Traditionally, the healthcare process starts with a person asking the advice of a physician, who will then prescribe a cure. At that moment, the person becomes a “patient”. The patient will patiently assume that the physician knows better and will follow the instructions.

The first revolution to that process started with the spread of internet. Dr. Google become a second source of knowledge jeopardizing the almighty standing of the physician.

Then came the Covid-19 pandemic, during which the physician was mostly unreachable. The patient was left alone to deal with his or her health problems. In the best of cases the physician was reachable by some kind of teleconference.

All the above added up to make the patient realize that he or she could deal with a health problem in ways that do not necessarily involve a physician. At that point, the patient becomes a consumer: a consumer of information and of alternatives other than the ones prescribed by the healthcare professional. A new demand from a new consumer has been born.

The consumer demand has to be met. Accordingly, on the supply side, many start-ups and technology giants have plunged into the market, offering everything from innovative services to medical wearables and apps of all sorts, all destined to complement, if not to substitute, the physician’s knowledge.

The trend should be welcomed by all. Health consumers now have a wider range of resources to choose from; physicians now have more time to dedicate to serious health issues. At the same time, as the consumer becomes more active in his or her wellbeing, pressure on the traditional healthcare sector can be alleviated. In all, we have arrived at the win-win situation so long craved in the healthcare sector.

Those words by Olof Scholtz (German Chancellor) struck me as a very simple motto and, at the same time, something that we all need to practice. Expect in the coming year a few occasions where practicing “never to be hysterical” will be helpful. For instance, when facing the surge of the Omicron variant of Covid-19, or the EU relations with Russia or China, not to mention the on-going renewal of the Iran nuclear deal.

Let us focus on the Covid-19 surge. Most countries in the EU have fallen back to restrictions that were established in previous surges. The difference is that now most people are vaccinated, so the EU Digital COVID Certificate can be used as an extra tool in avoiding the spread of the virus.

Have we learned anything from the previous surges? Unfortunately, the answer is NO. Two variants have spread recently and caused respective surges: Delta and Omicron. The first originated in India and the second in South Africa. According to most researchers, variants originate in populations with low vaccination levels, e.g. South Asia and sub-Saharan Africa. Has COVAX fulfilled expectations for supplying the quantity and quality necessary to those regions? Again, the answer is NO. On 29th November 2021, the WHO stated that “the majority of the donations to-date have been ad hoc, provided with little notice and short shelf lives.” Images from the BBC show how Nigeria, with as little as 5% of the population vaccinated, had to destroy one million vaccines due to their short expiration dates.

Will 2022 bring about a change to that situation, with the USA and EU countries for once making good their commitment with COVAX in quantity and quality? Will South Asia and sub-Saharan Africa attain a level of vaccinated population so as to prevent new variants? If so, most likely, we could put Covid-19 in our rearview mirror, still present but not affecting our lives so much.

The headline comes from a recent webinar intervention by Annabel Seebohm[i]. We are negatively experiencing in our everyday lives how the very much praised and extended “just in time” inventory management method has turned our lives upside down. Car factories are on hold, electronic gadgets are missing from the shelves, ports are blocked and unable to process incoming   goods. And, last but not least, the health system is stressed to the limits, because it was designed for “normal times”. “Normal times” does not take into account out-of-the-norm factors like a pandemic, like “just in time” does not take into account disruptions caused by lockouts due to a pandemic.

When Covid-19 struck, the health system designed for “normal times” was absolutely unprepared to cope with an unexpected inflow of patients: there was a need to build new hospitals, a need to recruit more health professionals, a need to explore new treatments, a need to design new care processes, a need for extra masks, medical aprons and other medical goods. And all of that had to be done in the shortest possible period of time, since people were dying by the millions (17.3 million so far according to The Economist)[ii].

Suddenly, we realized that “just in time” was not the panacea that everybody thought it was. Suppliers should move back to the point of need. That trend is obvious in the chip market, with the USA and the EU putting forward state subsidies to build chip factories in their territories, avoiding the actual dependence on the far east manufacturers.

The health sector is suffering from a similar malaise, even if the causes are different. There was an initial dependence on China for some medical products, but the two big restrictions came from inside the system: 1) lack of infrastructures such as ICU’s and hospital wards; and 2) lack of health professionals.

The first restriction has an easy solution since it can be solved with political will and money. The second restriction has a more difficult solution, it requires a great degree of advance planning. It is necessary that the design of the health system incorporates human resources for “abnormal times”. That leads to a degree of over dimensioning of human resources during normal times, contrary to “just in time” management system, incorporating the “just in case” management proposal. I am aware that this means increased budgets during “normal times”, but the rewards will be collected during “abnormal times”. It is our choice, the same kind of choice we make when buying insurance, in the hope that “abnormal times” will never come.

[i] linkedin.com/in/annabel-seebohm-ll-m-380b0392

[ii] https://www.economist.com/graphic-detail/coronavirus-excess-deaths-estimates?fsrc=core-app-economist

It is a fact that in most cases, those living in a risk area know that they live in a dangerous place but that they assume that it will never materialize. Accordingly, they do not plan to move out. Be it near a volcano, – almost 2 million people live within the range of the Vesuvius, – or by the banks of German rivers that regularly overflow, most people don’t lose sleep over these risks.

It does not matter that authorities draft very detailed risk maps. People refuse to move for various reasons: sentimental, lack of alternatives, indifference to the risks, not believing in science, conspiracy theories, etc.

How to overcome that resistance to move to safer quarters? I think that the most important step is to bring science to civil society. Indifference, science negation, conspiracy theories and such, are bred in misinformation and lack of information. If risk maps were drawn together with representatives of the people living in the affected areas, then the scientific backing for designing an area as dangerous would be transmitted to the population. The will of the people will be always the driving factor for deciding to remain in a risky area or to leave. But at least, those remaining in dangerous places will take their decision based on the latest scientific findings.

Landslides are normally triggered either by hydro-meteorological events or by earthquakes. Whatever the immediate cause, the vegetation cover of the affected area is going to determine the degree of devastation that the landslide will have. Factors such as “topography, geology, soils, hydrological conditions, landslide history and vegetation cover determine the response of a landslide-prone catchment to a specific trigger”[i].

Changes in the vegetation cover may be influenced by:

  • Climate change which might slowly but constantly alter it.
  • Extreme events -fire, wind, rain- which might result in rapid changes
  • Anthropogenic forces such as forest logging, changes in agricultural practices, and waste disposal with an immediate effect

Of the three factors, the third one is the one more clearly in the hands of individuals.

Policymakers and individuals, through their acts and inactions, affect how climate change evolves: positively or negatively. The problem, and probably the reason why “earth’s surface continues to significantly warm, with recent global temperatures being the hottest in the past 2,000-plus years”[ii], is that the solution has to be applied today in order to obtain a result in the mid to long term. Humans are not good at working today for a distant reward: at heart we are all kids.

But anthropogenic forces are different. The effect of deforestation is sensed immediately. A change in crops affects the soil in a matter of months. These actions are very near us: individuals are directly involved in them, policymakers can influence them, but the actors are you and me, our relatives and our neighbors. That being the case, what is preventing us from acting now in the right direction?   

[i] Papathoma-Koehle, M& Glade, T. The role of vegetation cover change in landslide hazard and risk. United Nations University, 2013

[ii] https://climate.nasa.gov/vital-signs/global-temperature/

A sustainable and practical approach to integrating CCA and DRR appears to still be “in its infancy”[i] The 2019 document published by the International Federation of Red Cross and Red Crescent Societies points out how the challenge of addressing climate change adaptation (CCA) and disaster risk reduction (DRR) in a coordinated way is more a desideratum than a reality.

Let us start with climate change. The good news is the Nobel prize given to Syukuro Manabe of Princeton University, Klaus Hasselmann of the Max Planck Institute for Meteorology, and Giorgio Parisi of Sapienza University of Rome for their work on climate change. The award was very timely since COP26, the UN summit on climate change, will be held next month in Great Britain. It will certainly be an added incentive for governments and institutions to commit to real actions fighting climate change.

But I think those grandiose actions tend to be built on quicksand There is probably already enough legislation, at least in the developed world which is by far the biggest culprit of climate change, and surely a good number of pledges by big corporations aiming at reducing their carbon footprint. But I think that it is at the base of the pyramid where action should be taken. Consumers are the big culprits in climate change. Consumers are those who vote for that big, oversized car and that plastic-wrapped apple in the supermarket.

Let us move on to disaster risk reduction. I have written several times about the fact that the first first-responders are the people living in the area at risk. If those people keep dumping debris in the dried-up riverbed; if those same people keep razing forests and substituting them for yearly crops, then the effects of an otherwise slightly higher than usual rainfall can be devastating. I am sure that, again at least in the developed world, there is enough legislation today to prosecute those actions; I am not so sure about the actual prosecution of those actions by the authorities. The inaction is prompted by the fact that society condones those actions. Again, the legislation and its implementation are built on quicksand.

The United Nations Framework Convention on Climate Change (UNFCCC) and its annual climate change conference (COP), as well as the UN Office for Disaster Risk Reduction (UNDRR) as the custodian of the Sendai Framework, are all very good. They promote actions by governments and corporations to act in both areas. But those two areas are intertwingled, as the above-mentioned document “Literature Review on Aligning Climate Change Adaptation (CCA) and Disaster Risk Reduction (DRR)”i contends. My point is that where the connection is stronger is at the base: the citizen. Only with clear and strong action at citizen level, through education at the base, will we be able to simultaneously tackle climate change and disaster risk reduction effectively.

[i] Literature Review on Aligning Climate Change Adaptation (CCA) and Disaster Risk Reduction (DRR) http://repo.floodalliance.net/jspui/handle/44111/4100

The Heat and Health Series published recently by The Lancet focuses on the devastating effects of heat on human beings. It is estimated that “54% of the global population [will be] exposed to more than 20 days of dangerous heat per year by 2100”. A strategy of disaster risk reduction (DRR) is needed because “Society must adapt in ways that not only enable it to survive, but thrive, in a much hotter future.”

Fighting heatwaves has brought up another example of the divide between rich and poor societies, as well as between rich and poor individuals within societies. Air conditioners are by far the preferred tool in fighting heat. But they are an expensive tool. Most vulnerable societies and people cannot have access to an environmentally cooled area, whether it is because they cannot afford it or because their living or working conditions make it impossible to cool the living/working environment. Think about the homeless or those working outdoors.

Another factor making air conditioning a tool that should be put on hold, is the environmental vicious circle created by its use. Most scientific literature recognizes that global warming is here to stay. Air conditioning runs on electricity, the production of which results in CO2 emissions contributing to global warming. A secondary effect is the anthropogenic waste heat they produce, contributing to the urban heat island effect.

A more long-term strategy for heat DRR should focus on the individual, coupled with permanent changes in urban planning. In the first centuries of the past millennium in southern Spain, Arabs put nature to work to cool the environment. Some of their ideas are being used in city planning today, introducing urban gardens and fountains to fight the heat island effect.

As for the individual, electric fans are more environmentally friendly than air conditioners, but above all, a good target communication strategy should be designed so as to reach the population more at risk. Workers laboring outside, such as those in agriculture or construction, have special needs. Not only access to water but also shelter and resting times. A strategy to match their needs and those of the employer can only be attained through a well-designed communication tool directed at employees and employers.

We should think more in long term changes to our DRR heat strategy, less air conditioning and more environmentally friendly solutions and communication.

The second focal point of the TIEMS handbook, Training for rural communities in emergency management & emergency situations, states as an objective the need to “Raising the awareness on technical solutions involving computers, communication and information technology and social sciences to provide emergency and disaster managers with helpful decision support”.

After the recent floods in Germany and the Netherlands, it has been stated that the high incidence on the population may be due to overreliance on ICT technology for communication purposes. It is a fact that ICT relies on the existence of a functioning electrical network. What happens if the electrical flow is cut off? In those situations, the ICT system will go and, with it, internet and mobile communications.

I was living in Germany many years ago, so long ago that the Berlin Wall still existed. One Sunday afternoon sirens started to sound. I don’t know if sirens, used during WWII and after, are the answer. What I know is that we have to put in place a communication network that works even if the electricity goes, even if internet goes, even if mobile communication goes.

Probably, relying on people directly communicating to each other would be the best bet. It would be good to investigate the application of the concept of fractal social organizations to the design of a communication network based on people.

I have been hearing for a long time that “fires are put out in winter”. What that means is that the work of clearing and cleaning the forest must be done during winter, to prevent fires during the summer. Equally, recovery or reconstruction after a disaster has to be worked out before the disaster occurs.

Priority 4 of the Sendai Framework for Disaster Risk Reduction 2015-2030 deals precisely with this. A quote from the introductory paragraph is enough to focus my point: “Disasters have demonstrated that the recovery, rehabilitation and reconstruction phase, which needs to be prepared ahead of a disaster, is a critical opportunity to ‘Build Back Better’, including through integrating disaster risk reduction into development measures,”

I know that we are still, probably, in the response phase of the prevention, preparedness, readiness, response, and recovery continuum that summarises crisis management. Nevertheless, the time to think about the recovery phase is coming, if it has not come already.

Again, as in my previous post dealing with population involvement during the emergency, there is not, to my knowledge, anything being done for the “implementation of normative frameworks, standards and plans for disaster risk reduction” involving stakeholders (civil society, volunteers, organized voluntary work organizations and community-based organizations).

The politicians are engaged in the “blame game” of trying to make the political rival responsible for almost 5 million deaths. Meanwhile, nothing is being done to inform the population on how to proceed when the next pandemic, or for that matter the next health emergency, comes. My only hope that something meaningful will be done lies in the current HORIZON EUROPE call on Disaster-Resilient Society for Europe.

In 2019 the WHO released the document “Health Emergency and Disaster Risk Management Framework” (Health-EDRM)[1]. At that time no one had heard of SARS-CoV-2 while, at the same time, it was a premonition of things to come.

A recent paper by Emily Ying Yang Chan et al[2] points out the need to reinforce a bottom-up approach to Health-EDRM in line with my previous post “Citizens’ role in hazard management[3].

A quick review of the Health-EDRM document (see Bullet 5.9) shows how the authors understood the role of the community in an emergency: “Participation of communities in risk assessments to identify local hazards and vulnerabilities can identify actions to reduce health risks prior to an emergency occurring. … The local population will also play the lead role in recovery and reconstruction efforts.”

It is clear that a year and a half after the explosion of Covid-19, “the local population” has been at best a passive actor in the fight against the pandemic. Its participation in the prevention, preparedness, readiness, response, and recovery continuum has been marginal.

I argue in the above-mentioned post, “Citizens’ role in hazard management”, that the involvement of the population should be based on its ability to identify a hazard before it becomes a real risk. For that it is necessary to involve the population by developing diffusion tools covering an array of specific hazards. To my knowledge, nothing existed in this area for a pandemic and, what is even worst, nothing is being done.

If anything has to be learnt from the development of the pandemic, it is that none of the actors were prepared to fight it effectively. But the population was taken completely by surprise, going from normal day to day business to complete lockdown. The population collaborated passively throughout this situation. The problem remains that, having an almost complete lack of knowledge of what the full consequences of the pandemic are, a large percentage of the population has embraced the so called “freedom” with open arms.

The whole structure of population involvement has fallen into pieces. Embracing with open arms the new “freedom” is the exact opposite of what involvement of the population in fighting the pandemic should mean. A large percentage of the population is, with “open arms”, exercising its “freedom” to help spread the SARS-CoV-2.

[1] https://www.who.int/hac/techguidance/preparedness/health-emergency-and-disaster-risk-management-framework-eng.pdf accessed 23/07/21

[2] https://doi.org/10.1016/S0140-6736(21)01233-2  accessed 23/07/21

[3] https://cgarciamanagement.wordpress.com/2021/07/22/citizens-role-in-hazard-management/ accessed 23/07/21