Emergency Management: From Principles to Action

David Etkin, School of Administrative Studies -- Emergency Management, York University, and Dave Hutton, PhD, formerly of the Centre for Emergency Preparedness and Response, Public Health Agency of Canada, and currently with the United Nations Relief and Works Agency, West Bank

Over the past decade, events such as the 2003 European heat wave, Hurricane Katrina and SARS have focused attention on the need for improved emergency management. In tracing the evolution of the emergency management field, this article examines the challenges faced in developing comprehensive, integrated systems, and examines the four pillars on which current systems are based.

The past decade has given rise to an increasing recognition among decision makers, practitioners and academics alike of the importance of developing an emergency management system that is based on a strong theoretical and evidence-based approach. Within the health care sector, events like the Severe Acute Respiratory Syndrome (SARS) crisis have demonstrated the importance of developing a health emergency management system that is grounded in established and tested principles of emergency management. Although much work is still required to achieve a comprehensive pan-Canadian health emergency management system, one which can ensure effective and timely coordination across all levels of government, the development of common policy and planning frameworks is allowing jurisdictions to plan, train and work together in a far more effective way.

What is Emergency Management?

For many years emergency management was associated with the Cold War and civil protection. Over the years, however, it has evolved into a far more dynamic and multidisciplinary process based on the notion that communities can choose how they prepare, cope with or adjust to the hazards that they face. Beginning in the 1970s, in large part due to the work of geographer Gilbert White and sociologist Eugene Haas,¹ emergency management became rooted within a theoretical framework based on four pillars that constitute an emergency management cycle:

• Mitigation/Prevention - long-term actions that reduce and/or prevent the risk of a disaster, such as constructing dams and land-use planning that prohibits people from building homes or businesses in high-risk areas.
• Preparedness - planning for disasters and putting in place the resources needed to cope with them when they happen -- for example, stockpiling essential goods and preparing emergency plans to follow in the event of a disaster.
• Response - actions taken during and immediately after a disaster has occurred, including the activities of police, firefighters and medical personnel.
• Recovery - longer term activities to rebuild and restore the community to its pre-disaster state.

Historically, the emphasis has been on preparedness and response, but increasing disaster-related losses over the past few decades have led to greater emphasis on mitigation/prevention and recovery. Experience has taught us that unless mitigation/prevention efforts are adequate, the impacts of disasters just get worse. As Benjamin Franklin so aptly put it, "An ounce of prevention is worth a pound of cure."

An all-hazards approach to planning

A key concept that has emerged in emergency management is the all-hazards approach. It is no longer sufficient or possible to plan for individual threats. Canadians are now faced with a wide range of risks to their health and safety, ranging from potential natural and technological disasters to acts of terrorism and infectious disease outbreaks. While it makes good sense to identify specific threats and how to respond to them, it is a daunting if not impossible task to create a specific emergency plan for every possible hazard. Thus, from the perspective of both efficiency and completeness, emergency management has adopted an all-hazards approach to planning.² Note that all-hazard planning does not exclude a risk-based approach that considers the probability and consequences of specific threats. The two approaches complement each other and should be used jointly as part of a comprehensive risk management strategy.

The idea behind all-hazards risk management is twofold:

• Emergencies and disasters have many aspects in common in terms of the mitigation, preparedness, response and recovery needed by people, communities and organizations. It makes sense, therefore, to plan for generic sets of actions that are required when something negative happens, no matter what the cause. For example, a community might need to evacuate for many possible reasons (e.g., a hurricane or toxic spill) and needs to have an evacuation plan applicable to any hazard.
• Actions taken to reduce one risk should not adversely affect another. For example, the levees protecting the Mississippi River and New Orleans from flooding have prevented the replenishment of soils in the coastal wetlands that have provided some protection to the city. The low-lying Mississippi Delta, which buffers the city from the Gulf of Mexico, is rapidly disappearing at the rate of 25 to 30 square miles of delta marsh per year.³ As shown during Hurricane Katrina, the loss of such protective mechanisms can have devastating human and health consequences.

Protecting the most vulnerable

Sound emergency management takes into account the capacity and resources that a community has to prepare for emergencies and disasters, as well as its residents' vulnerabilities to hazards. Thus, while it is critical that efforts contribute to an efficient response capacity -- including preparation of plans to respond to emergencies of all types, training and organization of emergency workers and stockpiling of critical supplies and equipment -- steps must also be taken to protect the most vulnerable persons and groups living in communities. Events like the European heat wave of 2003 and Hurricane Katrina have taught us that disasters almost always have the harshest effects on the frail, the elderly, the disadvantaged and the least able to cope (see article on page 23).

"An all-hazards emergency management approach looks at all potential risks and impacts, natural and human-induced (intentional and non-intentional) to ensure that decisions made to mitigate against one type of risk do not increase our vulnerability to other risks."⁴

Building community capacity

Although disasters may often have devastating consequences, they have also taught us that people can and do recover from such catastrophes, and that they must be regarded not as victims but as partners in both preparing for and recovering from extreme events. Volunteers of all ages and from all walks of life play an important part in enabling communities to prepare for and recover from emergencies (see article on page 34). For example, volunteers can fill sand bags during floods, work telephone information lines, or deliver food and supplies to persons unable to leave their homes. Enhancing resilience is now recognized as a key concept in building the capacity of communities to prepare for emergencies and disasters (see article on page 29).

Mitigating future risks

Disasters, finally, have taught us to plan for the future in ways that do not increase vulnerabilities. It is important that policies and programs are implemented in a sustainable manner, so that risks are not transferred from one community to another or postponed to future generations. Efforts to manage the effects of climate change are a case in point. Good emergency management builds on and enhances the capacities of communities to mitigate the risks that their members face both today and tomorrow.

Making Emergency Management Work in Canada

Health emergency management is not new to Canada. Each province and territory has legislation, emergency preparedness plans and coordinated response activities that can be mobilized during emergencies (see article on page 45). However, there may be events of such magnitude that a jurisdiction cannot manage without additional assistance, such as a massive earthquake, an infectious disease outbreak, or a large-scale terrorist attack.

The 2003 SARS crisis in Canada highlighted the importance of having a pan-Canadian health emergency management system that is based on established and evidence-based principles. Indeed, two of the key lessons learned from SARS were: first, the need for common emergency planning and preparedness frameworks and protocols in order that jurisdictions communicate and share resources effectively; and second, clear jurisdictional roles and responsibilities in order to avoid confusion in planning and decision-making processes.

These have, in part, been addressed through the development of the National Framework for Health Emergency Management,⁵ which sets out guidelines that can be used by jurisdictions across Canada to develop consistent policies and practices to enhance the safety and protection of Canadians during emergencies.

The National Framework (Figure 1) is based on the four pillars of emergency management. At each phase, the emphasis is on particular activities -- for example, the pre-event phase emphasizes critical planning and preparedness activities, such as the development of multi-jurisdictional coordination and planning mechanisms, the establishment of communication mechanisms with common terminology and protocols, as well as the training of emergency managers and first responders.

Figure 1: Canada's National Framework for Health Emergency Management

Source: Federal/Provincial/Territorial Network on Emergency Preparedness and Response, 2004.⁵

Ensuring a coordinated approach

Many of the concepts identified within the National Framework are now being operationalized through the Pan-Canadian Health Incident Management System (PCHIMS).⁶ Among the most critical components is the capacity to link the separate emergency response systems of Canada's ten provinces and three territories. Agreement on common terminology and planning processes is essential to avoid confusion when jurisdictions must work together. This will help ensure that three critical elements of managing a coordinated response are addressed:

• How do we communicate with each other?
• How do we plan together?
• Who is responsible for doing what?

Coordination is also required to implement and maintain strong communication and information management processes. The capacity to prepare for and respond to a range of unpredictable threats, above all, rests on the capacity to share and coordinate information amongst organizations and across sectors. In addition, communication with the public is essential to enabling people to prepare themselves for disasters, alerting them to potential threats to their health and safety, and ultimately maintaining their trust and confidence during times of crisis.

Access to resources

It is also essential that jurisdictions have adequate equipment and supplies in place to respond to large-scale disasters. Resource management is a key emergency management principle, which ensures that both human and material resources can be rapidly mobilized, tracked and accounted for during emergencies. Depending on the type of emergency, resources can range from medical personnel like physicians and nurses to hospital beds, medical supplies and medicines, as well as diagnostic support such as laboratories. In Canada, resource management is supported through several mechanisms, including mutual assistance agreements between jurisdictions, cross-border agreements between provinces and territories, and the National Emergency Stockpile System (NESS), which maintains depots of essential health supplies and equipment across Canada (see article on page 37).

Responding across sectors

Maintaining the health of people during emergencies, however, is not limited to the health sector. Essential non-medical issues like emergency food, clothing, lodging and family reunification for evacuees are also critical to maintaining health and safety. Emotional, spiritual and other forms of psychosocial support are also important to assist people during times of crisis. Emergency social services and non-government and voluntary organizations play a major role in fulfilling these needs (see article on page 34).

It is also essential that broader public health functions are integrated into emergency response structures for a range of public health threats that require planning and preparedness. These include acts of bio-terrorism (e.g., release of anthrax or smallpox), radiological and chemical accidents, as well as infectious disease outbreaks like Pandemic Influenza. Emergency management must be able to work both with and across all sectors of health (e.g., pharmacies, acute and long-term care, and public health) to coordinate diverse public health interventions (including but not limited to rapid epidemiological investigation, infection control measures, quarantine guidelines, and specimen collection and transport).

Conclusion

Since the World Trade Center Attacks of 2001 and the SARS crisis of 2003, significant steps have been taken to strengthen Canada's health emergency management system -- but much work lies ahead. While Canada has to date escaped the devastating type of disasters that have struck the United States, this has meant that emergency preparedness is often overlooked as an essential component in ensuring the continuing health and safety of Canadians.

This not only has obvious funding and resource implications, particularly at the municipal level where emergency management is often only one of an official's multiple responsibilities, but has meant that emergency management as a discipline -- grounded in a theoretical framework and based on evidence-based practice -- is only just emerging in this country. The capacity to develop and implement a truly integrated and comprehensive health emergency management system in Canada will ultimately depend on decision makers, researchers and practitioners working together to ensure that policies and programs are rooted within evidence-based frameworks and standards of practice.

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Spotlight on Research: Critical Health Infrastructures During Disasters - Lessons Learned

Kaila-Lea Clarke, Climate Change and Health Office, Healthy Environments and Consumer Safety Branch, Health Canada

Case studies illustrate some of the ways that weather-related emergencies can affect human health, the health care system and the critical infrastructure on which it depends. This article highlights some of the lessons learned from case studies of the 1998 ice storm and Hurricane Juan.

It is estimated that the number of extreme weather-related events in Canada increased from approximately three per year in the 1970s and 1980s to twelve per year in the 1990s.¹ As the article on page 8 has pointed out, this trend is projected to increase as the climate continues to change. In the 1990s, natural disasters caused 179 deaths and 1,000 injuries, and affected over 700,000 Canadians. The people affected were evacuated, made homeless or lost critical infrastructure services. Although mortality in Canada attributed to natural disasters has decreased in the past several years, the number of people affected has risen.

During weather-related emergencies, the health care system plays an essential role in reducing mortality and morbidity, but this role can become compromised if the system, or the critical infrastructure upon which it relies, is affected negatively by the event. Hurricane Juan and the 1998 ice storm are two Canadian disasters that illustrate the role of critical infrastructure and public health response in decreasing the risk of injury, illness, stress-related disorders and fatalities associated with extreme weather events. Both provided emergency managers and public health officials with lessons that have contributed to more effective planning for and management of health care services in the face of weather-related disasters.

For this project, the Climate Change and Health Office at Health Canada drew its analysis from peer-reviewed scientific publications, and professional association and government reports from multiple disciplines, including nursing, public health, medicine and emergency preparedness. Standard academic and government databases were also searched via keyword content and title searches. A valuable resource was Public Safety Canada's Canadian Disaster Database² (see Using Canada's Health Data, page 47).

Hurricane Juan Hits the Maritimes

In September 2003, Hurricane Juan, a category 2 hurricane, made landfall in Nova Scotia as one of the most powerful and damaging hurricanes ever to affect Canada. Juan was responsible for eight deaths.² More than 300,000 people were without power for up to 10 days, telephone service was disrupted and the water infrastructure was compromised.⁴

Major hospitals were affected by the devastation, including the Victoria General Hospital in Halifax. With part of its roof ripped off, the hospital sustained flooding and water damage to eight floors, including storage rooms that contained sterile medical supplies. More than 200 patients had to be relocated to other facilities. Beds at functioning facilities became scarce, as most patients, even those with minor injuries, could not be sent home since the essential resources needed to manage their own care (power, water and telephone) were compromised.

The impacts of Juan were felt for up to four weeks after the event. For example, owing to flooding and air quality issues related to the presence of possible moulds, the Victoria General did not open its operating theatres until four weeks after the initial event. The resulting cancellation of 78% of scheduled surgeries increased surgical wait lists as the 370 cancelled surgeries were rebooked.⁴

Lessons learned

Many lessons were learned from the experience and several adaptations have been implemented in order to ensure that health professionals in the Halifax region are better prepared for future emergency situations. There is now greater recognition that the management of relocated patients, staff and medical equipment presents many unanticipated challenges, and that specific personnel need to be allocated to these tasks. This would help to ensure the communication of direct and accurate information about the needs of patients and staff. For example, it has been recommended that a familiar charge nurse or manager be appointed to staff at all times when they are relocated to an unfamiliar work environment.⁴

After Hurricane Juan, a toll-free phone number was established to provide hospital staff with up-to-date information during emergency situations. Adaptations to improve communication are being considered, including access to alternate satellite feed for TV coverage and digital access via the Internet that would allow for communication to the public about scheduling changes at hospitals during an emergency (such as cancelled surgeries and closed emergency rooms). A program is also being developed to train duty officers and administrators to respond to emergency situations. Finally, the District Emergency Response Centre has been moved to a new location equipped with improved systems for emergency power.⁴

The 1998 Ice Storm in Eastern Canada

A massive ice storm befell eastern Canada in January 1998. It was unprecedented in terms of the number of individuals affected, the intensity of the freezing rain and the duration of the event. The storm resulted in the disruption of power and water supplies, public and health services, and emergency services were hindered by the lack of communication. The storm lasted for several days; its effects were felt for weeks afterwards. Collectively within Ontario and Québec, approximately 260 communities declared a disaster. The following data illustrate the magnitude of the disaster:

• Property damage was extensive and the economic losses amounted to nearly $5.41 billion making it one of the most expensive disasters in Canadian history.²
• 945 people were injured and 28 lives were lost.²
• Over 120,000 km of power lines and telephone cables were destroyed.⁵
• More than 3.5 million people lost electricity; for some, it was not restored until more than three weeks later.¹
• The storm resulted in mass evacuations, forcing some people to take up residence in temporary shelters.

Interestingly, most deaths were not due to direct exposure during the storm. Rather, they were attributed to the use of indoor open flames or heaters used in the absence of functioning power infrastructure.⁶ For example, 700 cases of carbon monoxide poisoning were reported in one health region alone.⁷ Common injuries included frostbite and fractures from falls on slippery sidewalks or while clearing ice from roofs. Insomnia, anxiety, irritability and some longer term mental illnesses were also reported.⁷

The conditions created by the storm put hospitals and emergency services to the test. Hospitals experienced an increase in the number of individuals seeking medical attention for injuries, carbon monoxide poisoning, respiratory infections and heart problems.⁸ Hospitals had to accommodate individuals who were being transferred from smaller hospitals, home-care programs and nursing homes that could no longer provide essential services -- such as power for respirators.⁸ Some hospitals operated on generators for up to three weeks. Larger hospitals that had emergency generators were able to provide only the most essential hospital services, while smaller hospitals had generators that supplied only lights and telephones.⁷ Ambulances and emergency medical technicians were heavily relied upon for medical emergencies and to transport people to shelters and hospitals, as well as to transport medicines and medical equipment. Hazardous road conditions and lack of a reliable communication system challenged the transport of people and goods.

Learning on the spot

Health professionals in affected communities resorted to a number of ad hoc adaptations, and learned how well they sufficed as they were implemented. For example:

• To prevent the spread of illnesses in shelters, those that became sick were isolated from the other residents, and health care workers were vaccinated.⁷
• Many hospitals provided shelter to the families of their employees and medical staff, in order to maintain staff levels and availability.⁸
• The Ordre des psychologues du Québec set up a hotline to help the public cope with stress-related disorders.⁷
• The Ordre des pharmaciens du Québec refilled medications without requiring a prescription or bottle.⁷

After the ice storm, the Québec government mandated the Nicolet Commission to review the event and the manner in which communities responded.⁹ Since then, the province has taken important steps to strengthen emergency preparedness and response capacity at both the community and individual level. As a result, the province is now in a position to better cope with future extreme events (see article on page 21).

Future Research Needs

Much can be learned from events like Hurricane Juan and the 1998 ice storm. Other recent examples are not difficult to find: the recent hurricane-like severe wind storm in British Columbia in the autumn of 2006 resulted in a boil water advisory affecting two million people;¹⁰ and, in August 2005, the Greater Toronto area was hit with heavy rain that washed away infrastructure and flooded basements.¹¹

Rapid surveillance of health impacts following events such as these is important, as it can provide accurate and timely information that can be used to inform health professionals when planning for future events.¹² Information is also needed regarding long-term health impacts and the role of health services in the recovery process during and after an event. Few Canadian studies have reported on factors that lead to successful recoveries. Such information would help to increase the resilience of public health systems to future events, thereby limiting or minimizing the long-term threats to human health and well-being.

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Case Study in Emergency Preparedness and Response: The Québec Model

Claude Martel, Service des activités de sécurité civile, ministère de la Santé et des Services sociaux du Québec

The 1996 Saguenay floods and the 1998 eastern Canadian ice storm were instrumental in the development, by the Government of Québec, of a comprehensive program of research and policy action that has resulted in improved emergency preparedness at all levels, including local and regional municipalities.

Although the ice storm of 1998 lasted only a few days, it debilitated much of Québec, eastern Ontario, New Brunswick and Nova Scotia for weeks following the event. In the aftermath of this disaster, the Government of Québec recognized the need to address the weaknesses that the storm had exposed -- in particular, the deficits in surge capacity across the province.

Surge capacity is the capacity needed to react to a sudden, constant or complex need for goods and services that are essential to individuals or groups affected by a real or threatened disaster. Achieving surge capacity calls for a combination of measures aimed at action, coordination and communication to support emergency management policies, approaches, processes and organizations (see sidebar). It also calls for the mobilization of many players and resources and requires coherence and complementarity among players and jurisdictions.

Taking Comprehensive Action

Following the ice storm, the Government of Québec, along with its partners, took action on a number of fronts to strengthen its emergency preparedness and response capacity -- including the surge capacity that would be required to respond to a sudden, sustained and/or complex demand for goods and vital services during a disaster. The action taken demonstrated that, since prevention alone cannot eliminate all the risks, the concept of surge capacity must apply as much to preparedness as to response and recovery.

New public safety legislation

At the centre of the efforts was Québec's Civil Protection Act (2001),¹ which put in place a model of civil safety that included essential structural elements at the local, regional and provincial levels. The Act revised and extended public safety legislation to improve the emergency preparedness of various organizations and agencies within local and regional municipalities. It also ensured that, at every level, all necessary sectors were engaged.

An integrated, all-hazards approach

The health sector was identified as having a key role. Under the Civil Protection Act, Québec's National Civil Protection Plan (NCPP)² was developed to provide the general planning framework for the health sector in the event of a disaster. The plan ensures an integrated government approach, by clearly defining the linkages and responsibilities of every department and governmental organization. This coherent, all-hazards framework regulates the operation of 15 sectors, including health, services to disaster victims, food supply, housing, safety, communication, environment, energy, municipality, transport, economy, finance, logistics and others. It also serves as a frame of reference for Québec's 18 socio-health regions.

The activities of participating sectors rely on a rich source of human, material, informational and financial resources. Figure 1 provides a snapshot of just three of these sectors.

Figure 1: Allocation of Resources to Selected Sectors under Québec's National Civil Protection Plan

Building Surge Capacity in the Health System

The aim of the NCPP's Health Mission is to preserve the life and well-being of people during disasters. It establishes a framework for planning for and responding to disasters that will provide the required surge capacity, by:

• supporting the promotion, prevention, protection and maintenance of essential services
• regulating pre-hospital, diagnostic and medical services
• ensuring the availability of hospital nurses, temporary living arrangements and first-level psychosocial and telephone support
• regulating the human, material, informational and financial resources of the provincial health network to provide additional surge capacity, as needed

Most importantly, the Health Mission clearly defines the responsibilities of each partner and sector, offers a communication strategy, and provides an operational framework for surveillance, alerts and resources.

Coordinated action at the local level

The province's Disaster Site Coordination Framework³ was developed to guide municipalities and local organizations, including health organizations, in implementing coordinated intervention during disasters. It also facilitates the communication of critical information and relevant explanations between responders.

To enhance the protection of people, goods and the environment, Québec's Ministry of Public Security applies a risk management approach to help analyze and manage a number of natural and human-induced risks (see Figure 2).

Figure 2: Risk Management Cycle

Source: Québec Ministry of Public Security, 2008.⁴

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The Health Impacts of Disasters: Who Is Most at Risk?

Simone Powell, Division of Aging and Seniors, Centre for Health Promotion, Public Health Agency of Canada

The author would like to acknowledge the contributions of Jennifer Payne, Bureau of Women's Health and Gender Analysis, Regions and Programs Branch, Health Canada, as well as Louise A. Plouffe and Patti Gorr, Division of Aging and Seniors, Centre for Health Promotion, Public Health Agency of Canada.

Research shows that the health impacts of disasters are not distributed uniformly across the population. This article explores the concept of vulnerability and its underlying determinants. It also presents an over view of who is most at risk, with a closer look at seniors -- their vulnerabilities, the nature of their needs and their potential contributions. The research provides findings relevant to future disaster planning for seniors and others in Canada.

Vulnerability and Disasters

All populations exposed to a disaster event are at risk of suffering serious health impacts. However, research has shown that some groups are more at risk than others to the immediate and long-term consequences.¹

Vulnerability to disasters can be understood as "the relation ship between common social and economic characteristics of the populations, individually and collectively, and their ability to cope with hazards that they face."² Canada's National Framework for Health Emergency Management notes that identifying the characteristics of vulnerable populations is as important as understanding the characteristics of a hazard.² Further, the emergency management profession is recognizing that the only way to make a significant change to a community's catastrophic risk profile is to influence the social, economic and physical factors that determine the community's exposure to those risks and its ability to cope with an actual impact.³

Determinants of health and vulnerability

The factors that increase an individual's vulnerability to harm in a disaster situation are similar to those factors which determine the general health of individuals: physical determinants; social networks and environments; education and literacy; economic determinants; personal health practices/coping skills; health services; biology and genetic endowment; healthy child development; gender; and culture.⁴,⁵

Understanding these determinants and how they relate to vulnerability is critical. It can help explain why some groups are more vulnerable or "at risk" than others and, hence, provide guidance for understanding the impacts of disasters and for taking action throughout the emergency management cycle. For example, persons with limited social networks or who are socially isolated may lack access to assistance during an emergency. Others with low income may not have the financial resources needed to prepare for, respond to (e.g., evacuate quickly) or recover from an emergency. They also may be forced, because of their economic circumstances, to live in poor quality housing that may not withstand the impacts of a disaster.¹

Just as is the case with the determinants of health, the factors that influence vulnerability do not act in isolation. Rather, they can interact in a way that exacerbates the impacts of emergencies. Moreover, these factors can change with age, life circumstances and gender roles.³

Who is Most at Risk?

Drawing on expert consultations, existing literature and the application of the social determinants of health, the Canadian Red Cross identified 10 high-risk population groups in Canada who are least likely to anticipate, prepare for, cope with and recover from the effects of a disaster, and whose needs should be taken into consideration in emergency planning (Figure 1).²

Identification of these groups does not suggest that their members are homogeneous or that they are mutually exclusive categories. On the contrary, throughout the disaster cycle for each hazard, vulnerability should not be assumed but investigated.³ As noted by the Organisation for Economic Co-operation and Development, it is "necessary to identify vulnerabilities and vulnerable population groups and find ways to monitor and reach these groups and integrate that data into risk and vulnerability assessments."¹

Meeting the Needs

Having a sense of who is most at risk during an emergency can help communities and emergency management organizations to reduce risk and prioritize responses. However, confronting a long list of at-risk groups can prove to be overwhelming, particularly if one considers that over half of a community's population may be at risk during an emergency.¹⁵

In response to this challenge, a functional needs approach has been gaining acceptance among emergency management planners as a way to identify, plan for and meet the needs of high-risk or vulnerable groups (see sidebar). Rather than grouping needs based on population characteristics of age, gender, disability, etc., this approach identifies cross-cutting areas of functional needs that may be faced by one or more at-risk populations. By so doing, it also accommodates people who may not fit into a single or specific population group (e.g., children with a disability), who may not identify themselves as part of a group, or whose needs are tem porary.¹⁶

While such an approach can help ensure that a full range of functional needs is identified and addressed, it is important not to lose sight of the particular historic, social and personal contexts that shape the lives of "at-risk" groups. A lifetime of discrimination and marginalization, or exposure to previous emergencies, losses and diseases, also influences how people respond to and cope with disasters and must be taken into consideration in emergency planning.

In this context, the Public Health Agency of Canada (PHAC), in conjunction with the World Health Organization (WHO) and others, has examined the real-life experiences of seniors in disasters, providing useful information that can be applied to planning for seniors and for groups that -- particularly in an emergency situation -- may share some of the functional needs and challenges faced by seniors.

International Research on Seniors and Disasters

Evidence from past disasters has demonstrated that older adults are disproportionately represented among the dead and injured. For example, the greatest age-specific death rates resulting from the 2004 tsunami in Aceh, Indonesia, were among adults aged 60 to 69 (23%) and those aged 70 and over (28%). Likewise, 70% of persons who died during the 2003 heat wave in France were over the age of 70, and during Hurricane Katrina 71% of the dead in Louisiana were over the age of 60.⁷

Between 2006 and 2050, the proportion of people aged 60 and over will double from 11% to 22% of the global population.¹⁸ The oldest segment of the population (over age 80) is growing at an even faster rate. This same trend is found in Canada, where the proportion of older Canadians is projected to double in almost 50 years.¹⁹

Building the Evidence

Despite the fact that seniors are disproportionately affected during disasters, they have often been overlooked or given low priority in emergency situations.²⁰ To examine this situation more closely, PHAC, in collaboration with the WHO and other partners, undertook 16 international case studies (see sidebar) to examine how older people were affected in a range of disasters. Case study authors used available data sources (including age-disaggregated data when available) on the impact of these disasters to assess the strengths, gaps and best practices regarding emergency planning and response, including contributions made by seniors. They also offered policy recommendations for better meeting the needs of seniors.⁷

Sixteen International Case Studies

War - Lebanon (2006)

Drought - Bophirima, South Africa (2003)

Heat Waves - France (2003)

Floods - Mozambique (2000); Manitoba (1997); Saguenay, Québec (1996)

Hurricanes - Jamaica (2004-2005); New Orleans (2005); Cuba (1985-2005)

Earthquakes - Turkey (1992-1999); Kashmir (2005); Kobe, Japan (1995)

Tsunami - Aceh, Indonesia (2004)

Ice Storm - Québec (1998)

Wildfires - British Columbia (2003)

Nuclear Power Plant Explosion - Chernobyl, Ukraine (1986)

What contributes to seniors' vulnerability?

It is not age per se that makes seniors vulnerable to disasters. Rather, it is the combination of factors that are often associated with older age that increases vulnerability and capacity to cope. More over, limitations that are manageable under normal circumstances may quickly become overwhelming in a crisis.

By looking at the determinants of vulnerability, the case studies provide information that helps us understand why seniors are more vulnerable, and how to mitigate the risks they face.

Social Networks/Environments: Seniors, particularly those with chronic conditions, are often able to cope on a daily basis and maintain a sense of independence because of the assistance they receive from others. Emergency situations disrupt these relationships leaving older people, especially those with small social networks, at risk for isolation, neglect, exploitation and violence. In the Kashmir, Jamaica and Lebanon cases, the loss of these relationships resulted in social isolation, marginalization and even abandonment when family members were overwhelmed by their own needs or were un able to evacuate their older family members.

Gender: Older women are more likely to live in poverty and in inadequate housing. Because of their longer life expectancy they frequently live alone, often with chronic disabling conditions. In the Lebanon, Aceh and British Columbia case studies, older women were significantly more dependent on others for information, support, access to health care and other services. Women living in poverty were particularly vulnerable in Jamaica. Men also faced difficulties when they took on roles normally ascribed to women, such as child care in the case of Aceh.

Economic Determinants: Seniors living on limited incomes often live in poor housing, in high-risk areas and lack access to transportation. Further, they are often less likely or able to prepare for an emergency. The effects of low income were particularly evident in the disasters in Kobe, Jamaica, Bophirima and British Columbia, where, during the recovery phase, seniors were less likely to receive financial aid or be considered candidates for post-disaster loan programs.

Health and Social Service Systems: Aging-related physical changes and chronic illnesses create more dependency on health and social services. When emergencies disrupt or shut down these services, seniors are at greater risk for injury, exacerbated health conditions and death. Disruption of health services prevented access to care by seniors in a number of case studies including Jamaica, Kashmir and Lebanon. In France, poor coordination between emergency, health and social services had deadly outcomes for seniors.

How to mitigate negative impacts

Case study findings confirm previous disaster research, and go further to offer insights into practices that exacerbate vulnerability as well as those that have been shown to mitigate negative outcomes in each phase of a disaster.

Preparation Phase - Neglecting to include seniors' needs and contributions in emergency plans and policies contributed to negative outcomes. On the other hand, when seniors were specifically identified in plans, effective communication strategies were used and seniors were provided with appropriately designed shelters and a continuity of health services. In Cuba, where the emergency plans were the most comprehensive of the jurisdictions studied:

• Both the mortality rate for seniors (4 out of 17 deaths) and the overall mortality rate were lower in Cuba during hurricanes from 1985 to 2001 than in neighbouring islands.
• Great efforts were made to ensure that seniors were active members of local emergency committees and that they played a role in public information and education.

Response Phase - Failure to take seniors and their functional needs into account resulted in delays in evacuating long-term care facilities, poorly designed shelters, separation from family, health services that were unable to cope with excessive demands for medical attention and inadequate consideration of seniors' food and nutrition requirements. When response plans considered the needs of seniors, the process worked well:

• In British Columbia and Québec, home care staff prepared older clients for relocation.
• In Kashmir, a no-queue system was established for older adults at food distribution points, while in Kashmir and Cuba, food was delivered to those who could not evacuate.
• In British Columbia, Cuba, Jamaica, Kobe, Lebanon and Québec, emphasis was placed on relocating at-risk seniors to safe shelters.
• In Turkey and Kobe, specialized housing was created.
• In Kobe, substantial efforts were made to address psychosocial needs through community support and interaction.

Recovery Phase - Seniors were disadvantaged by a number of faulty practices, such as exclusion from livelihood recovery programs and retraining, inaccessible or incomprehensible benefit application forms and processes, premature withdrawal of support services, housing that was socially and structurally unsuitable, and exclusion from the rebuilding process. Good practices included:

• In Turkey, Jamaica, Aceh and Kobe, restoration of older persons' homes was a priority in some locations.
• In Turkey, an NGO ran a rehabilitation centre with recreational facilities for seniors.
• In Kobe, housing for older persons was built with on-site services and support, as well as opportunities for social inter action.
• In Aceh, Cuba, Kashmir and Mozambique, seniors were included in recovery planning and reconstruction projects.

Seniors as Contributors

Almost all of the case studies uncovered ways in which older people made significant contributions, demonstrating that being in need and being able to contribute are not mutually exclusive (see sidebar). For example, seniors served as volunteers to provide outreach, information, material, practical assistance and emotional support -- in addition to supporting their families by taking on caregiving responsibilities and sharing their resources. By offering their strength and experience, older people also served as models of resilience and resourcefulness to other community members.

Policy Action in Support of Seniors

Since 2006, PHAC's Division of Aging and Seniors and the Centre for Emergency Preparedness and Response have collaborated to bring together the fields of emergency management and gerontology to exchange knowledge, create new partnerships and build a foundation for action. By working with Canadian and international experts, research has been moved into action, priorities have been identified, and new networks designed to move these priorities into concrete outcomes and to share tools and resources have been created. Examples include:

• A framework for action -- Building a Global Framework to Address the Needs and Contributions of Older People in Emergencies ²¹ -- was prepared by PHAC drawing on the case studies and guidance from experts at the 2007 Winnipeg International Workshop on Seniors and Emergency Preparedness. The framework was presented to the United Nations Commission for Social Development in February 2008.
• An advocacy brief was prepared by the WHO, HelpAge International and PHAC for the United Nations humanitarian community. This brief outlines key issues and provides some practical guidance for humanitarian workers.²²

Conclusion

Research on the determinants of disaster vulnerability -- much of which has roots in the population health field -- provides practical information that is increasingly being used in emergency management. Knowing who is vulnerable and the nature of their functional needs provides a foundation on which to identify and plan for individual and community needs, and offers direction on how resources can best be targeted. Many of the lessons learned from examining the nature of seniors' vulnerabilities and needs in real-life disasters can be applied to future disaster planning for seniors and other populations in Canada.

Whether considering the needs of high-risk groups, or looking across groups to determine the functional needs of a community's population, it is important that emergency organizations recognize the contributions that these groups can make and engage them as active participants in the emergency management process.

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Resilient Canadians, Resilient Communities

Peter Berry, PhD, Climate Change and Health Office, Healthy Environments and Consumer Safety Branch, Health Canada, and Dave Hutton, PhD, formerly with the Centre for Emergency Preparedness and Response, Public Health Agency of Canada, and currently with the United Nations Relief and Works Agency, West Bank

Experiences with emergencies in a number of communities in Canada over the past century have tested their resilience. Many lessons have been learned and, together with findings from a growing body of research, these experiences have shed light on how community resilience can be strengthened. This article discusses the value and role of resilience in withstanding, recovering and learning from disasters -- particularly important in light of emerging issues and trends which could portend even greater impacts on human health.

The Importance of Resilience

The principle of resilience is emerging as an integral component of emergency management practice in Canada. Resilience can generally be defined as the "capability of individuals and systems [families, groups and communities] to cope with significant adversity or stress in ways that are not only effective, but tend to result in an increased ability to constructively respond to future adversity."¹

Resilient people and resilient communities suffer less in the face of disasters that threaten health and well-being. Three properties of resilience lessen human suffering during and after an event:²

• the ability of a community to withstand a disaster and its consequences (resistance)
• the ability of a community to "bounce back" to its pre-disaster level of functioning (recovery)
• the extent to which a community learns from the disaster experience and transforms this knowledge into more advanced emergency management functioning (creativity)

Levels of Resilience Vary

Overall, Canadians enjoy high levels of health and well-being and access to health and social services, providing a strong foundation of resilience to a wide range of hazards. However, this foundation is not shared by everyone; some individuals and population groups, such as the poor and socially marginalized, are more vulnerable to disasters and less resilient than others (see article on page 23).

Levels of resilience can also vary across communities and regions. The risk factors associated with the frequency of emergencies and the severity of their consequences include dense populations in urban areas, human settlement in hazard-prone areas, and complex and deteriorating infrastructures (see article on page 8). These risk factors may reduce levels of community or regional resilience.

It is not possible -- nor is it the role of emergency management -- to eliminate all of the many factors that make people less resilient to hazards. However, it is important that emergency managers and public health decision makers work with communities to identify risks and vulnerabilities, and to develop the resources and capacities that enable people to effectively prepare for, respond to and recover from all types of threats.

How Emergency Management Plays a Role

A key purpose of emergency management is to assist communities to prepare for unexpected and sometimes overwhelming events that threaten people's physical, economic, social and/or emotional well-being. Good emergency management recognizes that this is most effectively achieved by working closely with communities to identify risks and hazards and to mobilize and strengthen existing resources and capacities. In this sense, emergency management is only as strong as the communities it supports.

Focusing on mitigation and prevention

A fundamental step in preparing communities for disasters is to reduce the potential impacts of threats from hazards. Mitigation activities can be either non-structural or structural in nature. Health promotion is an example of non-structural mitigation. In emergencies, hospitals are inundated, leaving those but the most seriously ill at risk of not being able to access medical care. A focus on disease prevention and control among other actions may reduce demand on hospitals and render the population healthier and more resilient to the effects of emergencies and disasters.

An example of structural mitigation is ensuring that health care facilities are not built on flood plains, or are protected by dikes. The city of Winnipeg demonstrated the resilience concept of "creativity" when it responded to its experience with the 1950 Red River flood by building a floodway around the city, thereby substantially improving its resistance to future floods (see sidebar). This resistance was amply demonstrated during the 1997 flood which resulted in fewer community impacts.

Although historically there has been less focus on prevention and mitigation efforts in Canada, the National Disaster Mitigation Strategy⁴ is now focusing attention on Canada's need to strengthen its mitigation/ prevention activities. There is also growing consensus within the international community that more emphasis must be placed on mitigation/prevention. At the 2005 United Nations World Conference on Disaster Reduction, the delegates stated that: "We recognize that a culture of disaster prevention and resilience, and pre-disaster strategies, which are sound investments, must be fostered at all levels."⁵

Assessing hazards to improve resilience

Identifying and understanding the hazards and risks that may threaten a community is a key step in building resilience. Although a community may have many resources, it is important that they are employed in an effective and equitable way to respond to particular events. To be most informative, hazard, risk and vulnerability assessments require information on the location of critical infrastructures, the expected location, frequency and magnitude of hazards, and where "at-risk" populations reside.⁶

The recently released report Human Health in a Changing Climate: A Canadian Assessment of Vulnerabilities and Adaptive Capacity provides information to aid community and regional public health and emergency management officials gauge future risks to health from climate change and identify needed adaptations.⁷ A key finding is that climate change is expected to increase extreme weather and other climate-related events in Canada such as floods, droughts, forest fires and heat waves -- all of which increase health risks to Canadians. Resilience to these natural hazards can be increased through efforts to renew and strengthen critical infrastructure, improve the emergency preparedness of individuals and enhance disaster mitigation activities across Canada.⁸

Developing early warning systems

Early warning systems maximize the probability that people can take the appropriate actions to protect themselves from a natural hazard event. These systems are designed to detect or forecast a potential danger and issue an appropriate alert. Canada relies on several systems that issue warnings for specific hazards (e.g., heat waves, storms). A common problem is the weak link between the technical capacity to issue the warning and the capacity of the warning to trigger the appropriate response among the public.⁹ Despite this, early warning systems have been shown to reduce the loss of life associated with natural hazards. ¹⁰,¹¹,¹²,¹³

Maintaining community infrastructure

Many communities in Canada face pressures from aging infrastructure, increasing the risk of destruction and service disruption during a disaster.¹⁴ Because modern infrastructures serve a complex range of functions -- such as transportation, communication, energy, utilities, water and waste systems -- their interconnectedness exacerbates a community's vulnerability to disasters.¹⁵ Building and maintaining infrastructure to withstand the impacts of an increasing number of extreme events is an investment that can improve a community's resilience during and after a disaster.

Health-related infrastructure such as hospitals, emergency medical services, walk-in clinics and pharmacies, as well as related psychosocial services such as telephone help-lines and grief counselling, are not only important in maintaining the health of people in everyday life, but also serve as the foundation to respond to any emergency or disaster.

Supporting community groups and networks

Perhaps the greatest resource of any community is its people. People and communities struck by disasters should not be regarded as either helpless or as passive recipients of assistance. Rather, they should be seen as active partners in emergency preparedness and planning.

Engaging community groups in emergency management activities is critical to enhancing resilience. Working with community groups and networks can enhance outreach and raise awareness among the public, particularly hard to reach or socially invisible groups (e.g., frail and isolated seniors, non-English speaking newcomers, the poor and homeless). Community partners are also often the most knowledgeable about the distinct needs of their members. Although community organizations are increasingly recognized as partners in emergency management, a recent study found that many emergency management and voluntary organizations in Canada do not have the networks and resources needed to maximize their collective potential.¹⁶

Public and private sector organizations are also critical partners. Those with well-planned and tested business continuity plans will be better prepared to provide their services during a disaster and, by continuing to function, will enhance their community's capacity to "bounce back." Businesses play a key role in assisting communities to recover after disasters, often contributing financial resources and much needed supplies and materials to affected communities.

Enhancing individual preparedness

Individual action to plan and prepare for disasters is the cornerstone of stronger and more resilient communities in Canada. The ability of an individual or family to be self-sufficient for at least the first 72 hours after a disaster lessens personal suffering and hardship and reduces the demands on overstretched response systems.

Raising awareness and understanding of the risks that people face is an ongoing priority for emergency managers. A recent study conducted by the Public Health Agency of Canada and the University of Manitoba found that only 16% of surveyed Manitobans believed that a disaster would definitely occur in the area where they live, while 53% thought a disaster might occur, but was not likely.¹⁷ Participants' worries tended to focus on more immediate issues such as personal and family health. Similarly, a Health Canada study found that although many Canadians are concerned about climate-related health risks,¹⁸ they often fail to heed the advice of public health authorities to prepare for emergencies and reduce health risks from events such as heat waves.¹⁹

Working closely with communities can help ensure that people's different beliefs, attitudes and perceptions are taken into account when preparing messages and public information. This, in turn, can increase the likelihood that provided information will be listened to and acted upon.²⁰

Building an All-Inclusive Approach

In 2007, the World Health Organization (WHO) oversaw the development of a six-year health sector strategy for community capacity development to protect health in emergencies.²¹ This risk-reduction strategy recognizes that although many emergencies are unpredictable, much can be done to prevent and mitigate their effects as well as to strengthen the response capacity of communities at risk (see sidebar).

Canada's future capacity to reduce health risks from disasters will ultimately depend on the ability of public health and emergency management officials and their partners to assess community risk and to plan, prepare and respond effectively. Successful collaboration with all community groups, including those representing the community's most vulnerable residents, is paramount. Community and individual resilience can be actively strengthened. Enhancing resilience through all phases of emergency management -- prevention, preparation, response and recovery -- requires coordinated effort. The steps that Canadians, communities and their leaders take today to build resilience to emergencies will have a profound impact on public health tomorrow.

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Spotlight on Research: The Rural Reality

Danielle Maltais, PhD, Département des Sciences humaines, Université du Québec à Chicoutimi

When disaster strikes, the type of help provided to individuals and their communities depends on a variety of factors, such as the severity of the disaster and the characteristics of the population affected. Both sociodemographic and psychological factors figure into the equation.

Sociodemographic Factors

Understanding and respecting a community's resources, traditions and values is critical to enabling individuals to accept psychosocial help in a disaster situation. Rural communities have particular characteristics that can either support or hinder both recovery efforts and the adoption of community-based strategies to minimize the negative consequences of a disaster. On the socioeconomic front, rural communities appear to be disadvantaged compared to their urban counterparts, due to higher rates of poverty, unemployment and underemployment. Moreover, rural communities have a larger population of seniors, who have unique needs in times of disaster (see article on page 23).

Research also shows that the physical health of rural dwellers is generally lower and more fragile than that of city dwellers. People who live in rural areas have higher rates of chronic disease, cardiovascular disease, hypertension and diabetes.¹ They also have poorer access to a variety of health care services -- social and medical services are frequently not available in rural and remote areas, or are not up to par with urban centres. Similarly, access in rural communities to education and training, as well as to infrastructure, funding and government services, is more limited. Other issues, such as the exodus of youth, economic restructuring and globalization also diminish the capacity of rural communities to respond to a disaster.

Psychosocial Impacts

Canadian research confirms the fragile state of rural dwellers exposed to a disaster. Studies of two small (less than 1,500 people) rural communities clearly revealed that, in the aftermath of severe flooding, the physical health and psychosocial functions of these residents were strongly affected for weeks, months and even years.¹,² Among other things, the researchers observed the emergence of feelings of insecurity, the onset or aggravation of health problems, signs of depression, anxiety and post - traumatic stress, marital conflicts, prolonged disruption of social or leisure activities, and job loss.

In a study of families affected by the ice storm of 1998, researchers observed that the reactions and feelings of families with young children in rural areas and farmers dealing with power shortages were more negative, and that they had more problems and more sources of stress to deal with than did urban dwellers.³

On a more positive note, certain social factors and attributes specific to people living in rural communities indicate that rural dwellers generally demonstrate resilience in the face of disaster and manage to make decisions that help the community "get back on its feet." These include having a strong network of friends and neighbours willing to help, greater self-reliance, resourcefulness and independence, the desire to preserve one's quality of life, as well as the community's level of energy.

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Spotlight on Research: Tapping the Potential of Voluntary Sector Organizations

Connie Berry, Office of the Voluntary Sector, Centre for Health Promotion, Public Health Agency of Canada, and Don Shropshire , National Director, Disaster Management, Canadian Red Cross

The voluntary sector constitutes an important part of any community and consequently plays important roles during times of emergency. This article explores those roles and draws on the results of collaborative research initiatives¹ among federal government authorities, academics and voluntary organizations regarding the potential for increasing engagement with the voluntary sector to prepare for and respond to health emergencies, including supporting high-risk populations.

The voluntary sector includes a variety of non-profit organizations and community groups, such as religious groups, social services and community associations, as well as the volunteers themselves. While some key voluntary organizations have a mandate to participate in emergency response, the vast majority of the over 161,000² registered Canadian non-profit organizations do not. Nevertheless, many play an indirect role, and research indicates that the sector offers untapped potential to further contribute to a community's capacity to cope with and respond to health emergencies.

The Voluntary Sector in Emergency Response

When a disaster strikes, a wide range of emergency health and social services are called into action. Many of these services -- reception centre management, registration and inquiry, emergency lodging, feeding, clothing, first aid and personal services -- are often mandated to specific voluntary sector organizations, such as the Red Cross, St. John Ambulance and the Salvation Army, by the applicable municipal, provincial or territorial authority. Other organizations make important contributions by providing key support services and addressing surge capacity. As well, there are some emerging roles that hold great potential:

Ensuring continuity of key support services

Many voluntary organizations act as a "safety net" supporting those who are socially vulnerable, through community-based services such as "Meals on Wheels." (Of Canadian voluntary organizations, 23% serve children and youth, 11% serve the elderly and 8% serve people with disabilities.²) Through service continuity planning, such organizations are able to continue their service delivery during an emergency, thereby mitigating the effects on their clients and minimizing the demands on emergency health and social services.

Mobilizing human resources: surge capacity

During the Severe Acute Respiratory Syndrome (SARS) crisis, the Canadian Red Cross, St. John Ambulance and the Salvation Army supported local authorities by mobilizing over 700 volunteers and staff to deliver 13,500 health kits and food parcels to over 10,000 people quarantined in their homes; as well, they supported health professionals to provide screenings in airports and Emergency Operations Centres.⁵

Emerging roles

In addition to emergency health and social services, public authorities are increasingly turning to voluntary organizations to play a greater role in other areas, given their knowledge and position in the community. These roles can be provided through organizations and community groups, or more informally through neighbour - helping-neighbour initiatives, and include:

Addressing Special Needs - Emergency managers identify "reaching high-risk populations with targeted preparedness information and warnings" as a key risk- communication challenge.⁶ Voluntary organizations could be natural partners in planning public health warnings for particular populations. For example, ethnocultural organizations could help overcome language and cultural barriers faced by new Canadians.

Leveraging Community Resources - The voluntary sector has access to skills, assets and resources that could supplement the public authorities' response to a disaster or health emergency. For example, during the 2003 Northeastern Blackout, the Ottawa Kids Hotline handled hundreds of calls from distressed adults, stretching far beyond its usual mandate.

Fostering Civic Engagement - By bridging a diversity of community actors, voluntary organizations⁷ nurture an environment where citizens not only have resources but feel empowered and responsible to use them,⁸ thereby contributing to a community's resilience. Evidence indicates that a vital voluntary sector and engaged citizenry provide a strong foundation for collaboration in emergency situations,⁹ with engaged citizens being more likely to take responsibility for themselves and for others in both hazard mitigation and disaster response.

Tapping the Voluntary Sector's Potential

While the voluntary sector's response to SARS was successful, the organizations that had responded to the event recognized that they would not have the capacity to provide a similar scope of response if a more widespread event were to occur. In strategizing how best to develop the required surge capacity, they identified a couple of challenges:

• how to strengthen their own capacity and expand the cadre of voluntary organizations that public authorities normally turn to in times of emergency
• how to plan and target limited resources to address the needs of those with the least capacity to help themselves

Recognizing the voluntary sector's untapped potential, a voluntary sector-led initiative looked at how governments and the voluntary sector could collaborate to build and sustain the surge capacity required for a large-scale emergency. The initiative resulted in a Voluntary Sector Framework for Health Emergencies¹⁰ that encouraged all organizations to consider mobilizing their resources to supplement the services delivered by the authorities in health emergencies.

Building on this initiative, in 2007 the Canadian Red Cross teamed up with Brandon University, the Public Health Agency of Canada and Public Safety Canada to assess the gaps in meeting the needs of high-risk populations and to identify the types of resources and networks that would promote disaster planning to reduce vulnerability.⁶ As part of this project, two online surveys were administered to collect baseline data about existing relationships between governments' emergency management organizations and voluntary organizations in order to assess their readiness to serve high-risk populations.

Identifying gaps

Emergency management organizations were asked "Which of the following high-risk populations has your organization considered in its emergency management activities?" Two thirds reported taking seniors and persons with disabilities into account (see Table 1), suggesting that the recent focus on age and disability concerns may be having a positive effect. However, only a third addressed the needs of cultural minorities and women. These disparities may reflect the language barriers that sometimes limit outreach to new immigrants, as well as a lack of understanding and training on the gender dimensions of disasters. Learning more about the needs of high-risk populations, of which the public authorities may neither be aware of nor equipped to address, could highlight gaps that the voluntary sector might be called upon to fill.

Table 1: Outreach to High-Risk Populations: Populations Considered in Emergency Management Activities

Source: Canadian Red Cross, 2007.⁶

Addressing voluntary sector constraints

When voluntary organizations were asked about the constraints limiting their capacity to provide emergency management services to the high-risk populations they serve, some identified a lack of awareness about emergency management systems, as well as a lack of mandate coupled with concerns over risks and liabilities (see Table 2). However, 70% of respondents cited resource constraints. As most voluntary organizations function on tight budgets without paid staff,¹¹ formal umbrella organizations or communication systems, an opportunity exists for emergency management organizations to strengthen the capacity of those working with high-risk groups.

Table 2: Constraints Facing Voluntary Organizations

Source: Canadian Red Cross, 2007.⁶

Broadening relationships

The survey results revealed a need for increased outreach between the emergency management and voluntary sector communities. While 70% of emergency management organizations reported collaboration with voluntary organizations serving high-risk groups, for the most part this involved ongoing relationships with those already involved in emergency response, such as the Red Cross, the Salvation Army and St. John Ambulance. Other organizations that would have valuable knowledge of particular high-risk groups were rarely cited as collaborative partners. For instance, of 48 respondents asked about partnerships with voluntary organizations serving high-risk groups, the Canadian National Institute for the Blind was cited three times, food banks (which have insight into survival strategies of low-income populations) once, and women's shelters not at all.⁶

Similarly, less than half of the voluntary sector respondents surveyed had existing relationships with any one category of emergency response official.⁶ Voluntary organizations feel the impact of these gaps, as illustrated by voluntary sector findings that cited emergency managers' need for greater sensitivity to misinformation about high-risk populations, stronger lines of communication with high-risk groups and greater collaboration with the voluntary sector. Although some progress is being made in bridging these gaps,¹² the voluntary sector still struggles for recognition of its contribution to emergency relief efforts.

In Summary

Increased collaboration between emergency management and voluntary sector organizations during pre-emergency planning stages could result in more robust response plans that would address the diverse needs of the Canadian population. A shared understanding and improved integration of the potential contribution of the voluntary sector in emergency response activities could optimize the use of human and other resources, leading to a cost-effective, integrated approach. While a full study of the economic contribution of voluntary organizations and volunteers to emergency response activities has not been conducted in this country, the significance of its contribution warrants further research.

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