title: Research and Evaluations of the Health Aspects of Disasters, Part II: The Disaster Health Conceptual Framework Revisited.
abstract: A Conceptual Framework upon which the study of disasters can be organized is essential for understanding the epidemiology of disasters, as well as the interventions/responses undertaken. Application of the structure provided by the Conceptual Framework should facilitate the development of the science of Disaster Health. This Framework is based on deconstructions of the commonly used Disaster Management Cycle. The Conceptual Framework incorporates the steps that occur as a hazard progresses to a disaster. It describes an event that results from the changes in the release of energy from a hazard that may cause Structural Damages that in turn, may result in Functional Damages (decreases in levels of function) that produce needs (goods and services required). These needs can be met by the goods and services that are available during normal, day-to-day operations of the community, or the resources that are contained within the community's Response Capacity (ie, an Emergency), or by goods and services provided from outside of the affected area (outside response capacities). Whenever the Local Response Capacity is unable to meet the needs, and the Response Capacities from areas outside of the affected community are required, a disaster occurs. All responses, whether in the Relief or Recovery phases of a disaster, are interventions that use the goods, services, and resources contained in the Response Capacity (local or outside). Responses may be directed at preventing/mitigating further deterioration in levels of functions (damage control, deaths, injuries, diseases, morbidity, and secondary events) in the affected population and filling the gaps in available services created by Structural Damages (compromise in available goods, services, and/or resources; ie, Relief Responses), or may be directed toward returning the affected community and its components to the pre-event functional state (ie, Recovery Responses). Hazard Mitigation includes interventions designed to decrease the likelihood that a hazard will cause an event, and should an event occur, that the amount of energy released will be reduced. Capacity Building consists of all interventions undertaken before an event occurs in order to increase the resilience of the community to an event related to a hazard that exists in an area-at-risk. Resilience is the combination of the Absorbing, Buffering, and Response Capacities of a community-at-risk, and is enhanced through Capacity-Building efforts. A disaster constitutes a failure of resilience.
authors.affiliation: 1Emeritus Professor of Medicine and Physiology,School of Medicine and Public Health,University of Wisconsin,Madison,Wisconsin USA;Emeritus Editor-in-Chief,Prehospital and Disaster Medicine.
authors.forename: Marvin L
authors.initials: ML
authors.lastname: Birnbaum
authors.affiliation: 2Nursing Section Editor,Prehospital and Disaster Medicine;Executive Secretary,World Association for Disaster and Emergency Medicine,Madison,WisconsinUSA.
authors.forename: Elaine K
authors.initials: EK
authors.lastname: Daily
authors.affiliation: 3Assistant Professor,Division of General Surgery,Department of Surgery,School of Medicine and Public Health,University of Wisconsin,Madison,WisconsinUSA.
authors.forename: Ann P
authors.initials: AP
authors.lastname: O'Rourke
authors.affiliation: 4Retired, World Health Organization; Consultant,World Association for Disaster and Emergency Medicine,Adelaid,South Australia,Australia.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Loretti
mesh_terms: D057191:Capacity Building; D004189:Disaster Planning / Q000458:organization & administration*; D004190:Disasters; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D012106:Research
keywords: CMR crude mortality rate; UN United Nations; UN-ISDR United Nations International Strategy for Disaster Reduction; conceptual framework; disaster; health; resilience; risk