Health & Place 30 (2014) 116–119
Contents lists available at ScienceDirect
Health & Place journal homepage: www.elsevier.com/locate/healthplace
Viewpoint
Geological hazards: From early warning systems to public health toolkits Edgar Samarasundera a,n, Anna Hansell b,c, Didier Leibovici d, Claire J. Horwell e, Suchith Anand d, Clive Oppenheimer f a Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St. Dunstan's Road, London W6 8RP, United Kingdom b Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, St. Mary's Campus, W2 1PG, United Kingdom c Imperial College NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom d Nottingham Geospatial Institute, University of Nottingham, Triumph Road, Nottingham NG7 2TU, United Kingdom e Institute of Hazard, Risk and Resilience, Department of Earth Sciences, Durham University, Durham DH1 3LE, United Kingdom f Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom
art ic l e i nf o
a b s t r a c t
Article history: Received 15 July 2011 Received in revised form 6 June 2014 Accepted 1 September 2014 Available online 22 September 2014
Extreme geological events, such as earthquakes, are a significant global concern and sometimes their consequences can be devastating. Geographic information plays a critical role in health protection regarding hazards, and there are a range of initiatives using geographic information to communicate risk as well as to support early warning systems operated by geologists. Nevertheless we consider there to remain shortfalls in translating information on extreme geological events into health protection tools, and suggest that social scientists have an important role to play in aiding the development of a new generation of toolkits aimed at public health practitioners. This viewpoint piece reviews the state of the art in this domain and proposes potential contributions different stakeholder groups, including social scientists, could bring to the development of new toolkits. & 2014 Elsevier Ltd. All rights reserved.
Keywords: Geology GIS Internet Natural environment World Wide Web
1. Geohazards and public health Internet-based geospatial tools and information are playing an increasing role in monitoring, modelling and managing health risks posed by the natural environment. Much of these applications have been in the arena of infectious diseases (e.g. MorenoSanchez et al., 2006) reflecting their obvious priority in global health. An example is the U.S.–Mexico Border Environmental Health Initiative (http://borderhealth.cr.usgs.gov/projectindex. html) which provides decision support tools for public health officials, environmental managers and the general public. However, there are other aspects of the natural environment which pose risks to human health. This includes geological risks from ongoing exposures to chemicals in rocks and soils, as well as atmospheric particulate exposures. Sudden geological events such as landslides, earthquakes and volcanic eruptions (collectively
n
Corresponding author. Tel.: þ 44 20 7594 0823; fax: 44 20 7594 0854 E-mail addresses: [email protected] (E. Samarasundera), [email protected] (A. Hansell), [email protected] (D. Leibovici), [email protected] (C.J. Horwell), [email protected] (S. Anand), [email protected] (C. Oppenheimer). http://dx.doi.org/10.1016/j.healthplace.2014.09.001 1353-8292/& 2014 Elsevier Ltd. All rights reserved.
termed geohazards) and their derived hazards such as tsunamis, also pose risks. Internet-based, geographic information plays an important role across all aspects of geological risk mitigation and much of this can be demonstrably shown to have been translated into public health initiatives. For example, the World Health Organization Eastern Mediterranean Region Office E-atlas of environmental health hazards (http://www.who-eatlas.org/eastern-me diterranean/) was created to aid public health emergency preparedness and response. Nevertheless as Horwell and Baxter (2006) note, there is much more that needs to be done in terms of linking earth sciences, epidemiological knowledge and medical preparedness. One should also add the social sciences into this network. In essence there are significant shortfalls in bridging the gap between geological knowledge and health protection. We contend that, in the case of geohazards, there is sometimes a lack of coordination between geologists, who operate early warning systems (EWS) and those responsible for health protection. An example of this was observed during the 2004 tsunami which affected the Indian Ocean countries following a major landslide event linked to tectonic activity. Such extreme events typically result in sanitation and waste disposal problems, as well as impacts caused by stricken power
E. Samarasundera et al. / Health & Place 30 (2014) 116–119
Table 1 Search terms for literature review. Successful search terms
Unsuccessful search terms yielding irrelevant content
Earthquakeþ health Earthquakeþ “public health” Volcanic þ health Volcanic þ “public health” Tsunami þhealth Tsunami þ“public health” Earthquakeþ GIS Volcanic þ GIS Tsunami þGIS Earthquakeþ “remote sensing” Volcanic þ “remote sensing” Tsunami þ“remote sensing”
Geological þ health Geological þ “public health” “Extreme geological events”þ health “Extreme geological events” þ “public health”
generation which affects water pumping stations, leading to risk of secondary health-related problems including such as further toxic exposures and infectious disease outbreaks (Akbari et al., 2004; Ministry of the Environment Republic of Indonesia, 2005; Joint UNEP/OCHA Environment Unit, 2005a; Joint UNEP/OCHA Environment Unit, 2005b). There is the possibility of longer-term health impacts as well, for example, in the case of volcanic eruptions due to exposure to atmospheric particulates from ash deposition (Hansell et al., 2006; Horwell and Baxter, 2006; Horwell et al., 2013). Public health usually functions in reactive mode regarding such extreme events and policies seldom plan for high risk, low probability scenarios. For example, the United Nations Global Assessment Report on Disaster Risk Reduction 2011 (ISDR, 2011) highlighted the lack of contingency plans for the Icelandic volcanic ash cloud that affected Europe in 2010, pointing out it was not unusual in that such eruptions occur every 20–40 years on average and that it is predictable that parts of Europe may be affected with north-northwesterly winds occurring 6% of the time; further the volcano had been in eruption for 4 weeks before the ash cloud reached UK airspace so there had been time to act. Health consequences of a future, large-scale Icelandic eruption may be severe in Europe: a risk assessment (Schmidt et al., 2011) of an eruption similar to that happening in 1783–84 suggested that it would cause approximately 142,000 additional deaths from cardiovascular and respiratory disease in Europe if a similar eruption were to occur today. This viewpoint piece reviews the state of the art in this domain and proposes potential contributions different stakeholder groups, including social scientists (such as sociologists, human geographers and social anthropologists), could bring to the development of new toolkits. In particular we examine the current state of affairs in institutional and technical frameworks pivotal to better integrating warning systems and public health tools for the ultimate purpose of better public health decisionmaking. To provide a foundation for the views expressed in this article a search for relevant literature and frameworks/initiatives using Thomson Reuters Web of Science and the National Center for Biotechnology Information Pubmed; the search terms employed in this study can be found in Table 1. This formal literature search was supplemented by domain literature knowledge from each of the co-authors.
2. Where are we now? Much to date has relied solely on mapping of at-risk populations (e.g. El Abidine El Morjani et al., 2007; Peduzzi et al., 2005,
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2009) and post-disaster on-the-ground mapping for relief response (MapAction, 2009). There is still nevertheless a shortfall in reliable, operational systems for identifying priority locations for public health investigations and resource allocation commensurate with on-the-ground circumstances which may be rapidly changing. Without the necessary institutional frameworks and collaborative technologies such operational systems for public health is a distant aspiration but nothing more. This situation is starting to change with the emergence of the Group on Earth Observations (Patz, 2005) for developing coordinated data acquisition and surveillance. The group is working on a technical framework termed the Group on Earth Observation System of Systems (GEOSS), which aims to better integrate health-related needs as one of its nine societal benefit goals (Nativi, 2010). However, the current and planned work of GEOSS health stream includes no reference to geohazards and health together (geohazards vulnerability mapping is included but not linked to health). This may well suggest that the health practitioner community has not pushed this aspect of health protection to highlight the information toolkit gaps. This contrasts with the GEOSS programmes regarding not only infectious disease control, but also atmospheric and water pollution. National and even continent-wide spatial data infrastructures such as INSPIRE (http://inspire.jrc.ec.europa.eu/) now aid the dissemination of geographic information using centralised Internet portals. Another promising avenue for change is the Open Geospatial Consortium (OGC, http://www.opengeospatial.org/) which has established a range of standard specifications for Web services that facilitate the exchange and processing of geospatial data (Granell et al., 2010; Reichardt, 2010). Though there have been open source GIS developments for more than 30 years, the specification and widespread use of OGC standards has led to rapid developments currently being witnessed in open source GIS including interoperability and the capacity to perform Googlebased “mash-ups” (Anand et al., 2010; Leibovici et al., 2011; Pollino et al., 2012). We suggest that the ‘health and place’ community could make more effort to push for such initiatives to better link with WHO GIS programmes, with existing earth sciences initiatives (Table 2) such as the United Nations Environment Programme (UNEP) Project of Risk Evaluation, Vulnerability, Information and Early Warning (PREVIEW) (Giuliani and Peduzzi, 2011). PREVIEW is a global, Internet-based portal underpinned by a spatial data infrastructure. Achieving synergies between WHO and UNEP could make regularly updated geohazards data feeding into existing health GIS toolkits for local users to utilise a reality and not just a distant aspiration. One example of an existing health GIS toolkit used by local-level users is the Small Area Health Statistics Unit (SAHSU) Rapid Inquiry Facility (RIF) (Beale et al., 2010). The RIF was initially designed as a menu-based tool for SAHSU staff with no specialist training in GIS or geographical data linkage techniques, to help them analyse routinely collected health data in relation to environmental exposures in the UK and has subsequently been adapted for use in several European countries, and within the US Centers for Disease Control and Prevention (CDC) environmental public health tracking programme. It is situated in a desktop GIS platform and draws on external health, population, exposure and risk modifier information (e.g. deprivation, age) to provide relative risks in relation to exposures, but could readily be modified for use in extreme event situations. Currently the RIF team are redeveloping the tool to better integrate commercial and open source technologies (http://www.sahsu.org/content/rapid-en quiry-facility). This redevelopment includes the inclusion of XMLbased interfaces, theoretically enabling seamless access to near real-time datasets from Internet sources.
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E. Samarasundera et al. / Health & Place 30 (2014) 116–119
Table 2 Some examples of geology-related, early warning systems (EWS) and related initiatives utilising geographic information. Initiative
Purpose
Internet address
BGS GeoIndex
Provides maps of geological hazards such as landslide activity for the general public. Online atlas of the distribution of chemicals in rocks and soils across Europe, including those relevant to medical geology. Globally coordinated initiatives aimed at delivering user-friendly environmental information and tools to relevant parties, including health practitioners. Updates on current volcanic hazard risk to the local authorities including National Disaster Preparedness and Response Advisory Committee. Volcanic EWS for the USA, currently at paper-stage. An international programme, involving key geological organisations, such as the European Union's EuroGeoSurveys and the Group on Earth Observations. The initiative is designed to provide geological datasets interactively over the internet. Provision of RSS feeds to member states on potential risks (regional service only). EWS hosted by the United Nations involving interactive atlases; includes geological hazards as well as other environmental risks. Near real-time maps of tectonic movements for preparedness exercises and post-earthquake response and recovery.
http://www.bgs.ac.uk/GeoIndex/hazards.htm
Geochemical atlas of Europe GEO and GEOSS
Montserrat volcano observatory NVEWS OneGeology
Pacific Tsunami Warning Centre PREVIEW ShakeMaps
3. How can we make progress from here? Looking at other arenas within the public health sector may yield some insight. For example Mexico and the USA have a joint initiative covering the Gulf of Mexico, the Harmful Algal Blooms Observing System (HABSOS), which integrates hourly-updated satellite imagery on weather with other environmental datasets in an Internet-based GIS tool (http://habsos.noaa.gov/) which in turns links directly into the Centers for Disease Control's Harmful Algal Bloom-related Illness Surveillance System (HABISS). Such cooperative, Internet-based systems aimed at public health practitioners could offer much potential in the geohazards arena. Indeed one of the aftermaths of the Indian Ocean tsunami has been the realisation that global EWS for environmental hazards are important and a survey of current EWS by the United Nations (2006) suggests that a turning point is near in this agenda. Nevertheless how could such a global EWS link into the public health sector effectively? Social science has a key role to play here. Few (2007) provides suggestions in the context of framing social research in the arena of meteorology-related hazards which could plausibly be applied to the geological arena, proposing a health impact pathway examining the dynamics between (1) the external environment, (2) the perceptions, capabilities and actions of individuals/communities, and (3) health outcomes. In essence he suggests a framework akin to epidemiological pathways, which in both ours and Few's view is better suited to societal planning and response – especially regarding health – than the disaster management cycle models commonly used in the geological community such as the United Nations SPIDER programme (http://www.un-spider.org/ guide-type/disaster-management-guides). Such place-relevant issues feed not only into management and social research frameworks, but also into mapping, which in turn provides a useful foundation for improving communication between earth scientists and the public health sector via the presence of tangible toolkits. We suggest that the development of the GEOSS health stream and data infrastructures such as INSPIRE could provide a framework in the form of a centralised Web portal for more effective communication between the geological and public health sectors. On-going public health community awareness and emergency preparedness are vital, as is reliable and robust spatial information at a range of geographic scales, for example with respect to timely
http://www.gtk.fi/publ/foregsatlas/index.php http://www.earthobservations.org/index.shtml http://www.earthobservations.org/geoss_he.shtml http://www.mvo.ms/
http://volcanoes.usgs.gov/publications/2009/nvews.php http://www.onegeology.org/portal/
http://ptwc.weather.gov/ http://www.grid.unep.ch/activities/earlywarning/ preview/ http://earthquake.usgs.gov/earthquakes/shakemap/
updates on both local and regional geological activities, as well as planned evacuation routes. In technical terms in emergencies what is required is real-time geographic information where networks of sensors driven by OGC standards could be retrieved from a geological EWS to allow updating of risks. A portal of this kind would then permit public health analysts using tools such as RIF to monitor risk, make predictions and plan responses in near realtime, a valuable asset in an extreme event scenario. The outputs from a Web-enabled RIF (or similar tool) could feed into health alerts and recommendations which could be received on smartphones for both professionals and citizens, potentially even allowing users to react in validating, confirming or updating the information. For such a portal to work effectively as a public health tool, designing place-relevant, social research frameworks for extreme geological events akin to those proposed for other domains of environmental health such as the effects of flooding (Coates, 2010; Few, 2007; Few and Matthies, 2006) and water resources (Parkes et al., 2010) will be vital in any effort to develop effective, public health tools for geohazards. There is certainly a social science and post-event literature to build on (e.g. Tobin and Whiteford, 2001; Whiteford et al., 2002) and those primarily engaged in societal aspects of human health will be needed to progress this agenda in a holistic framework. Ultimately one can view the gap between what we have in terms of health GIS tools for geohazards and what we need as revolving around relatively limited communication between different fields, especially between geologists and ‘health and place’ specialists, although there are exceptions. For example the International Volcanic Health Hazard Network (IVHHN) (http://www.ivhhn.org/) has been working on this since 2003. A particularly valuable facet of IVHHN is the production of public information pamphlets for emergency preparedness, a service which would benefit from much closer ties with those responsible for health protection.
4. Conclusions The aftermath of the 2004 Indian Ocean tsunami discussed in the first section is a demonstration of what can happen without such systems in place. However, a pertinent question from an institutional perspective is whose responsibility would it be for
E. Samarasundera et al. / Health & Place 30 (2014) 116–119
translating early warnings into the commencement of health protection procedures in the case of trans-national hazards such as a tsunami? This is a more complex scenario which may be best suited to developing formalised protocols between the World Meteorological Organization, SPIDER and WHO regional offices. Also what might such a portal and its systematic links look like in terms of information flow and institutional roles? The time is certainly right for encouraging wide discourse on translating geographic information on rare, extreme events from geological EWS into public health toolkits, and there also is still much practical work that needs to be done. Those primarily engaged in the social science aspects of global health should consider becoming more actively involved in research and development in the geohazards arena.
Acknowledgements The work of the Small Area Health Statistics Unit is funded by Public Health England as part of the MRC-PHE Centre for Environment and Health. The Department of Primary Care & Public Health at Imperial College is grateful for support from the NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) Scheme, the NIHR Biomedical Research Centre scheme, and the Imperial Centre for Patient Safety and Service Quality. References Akbari, M.E., Farshad, A.A., Asadi-Lari, M., 2004. The devastation of Bam: an overview of health issues 1 month after the earthquake. Public Health 118, 403–408. Anand, S., Batty, M., Crooks, A., Hudson-Smith, A., Jackson, M., Milton, R., Morley, J., 2010. Data Mash-Ups and the Future of Mapping, Horizon Scanning Report 10_01. JISC, Bristol, UK. Beale, L., Hodgson, S., Abellan, J.J., Lefevre, S., Jarup, L., 2010. Evaluation of spatial relationships between health and the environment: the rapid enquiry facility. Environ. Health Perspect. 118, 1306–1312. Coates, T., 2010. Conscious Community: Belonging, Identities and Networks in Local Communities' Response to Flooding (Ph.D. thesis). University of Middlesex. El Abidine El Morjani, Z., Ebener, S., Boos, J., Ghaffar, E.A., Musani, A., 2007. Modelling the spatial distribution of five natural hazards in the context of the WHO/EMRO Atlas of Disaster Risk as a step towards the reduction of the health impact related to disasters. Int. Health Geogr. 6, 8. Few, R., 2007. Health and climatic hazards: framing social research on vulnerability, response and adaptation. Glob. Environ. Change 17, 281–295. Few, R., Matthies, F. (Eds.), 2006. Flood Hazards and Health: Responding to Present and Future Risks. Earthscan, London. ́ L, Gould, M, 2010. Service-oriented applications for environmental Granell, C., Diaz, models: reusable geospatial services. Environ. Model. Softw. 25 (2), 182–198. Giuliani, G., Peduzzi, P., 2011. The PREVIEW global risk data platform: a geoportal to serve and share global data on risk to natural hazards. Nat. Hazards Earth Syst. Sci. 11 (1), 53–66. Hansell, A.L., Horwell, C.J., Oppenheimer, C., 2006. The health hazards of volcanoes and geothermal areas. Occup. Environ. Med. 63, 125–149. Horwell, C.J., Baxter, P.J., 2006. The respiratory health hazards of volcanic ash: a review for volcanic risk mitigation. Bull. Volcanol. 69, 1–24. Horwell, C.J., Baxter, P.J., Hillman, S.E., Calkins, J.A., Damby, D.E., Delmelle, P., et al., 2013. Physicochemical and toxicological profiling of ash from the 2010 and 2011 eruptions of Eyjafjallajokull and Grimsvotn volcanoes, Iceland using a rapid respiratory hazard assessment protocol. Environ. Res. 127, 63–73.
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Joint UNEP/OCHA Environment Unit, 2005a. Indian Ocean Tsunami Disaster of December 2004: UNDAC Rapid Environmental Assessment of Aceh, Indonesia. UNEP/OCHA, Geneva. Joint UNEP/OCHA Environment Unit, 2005b. Indian Ocean Tsunami Disaster of December 2004: UNDAC Rapid Environmental Assessment in the Democratic Socialist Republic of Sri Lanka. UNEP/OCHA, Geneva. Leibovici, D.G., Bastin, L., Anand, S., Hobona, G., Jackson, M., 2011. Spatially clustered associations in health related geospatial data. Trans. GIS 15 (3), 347–364. MapAction, 2009. Field Guide to Humanitarian Mapping. MapAction, Little Missenden. Ministry of the Environment Republic of Indonesia, 2005. Rapid Environmental Impact Assessment: Banda Aceh, Sumatra. Ministry of the Environment Republic of Indonesia. Moreno-Sanchez, R., Hayden, M., Janes, C., Anderson, G., 2006. A web-based multimedia spatial information system to document Aedes aegypti breeding sites and dengue fever risk along the US–Mexico border. Health Place 12, 715–727. Nativi, S., 2010. The implementation of international geospatial standards for earth and space sciences. Int. J. Digit. Earth 3, 2–13. Parkes, M.W., Morrison, K.E., Bunch, M.J., Hallstrom, L.K., Neudoerffer, R.C., Venema, H.D., Waltner-Toews, D., 2010. Towards integrated governance for water, health and social–ecological systems: The watershed governance prism. Glob. Environ. Change 20, 693–704. Patz, J., 2005. Satellite remote sensing can improve chances of achieving sustainable health. Environ. Health Perspect. 113, A84–A85. Peduzzi, P., Dao, H., Herold, C., 2005. Mapping disastrous natural hazards using global datasets. Nat. Hazards 35, 265–289. Peduzzi, P., Dao, H., Herold, C., Mouton, F., 2009. Assessing global exposure and vulnerability towards natural hazards: the disaster risk index. Nat. Hazards Earth Syst. Sci. 9, 1149–1159. Pollino, M., Fattoruso, G., La Porta, L., Della Rocca, A.B., James, V., 2012. Collaborative open source geospatial tools and maps supporting the response planning to disastrous earthquake events. Future Internet 4, 451–468. Reichardt, M., 2010. Open standards-based geoprocessing web services support the study and management of hazard and risk. Geomat. Nat. Hazards Risk 1, 171–184. Schmidt, A., Ostro, B., Carslaw, K.S., Wilson, M., Thordarson, T., Mann, G.W., Simmons, A.J., 2011. Excess mortality in Europe following a future Laki-style Icelandic eruption. Proc. Natl. Acad. Sci. USA 108, 15710–15715. Tobin, G.A., Whiteford, L.M., 2001. Children's Health Characteristics Under Different Evacuation Strategies: the Eruption of Mount Tungurahua, Ecuador. Papers of the Applied Geography Conferences, vol. 24, pp. 183–191. United Nations, 2006. Global Survey of Early Warning Systems. UN/ISDR, Geneva. United Nations Office for Disaster Reduction, 2011. Global Assessment Report on Disaster Risk Reduction. UNISDR, Geneva. Whiteford, L.M., Tobin, G.A., Laspina, C., Yepes, H., 2002. In the Shadow of the Volcano: Human Health and Community Resilience Following Forced Evacuation. Technical Report: The Centre for Disaster Management and Humanitarian Assistance, Tulane.
Internet references Harmful Algal Blooms Observing System (HABSOS). 〈http://habsos.noaa.gov/〉 (accessed 10.05.13). Infrastructure for Spatial Information in the European Community (INSPIRE). 〈http://inspire.jrc.ec.europa.eu/〉 (accessed 10.05.13). International Volcanic Health Hazard Network. 〈http://www.ivhhn.org/〉 (accessed 10.05.13). Open Geospatial Consortium. 〈http://www.opengeospatial.org/〉 (accessed 10.05.13). Rapid Enquiry Facility. 〈http://www.sahsu.org/content/rapid-enquiry-facility〉 (accessed 02.04.13). United Nations Platform for Space-based Information for Disaster Management and Emergency Response (UN SPIDER). 〈http://www.un-spider.org/knowledgebase/disaster-and-risk-management-guides〉 (accessed 10.05.13). U.S.–Mexico Border Environmental Health Initiative. 〈http://borderhealth.cr.usgs. gov/〉projectindex.html (accessed 10.05.13). World Health Organisation Eastern Mediterranean Region Office E-atlas of Disaster Risk. 〈http://www.who-eatlas.org/eastern-mediterranean/〉 (accessed 10.05.13).
Contents lists available at ScienceDirect
Health & Place journal homepage: www.elsevier.com/locate/healthplace
Viewpoint
Geological hazards: From early warning systems to public health toolkits Edgar Samarasundera a,n, Anna Hansell b,c, Didier Leibovici d, Claire J. Horwell e, Suchith Anand d, Clive Oppenheimer f a Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St. Dunstan's Road, London W6 8RP, United Kingdom b Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, St. Mary's Campus, W2 1PG, United Kingdom c Imperial College NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom d Nottingham Geospatial Institute, University of Nottingham, Triumph Road, Nottingham NG7 2TU, United Kingdom e Institute of Hazard, Risk and Resilience, Department of Earth Sciences, Durham University, Durham DH1 3LE, United Kingdom f Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, United Kingdom
art ic l e i nf o
a b s t r a c t
Article history: Received 15 July 2011 Received in revised form 6 June 2014 Accepted 1 September 2014 Available online 22 September 2014
Extreme geological events, such as earthquakes, are a significant global concern and sometimes their consequences can be devastating. Geographic information plays a critical role in health protection regarding hazards, and there are a range of initiatives using geographic information to communicate risk as well as to support early warning systems operated by geologists. Nevertheless we consider there to remain shortfalls in translating information on extreme geological events into health protection tools, and suggest that social scientists have an important role to play in aiding the development of a new generation of toolkits aimed at public health practitioners. This viewpoint piece reviews the state of the art in this domain and proposes potential contributions different stakeholder groups, including social scientists, could bring to the development of new toolkits. & 2014 Elsevier Ltd. All rights reserved.
Keywords: Geology GIS Internet Natural environment World Wide Web
1. Geohazards and public health Internet-based geospatial tools and information are playing an increasing role in monitoring, modelling and managing health risks posed by the natural environment. Much of these applications have been in the arena of infectious diseases (e.g. MorenoSanchez et al., 2006) reflecting their obvious priority in global health. An example is the U.S.–Mexico Border Environmental Health Initiative (http://borderhealth.cr.usgs.gov/projectindex. html) which provides decision support tools for public health officials, environmental managers and the general public. However, there are other aspects of the natural environment which pose risks to human health. This includes geological risks from ongoing exposures to chemicals in rocks and soils, as well as atmospheric particulate exposures. Sudden geological events such as landslides, earthquakes and volcanic eruptions (collectively
n
Corresponding author. Tel.: þ 44 20 7594 0823; fax: 44 20 7594 0854 E-mail addresses: [email protected] (E. Samarasundera), [email protected] (A. Hansell), [email protected] (D. Leibovici), [email protected] (C.J. Horwell), [email protected] (S. Anand), [email protected] (C. Oppenheimer). http://dx.doi.org/10.1016/j.healthplace.2014.09.001 1353-8292/& 2014 Elsevier Ltd. All rights reserved.
termed geohazards) and their derived hazards such as tsunamis, also pose risks. Internet-based, geographic information plays an important role across all aspects of geological risk mitigation and much of this can be demonstrably shown to have been translated into public health initiatives. For example, the World Health Organization Eastern Mediterranean Region Office E-atlas of environmental health hazards (http://www.who-eatlas.org/eastern-me diterranean/) was created to aid public health emergency preparedness and response. Nevertheless as Horwell and Baxter (2006) note, there is much more that needs to be done in terms of linking earth sciences, epidemiological knowledge and medical preparedness. One should also add the social sciences into this network. In essence there are significant shortfalls in bridging the gap between geological knowledge and health protection. We contend that, in the case of geohazards, there is sometimes a lack of coordination between geologists, who operate early warning systems (EWS) and those responsible for health protection. An example of this was observed during the 2004 tsunami which affected the Indian Ocean countries following a major landslide event linked to tectonic activity. Such extreme events typically result in sanitation and waste disposal problems, as well as impacts caused by stricken power
E. Samarasundera et al. / Health & Place 30 (2014) 116–119
Table 1 Search terms for literature review. Successful search terms
Unsuccessful search terms yielding irrelevant content
Earthquakeþ health Earthquakeþ “public health” Volcanic þ health Volcanic þ “public health” Tsunami þhealth Tsunami þ“public health” Earthquakeþ GIS Volcanic þ GIS Tsunami þGIS Earthquakeþ “remote sensing” Volcanic þ “remote sensing” Tsunami þ“remote sensing”
Geological þ health Geological þ “public health” “Extreme geological events”þ health “Extreme geological events” þ “public health”
generation which affects water pumping stations, leading to risk of secondary health-related problems including such as further toxic exposures and infectious disease outbreaks (Akbari et al., 2004; Ministry of the Environment Republic of Indonesia, 2005; Joint UNEP/OCHA Environment Unit, 2005a; Joint UNEP/OCHA Environment Unit, 2005b). There is the possibility of longer-term health impacts as well, for example, in the case of volcanic eruptions due to exposure to atmospheric particulates from ash deposition (Hansell et al., 2006; Horwell and Baxter, 2006; Horwell et al., 2013). Public health usually functions in reactive mode regarding such extreme events and policies seldom plan for high risk, low probability scenarios. For example, the United Nations Global Assessment Report on Disaster Risk Reduction 2011 (ISDR, 2011) highlighted the lack of contingency plans for the Icelandic volcanic ash cloud that affected Europe in 2010, pointing out it was not unusual in that such eruptions occur every 20–40 years on average and that it is predictable that parts of Europe may be affected with north-northwesterly winds occurring 6% of the time; further the volcano had been in eruption for 4 weeks before the ash cloud reached UK airspace so there had been time to act. Health consequences of a future, large-scale Icelandic eruption may be severe in Europe: a risk assessment (Schmidt et al., 2011) of an eruption similar to that happening in 1783–84 suggested that it would cause approximately 142,000 additional deaths from cardiovascular and respiratory disease in Europe if a similar eruption were to occur today. This viewpoint piece reviews the state of the art in this domain and proposes potential contributions different stakeholder groups, including social scientists (such as sociologists, human geographers and social anthropologists), could bring to the development of new toolkits. In particular we examine the current state of affairs in institutional and technical frameworks pivotal to better integrating warning systems and public health tools for the ultimate purpose of better public health decisionmaking. To provide a foundation for the views expressed in this article a search for relevant literature and frameworks/initiatives using Thomson Reuters Web of Science and the National Center for Biotechnology Information Pubmed; the search terms employed in this study can be found in Table 1. This formal literature search was supplemented by domain literature knowledge from each of the co-authors.
2. Where are we now? Much to date has relied solely on mapping of at-risk populations (e.g. El Abidine El Morjani et al., 2007; Peduzzi et al., 2005,
117
2009) and post-disaster on-the-ground mapping for relief response (MapAction, 2009). There is still nevertheless a shortfall in reliable, operational systems for identifying priority locations for public health investigations and resource allocation commensurate with on-the-ground circumstances which may be rapidly changing. Without the necessary institutional frameworks and collaborative technologies such operational systems for public health is a distant aspiration but nothing more. This situation is starting to change with the emergence of the Group on Earth Observations (Patz, 2005) for developing coordinated data acquisition and surveillance. The group is working on a technical framework termed the Group on Earth Observation System of Systems (GEOSS), which aims to better integrate health-related needs as one of its nine societal benefit goals (Nativi, 2010). However, the current and planned work of GEOSS health stream includes no reference to geohazards and health together (geohazards vulnerability mapping is included but not linked to health). This may well suggest that the health practitioner community has not pushed this aspect of health protection to highlight the information toolkit gaps. This contrasts with the GEOSS programmes regarding not only infectious disease control, but also atmospheric and water pollution. National and even continent-wide spatial data infrastructures such as INSPIRE (http://inspire.jrc.ec.europa.eu/) now aid the dissemination of geographic information using centralised Internet portals. Another promising avenue for change is the Open Geospatial Consortium (OGC, http://www.opengeospatial.org/) which has established a range of standard specifications for Web services that facilitate the exchange and processing of geospatial data (Granell et al., 2010; Reichardt, 2010). Though there have been open source GIS developments for more than 30 years, the specification and widespread use of OGC standards has led to rapid developments currently being witnessed in open source GIS including interoperability and the capacity to perform Googlebased “mash-ups” (Anand et al., 2010; Leibovici et al., 2011; Pollino et al., 2012). We suggest that the ‘health and place’ community could make more effort to push for such initiatives to better link with WHO GIS programmes, with existing earth sciences initiatives (Table 2) such as the United Nations Environment Programme (UNEP) Project of Risk Evaluation, Vulnerability, Information and Early Warning (PREVIEW) (Giuliani and Peduzzi, 2011). PREVIEW is a global, Internet-based portal underpinned by a spatial data infrastructure. Achieving synergies between WHO and UNEP could make regularly updated geohazards data feeding into existing health GIS toolkits for local users to utilise a reality and not just a distant aspiration. One example of an existing health GIS toolkit used by local-level users is the Small Area Health Statistics Unit (SAHSU) Rapid Inquiry Facility (RIF) (Beale et al., 2010). The RIF was initially designed as a menu-based tool for SAHSU staff with no specialist training in GIS or geographical data linkage techniques, to help them analyse routinely collected health data in relation to environmental exposures in the UK and has subsequently been adapted for use in several European countries, and within the US Centers for Disease Control and Prevention (CDC) environmental public health tracking programme. It is situated in a desktop GIS platform and draws on external health, population, exposure and risk modifier information (e.g. deprivation, age) to provide relative risks in relation to exposures, but could readily be modified for use in extreme event situations. Currently the RIF team are redeveloping the tool to better integrate commercial and open source technologies (http://www.sahsu.org/content/rapid-en quiry-facility). This redevelopment includes the inclusion of XMLbased interfaces, theoretically enabling seamless access to near real-time datasets from Internet sources.
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Table 2 Some examples of geology-related, early warning systems (EWS) and related initiatives utilising geographic information. Initiative
Purpose
Internet address
BGS GeoIndex
Provides maps of geological hazards such as landslide activity for the general public. Online atlas of the distribution of chemicals in rocks and soils across Europe, including those relevant to medical geology. Globally coordinated initiatives aimed at delivering user-friendly environmental information and tools to relevant parties, including health practitioners. Updates on current volcanic hazard risk to the local authorities including National Disaster Preparedness and Response Advisory Committee. Volcanic EWS for the USA, currently at paper-stage. An international programme, involving key geological organisations, such as the European Union's EuroGeoSurveys and the Group on Earth Observations. The initiative is designed to provide geological datasets interactively over the internet. Provision of RSS feeds to member states on potential risks (regional service only). EWS hosted by the United Nations involving interactive atlases; includes geological hazards as well as other environmental risks. Near real-time maps of tectonic movements for preparedness exercises and post-earthquake response and recovery.
http://www.bgs.ac.uk/GeoIndex/hazards.htm
Geochemical atlas of Europe GEO and GEOSS
Montserrat volcano observatory NVEWS OneGeology
Pacific Tsunami Warning Centre PREVIEW ShakeMaps
3. How can we make progress from here? Looking at other arenas within the public health sector may yield some insight. For example Mexico and the USA have a joint initiative covering the Gulf of Mexico, the Harmful Algal Blooms Observing System (HABSOS), which integrates hourly-updated satellite imagery on weather with other environmental datasets in an Internet-based GIS tool (http://habsos.noaa.gov/) which in turns links directly into the Centers for Disease Control's Harmful Algal Bloom-related Illness Surveillance System (HABISS). Such cooperative, Internet-based systems aimed at public health practitioners could offer much potential in the geohazards arena. Indeed one of the aftermaths of the Indian Ocean tsunami has been the realisation that global EWS for environmental hazards are important and a survey of current EWS by the United Nations (2006) suggests that a turning point is near in this agenda. Nevertheless how could such a global EWS link into the public health sector effectively? Social science has a key role to play here. Few (2007) provides suggestions in the context of framing social research in the arena of meteorology-related hazards which could plausibly be applied to the geological arena, proposing a health impact pathway examining the dynamics between (1) the external environment, (2) the perceptions, capabilities and actions of individuals/communities, and (3) health outcomes. In essence he suggests a framework akin to epidemiological pathways, which in both ours and Few's view is better suited to societal planning and response – especially regarding health – than the disaster management cycle models commonly used in the geological community such as the United Nations SPIDER programme (http://www.un-spider.org/ guide-type/disaster-management-guides). Such place-relevant issues feed not only into management and social research frameworks, but also into mapping, which in turn provides a useful foundation for improving communication between earth scientists and the public health sector via the presence of tangible toolkits. We suggest that the development of the GEOSS health stream and data infrastructures such as INSPIRE could provide a framework in the form of a centralised Web portal for more effective communication between the geological and public health sectors. On-going public health community awareness and emergency preparedness are vital, as is reliable and robust spatial information at a range of geographic scales, for example with respect to timely
http://www.gtk.fi/publ/foregsatlas/index.php http://www.earthobservations.org/index.shtml http://www.earthobservations.org/geoss_he.shtml http://www.mvo.ms/
http://volcanoes.usgs.gov/publications/2009/nvews.php http://www.onegeology.org/portal/
http://ptwc.weather.gov/ http://www.grid.unep.ch/activities/earlywarning/ preview/ http://earthquake.usgs.gov/earthquakes/shakemap/
updates on both local and regional geological activities, as well as planned evacuation routes. In technical terms in emergencies what is required is real-time geographic information where networks of sensors driven by OGC standards could be retrieved from a geological EWS to allow updating of risks. A portal of this kind would then permit public health analysts using tools such as RIF to monitor risk, make predictions and plan responses in near realtime, a valuable asset in an extreme event scenario. The outputs from a Web-enabled RIF (or similar tool) could feed into health alerts and recommendations which could be received on smartphones for both professionals and citizens, potentially even allowing users to react in validating, confirming or updating the information. For such a portal to work effectively as a public health tool, designing place-relevant, social research frameworks for extreme geological events akin to those proposed for other domains of environmental health such as the effects of flooding (Coates, 2010; Few, 2007; Few and Matthies, 2006) and water resources (Parkes et al., 2010) will be vital in any effort to develop effective, public health tools for geohazards. There is certainly a social science and post-event literature to build on (e.g. Tobin and Whiteford, 2001; Whiteford et al., 2002) and those primarily engaged in societal aspects of human health will be needed to progress this agenda in a holistic framework. Ultimately one can view the gap between what we have in terms of health GIS tools for geohazards and what we need as revolving around relatively limited communication between different fields, especially between geologists and ‘health and place’ specialists, although there are exceptions. For example the International Volcanic Health Hazard Network (IVHHN) (http://www.ivhhn.org/) has been working on this since 2003. A particularly valuable facet of IVHHN is the production of public information pamphlets for emergency preparedness, a service which would benefit from much closer ties with those responsible for health protection.
4. Conclusions The aftermath of the 2004 Indian Ocean tsunami discussed in the first section is a demonstration of what can happen without such systems in place. However, a pertinent question from an institutional perspective is whose responsibility would it be for
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translating early warnings into the commencement of health protection procedures in the case of trans-national hazards such as a tsunami? This is a more complex scenario which may be best suited to developing formalised protocols between the World Meteorological Organization, SPIDER and WHO regional offices. Also what might such a portal and its systematic links look like in terms of information flow and institutional roles? The time is certainly right for encouraging wide discourse on translating geographic information on rare, extreme events from geological EWS into public health toolkits, and there also is still much practical work that needs to be done. Those primarily engaged in the social science aspects of global health should consider becoming more actively involved in research and development in the geohazards arena.
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