Health Vulnerability Index for Disaster Risk Reduction: Application in Belt and Road Initiative (BRI) Region.

Despite the importance of health vulnerability in disaster risk assessment, most of the existing disaster vulnerability indicators only emphasize economic and social vulnerability. Important underlying health risks such as non-communicable disease are not included in vulnerability measures. A three-phase methodology approach was used to construct a disaster risk model that includes a number of key health indicators which might be missing in global disaster risk analysis. This study describes the development of an integrated health vulnerability index and explains how the proposed vulnerability index may be incorporated into an all-hazard based disaster risk index in the Belt and Road Initiative (BRI), also known as the "Silk Road Economic Belt", region. Relevant indicators were identified and reviewed in the published literature in PubMed/Medline. A two-stage dimension reduction statistical method was used to determine the weightings of relevant dimensions to the construction of the overall vulnerability index. The proposed final health vulnerability index included nine indicators, including the proportion of the population below 15 and above 65 years, under-five mortality ratio, maternal mortality ratio, tuberculosis prevalence, age-standardized raised blood pressure, physician ratio, hospital bed ratio, and coverage of the measles-containing-vaccine first-dose (MCV1) and diphtheria tetanus toxoid and pertussis (DTP3) vaccines. This proposed index, which has a better reflection of the health vulnerability in communities, may serve as a policy and implementation tool to facilitate the capacity-building of Health-Emergency Disaster Risk management (Health-EDRM).

TOPOFF 2 and the inclusion of dental professionals into federal exercise design and execution.

This article examines the dental professional's role in emergency management activities, specifically related to design and execution of such federal exercises as the Top Officials (TOPOFF) series. Experiences from the Chicago TOPOFF 2 exercise are used as an example.

Office of the Assistant Secretary for Preparedness and Response; HHS Public Health Emergency Medical Countermeasures Enterprise implementation plan for chemical, biological, radiological and nuclear threats. Notice.

The United States faces serious public health threats from the deliberate use of weapons of mass destruction (WMD)--chemical, biological, radiological, or nuclear (CBRN)--by hostile States or terrorists, and from naturally emerging infectious diseases that have a potential to cause illness on a scale that could adversely impact national security. Effective strategies to prevent, mitigate, and treat the consequences of CBRN threats is an integral component of our national security strategy. To that end, the United States must be able to rapidly develop, stockpile, and deploy effective medical countermeasures to protect the American people. The HHS Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) has taken a holistic, end-to-end approach that considers multiple aspects of the medical countermeasures mission including research, development, acquisition, storage, maintenance, deployment, and guidance for utilization. Phase one of this approach established the HHS PHEMCE Strategy for Chemical, Biological, Radiological, and Nuclear Threats (HHS PHEMCE Strategy). The HHS PHEMCE Strategy, published in the Federal Register on March 20, 2007, described a framework of strategic policy goals and objectives for identifying medical countermeasure requirements and establishing priorities for medical countermeasure evaluation, development and acquisition. These strategic policy goals and objectives were used to establish the Four Pillars upon which this HHS Public Health Emergency Medical Countermeasures Enterprise Implementation Plan (HHS PHEMCE Implementation Plan) is based. The HHS PHEMCE Implementation Plan considers the full spectrum of medical countermeasures-related activities, including research, development, acquisition, storage/maintenance, deployment, and utilization. The HHS PHEMCE Implementation Plan is consistent with the President's Biodefense for the 21st Century and is aligned with the National Strategy for Medical Countermeasures against Weapons of Mass Destruction.

Changes in the marine pollution management system in response to the Amorgos oil spill in Taiwan.

The Marine Pollution Control Act (MPCA) of Taiwan was promulgated on November 1, 2000, with the specific aim of controlling marine pollution, safeguarding public health, and promoting the sustainable use of marine resources. In addition to land-based pollution, oil spills are one of the most significant threats to the local marine environment largely on account of the some 30,000 tankers which pass through Taiwan's coastal waters each year. In January 2001, two months after the enactment of this newly-introduced law, a Greek merchant vessel, the Amorgos ran aground in the vicinity of a national park on the southern tip of Taiwan, causing a serious oil spill and leading to considerable changes with regard to the marine pollution management system. The incident brought to the forefront many serious problems, such as a lack of experience, expertise as well as equipment required to respond to such disasters, as well as the ambiguous, unclear jurisdiction among related agencies. Thus, this paper reviews the incident of the Amorgos spill, identifies the major issues and lessons learned, and proposes several recommendations in an effort for Taiwan to further improve its marine pollution management system.

Preparing for a bioterrorist attack: legal and administrative strategies.

This article proposes and discusses legal and administrative preparations for a bioterrorist attack. To perform the duties expected of public health agencies during a disease outbreak caused by bioterrorism, an agency must have a sufficient number of employees and providers at work and a good communications system between staff in the central offices of the public health agency and those in outlying or neighboring agencies and hospitals. The article proposes strategies for achieving these objectives as well as for removing legal barriers that discourage agencies, institutions, and persons from working together for the overall good of the community. Issues related to disease surveillance and special considerations regarding public health restrictive orders are discussed.

Legal preparedness for bioterrorism.

Responding to a terrorist biological weapon attack poses new challenges not only for the public health response community but also to the very construct of public health police powers as we know them today. States are debating the merits of revising and updating these powers in order to ensure an effective and legally appropriate response. This article covers three aspects of the policy debate: the experience in one state from a legislative perspective, a discussion from an academic viewpoint, and one example of the role of enhanced powers from the response perspective.

The future of public health preparedness.

This redacted version of a speech by former United States Senator Sam Nunn, Chairman of the Nuclear Threat Initiative, points out that although there are concerns about global issues involving security and weapons of mass destruction and bioterrorism, it was not until September 11, 2001, that these issues (and new, unforeseen ones) were getting the funding and attention they deserved. In the event of a biological attack, millions of lives may depend on how quickly we diagnose the effects, report the findings, disseminate information to the healthcare communities and to state and local governments, and bring forth a fast and an effective response at the local, state, and federal levels. Public health must become an indispensable pillar of our national security framework. As we develop a national strategy to respond to these challenges, we must think in the broader context of causes as well as symptoms. To provide context for the next 25 years, Senator Nunn provided an overview of the "Seven Revolutions" for change identified by the Center for Strategic and International Studies (CSIS) with which he is also associated. Finally, he discusses major security challenges facing the United States.