The programme includes the IDRC Davos 2016 agenda of sessions, plenary sessions, special panels and workshops. Click on the session title for more details.

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Session 03: Public Health: New Insights and Novel Approaches
Monday, 29/Aug/2016:
8:30am - 10:00am

Session Chair: James Herbert WILLIAMS, University of Denver
Session Chair: Reza NASSIRI, Michigan State University
Room: Sertig

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Integrative Review of Factors Associated with the Willingness of Health Care Personnel to Work during an Influenza Public Health Emergency

Mahesh DEVNANI, Anil Kumar GUPTA

Post Graduate Institute of Medical Education and Research, Dept. of Hospital Administration, Chandigarh, India

With the increasing number of public health emergencies like recent Zika outbreak, 2015 Ebola epidemic, SARS of 2002-2003, avian flu of 2006, and 2009 H1N1 pandemic influenza, it is important to understand the state of the evidence concerning the willingness of healthcare personnel (HCP) to work during a public health emergency as an effective response to any such public health emergency depends on the majority of uninfected HCP.

A systemic literature review of relevant, peer-reviewed, quantitative only, English language studies published from January 1, 2001 through June 30, 2010 was conducted. Search strategies included the Cochrane Library, PubMed, PubMed Central, EBSCO Psychological and Behavioral Sciences Collection, Google Scholar, ancestry searching of citations in relevant publications, and information from individuals with a known interest in the topic.

Thirty-two studies met the inclusion criteria. Factors associated with a willingness to work during an influenza public health emergency include: being male, being a doctor or nurse, working in a clinical or emergency department, working full-time, prior influenza education and training, prior experience working during an influenza emergency, the perception of value in response, the belief in duty, the availability of personal protective equipment (PPE), and confidence in one's employer. Factors found to be associated with less willingness were: being female, being in a supportive staff position, working part-time, the peak phase of the influenza emergency, concern for family and loved ones, and personal obligations. Interventions that resulted in the greatest increase in the HCP's willingness to work were preferential access to Tamiflu for the HCP and his/her family, and the provision of a vaccine for the individual and his/her family.

Information from this review can guide emergency policy makers, planners, and implementers in understanding, planning and influencing the willingness of HCP to work during an influenza public health emergency.

Effective Translation of Epidemiological Modeling to Support Resilience: Building Tools for Public Health Decision Making

Ellie GRAEDEN1, Claire STANDLEY2, Erin SORRELL2, Justin KERR1, Rebecca KATZ2

1Talus Analytics, United States of America; 2Milken Institute School of Public Health The George Washington University, United States of America

Resilience to infectious disease requires communities to respond rapidly and effectively to support prevention and response. These decisions are complex and require understanding of the diseases, disease intervention and control measures, and the disease-relevant characteristics of the local community. Though disease modelling frameworks have been developed to address these questions, the complexity of these models presents a significant barrier to community-level decision makers in using the outputs of the most scientifically robust methods to support pragmatic decisions about implementing a public health response effort, even for endemic diseases with which they are already familiar. Here, we describe the development of an application available for mobile devices or on the web, with a simple user interface, to support on-the-ground decision-making for integrating disease control programs, given local conditions and practical constraints. The model upon which the tool is built provides predictive analysis for the effectiveness of integration of schistosomiasis and malaria control, two diseases with extensive geographical and epidemiological overlap, and which result in significant morbidity and mortality in affected regions. Working with data from countries across sub-Saharan Africa and the Middle East, we present here a proof of principle for the use of our tool in providing guidance on how to optimize integration of vertical disease control programs. This tool represents a significant step forward in effectively translating the best available scientific models to support practical decision making on the ground with the potential to significantly increase the efficacy and cost-effectiveness of disease control, enhancing both health and resilience. Furthermore, this approach presents a new opportunity to improve public health resilience in the face of the changing landscape of infectious diseases resulting from global climate change.

Longterm Impacts of Natural Disasters on Public Health Systems


UMIT - University for Health Sciences, Medical Informatics and Technology, Austria

All over the world people are confronted with natural disasters. Depending on the conditions (e.g., type, intensity and duration of a natural disaster, disaster response, vulnerability) a disaster may have different impacts on public health systems. Literature research revealed a severe lack of research concerning long-term impacts on public health issues. The WHO defines public health as all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. This definition was taken into consideration in order to identify long-term impacts. For the analysis the research team used two Austrian natural disasters (avalanche and flood). A mixed-method approach was chosen. First, a theory-based questionnaire was developed that serves as guideline for the data collection by document analysis. Second, interviews were conducted with experts who were involved in the disaster management to gain further data. The transcribed text of the interviews was analysed by GABEK (GAnzheitliche BEwältigung von Komplexität), which supports the structuring of expressed experiences, knowledge, and perceptions. As a result, we receive holistic pictures of complex social phenomena. We have identified various long-term impact variables in conjunction with different time frames. Although the impact variables and time frames depend on the nature and extent of the disaster, affected people, existing infrastructure etc., an attribution of single long-term impacts to the categories “health system performance”, “security“ and „health protection” has been proved as reasonable. It gave a first systematisation of long-term impacts. Based on the learning experiences of each disaster, key strategies and recommendations from a public health system perspective have been developed. The results of this research project is part of an EU-funded project called PsyCris (PSYcho-social Support in CRISis Management).

Collaborative Health Threat Detection and Risk Assessment: A Case Study


Joint Research Centre of the European Commission, United Kingdom

The early detection and risk assessment of emerging global health threats is a complex multi-disciplinary task requiring significant expertise and resources. This presentation will introduce the Early Alerting and Reporting (EAR) platform of the Global Health Security Initiative and the Hazard Detection and Risk Assessment (HDRAS) project of the World Health Organisation which provide a solution to this challenge. In addition, it will present the EIOS project which will unify the two systems and expand and deepen the rapid risk assessment functionality with the aim of providing truly actionable, timely advice to policy makers.

Both projects involve harvesting information from open source news using the European Media Monitoring technology to provide the base information classified and sorted by threat type, location, source type and source. This is then presented to users who can identify incidents of interest. Automatic notifications are created whenever incidents under review are generated allowing other analysts to collaborate on the risk assessment. A daily digest of selected articles is created and circulated to interested users. The system proved its value during the Ebola outbreak of 2014. The story of the early days of the outbreak will be told from the point of view of the EAR platform showing the first detection and subsequent interaction and collaboration.

Finally, the planned extension of the system to inform rapid risk assessment using contextual information of various forms provided to users based on the nature of the threat identified will be explained and the ‘segmentation’ of the system to allow different organisations and departments to work together and also maintain privacy during the monitoring and risk assessment phases.

Trauma Signature Analysis of the 2014/2015 West Africa Ebola Outbreak: The Prominent Role of Fear-Related Behaviors (FRBs)

James Michael SHULTZ

University of Miami Miller School of Medicine, United States of America

The 2014/2015 West Africa Ebola virus disease (EVD) pandemic – a “biological disaster” - dwarfed all previous outbreaks. Earlier episodes were rural, short-lived, and sputtering, but the West Africa EVD outbreak surged through dense-packed urban populations in Guinea, Sierra Leone, and Liberia, intensifying into a firestorm of disease. Among these three nations, more than 28,600 persons became ill and more than 11,300 died by year-end 2015. The World Health Organization vividly described how fear-related behaviors (FRBs) propelled virus transmission in West Africa.

An international team of psychiatric experts applied trauma signature (TSIG) analysis to examine the psychological stressors in relation to exposure to the unique constellation of hazards in the West Africa EVD pandemic. TSIG analysis is an evidence-based method that examines the interrelationship between population exposure to a disaster (pandemic in this case), and interrelated physical and psychological consequences, for the purpose of providing timely, actionable guidance for effective mental health and psycho-social support (MHPSS) tailored to the defining features of the event. For the Ebola outbreak, the TSIG analysis consisted of the creation of a hazard profile, a matrix of psychological stressors by disaster phase, and a “trauma signature” summary for the outbreak-affected populations. FRBs, and fear-riddled media portrayals, were specifically examined.

The TSIG analysis highlights how FRBs have elevated risks for EVD propagation and untoward psychological consequences, yet evidence-based MHPSS programs and policy planning were missing links in the response to this outbreak. EVD is a dread disease. Fear reactions and FRBs are expected, prominent, pervasive, and likely to exacerbate disease spread in future infectious disease outbreaks. MHPSS approaches must complement the medical response to intervene early on FRBs, to diminish preventable EVD transmission, and to support the psychological needs of civilians, patients, health care workers and other responders, and family members.

Overview of Health Impacts Caused by the Fukushima Nuclear Disaster and our Opportunity to ‘Build Back Better’

Sae OCHI1, Shigeaki KATO2, Claire LEPPOLD3, Toyoaki SAWANO3, Shuhei NOMURA4, Tomohiro MORITA1, Masaharu TSUBOKURA1, Tomoyoshi OIKAWA3, Ryuzaburo SHINEHA1

1Soma Central Hospital, Japan; 2Joban Hospital, Fukushima, Japan; 3Minamisoma Municipal General Hospital, Japan; 4Imperial College London, London, United Kingrom

The 2011 Fukushima Daiichi nuclear power plant accident brought unforeseen public health challenges. Although considerable attention has been paid to health problems related to radiation exposure among residents, major health concerns have instead arisen from social disruption, caused largely by fear of radiation. For example, sudden and unplanned mass evacuation and long-term displacement have deteriorated mental and physical well-being of evacuees. Yet, there has been little incentive to gain a holistic view of emerging health issues caused by the accident.

Using health data obtained in Soma and Minamisoma city, this presentation will illustrate the complexity of health and public health problems caused by a nuclear accident. These problems include:

1) Residents within mandatory evacuation zone who were left behind;

2) Impact of unplanned mass evacuation on vulnerable population;

3) Decline in health due to prolonged residency in temporary housing;

4) Decrease in the number of hospital staff around the evacuation zone; and

5) Health problems of decontamination workers in precarious employment.

This diversity of health problems tells us that only taking account of health issues related to radiation exposure is not sufficient to prepare for future nuclear disaster. Instead, enhancing ‘absorbing, buffering, and responding capacity’ against any disaster will be a key to effective disaster preparedness for potential disaster areas. In particular, the following two points are essential to reduce indirect health impacts of nuclear disasters:

1) Promoting health among residents before a disaster; and

2) Developing robust healthcare systems to deal with a disaster.

Ultimately, the most effective disaster preparedness is to aim at sustainable development of the community by ensuring healthy lives and promoting well-being for all at all ages. With this regard, energy in future should be not only clean, safe, sustainable for environment, but also beneficial for health of the residents.

Post-nuclear Disaster Evacuation and Chronic Health in Adults in Fukushima, Japan: A Long-term Retrospective Analysis

Shuhei NOMURA1, Marta BLANGIARDO2, Masaharu TSUBOKURA3, Akihiko OZAKI3, Tomohiro MORITA4, Susan HODGSON2

1Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom; 2MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom; 3Department of Radiation Protection, Minamisoma Municipal General Hospital, Japan; 4Department of Radiation Protection, Soma Central Hospital, Japan

Objective: Japan's 2011 Fukushima Daiichi Nuclear Power Plant incident required the evacuation of over a million people, creating a large displaced population with potentially increased vulnerability in terms of chronic health conditions. We assessed the long-term impact of evacuation on diabetes, hyperlipidemia, and hypertension.

Participants: We considered participants in annual public health check-ups from 2008 to 2014, administrated by Minamisoma City and Soma City, located about 10-50 km from the Fukushima nuclear plant.

Methods: Disease risks, measured in terms of pre- and post-incident relative risks, were examined and compared between evacuees and non-/temporary-evacuees. We also constructed logistic regression models to assess the impact of evacuation on the disease risks adjusted for covariates.

Results: Data from a total of 6,406 individuals aged 40-74 who participated in the check-ups both at baseline (2008-2010) and in one or more post-incident years were analyzed. Regardless of evacuation, significant post-incident increases in risk were observed for diabetes and hyperlipidemia (Relative Risk: 1.27 to 1.60 and 1.12 to 1.30, respectively, depending on evacuation status and post-incident year). After adjusted covariates, the increase in hyperlipidemia was significantly greater among evacuees than among non-/temporary-evacuees (Odds Ratio: 1.18, 95% CI: 1.06–1.32, p<0.01).

Conclusions: The novelty of this study is that evacuation following the Fukushima disaster was found to be associated with a small increase in long term hyperlipidemia risk in adults. Our findings help identify discussion points on disaster planning, including preparedness, response and recovery measures applicable to future disasters requiring mass evacuation.

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