Cities and public health crises
Report of the international consultation
29-30 October 2008 -
Available online as PDF file at: http://www.who.int/ihr/lyon/FRWHO_HSE_IHR_LYON_2009.5.pdf
"…..The International Health Regulations require countries to strengthen their capacity for surveillance of and response to disease outbreaks and other public health emergencies both at national level and at state or city level too. That is why the World Health Organization (WHO), with the support of Lyonbiopôle, jointly organized an international technical consultation on "Cities and Public Health Crises" in
In 1900, just 13% of the world's population lived in urban areas.
By 2008, half of the world's population was living in urban settings.
By 2025, 70% of the world's population will be urban.
Cities have a number of vulnerabilities such as unhealthy slums, crime and violence, and can even be targets for terrorist attacks. Further, since a city contains so many people, infectious diseases will be communicated faster and to more people there than in rural areas. Many cities have large international airports and sea-ports, making them prone to the import of diseases, while unsanitary areas within a city may be breeding grounds for epidemic-prone diseases such as cholera and other diarrhoeal diseases. People living on the street may become reservoirs of infections such as drug-resistant tuberculosis, while flocks of poultry and pigeons provide convenient hosts for emerging infections such as avian influenza viruses.
Coordinating the response
Crisis management in a city must be coordinated outside between the municipal and national or state authorities and inside between the services that provide health care and those that provide emergency response, as well as with public amenities such as transport services, airport and port authorities, tourism, industry, education, commerce, and the media.
A framework for collaboration between national and local authorities in times of crisis must be developed in advance to avoid confusion.
Maintaining water supply, sanitation and waste management is crucial to keep people in good health so if the usual services cannot be maintained alternatives must rapidly be provided. Many city-dwellers rely on public transport to get to work and buy food. Also, to avoid major financial losses, city authorities and company owners will need to keep businesses running during an emergency. Solutions must be found in advance to enable, for instance, employees to work from home.
Plans should also be ready to mobilize medical staff from other places to provide health care in designated facilities at a time of crisis. Last but not least, legal issues – such as quarantining infected persons or sharing a patient's data with outbreak investigators – are best resolved before a crisis occurs….."
Content:
Executive summary
1 - Introduction
2 - Background
The growth of cities
The vulnerability of cities
Slums
Crime and violence Natural disasters
Infectious diseases in cities
The speed of infection
Imported infections
Foodborne diseases
Infections that originate in the city
Nuclear and chemical accidents
The International Health Regulations
3 - Coordinating the response to public health crises in cities
Coordinating the stakeholders
Crisis management
Identifying stakeholders
Scenario modelling
Ensuring consistency
National and city responsibilities
Political interests
Business interests Informed decision-makers
Managing an evolving situation
Coordinating resources
Maintaining city services
Public amenities
Public services
Ensuring business continuity
Food supply
Small and medium enterprises
Public health in business continuity courses
Preparing for the worst
Existing systems for coordination
Legal issues
Emergency drills
Effectiveness of interventions
4 - Managing the response to public health crises in cities
Contact-tracing
Unknown contacts
Databases
Contacts with no address
Case management
Treating an unknown disease Diagnostic services
The surge of patients
Non-standard treatments
Isolation and quarantine
Limiting disease spread in hospitals
Temporary hospitals
Self-quarantine
Exodus
Stocks of medical equipment and supplies
Health workers
Shortage of health workers
Employment conditions
Accommodation for staff
Burial of the dead
Mapping the emergency
Travellers and non-residents
Locating and accommodating non-residents
Stranded passengers
Screening
The homeless
Human rights
Security for the public health team
The psychological state of survivors
5 - Communicating in a public health crisis
WHO's principles for outbreak communication
Avoiding mixed messages
Consistent messages
Crisis communication training
Regular news briefings
Setting an example
Communicating with subcultures
and immigrant groups
Convincing the educated
Communicating in an evolving situation
Changes in policy
Science-based information
Statistics
Respect for people's concerns
Media relations
6 - Conclusion
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