title: Reducing Disaster Exacerbated Non-Communicable Diseases Through Public Health Infrastructure Resilience: Perspectives of Australian Disaster Service Providers.
abstract: BACKGROUND
  The exposure of people and infrastructure to flood and storm related disasters across the world is increasing faster than vulnerability is decreasing. For people with non-communicable diseases this presents a significant risk as traditionally the focus of disaster management systems has been on immediate trauma and communicable diseases. This focus must now be expanded to include the management of non-communicable diseases because these conditions are generating the bulk of ill health, disability and premature death around the globe. When public health service infrastructure is destroyed or damaged access to treatment and care is severely jeopardised, resulting in an increased risk of non-communicable disease exacerbation or even death. This research proposes disaster responders, coordinators and government officials are vital assets to mitigate and eventually prevent these problems from being exacerbated during a disaster. This is due to their role in supporting the public health service infrastructure required to maximise treatment and care for people with non-communicable diseases. By focusing on the disaster cycle as a template, and on mitigation and prevention phases in particular, these actions and activities performed by disaster service responders will lead to overall improved preparedness, response, recovery and rehabilitation phases.
  
  
  METHODS
  Data were collected via 32 interviews and one focus group (eight participants) between March 2014 and August 2015 (total of 40 participants). The research was conducted in the State of Queensland, Australia, with disaster service providers. The analysis included the phases of: organizing data; data description; data classification; and interpretation.
  
  
  RESULTS
  The research found a relationship between the impact of a disaster on public health service infrastructure, and increased health risks for people with non-communicable diseases. Mitigation strategies were described for all phases of the disaster cycle impacting public health service infrastructure. Specific measures include: increasing the use of telemedicine; preplanning with medical suppliers; effective town planning; health professionals visiting evacuation centers; evacuation centers having power for medical equipment; hubs for treatment and care after a disaster; evacuation of high risk people prior to disaster; mapping people at risk by non-communicable disease; and a mechanism for sharing information between agencies. A common theme from the participants was that having accurate and easily accessible data on people with non-communicable diseases would allow disaster service providers to adequately prepare for and respond to a disaster.
  
  
  CONCLUSIONS
  Disaster service providers can play a vital role in reducing the risk of disaster exacerbated non-communicable diseases through public health service infrastructure resilience. They are often employed in communities where disasters occur and are therefore best-placed to lead implementation of the mitigation strategies identified in this research. To sustainably implement the mitigation strategies they will need to become integrated into effective performance and monitoring of the disaster response and health sector during non-disaster periods. For this to occur, the strategies should be integrated into business and strategic plans. Achieving this will help implement the Sendia Framework for Disaster Risk Reduction 2015-2030 and, most importantly, help protect the health of people with non-communicable diseases before, during and after a disaster.
authors.affiliation: College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia.
authors.forename: Benjamin J
authors.initials: BJ
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, USA.
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Burkle
authors.affiliation: College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Aitken
authors.affiliation: School of Medical Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; 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, Townsville, Queensland, Australia.
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