to the existing H-EDRM system, with an emphasis on human resources, health service delivery, and logistics and the forward-looking strategies for the next health emergencies and disasters.MethodsWe performed a retrospective observational case study using qualitative methodology. Data was collected via semi-structured interviews and analyzed considering the World Health Organization (WHO) H-EDRM framework. Multiple interviewees were selected to obtain a holistic perspective on the Italian response to COVID-19. Stakeholders from five different sectors (policy-making, hospital, primary care, third sector, lay community) from three of the most impacted Italian regions (Piemonte, Lombardia, and Veneto) were interviewed, for a total of 15 respondents.ResultsResults on human resources revolved around the following main themes: personnel, training, occupational health, and multidisciplinary work; results on health service delivery encompassed the following main themes: public health, hospital, and primary care systems; results on logistics dealt with the following themes: infrastructures, supplies, transports, and communication channels. Lessons learned stressed on the importance of considering pragmatic disaster preparedness strategies and the need for cultural and structural reforms. Stakeholders mentioned several implications for the post-pandemic H-EDRM system in Italy.ConclusionsFindings highlight that the interconnection of sectors is key in overcoming pandemic-related challenges and for future disaster preparedness. The implications for the Italian H-EDRM system can inform advancements in disaster management in Italy and beyond.

The Sendai Framework for Disaster Risk Reduction 2015–2030 recognizes health at the heart of disaster risk management (DRM) at the global policy level. Five years on, it has catalyzed the rapid development of the field of Health Emergency and Disaster Risk Management (Health EDRM) by providing a mandate for building partnerships as well as enhancing scientific research. Key milestones achieved include publication of the World Health Organization’s Health EDRM Framework, development of the WHO Thematic Platform for Health EDRM and the WHO Health EDRM Research Network, and further application of health information principles to DRM. Furthermore, health actors at all levels have continued to engage in the Sendai Framework processes and have had a key role in its implementation and proposed monitoring. There have been significant gains made through the partnership of health and DRM, but the relationship has not been without its challenges. Many national, regional, and global initiatives continue to operate with a lack of consistency and of linkages to respond to the Sendai Framework’s call for embedding health resilience in DRM, and conversely, embedding DRM in health resilience. Overcoming this hurdle is important, and doing so will be a key marker of success of the next 10 years of partnership under the Sendai Framework.

In October 2018, at Asia Pacific Conference for Disaster Medicine (APCDM), an expert meeting to identify key research needs was organized by the World Health Organization (WHO) Centre for Health Development (WHO Kobe Centre (WKC)), convening the leading experts from Asia Pacific region, WHO, WHO Thematic Platform for Health Emergency and Disaster Risk Management (Health-EDRM) Research Network (TPRN), World Association for Disaster and Emergency Medicine (WADEM), in collaboration with Asia Pacific Conference for Disaster Medicine (APCDM) and Japan International Cooperation Agency (JICA). International experts, who were pre-informed about the meeting, contributed experience-based priority issues in Health-EDRM research, ethics, and scientific publication. Two moderators, experienced in multi-disciplinary research interacted with discussants to transcribe practical issues into related methodological and ethical issues. Each issue was addressed in order to progress research and scientific evidence in Health-EDRM. Further analysis of interactive dialogues revealed priorities for action, proposed mechanism to address these and identified recommendations. Thematic discussion uncovered five priority areas: (1) the need to harmonize Health-EDRM research with universal terms and, definitions via a glossary; (2) mechanisms to facilitate and speed up ethical review process; (3) increased community participation and stakeholder involvement in generating research ideas and in assessing impact evaluation; (4) development of reference materials such as possible consensus statements; and (5) the urgent need for a research methods resource textbook for Health-EDRM addressing these issues.