We will begin this new section with an interview with the Director of the Pan American Health Organization, Dr. Mirta Roses Periago, in which she gives her vision and opinion of the work and contribution of PAHO/WHO in the area of emergencies and disasters.

1. Once again, we have witnessed the high cost, in both human and financial terms, of hurricanes in the Caribbean. Keeping in mind the lessons learned from these and other disasters, how can the health sector in the Americas be better prepared and improve safety in the face of disasters?

Disaster preparedness is a continuous process of improving the capacity to respond to emergencies. This implies keeping disaster response plans up-to-date, investing in proper training for the health workforce and designating sufficient resources to respond to emergencies and disasters. In the eyes of PAHO/WHO, the formal establishment of a unit or office in each Ministry of Health, responsible for disaster management, has been our primary objective and indicator of success. However, to be effective, these offices must meet certain criteria: they must cover the entire disaster cycle, from prevention and mitigation to coordination of the response in all types of large-scale emergencies; they must be staffed with full time professionals and have a formal budget; there must be direct access to and communication with the Ministry’s highest political level and fluid relationships and collaboration with other key sectors.

Disaster preparedness at the national level must extend down to provincial and municipal levels, thus allowing national coordinators to exercise a greater regulatory and support role. Countries that invest in, strengthen and decentralize disaster management capacity are one step closer to ensuring continuity and professionalism in disaster prevention and response.

2. Reducing risks and vulnerabilities to disasters implies joint, concerted work amongst actors; how do you see the United Nations’ Humanitarian Reform, what opportunities and challenges does it present to PAHO/WHO?

The UN Humanitarian Reform has presented both opportunities and challenges for PAHO/WHO. The creation, by the UN, of the Cluster mechanism has helped to solidify the Ministry of Health’s leadership position in disaster-affected countries. Now that the UN has tasked PAHO/WHO to lead the health cluster when it is activated in the Americas, the Ministry of Health has the chance to exercise its central coordination role under this framework, which brings together the many organizations working in health at national and international level in the wake of disasters to reach agreed-upon objectives.

However, humanitarian reform also implies a new way of working on the part of the humanitarian system as a whole. One important challenge is to ensure that our member states are well informed of how the humanitarian reform may impact them and how they may be better prepared to benefit from these changes. In the Americas our health institutions have important experience in forging alliances and working in collaboration and coordination with many partners, but they need to deepen these good relations to guarantee the success of this new reform process.

Dr. Mirta Roses Periago

In September 2002, Dr. Mirta Roses was elected by the countries of the Americas as Director of the Pan American Health Office and she took up her post on 1 February 2003 for a period of 5 years, becoming the first woman to take on this position.

In September 2007, she was re-elected for a further period of 5 years. Dr. Roses has promoted a work philosophy which combines consensus-building and the forging of alliances to win new social actors to defend the health cause. She has focused on the achievement of visible results in the health sector in the Americas, and support to priority countries in the drive towards equity in health through the decentralization of resources for national priorities and assistance to populations in need.

We invite you to get to know the Director’s Blog at www.paho.org

3. Climate change presents new health challenges, with the potential to increase disasters and emergencies worldwide. What can be done about this new hazard? What short and medium-term measures can be taken in the most vulnerable countries in the Americas?

This year’s World Health Day, celebrated in April 2008, focused the world’s attention on the health effects of climate change and global warming and called for taking short, medium and long-term actions to protect health. Climate change is affecting the most important determinants of health: the air, water and food. Although it is a global phenomenon, some regions and certain population groups are more vulnerable than others, including the poor and most marginalized. Sadly, these are the very groups that least contribute to the cause of the problem, yet now face important health risks as a result of climate change.

We must be concerned with improving preparedness and making early warning systems more efficient to deal with the growing number of intense meteorological disasters such as hurricanes and El Niño events. But that is not all. The impact of climate change will manifest itself in an increase in environment-related communicable diseases, in the availability of and access to safe water or in food production. Long term, climate change will alter natural economic and social systems that contribute to maintaining acceptable levels of health, but which are under pressure in developing countries.

The good news is that it is not too late to minimize these risks. To protect health and reduce climate change-related risks, governments, international agencies and the donor community must intensify political commitment, promote innovative technical measures to deal with the problems and increase collaboration. Examples of these measures include strengthened surveillance and control of infectious diseases, the safer use of increasingly scarce water sources, and the efficient coordination of the health response to emergencies.

4. Both this year and next we are celebrating the World Disaster Reduction Campaign “Hospitals safe from Disasters”, as declared by the United Nations. For over a decade, PAHO has taken leadership on this issue, what has already been achieved, what more can be done and why is it critical to ensure highest-level political support to achieve significant and long-lasting progress?

Since the 80s, Ministries of Health have grown to recognize that it is fruitless to concentrate all efforts on improving the capacities of the health workforce if these efforts are not accompanied by actions to address the vulnerability of the facilities in which they work. As a result, in recent years, PAHO has been promoting disaster mitigation activities in health facilities.

I would like to highlight the launch of a new tool which was developed in the Americas—the Hospital Safety Index - which is gaining growing acceptance in other regions of the world. This low-cost, easy to apply, diagnostic tool provides a snapshot of the probability of a hospital or health facility remaining operational in emergency situations. Hundreds of professionals from multiple disciplines have been or will be trained to use the Index in Caribbean, Central American and South American countries.

It is necessary to achieve greater commitment on the part of governments, agencies and donors if we are to make meaningful changes that call for mandatory compliance to building codes and which allow resources to be allocated to incorporate mitigation measures in hospitals. Countries have demonstrated progress, but there is a need to reinforce this work to ensure that specific plans of action are developed to achieve safer hospitals and societies in the event of disasters.

5. It is generally agreed that disaster management must address preparedness and improve response as well as prevent or mitigate the medium and long-term effects. What are PAHO’s priorities in the coming years? Which areas will you focus on to make a substantive difference?

The challenges are enormous because no one area can be overlooked. Natural hazards or those caused by human activities, with their subsequent impact on the countries and population groups that often require the greatest protection, will always exist. Consequently, our vision for the future is one in which effective and sufficient capacity exists in the Region to reduce health risks from disasters, so as to prevent not only the negative impact on health but also on health infrastructure and the interruption of health services. This will maximize the chances for timely and efficient response to disasters.

To make this happen, PAHO will continue to engage all of the Organization’s technical expertise to support traditional disaster preparedness, mitigation and response activities. However, at the same time, we must work with governments to strengthen political commitment and introduce technical innovations to increase the impact of our efforts. We cannot fail to forge deeper partnerships at national, regional and global level to enrich our knowledge about disaster risk reduction in the health sector and to share our own experiences and lessons learned.

Finally, we will use our technical influence and skills to advocate for making health risk reduction an increasing priority on the agendas of non-health actors. Conversely, within our own sphere of influence, we will work to ensure that risk reduction in general supports or is included in health initiatives such as primary health care, patient safety, workers’ safety and other efforts that contribute to achieving the Millennium Development Goals.