Responding to Catastrophes: A Public Health Perspective

From a public health perspective, it is difficult to define exactly what a catastrophe is. Catastrophes can be of sudden onset or they can develop slowly; they can be the result of natural causes, such as hurricanes, droughts, or earthquakes, or they can be man-made, a consequence of war or of terrorist acts. Some would say that the distinction between these is not totally clear-even in earthquakes, for example, mortality rates are predictably higher among the poor, those who live in housing that does not conform to local construction standards. The Indian Ocean tsunami of December 2004 did not spare anyone on the basis of socioeconomic status, but those with means were able to rebuild, rehabilitate, and reconstruct their lives much more rapidly and more completely than those who had only minimal assets. Finally, the plight of the poor left behind in the wake of Hurricane Katrina, one of the world's most recent major catastrophes, was visible on televisions around the world. The blurriness of the lines between these categories, acute versus slow onset and natural versus man-made disaster, has led some to coin the term "complex emergency." The global response to complex emergencies has become a subject of relatively recent study and many of its medical, engineering, and even legal ramifications are still being refined. Dr. Waldman has a medical degree from the University of Geneva, Switzerland and a Master of Public Health degree from the Johns Hopkins School of Hygiene and Public Health. After beginning his career as a volunteer in the World Health Organization's Smallpox Eradication Program, he joined the Centers for Disease Control and Prevention ("CDC") in 1979. After having provided technical assistance to the Refugee Health Unit of the Ministry of Health of the Democratic Republic of Somalia, he, together with colleagues at the CDC, published a series of articles describing and analyzing the epidemiology of refugee health. He has worked for a var