title: Identifying and Describing the Impact of Cyclone, Storm and Flood Related Disasters on Treatment Management, Care and Exacerbations of Non-communicable Diseases and the Implications for Public Health.
abstract: BACKGROUND
  Over the last quarter of a century the frequency of natural disasters and the burden of non-communicable diseases (NCD) across the globe have been increasing. For individuals susceptible to, or chronically experiencing, NCDs this has become a significant risk. Disasters jeopardize access to essential treatment, care, equipment, water and food, which can result in an exacerbation of existing conditions or even preventable death. Consequently, there is a need to expand the public health focus of disaster management to include NCDs. To provide a platform for this to occur, this article presents the results from a systematic review that identifies and describes the impact of cyclone, flood and storm related disasters on those susceptible to, or experiencing, NCDs. The NCDs researched were: cardiovascular diseases; cancers; chronic respiratory diseases; and diabetes.
  
  
  METHODS
  Four electronic publication databases were searched with a date limit of 31 December 2014. The data was analyzed through an aggregation of individual papers to create an overall data description. The data was then grouped by disease to describe the impact of a disaster on treatment management, exacerbation, and health care of people with NCDs. The PRISMA checklist was used to guide presentation of the research.
  
  
  RESULTS
  The review identified 48 relevant articles. All studies represented developed country data. Disasters interrupt treatment management and overall care for people with NCDs, which results in an increased risk of exacerbation of their illness or even death. The interruption may be caused by a range of factors, such as damaged transport routes, reduced health services, loss of power and evacuations. The health impact varied according to the NCD. For people with chronic respiratory diseases, a disaster increases the risk of acute exacerbation. Meanwhile, for people with cancer, cardiovascular diseases and diabetes there is an increased risk of their illness exacerbating, which can result in death.
  
  
  CONCLUSIONS
  Cyclone, flood and storm related disasters impact on treatment management and care for people with NCDs. Possible consequences include exacerbation of illness, complications or even death. There is now a need to expand traditional disaster approaches by public health to incorporate NCDs. This must be guided by the major NCDs identified by the World Health Organization and implemented in-line with the Sendai Framework for Disaster Risk Reduction: 2015-2030. This includes understanding all the factors that influence both direct and indirect (preventable) morbidity and mortality related to NCDs during and after disasters. Once achieved, disaster planners and public health professionals will be in a position to develop and implement effective mitigation strategies.
authors.affiliation: College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia; Cairns and Hinterland Hospital and Health Service, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ryan
authors.affiliation: College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Franklin
authors.affiliation: Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts; The Woodrow Wilson International Center for Scholars, Washington, DC, USA.
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Burkle
authors.affiliation: College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia; School of Public Health, Queensland University of Technology, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Aitken
authors.affiliation: School of Medical Sciences, Edith Cowan University; College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
authors.forename: Erin
authors.initials: E
authors.lastname: Smith
authors.affiliation: College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia; World Safety Organization Collaborating Centre for Injury Prevention and Safety Promotion.
authors.forename: Kerrianne
authors.initials: K
authors.lastname: Watt
authors.affiliation: College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; Faculty of Health Sciences, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Leggat