Public Health Emergencies, Cancer, and the Legacy of Katrina

Public health emergencies denote disasters that adversely impact the public health system and its protective infrastructure.Public health emergencies were first defined in the prototypical complex humanitarian emergencies that dominated the last three decades in developing countries, such as the Sudan, Somalia, Liberia, and Sierra Leone, when unprecedented direct and indirect mortality and morbidity occurred as a consequence of public health protection being destroyed, overwhelmed, not recovered or maintained, or denied to populations for ethnic or religious reasons through political violence, war, or conflict.The consequences primarily focused on limitations of public health infrastructure tied to water, sanitation, shelter, food, and basic health, and its effects on the most vulnerable populations of women, children, the disabled, and the elderly.Emphasis in relief aid is placed on controlling and managing outbreaks of communicable diseases, food shortages leading to under-nutrition and eventual malnutrition, insecurity, population displacement, and loss of livelihoods.In developing countries suffering acute and chronic poverty with life spans in the thirties and forties, chronic diseases are less common and when they exist, often suffer early complications, and demise from lack of resources for diagnosis and treatment.In many respects, chronic diseases remain a luxury not experienced by the poor and dispossessed.In recent years, complex emergencies have occurred in developed countries such as the former Yugoslavia, and now Iraq where prolonged war subtlety moved established public health systems with good health indices to a status consistent with the worst in the world.Whereas studies focus on worsening infant and under age mortality rates, both Iraq and the former Yugoslavia also suffered when warehoused medications became unavailable and when diagnostic resources for chronic diseases such as diabetes, cardiac disease, and cancer were destroyed.Many died in the process, but for the most part, these deaths have gone uncounted and unnoticed.In the rush to provide some semblance of emergency health provisions, assessments and aid programs rarely address populations with chronic diseases or are included in epidemiological studies that identify and define the most vulnerable of populations.Recently, political scientists have added new information to our understanding of public health emergencies by measuring the burden of disease from war and conflict using disability adjusted life year.Even after the shooting has stopped, indirect (excess deaths) mortality may continue to increase for as long as several years and may not return to the pre-war baseline for up to a decade due to a lack of recovery and rehabilitation of political governance, economic stability, public safety, and the dependent public health system and its infrastructure.1 Though people living in highly-developed countries may think their public health systems are protected from such a rapid decline in post-disaster public health.We now know that similar public health emergencies can occur whenever and wherever the protective public health cover is breached.This was observed following Hurricane Katrina and the Indian Ocean Tsunami.Furthermore, large-scale, naturally occurring epidemics, pandemics, or deliberate biological, chemical, or radiation disasters have the potential to cause widespread and catastrophic public health emergencies.