3.

1 The Risk Formula (I)

What is "Risk"?
Risk is the likelihood, or probability, of an adverse outcome. It is
a function of the interactions between the natural hazard,
exposure, and vulnerability (risk factors), with the
manageability (coping capacity) of the affected individual or
community. In the context of disaster, risk is defined
as "expected losses (of lives, persons injured, property damaged,
and economic activity disrupted) due to a particular hazard for a
given area and reference period" (CRED, 2009).
People who are made vulnerable from the exposure to intense
and frequent natural hazards are at higher risk. To reduce such
risk we can increase their coping and recovery capacity (also
called manageability in the formula) from being exposed to the
hazard.

"The Risk Formula"

The Risk Formula is a concept that would help us understand and
take systematic actions to reduce the risk of disasters impacts.
The Risk Formula shows the relationships between five
components, namely: Risk, Hazard, Exposure, Vulnerability,
and Manageability.
In the equation, risk is the product of three factors: hazard,
exposure, and vulnerability. Risk exists only if there is
vulnerability and exposure to the hazard, and only if their product
is greater than the manageability. Thus, the same triggering
event that resulted in a disaster in one community may not
become a disaster in another community. The risk may be
different depending on the factors in the equation and how they
evolve within a community. This equation is important as it helps
to justify the needs for disaster preparedness programs and
education.
Definition of each component:

 Hazard: A dangerous phenomenon, substance, human

activity or condition that may cause loss of life, injury or
other health impacts, property damage, loss of livelihoods
and services, social and economic disruption, or
environmental damage.
Exposure: People, property, systems, or other elements
present in hazard zones that are thereby subject to potential
losses. In the equation above, it stands for the duration
and/or extent of the hazard.
Vulnerability: The characteristics and circumstances of a
community, system or asset that make it susceptible to the
damaging effects of a hazard. In the above equation it refers
to the degree of loss (from 0% to 100%) resulting from a
potentially damaging phenomenon.
Manageability: The organisational response to the hazard
and the ability of the population to respond to it
Risk: The possibility of damage, loss, injury, death, or other
negative consequences as a result of the components above.

3.3 Applying the Risk Formula

What is the Disaster Risk Index (DRI)?
DRI is a calculation of the average risk of death per country in
large and medium scale disasters associated with earthquakes,
tropical cyclones, droughts and floods, based on data from 1980
to 2000. The components included in the DRI are hazard, physical
exposure, and vulnerability.
Hazard: The DRI includes four hazard types, namely:
earthquakes, tropical cyclones, floods, and droughts.
Physical Exposure: The physical exposure is expressed in
the number of people in a country (absolute terms) or the
frequency of hazard event per million people (relative
terms).

 Vulnerability: Vulnerability refers to various social,

economic, cultural, political and physical variables that make
people more or less able to recover from the hazard event.
In the DRI, the term risk exclusively refers to the risk of death
in disaster, and does not include the risk of damage to livelihoods
and the economy, because of the limited data available from all
countries. As emphasised in its definition, DRI only measured the
medium- and large- scale disasters, defined as at least 10 deaths,
100 affected people, and/or a call for international assistance.

Who faces the highest risk?

According to the DRI, Southeast and Southwest Asia face the
highest and most consistent risk across regions, followed by
Africa and Latin America respectively. Northern America, Europe
and Eastern-Europe face the lowest risk.
Take-Home Message

A natural hazard will not become a disaster unless people are

vulnerable and exposed to it. The degree of impact is dependent
on peoples vulnerability, i.e. the extent to which a community,
structure, service or geographic area is likely to be damaged or
disrupted by the impact of a particular hazard. This impact can
also be mitigated by the manageability, orcoping capacity, of
the population, which often refers to the organisational response
to the hazard and the ability of the population to respond. From
the above equation, it is indicated that hazard, exposure, and
vulnerability must be reduced while manageability must increase
in order to reduce risk.

3.5 Five General Public Health Consequences of Disasters

Public Health has been defined as: The science and art of
preventing disease, prolonging life and promoting health through
the organised effort of society (The UKs Faculty of Public Health,
2010). Disasters often result in five general public health
consequences of disasters.

What do we mean by general public health consequences?

Unlike clinical medicine, where physicians and allied health
professionals focus on treating diseases and managing the health
of individuals, public health professionals focus on the health of
populations. So when we say the general public health
consequences of disasters, we mean the likely, yet not necessarily
specific, impact that disasters bring upon populations. In most
situations, there are five general public health consequences of
disasters:
Overwhelming of local response capacity with unexpected
mortality and morbidity
Destroying health infrastructure and disrupting provision of
services
Creating adverse effects on the environment and population
Affecting psychological and social behavior
Resulting in undesirable long-term consequences.

3.6 Unexpected Mortality and Morbidity

What is it?
Unexpected mortality and morbidity often overwhelms the local
capacitys response system. These excess negative health
impacts that occur as a direct or indirect result of the crisis, i.e.
that would not have happened had the disaster not taken
place.Mortality refers to a measure of deaths in a given
population, location or other measures of interest; crude
mortality rateand under-5 mortality rate are two common
mortality indicators that we have gone through in lesson
2. Morbidity, on the other hand, is a measure of disease
incidence or prevalence in a given population; it refers to physical
or psychological states resulting from disease, illness, injury or
sickness. Morbidity can present in different ways, but the number
of people with a specific disease and the duration of illnesses are
common measures of morbidity.

Factors affecting the characteristics of unexpected mortality and

morbidity
The magnitude and causes of unexpected mortality and morbidity
vary according to the type of crisis as well as the demographic
and epidemiologic profile of the population.
Type, Duration & Severity of Disaster For instance, in
natural disasters there is usually a dramatic peak of deaths
and injuries within the first 72 hours, while in the case of
chronic violence, the increase in mortality may span over a
long period of time. The more severe a disaster, the higher
the unexpected mortality and morbidity.
Demographics of the Population This refers to the age,
sex, race, birth rate, immigration and emigration dynamics
of the population. A fundamental concept here is
the demographic transition (Kirk, 1996), where countries
evolve from having high birth and death rates in the preindustrial era (Stage 1), to having low birth and death rates
(Stage 3). Many low or middle-income countries are in the
process of this transition, where they experience a lowering
in death rates but a stable high birth rate (Stage 2). As
suggested, this transition is associated with country
development. Disasters that occur in developed or Stage-3
countries are likely going to cause unexpected mortality and
morbidity among the older population, whereas in
developing or Stage-2 countries, the younger population will
be more affected.
Epidemiologic Characteristics of the Population This
refers to the matters that make a population healthy or sick,
e.g. vaccination coverage and common causes of death or
diseases. A fundamental concept is the epidemiologic
transition - the process by which patterns of mortality and
morbidity of diseases transform from one of high mortality
among infants and children as a result of epidemics and
famine, to one characterised with an extended lifeexpectancy and high mortality due to lifestyle diseases such
as cardiovascular and cancer-related diseases.

Impact on disaster survivors

The excess deaths and health problems of a disaster may be a
direct result of the hazardous event, e.g. many people washed
away by a tsunami. However, excess deaths and morbidity can be
observed in the survivors immediately too! Why?
Because excess mortality and morbidity often co-occur with a
disruption in, and overwhelming of, the local capacity to respond,
which creates risk factors, such as overcrowding, inadequate
shelter, insufficient nutrient intake, insufficient vaccination
coverage, unclean water, poor sanitation, unhygienic conditions,
and high exposure to the proliferation of disease vectors that
result in excess mortality and morbidity among the survivors.

3.8 Adverse Impact on Environment and Population

The impacts of disasters, whether natural or man-made, have
implications on the environment. Climate change and
environmental degradation may exacerbate the impact of a
disaster, and vice versa. Take the Indian Ocean Tsunami in 2004
as an example, the coastal areas, coral reefs, mangroves,
agricultural areas, and forests were heavily damaged. Moreover,
the depletion or contamination of natural resources may reduce
the availability of basic needs for health and pose other hazards
that increase the vulnerability of the population. The diagram
below is an illustration of the possible environmental causes and
consequences of disasters.

Environmental impacts of disasters on the population

Environmental impacts of disasters can be devastating and cause
serious risk to life and livelihood. In general, the impacts can be
classified into three types:
Acute risk from release of hazardous materials
Disasters can induce the release of toxic substances that
may cause environmental emergencies. The earthquake and
tsunami in Japan, as discussed in lesson 2, triggered the

explosion of a nuclear power plant that released radioactive

materials into the air, posing health risks to the neighboring
communities.
Debris and damage to natural
resources/environmental infrastructure
Direct and indirect damage caused by disasters to the
environment may result in environmental degradation that
can create new vulnerabilities and/or exacerbate the
populations existing ones.
Relief and recovery operations carry environmental
costs
These include improper management of healthcare waste,
expired medicines, chemicals required for health protection
(e.g. chemicals used for water treatment), debris, human
cadavers, and animal carcasses.

3.9 Adverse Psychological and Social Behaviour

We have learnt in Lesson 1 that health should not be limited to
physical health, but should also include mental and social wellbeing. In a disaster setting, where survivors have witnessed or
gone through traumatising events, adverse psychological and
social behavior is the fourth general public health consequence of
disasters.
Psychosocial health refers to psychological and social aspects that
influence our health. It is a combination of:
Spiritual health (being)
Emotional health (feeling)
Mental health (thinking)
Social health (relating)
Do you remember the social determinants of health we
mentioned in Section 3.4? In a disaster, apart from physical
injuries, people experienced drastic changes in their socioenvironmental determinants (Carballo, et al., 2006), such as the

loss of loved ones, housing and property. The diagram below

displays the biopsychosocial model of mental disorder proposed
by Kinderman in 2005. It states that psychological and social
problems are a result of a combination of biological factors, social
factors and circumstantial factors through mediating
psychological processes.

This figure illustrate the suggestion by Kinderman that psychological and social
problems are a result of mediating psychological processes of biological, social
and circumstantial factors.
Kinderman, 2005

These factors include:

Changes in physiology and mental status due to increased
stress as well as feelings of powerlessness due to
bereavement, loss of property and loss of livelihood;
Mental health problems such as post-traumatic stress
disorder, depression and anxiety disorder
The scarcity of basic provisions and disruptions to economy;
Destruction of social networks;
Breakdown of law enforcement and cessation of violence
prevention and other social support programs.

Disaster and violence

Violence is not a result of ALL disasters. The risk of violence
increases with the breakdown of social networks, changes in
behaviour (e.g. drug and alcohol addiction) and distress
responses (e.g. fear and sense of helplessness) (World Health
Organization, 2002).The following are a few types of violence that
have been shown to increase after some disasters:
Child abuse and neglect:
Intimate partner violence and sexual violence
Exploitation and trafficking (in areas where trafficking is
already prominent)

This violence may induce other health and social related

consequences. For example, sexual violence may lead to
unwanted pregnancy, transmission of HIV/AIDS and suicide
(World Health Organization, 2005).

3.10 Long-term Consequences

The rising numbers of deaths and morbidities are usually
documented in the early phase of disasters, but few studies
examine the long-term impact and recovery challenges that
persist in communities years after. The long term health effects of
disasters vary according to the type of disaster, its duration, and
the affected area. For instance, in the internally displaced
communities in Bosnia, common medical problems were chronic
and psychological diseases, while after the atomic bombings of
Hiroshima and Nagasaki, excess cases of cancers, infertility,
adverse pregnancy outcomes, and birth defects were observed.
Long-term consequences of disasters involve impacts not only at
the individual-level, but also at the community- and countrylevel. Disasters can change the social-demographic makeup of a
community by creating a disproportionally high number of
orphans and widows, with significant implications on long-term
population planning and welfare spending. Disasters also have
long-term consequences on the countrys economy, which will be
discussed in Section 3.11.
For now, we will use the Chernobyl Accident to illustrate the
various dimensions of long-term consequences as a general
public health impact of disaster.

Take-Home Message

The impact of disasters can be understood using the definition of

health and the socio-ecological approach to health. The former
connotes that health comprises three dimensions: physical,

mental and social well-being, and the latter suggests that health
is a result of a combination of modifiable and non-modifiable
determinants that exist across the intrapersonal, interpersonal,
community/institutional and macro public-policy realms.
Disasters also result in five general public health consequences,
they are:
Unexpected mortality and morbidity;
Destruction of health infrastructure and provision of
services;
Adverse effects on environment and population;
Harmful influences on social behavior and psychological
health;
Undesirable long-term consequences.

3.11 Economic Impact (I)

While some disasters, such as storms and earthquakes, tend to
be short-lived events lasting from several seconds to a few hours
or days, they can cause substantial damage in a concentrated
area. Other disasters such as droughts and conflicts can be of
longer duration, lasting for weeks, months and years. However,
regardless of the type of the event, any disaster can leave
economic consequences that may linger for years. Disaster losses
manifest themselves in numerous ways and, unfortunately, it is
nearly impossible to estimate them with great accuracy. In
general, the economic impact can be assessed based on the
losses as a result of the disaster, which can be direct or indirect
losses.
Losses refer to the reduction in wealth caused by damage to
structures or other physical assets (e.g. housing, crops,
roads).Direct losses are those resulting from building, lifeline,
and infrastructure damages, while indirect losses are those lost
as a result of the physical damage, such as reduced tourism,

disrupted service provision and decreased productivity.

(Hallegatte, Przyluski, 2010). In contrast, costs refer to the
resources required to undertake replacement, repairment and
reinforcement of the tangible assets that are destroyed.

The graph shows the rising trend of economic losses due to disasters since 1950
in US billion dollars.
Graph by Economic Commission for Latin America and the Caribbean (ECLAC)
Subregional Office in Mexico - Some rights reserved

Recent trends of economic impact from disasters

The graph above shows the quadrupling value of disasters losses
from 1950 to 2005 globally. The increase in insured losses mean
that those particular affected local economies are less dependent
on the private sector and the government in providing money for
recovery.
Evidence suggests that disasters can affect the economy at the
national level by hampering the gross domestic product for a
short period. A study (Charvriat, 2000) of 35 disaster events in
in Latin America and the Caribbean from 1980 to 1996 identified

a decline of gross domestic product in 28 cases in the year of the

disaster's occurrence and a sharp increase two years after the
disaster.

3.12 Economic Impact II

How natural hazards affected the countrys economic condition:
The vulnerability of a countrys economy to natural hazards is
dependent on many factors, including:
Type of natural hazards e.g., hydro-meteorological
hazards can affect the agricultural performance more,
particularly countries which heavily rely on agriculture.
The economic structure
This refers to the overall systems productivity, the diversity
and competition between sectors and the nature of
productive capital. For instance, in the Dominican Republic,
the banana plantation industry is one of the main economic
driving forces that suffers enormous setbacks due to the
increased frequency and intensity of disasters; but, because
the country has a diversified economic setup with industries
that are less dependent on the climate, the country has a
strong capability to recover.
The geographic size of a country
For very small countries, the hazards may be countrywide,
whereas for larger countries, the hazards may only affect
certain parts of the country.
The countrys income level and stage of development
Developing countries are typically perceived as the most
vulnerable countries affected by disasters. The absolute
economic loss in developing countries may be small relative
to developed countries but it can disrupt the whole economy
of the country.
The prevailing socio-economic conditions
The economic policy, price fluctuation, and market

regulation may lessen or exacerbate the impact of a

disaster.