Below are WADEM’s Position Statements as adopted by the Board of Directors.
Strong health care systems are founded on a strong primary healthcare sector of local community-based healthcare providers.1,2 This can be attributed to the central role primary care plays in integrating care within health systems.3,4 Health care systems with an effective primary care sector demonstrate greater effectiveness and efficiency and are more equitable.5 Importantly, the effective integration of the primary care sector into the health care system can reduce the high health costs and health services’ utilization associated with chronic disease management.6
While the World Health Organization acknowledges primary health care as an “essential foundation for health emergency and risk management, and for building community and country resilience within health systems,”7 primary care is often underrepresented in discussions related to disaster and emergency situations.
As such, WADEM recognizes primary care as an essential element of disaster health care and supports a holistic whole-of-health approach to disaster management inclusive of all levels of healthcare within the entire disaster cycle of prevention, preparedness, response, and recovery. WADEM strongly endorses the inclusion and integration of the primary health care workforce in emergency preparedness and planning, with the goal of optimizing their contributions to emergency health response and recovery.
Building local health care professional capability and capacity is key to enhancing local community resilience, a key strategy alluded to in Australia’s National Strategy for Disaster Resilience by the Council of Australian Governments.8 A resilient health system, as described by Fitzgerald, Capon, and Aitken, is “a system that integrates all aspects of health care [which] is essential for facing future challenges”.9 Greater emphasis on building community health care prevention and preparedness has the potential to foster efficient utilization of local response and associated resources and reduce the need for an external response when catastrophes do occur. This enables effective response to the significant increase in primary health care burden highlighted by the research, in particular the needs of those with chronic health conditions.10,11 It will also improve health care access within the community to trusted known local health care professionals who are naturally attuned, through daily practice, to the status of health at the community level (pers comm S.Burkle), as well as reinforce post-disaster continuity of care, recovery, and continuing viability of the health care sector.
The Sendai Framework for Disaster Risk Reduction (2015-2030)12 recommends:
In accordance with the Sendai Framework, current knowledge of the epidemiology of the comprehensive health effects of disasters provides an opportunity for risk reduction and improvement in community health outcomes following disasters. A 2011 scoping review on primary care in disasters stated “primary health care is very important for effective health emergency management during response and recovery, but also for risk reduction, including preparedness” 13 and calls for clarification of terminology inclusive of the entire disaster cycle, and increasing primary care disaster research.
Primary health care inherently provides such emphasis on prevention and risk reduction on a daily basis through the provision of:
Therefore, this WADEM position statement adopts the following:
Adopted by the Board of Directors on 31 August 2021.
WADEM endorses the need to improve the evidence-base of disaster health interventions; improve the quality and accountability of preparedness, response and recovery in this domain; and systematically structure and advance the science of disaster health. Evaluation has a strategic role to play in informing interventions designed to reduce the impact of disasters upon individuals and communities. The aim of such evaluation is to improve science related to the understanding of impacts of disasters and ensure relevance, efficiency, and effectiveness of interventions.
Evidence-based evaluation typologies, frameworks, and methodologies are required to guide users on the application of tools that effectively measure the impact of an intervention and allow for comparison of outcomes to inform current and future practitioners and enhance policymaking. This important development is aimed at facilitating the availability of evidence relevant to disaster evaluation standards and guide robust technical evaluation capacity development. Achievement of this will provide evidence as the basis for change in policies, programs, or projects. As a result, WADEM:
The relevance to the WADEM mission is that, through evaluating and understanding the impacts of disasters, communities can prevent, prepare, respond and recover more effectively.
Adopted by the Board of Directors on 9 April 2020.
Gendered expectations shape our risk, ability, and legacy. Internationally, mortality in most disasters is higher for women and children than men. More women than men inhabit risk-prone localities in inadequate housing, and through poverty, have fewer resources for adaptation to climate or escape in catastrophic disasters.
Most societies are patriarchal, where gender is the central organizing framework as evidenced by structural discrimination of men against women, for example, during pregnancy and the postnatal period including breastfeeding, in childcare arrangements, women’s lower status and income, the objectification of women, and violence against women. Those with diverse gender and sexual identities, too, are frequently ignored, excluded, and vilified.
The constraints and expectations of socially-constructed binary gender roles harm people with women expected to nurture others and sacrifice their own safety and wellbeing, and men expected to be protectors and providers, stoic and courageous. Such narrow gender roles and gendered power dynamics lead to damaging effects on mental and physical health and reluctance to seek help for all.
Women and people of diverse gender and sexual identity are at increased risk of violence in disasters through the reinforcement of traditional gender roles, exacerbated power inequality and exposure in evacuation sites and recovery centres. There is a greater willingness to excuse men’s violence when they present as suffering as a result of the disaster or have been cast as “heroes” in it. Disaster also disrupts services previously offered by housing, refuge, and domestic violence organizations. The limited targeted support for women and Lesbian, Gay, Bisexual, Trans, and Intersex (LGBTI) people experiencing domestic violence is exacerbated in the context of an emergency.
The lack of attention to violence against women and people of diverse gender and sexual identities in disasters and their aftermath must be addressed through first understanding the problem. Sex/gender-disaggregated data (with options for indeterminate/intersex/unspecified) will provide an informed basis on which to improve required services.
Male privilege brings costs for men as well as women. Gender norms encourage men and boys to be risk-takers, which can expose them to danger. Men are frequently reluctant to seek help after a disaster and can be isolated from support services and social networks due to culturally embedded notions of masculine stamina. It is common for men to self-medicate with drugs or alcohol as a coping mechanism after a trauma. As a result, WADEM:
The relevance to the WADEM mission is that through acknowledging and understanding the gendered impacts of disaster in emergency management and response, communities can prepare and rebuild more effectively, reduce violence, and ultimately save lives.
Adopted by the Board of Directors on 14 August 2019.
WADEM believes that all health care workers have the right to work in safety. For emergency responders to provide the best possible care to the community they need a safe, non-threatening environment that is respected by the community, family members, and bystanders. WADEM encourages the protection of health care workers against all threats or acts of violence in the workplace.
Attacks on health care include any act of verbal or physical violence, or obstruction, or threat of violence that interferes with the availability, access, and delivery of curative and/or preventive health services in any environment. These attacks endanger health care providers while depriving patients of their right to health care. These attacks may not only affect the clinical outcomes of patients, but, also, may affect their ability to care for themselves and their families, to participate in gainful employment, and to achieve their highest level of productivity.
Incidents of work-related violence have occurred worldwide. From 2014-2015, 44 out of every 1,000 Australian paramedics suffered some form of assault.1 The Centers for Disease Control and Prevention in the United States of America estimates that 2,600 EMS workers received hospital treatment in 2014 for injuries resulting from work-related violence. A recent study reviewing the impact of violence against paramedics across 13 countries, reported that 65% of responders had been assaulted.2 The US Occupational Safety and Health Administration (OSHA) reports that from 2002 to 2013, the incidents of serious workplace violence (those requiring days off for the injured worker to recuperate) were four times more common in health care than in private industry on average.3
The World Health Organization (WHO) issues a quarterly Attacks on Health Care4 dashboard with statistics of injuries and deaths in complex humanitarian emergencies. These data include out-of-hospital and in-hospital attacks reported through information that is publicly available, and from relevant WHO country offices. In 2017, there were reports of 322 health care attacks in 20 countries, including 65 in the prehospital setting, and 154 in a health care facility; 93 of the reported attacks were on health care providers and 10 were on patients.
One direct effect of work-related violence is the strain placed on health care delivery. Affected workers may be unavailable to work due to recuperative needs following an attack, and some workers may elect to abandon their health care career after years of education and experience. There is also a flow-on effect in terms of adverse mental health outcomes for emergency responders, with heightened rates of suicide and self-harm compared to the general population. The loss of dedicated, highly trained and educated health care providers in either of these ways is unacceptable. Furthermore, on-the-job assaults and threats may complicate the recruitment retention of future health care workers.5
WADEM supports the WHO Attacks on Health Care Project in all environments, in the developed and developing world, as well in complex humanitarian emergencies (CHE) to:
Adopted by the Board of Directors on 4 February 2019.
The mission of WADEM is the global improvement of prehospital and emergency health care, public health, and disaster health and preparedness. Accurate and transparent release of public health information is necessary to inform response and recovery activities associated with disasters.
The resolution to adopt the international health regulations in 2005 recognized the World Health Organization's leadership in monitoring and responding to public health emergencies.1
Preservation of global health security is reliant upon timely reporting of emergencies and health threats to enable appropriate preparedness and response.2
Withholding, suppression, delayed, or deliberate inaccurate reporting public health information presents a risk to potential health threats to populations. The restriction of epidemiological health information hampers efforts to respond to events3
The transparent and timely release of public health information is logical, ethical, and required to maintain and improve global health. As such, WADEM endorses that:
Adopted by the Board of Directors on 8 December 2017.
Climate change is affecting disaster risk and disaster impact. WADEM recognizes climate change as an issue of global concern. It is WADEM’s responsibility to support the capacity of emergency management, humanitarian, and health professionals to address the disaster impacts of climate change.
WADEM supports health improvement activities, with emphasis on health promotion during and following a disaster to reduce the effects of climate change, achieved by cooperation among and between multidisciplinary professions involved in research, education, management, and practice in prehospital, emergency, public health, and disaster health care.
The United Nations General Assembly has encouraged the Intergovernmental Panel on Climate Change to continue to assess the adverse effects of climate change upon communities and recognises the need for implementation of disaster risk reduction programmes.1 The Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation2 and the Fifth Assessment Report produced by the Intergovernmental Panel on Climate Change3 provide an updated review of scientific knowledge relevant to climate change and reported consensus on emerging risks associated with climate change; as such it represents an emerging threat to the health status of communities. Impact categories identified by these reports relative to disaster risk include:
The Lancet Countdown on tracking progress on health and climate change is an international, multidisciplinary research collaboration which aims to track the health impacts of climate hazards, health resilience and adaptation, health co-benefits of climate change, and calls for mitigation and broader political engagement.4
The Sendai Framework for Disaster Risk Reduction (2015-2030), a 2015 UN landmark agreement, outlines priorities for action while identifying climate change as both a driver of disaster risk and as an influencing factor of disaster impact and sustainable development.5 As a result, WADEM:
Adopted by the Board of Directors on 24 April 2017.