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'We can't respond adequately'

Will lessons learned from Katrina and Rita usher in a new ethic of global disaster response?

BY SUSAN KIM | BALTIM0RE | September 26, 2005

"With these economic disparities - and there are enormous disparities - there's an increasing strain on social fabric."

—Lloyd Kolbe

Will lessons learned from Katrina and Rita usher in a new ethic of global disaster response?

The aftermath of these devastating disasters should be a wake-up call to examine the broad national and global trends making us vulnerable in the first place, said Professor Lloyd Kolbe, who focuses on these issues within Indiana Universityís public health program.

It's not just a matter of the technicalities of improved disaster response, explained Kolbe, it's examining what it means to be in harm's way.

First, he said, "take urbanizing effects. In the U.S., 75 percent of people are now part of urban populations."

Globally, he said, that urbanizing effect is combined with another factor: demographic extremes that include aging populations and large adolescent populations. "In the developing nations right now, the size of the adolescent population is unheralded in the species. And fully half of these adolescents are not employed and not in school. Our state department is taking some interest in that but not nearly the interest they should be taking," he said.

The effect of economic disparities became clear in the aftermath of Hurricane Katrina, he said, when some people were simply unable to lessen the effects of the disaster on themselves at all. "With these economic disparities - and there are enormous disparities - there's an increasing strain on social fabric. There are people who can afford health care and prescription medications. There are people who can't. And, in the wake of something like Katrina, it's not just about improving their health. It's about whether they live or not. It's about a lack of basics needed to sustain life and health."

As populations become denser and spike into more demographic extremes, global climate change is simultaneously occurring, he said. "There are not many people who are not convinced that we are experiencing global climate change for all of our people," he said. "We will experience diseases previously only confined to the tropics. There's little doubt that the polar ice caps are melting. It's pretty hard to refute that when your eyes can see it."

Another factor: our increasingly polluted environment, he said. "There's no doubt that we live in increasingly toxic environments."

In the aftermath of Katrina and Rita, some toxic spills have been fairly well-documented, but others aren't as visible, Kolbe pointed out. "I don't know how well-controlled, say, radiological material from dental offices would be. There are also hundreds of chemical plants, and gasoline in cars, cars with batteries leaking acid, and dry cleaner solvents. It's anyone's guess. Then there's the stuff in your own home under your sink - pesticides, drain cleaners. There are sediments in various lakes and bays, and high buildups of very serious heavy metals - lead, mercury. When that sediment dries out and starts to blow around, I worry about the effect of that dust on people. I worry about children."

These factors are all inter-related, he said. Hurricanes - and other disasters - occur anyway, but these population trends can tremendously exacerbate the effects. "We would have seen earthquakes regardless," he said. "But I am fascinated by how few people know about the New Madrid fault. I virtually live pretty close to it - Missouri, Tennessee, Kansas, Georgia. I believe that the west coast has made efforts to build that accommodate shifts in the earth - but most buildings around the New Madrid fault have not been built with that in mind."

Given the seemingly all-consuming feel of response to hurricanes Katrina and Rita, the thought of another large disaster leaves people - including Kolbe - unsettled.

Kolbe spent many years working for the Centers for Disease Control (CDC). "When I was working for the CDC, I said to our staff that we could handle one or two or three controversies at the same time. The dilemma is we only have so many resources, so many trained people. When we experience multiple disasters at the same time, we canít respond adequately."

Given today's risks, he said, disaster responders would do well to follow the thinking of at least some public health officials - and start planning for the worst. "If you ever work with people in medicine, those people are trained - and the public better hope they're trained - for the worst-case scenario. You are trained to make conservative estimates."

What's that mean in terms of disasters? It means preparation and mitigation will have to become better emphasized - and more global in nature, said Kolbe.

"We could be seeing more droughts, floods and all kinds of natural disasters. We could be seeing more terrorism - conventional, biological, chemical and radiological. We're seeing emerging and re-emerging infectious diseases and global pandemics."

Disaster responders and policymakers need to start thinking more globally, he said. "We need to train people in these simultaneous challenges, find a means where countries can work together. We need to prepare for these problems and work together."

Take vaccines as an example, he urged, "just focus on the production of vaccines. We should be finding ways of creating multi-national organizations that produce vaccines. We shouldn't be caught flat-footed with not having enough vaccines."

In the face of the inevitable future large disasters, where's the hope? It lies in a way of thinking about what it means to prepare for disasters, said Kolbe. "My conclusion is that we need a new ethic. Our globe has shrunk in many ways. We need a new way of thinking about how nations aggregate their resources to protect people who will be afflicted. These disasters do not respect the political boundaries and geographical boundaries we draw. We need a new ethic."

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