Structural Barriers to Disaster Resilience: Health and Disability

1. Structural Barriers to Disaster Resilience:Health and Disability Session 14

2. Session Objectives • Relate disabilities and health problems to other risk factors • Identify specific concerns of people with disability and health issues • Critically assess traditional emergency management approaches to disability and health • Identify resources and strategies for mitigating vulnerabilities of those who live with chronic health problems and disabilities

3. Who Defines “Disabled”or “Sick”? http://www.nod.org Americans With Disabilities Act http://www.usdoj.gov/crt/ada/adahom1.htm World Health Organization http://www.who.org

4. How Do People Become Disabled or Ill? • Social labeling • Genetic inheritance • Accidents • Violence • Aging • Patterns of everyday life • Living and working conditions • Organization culture and practice of nation’s health care system • Differing cultural, age and/or gender norms • Environmental conditions

5. Increased longevity Increasing access to health care extending life Persistent and increasing workplace hazards Increased exposure to air and water pollution Rising rates of homelessness and poverty with increased health risks and decreased access to health care High rates of self-inflicted injury Lifestyle “choices” “Diseases of affluence” Social Trends Increasing the Proportion of Americans with Impairments

6. Exposure to Hazards/Disasters Increases Impairment • Disabling injuries increase vulnerability to future disasters • Armed conflict can inflict disabling illness and psychosocial stress on civilians and noncombatants • Technological or human-agent disasters can be emotionally debilitating • Prolonged food scarcity and malnutrition following major environmental disasters undermine public health and disaster resilience • Prolonged exposure to environmental toxins increases incidence of debilitating illnesses

7. Racial/ethnic status Many health problems higher among racial//ethnic minority populations Exposure to toxins and pollutants higher among ethnic groups in hazardous occupations African Americans have higher rates of disability than Anglos Gender Pre- and post-health needs increase childbearing women’s vulnerability Women more than men live with chronic depression Men more than women live with heart disease Women more than men exposed to postdisaster violence Socioeconomic status High rates of physical and mental illness among poor and low-income people Poverty associated with malnutrition and functional disabilities Restricted access to medical equipment, supplies, medicine, etc. among poor Lack of secure employment Disabled persons more likely to be unemployed and be poor Age Infants and frail elderly most susceptible and least resistant to pre- and post-disaster illness and injury Cognitive and physical impairments increase with age Functional limitations increase with age Intersecting Vulnerabilities

8. Risky Living Conditions of People with Disabilities • On lower incomes than non-disabled counterparts • In un-reinforced masonry buildings • Outside caregiving institutions with legislated obligations to prepare for emergencies • Inside caregiving institutions which may lack features designed to enhance safety of residents • On their own • With social distance or stigma associated with being labeled “disabled” in a society valuing self-sufficiency People living with disabilities tend to live:

9. Risky Living Conditions of the Severely or Chronically Ill • Biological hazards (due to malnutrition, weakened immune systems, etc.) • Life-threatening disruptions in medical care during emergencies • Deteriorating mental and physical health due to loss of caregiver support systems Severely or chronically ill persons are at increased risk of:

10. Vulnerability of Disabled or Severely/Chronically Ill Social changes accompanying disaster can increase vulnerability by: • Increasing the social isolation of persons who often live alone • Increasing rates of temporary disability among disaster survivors • Causing debilitating injuries, trauma and post-disaster stress • Increasing public health hazards such as water contamination • Decreasing people’s access to health and daily living support services • Increasing exposure to severe environmental conditions worsening pre-existing illness

11. Myths about Disabilities • Disabilities are visible • Disabled persons reside primarily in institutions • Disabilities make people dependent on others • Disabilities and chronic illnesses are “master identities”

12. Stereotypes Underlie Emergency Management Approach • Reinforces or creates dependency • Displaces focus from preventing problems to dealing with”special populations” as burdensome • Ignores resources of advocacy groups • Deprives persons with functional impairments of equitable access to resources • Undermines long-term recovery

13. Evacuation Egress and access for wheelchair users, sight-impaired, etc. Accessible emergency routes Capacity to evacuate needed equipment Early warning to provide time for complex moves Preparedness Involving disabled and advocacy organizations in emergency exercises Stockpiling of needed equipment Recording medical needs and caregiver contact information Emergency Relief Centers Knowledgeable volunteers trained to understand needs and capacities of disabled persons and chronically ill Appropriate medical equipment Interpersonal support networks Provision for helper animals Reconstruction/Recovery Increased accessibility into public buildings Priority attention to functionality of health care facilities and systems Peer counseling Health care workers knowledgeable about specialized medical needs Disability Issues

14. Exclusion Neglects specific needs which can affect people’s ability to anticipate, prepare fore, cope with, survive, and recover from disaster Neglects capacities and resources of the group Negates opportunities for partnering with groups and organizations knowledgeable about vulnerabilities and capacities of this social group Inclusion Is an overly medicalized approach Focuses on the person rather than the group Inadequately assesses complex and inter-related needs Neglects self-care capacities of those with disabilities and health barriers Reinforces stereotypes Traditional Emergency Management Approaches to Health and Disability

15. Participatory Planning Approach to Health and Disability • Increases self-organization among persons in these social groups • Promotes organizational collaboration between emergency managers and advocacy groups • Results in services designed by, for, and with persons with mental and physical limitations • Is a rights-based approach whereby members of these social groups are full and equal participants in planning and receive equitable and appropriate services • Empowers people living with disabilities and/or health barriers • Increased political visibility and strength of this group’s concerns during emergency relief and long-term reconstruction

16. Strategies for Mitigating Vulnerabilities • Make necessary accommodations to ensure equity • Critically evaluate and assess disaster policies, plans, services, and operations to reduce risk of undermining independence • Adopt a human rights rather than a “special needs” approach • Collaborate with local self-help and advocacy groups to reduce risk

17. Collaborative Advocacy Organizations • Disease-based support groups • Local service organizations • Disability rights organizations • HIV/AIDS advocates and grassroots groups • Environmental justice groups involved with health issues • National advocacy groups

18. Obstacles to Cooperation • Conflicts over interpretation of Americans with Disabilities Act with respect to accessible sheltering • Shelter managers may resist pressure to develop ADA-compliant shelters or be unable to locate appropriate facilities • Stereotyping about presumed medical needs of persons with disabilities can preclude communication • Advocacy groups and government agencies may conflict over implementation of program or, providing of appropriate services