Int J Disaster Risk Sci (2015) 6:164–176 www.ijdrs.

com
DOI 10.1007/s13753-015-0050-9 www.springer.com/13753

ARTICLE

The Sendai Framework for Disaster Risk Reduction: Renewing

Chadia Wannous4 • Virginia Murray1,2,5

Published online: 16 June 2015

Abstract The Sendai Framework for Disaster Risk health, resilience, and well-being higher up the disaster risk
Reduction 2015–2030 (SFDRR) is the first global policy reduction (DRR) agenda compared with the Hyogo
framework of the United Nations’ post-2015 agenda. It Framework for Action 2005–2015. This article reviews the
represents a step in the direction of global policy coherence historical and contemporary policy development process
with explicit reference to health, development, and climate that led to the SFDRR with particular reference to the
change. To develop SFDRR, the United Nations Office for development of the health theme.
Disaster Risk Reduction (UNISDR) organized and facili-
tated several global, regional, national, and intergovern- Keywords Disaster risk reduction
Global
mental negotiations and technical meetings in the period health
Health policy
Public health
Safe hospitals
preceding the World Conference on Disaster Risk Reduc-
tion (WCDRR) 2015 where SFDRR was adopted. UNISDR
also worked with representatives of governments, UN 1 Introduction
agencies, and scientists to develop targets and indicators
for SFDRR and proposed them to member states for Disasters destroy lives and livelihoods around the world.
negotiation and adoption as measures of progress and Between the years 2000 and 2012, it is estimated that over
achievement in protecting lives and livelihoods. The mul- 700,000 people lost their lives; more than 1.5 billion peo-
tiple efforts of the health community in the policy devel- ple were affected by disasters in various ways, with
opment process, including campaigning for safe schools women, children, and several other groups impacted dis-
and hospitals, helped to put people’s mental and physical proportionately. Disaster impacts also set back hard-won
economic development gains and affect all socioeconomic
strata, societal institutions, and sectors in one way or
& Amina Aitsi-Selmi another. The total economic loss was estimated to have
Amina.Aitsi-Selmi@phe.gov.uk exceeded USD 1.3 trillion over the 2000–2012 period
1
(UNISDR 2013a).
Public Health Strategy Division, Public Health England,
London SE1 8UG, UK
Disasters are not natural events. They are endogenous to
2
society and disaster risk arises when hazards interact with
Research Department of Epidemiology and Public Health,
University College London, London WC1E 6BT, UK
the physical, social, economic, and environmental vulner-
3
abilities and exposure of populations (UNISDR 2013b).
Division of International Cooperation for Disaster Medicine,
International Research Institute of Disaster Science (IRIDeS),
Many of the destructive hazards are natural in origin and
Tohoku University, Sendai 980-0845, Japan include earthquakes and extreme weather events resulting
4 in floods and droughts, which has resulted in disaster risk
The United Nations Office for Disaster Risk Reduction
(UNISDR), Geneva, Switzerland management policy being largely event driven. Therefore,
5 the attention of the policy community has naturally fallen
The United Nations Office for Disaster Risk Reduction
(UNISDR) Scientific and Technical Advisory Group, on the hazards and the related physical processes that result
Geneva, Switzerland in disasters.

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Progress in disaster risk reduction (DRR) research has In 2000, the International Strategy for Disaster Reduc-
shown that it is often not the hazard that determines a tion (UNISDR) was established following IDNDR of the
disaster, but the vulnerability, exposure, and ability of the 1990s. The UN/GA convened the second World Confer-
population to anticipate, respond to, and recover from its ence on DRR in Kobe, Hyogo, Japan 2005, which con-
effects. A shift from pure hazard response to the identifi- cluded the review of the Yokohama Strategy and its Plan of
cation, assessment, and ranking of vulnerabilities and risks Action and the adoption of the Hyogo Framework for
(including their unequal distribution in populations) Action 2005–2015: Building the Resilience of Nations and
became critical (Department for International Development Communities to Disasters (HFA) (UNISDR 2005) by 168
2006). This shift in focus takes into account social factors countries. The HFA outlined five priorities for action:
shaping local populations’ interpretation of risks and their
(1) Ensure that DRR is a national and a local priority with
thresholds for action (Eiser et al. 2012). The implication is
a strong institutional basis for implementation;
that societal determinants of risk (through individual or
(2) Identify, assess, and monitor disaster risks and
collective agency and with the assistance of science and
enhance early warning;
technology) can be identified and influenced to achieve
(3) Use knowledge, innovation, and education to build a
better economic and social development trajectories (Scott
culture of safety and resilience at all levels;
et al. 2013).
(4) Reduce the underlying risk factors;
The Sendai Framework for Disaster Risk Reduction
(5) Strengthen disaster preparedness for effective
2015–2030 (SFDRR) was born from the need to ensure
response at all levels.
DRR policy reflects our evolved understanding of the
complexity of disaster risk in the twenty-first century. In the HFA, health was mentioned only three times in
Implementation calls for closer collaboration among all one paragraph (19) under Priority 4 (reduce the underlying
sectors including the health sector in order to prevent, risk factors) (UNISDR 2005, p. 11):
prepare for, respond to, and recover from disasters that
Integrate DRR planning into the health sector; pro-
result from the highly interdependent and evolving risks to
mote the goal of ‘‘hospitals safe from disaster’’ by
which we are exposed.
ensuring that all new hospitals are built with a level
This article provides a brief summary of the history of
of resilience that strengthens their capacity to remain
UN-based frameworks for DRR, a reflection on the pro-
functional in disaster situations and implement miti-
cesses leading to these frameworks, and finally focuses on
gation measures to reinforce existing health facilities,
SFDRR. It discusses some of the reasons for and impor-
particularly those providing primary health care.
tance of having a strong health focus in SFDRR and the
benefits of the close relationship that health has with the This text focuses narrowly on hospitals and health
science and technology aspects in this framework. It offers facilities, overlooking the wider societal determinants of
ideas on how renewing the global commitment to people’s human health and well-being.
resilience, health, and well-being can be enhanced by the Around the same time, two further global policy pro-
implementation of SFDRR over the next 15 years. cesses were initiated in parallel to the HFA process: the
climate change agreements and Millennium Development
Goals. The three policy areas were intricately related as
2 Landmark Policy Developments Led they all draw on scientific knowledge and influence human
by the United Nations in Disaster Risk well-being directly or indirectly. However, they were not
Reduction linked together as clearly as they could have been in the
HFA and the policy processes for each area developed as
Providing assistance to disaster-affected populations is separate policy streams (Fig. 1). The economic develop-
almost as old as international cooperation itself (Kamido- ment, emergency response, and climate change communi-
hzono et al. 2015). A turning point came with the UN ties of research, policy, and practice are composed of
General Assembly (UN/GA)’s recognition of ‘‘the impor- different individuals and disciplines and managed by dif-
tance of reducing the impact of natural disasters for all ferent organizations with different funding streams that
people, and in particular for developing countries.’’ This deepen the siloes in theory and practice, albeit with some
led to the designation of the 1990s as the International degree of overlap that is increasingly recognized and
Decade for Natural Disaster Reduction (IDNDR 1994) in reflected in the UN post-2015 agenda.
which ‘‘the international community, under the auspices of Yet, there are obvious synergies between the three
the United Nations, paid special attention to fostering policy areas that can be emphasized and strengthened to
international co-operation in the field of natural disaster promote policy coherence and facilitate convergence of
reduction’’ (UNISDR 2012). objectives in implementation (ICSU and ISSC 2015). For

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Fig. 1 Twenty five years of international commitments to disaster risk reduction [Source Adapted from presentation by Andrew Maskrey, Lead
Author and Head of the Risk Knowledge (UNISDR 2015)]

example, important synergies that have not been realized technology sector, and members of the communities at risk,
exist between the proposed post-2015 sustainable devel- in order to guide scientific research, set research agendas,
opment goals and the SFDRR targets and indicators: pop- and support education and training (Aitsi-Selmi et al.
ulation health and well-being outcomes have been 2015).
identified explicitly within the SDGs, but these cannot be This year—2015—presents an unparalleled opportunity
achieved without managing those risks that are so closely to align landmark UN agreements through the convergence
associated with disasters such as weak critical infrastruc- of three global policy frameworks: the Sendai Framework
ture, for example, poorly built hospitals. The integration of for DRR 2015–2030 (March 2015), the Sustainable
climate change adaptation into planning and policy design, Development Goals (September 2015; SDGs), and the
and decision making can promote support resilient eco- Climate Change Agreements (December 2015; COP21).
nomic development and prevention-orientated emergency These major global policy instruments need to align
planning. urgently to facilitate and encourage better participation in
Synergies with the climate change and sustainable DRR, sustainable development, and climate-change miti-
development agenda should continue to be articulated and gation and adaptation from the science and technology
leveraged for more effective decision making and funding communities.
allocation. An all-hazard, risk-based, trans-disciplinary and
multisectoral approach will help to identify and prioritize
synergies, and this can help to formulate solutions to 3 Public Health Needs in Disasters
complex problems and the development of joint policy
initiatives. This requires collaboration, communication, During recent decades, the world has faced a greater fre-
and capacity development across the scientific disciplines quency and impact from disasters as well as a paradigm
and technical fields, and with all stakeholders including shift in the types of hazard and the possible risks that
representatives of governmental institutions, communities constitute a threat to human well-being, including climate
of policy making, scientific and technical specialists, the change (see also Kelman 2015), rapid and unmanaged

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urbanization, lack of resources, poverty, and loss of bio- resources to manage the isolation and treatment of patients
diversity. The 2004 Indian Ocean earthquake and tsunami overwhelmed the existing capacity of health care providers
was historically exceptional in terms of its impact on lives and local and national governments. The health disaster
and communities (Rodriguez et al. 2006). This disaster resulted in severe budget cuts to non-Ebola-related health
illustrated the vulnerability of multiple countries and services and a significant reduction in the use of health
communities to natural hazards that arise in distant loca- services owing to fears of cross-infection. As a result, more
tions. The event also encouraged the global community to people are estimated to have died from childbirth, malaria,
adopt a comprehensive framework for action, and identify and AIDS, as well as other diseases (Walker et al. 2015).
global priorities for work and practical steps that are Other than epidemics, disaster deaths are rarely due to
required to achieve disaster resilience. infectious diseases, instead occurring due to a variety of
The implementation of the HFA over the past 10 years causes that include blunt trauma, drowning, and air pollution,
has been urged on by similar events, such as Hurricane for instance, from forest fires or building collapses (Malilay
Katrina, which served to remind society of the terrible et al. 2013). Aside from physical injury and infectious dis-
consequences of limited planning and preparedness. Other eases, disasters can leave those affected with short- and long-
examples include the 2011 East Japan Earthquake and term mental health consequences. Significant changes can
Tsunami and Typhoon Haiyan in 2013, as well as the occur rapidly in people’s lives when they are exposed to
severe 2011 floods in Thailand that affected the Japanese extreme events and disasters. These can cause great stress to
car industry and the global computer industry for a sig- people, families, and communities because of their inherent
nificant period of time (Ye and Abe 2012). effects, such as suffering short-term fear of death and other
The expansion of DRR to include risk assessments mental health disorders (Williams and Drury 2011). Post-
addressing vulnerability and exposure has been compared to traumatic stress disorder (PTSD) is the most often studied
the widening of health activities to include prevention which manifestation of the psychosocial stress caused by disasters,
has traditionally been the preserve of public health. Public but mental health impacts also include general distress, anx-
health is increasingly concerned with the total health system iety, excessive alcohol consumption, and other psychiatric
and not only the eradication of a particular disease affecting disorders (Neria and Shultz 2012).
an individual patient (Murray et al. 2015). The consequences Those with chronic diseases could have worse outcomes
of disasters on human health and well-being are varied and and many risk dying when their medication is not available
include direct impacts on lives and livelihood sustainability or they lack access to health care. People with chronic
and indirect impacts on macroeconomic growth and social diseases have ongoing medical needs that can easily be
support mechanisms (Schipper and Pelling 2006). The US affected when health services are disrupted in disaster sit-
Centers for Disease Control and Prevention link hazards to uations. While further understanding is required in this
the transmission of infectious diseases, especially since area, a recent systematic review (Ochi et al. 2014) revealed
water supplies and sewage systems may be disrupted and that a considerable number of patients lose their medication
sanitation and hygiene may be compromised by population during evacuation, many lose essential medical aids such as
displacement and overcrowding that led to interrupted nor- insulin pens, and many do not even have a record of their
mal public health services (Malilay et al. 2013). prescriptions with them when evacuated. In the Philip-
All three World conferences on DRR were held in pines, during Typhoon Haiyan, the major medical and
Japan, which has been significantly affected by natural public health needs of the affected people were not injury-
hazards but has also been at the forefront of disaster pre- related, but the result of a lack of measures to prevent
paredness and recovery in many ways. The 1995 Hanshin- infectious diseases and the worsening of non-communica-
Awaji disaster, which killed more than 5500 immediately ble diseases due to the lack of access to food, water,
(Shinfuku 2002) and resulted in more than 40,000 injured, housing, and medicine (Egawa 2015).
spurred building code reform and health system strength-
ening that are thought to have helped to reduce the impact
of the 2011 earthquake and tsunami. In addition, the 4 Health After the Hyogo Framework: Changing
establishment of the Japanese Association for Disaster Public Health Priorities for Action in Disaster
Medicine (JADM) in May 1995 as a professional associa- Risk Reduction
tion is believed to have had an important role in strength-
ening the health system’s emergency preparedness and In this section, the development of the health theme in the
therefore resilience to disasters (Egawa 2014a, 2014b). Annual Reports of the Secretary General (ARSG) on the
In Western Africa, the Ebola outbreak (2014–2015) implementation of the International Strategy for Disaster
devastated health facilities and people’s trust in health care Reduction for the UN General Assembly (UN/GA) cover-
providers. The fragility of the health systems and the lack of ing the 2005–2014 period is examined.

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In 2005, the ARSG summarized the essential elements stakeholders about the devastating effects of disasters on
of the Hyogo Framework for Action, but health stake- human health and well-being.
holders were not highlighted (UN/GA 2005). In 2006, the As part of the assessment of the impact and progress of
ARSG stated that the World Health Assembly urged the HFA, the Mid-Term Review of the Hyogo Framework
member states to engage actively in collective measures to for Action (UNISDR 2011) was published in 2011 and was
establish global and regional preparedness plans that inte- facilitated by the UNISDR Secretariat through a partici-
grate risk reduction into the health sector and build patory approach involving stakeholders at international,
capacity to respond to health-related crises (UN/GA 2006). regional, and national levels. This report was guided by the
In 2008, the Hospitals Safe from Disasters campaign, advice of the 2009 GP for DRR, which requested a broad
supported by the World Health Organization and the World strategic review of the state of HFA implementation. The
Bank, attempted to better protect the lives of patients, information that was collected was primarily of a qualita-
health staff, and the public by reinforcing the structural tive nature, based on self-assessments and perceptions of
resilience of health facilities; ensuring that health facilities the stakeholders involved via the HFA monitor reporting
continue to function in the aftermath of disasters; and mechanism. In addition, a series of briefing papers was
upgrading preparation and training of health workers on developed and the UNISDR Scientific and Technical
preparedness plans (UN/GA 2008). In 2009, UNISDR Advisory Group was asked to contribute actively. In
ARSG encouraged national assessments of the safety of summary, this contribution stated that:
existing education and health facilities by 2011, and the
[…] recognising the importance of scientific and
development and implementation of concrete action plans
technical information for DRR UNISDR established a
for safer schools and hospitals by 2015 as was agreed at the
Scientific and Technical Committee in 2008 to address
Global Platform (GP) in May 2009 (UN/GA 2009).
policy matters of a scientific and technical nature,
In 2010, the UNISDR ARSG was particularly rich in
where science is considered in its widest sense to
capturing the impacts of disasters on health and hospitals.
include the natural, environmental, social, economic,
It stated that earthquakes in Haiti, Chile, and China have
health and engineering sciences, and the term ‘tech-
provided stark reminders of the increasing disaster risk in
nical’ includes relevant matters of technology, engi-
urban areas; and the same report predicted that it would
neering practice and implementation. In its report—
take many decades for Haiti to recover and grow as a
Reducing Disaster Risks through Science—issues and
society and an economy because critical hospitals, other
actions, to the GP 2009, the committee concentrated
healthcare facilities, and schools were damaged or
on addressing: climate change; changing institutional
destroyed, and were consequently unable to continue ser-
and public behaviour to early warnings; incorporating
vice delivery to affected communities (UN/GA 2010). In
knowledge of the wide health impacts of disasters;
2011, the ARSG report noted that drought remains a hidden
improving resilience to disasters through social and
risk, poorly understood despite its impacts on human
economic understanding. (UNISDR 2011, p. 35)
health, livelihoods, and multiple economic sectors as
drought leads to stress and insecurity for rural and pas- The Mid-Term Review concluded that the implemen-
toralist populations (UN/GA 2011). tation of HFA over the 5 years prior had generated sig-
In 2012, the UNISDR ARSG mentioned the One Million nificant international and national political momentum and
Safe Schools and Hospitals initiative—through which the action around DRR. It also underscored areas where further
Secretariat works with communities, civil society organi- work was necessary to build on the positive gains of the
zations, governments, and the private sector to make development of the HFA in order to achieve the expected
schools and hospitals safe from disasters—and noted that outcome of ‘‘substantial reduction of disaster losses, in the
the initiative had received over 200,000 pledges for safety lives and in the social, economic and environmental assets
(UN/GA 2012). Finally, in 2014, the ARSG stressed the of communities and countries’’ (UNISDR 2011, p. 69).
urgent need to anticipate medium- and long-term risk Although there was little on health in the HFA Mid-
scenarios and to identify concrete measures to minimize Term Review, there was increasing interest in health-re-
the creation of future risk, reduce existing levels of risk, lated issues in many discussions and debates around the
and strengthen social, environmental, and economic resi- GPs in 2011 and 2013. In part, this coincided with the
lience. The UN/GA observed that for the fourth consecu- Intergovernmental Panel on Climate Change (IPCC) in
tive year, economic losses from disasters had exceeded which UNISDR participated. In the Norway-UNISDR joint
USD 100 billion (UN/GA 2014). These policy statements report in 2008 (Norway and UNISDR 2008), it was clearly
demonstrate how, over the years, UNISDR annual reports demonstrated that there was a need for an IPCC report on
have had an increasing focus on health-related issues disasters. This IPCC Special Report: Managing the Risks of
because of the growing concerns expressed by many Extreme Events and Disasters to Advance Climate Change

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Adaptation showed that much can be done to reduce the stakeholders including the scientific community and civil
severity and frequency of extreme weather events influ- society organizations to assess progress on the implemen-
enced by anthropogenic climate change, through imple- tation of the HFA by drawing on information from the
menting sustainable development practices that aim to relevant scientific and policy fora and the online Hyogo
protect our environment and, concomitantly, improve Framework Monitor (http://www.preventionweb.net/eng
human health and well-being (IPCC 2012). IPCC reported lish/hyogo/hfa-monitoring/national/). Regional ministerial
in 2014 that there is increased evidence that climate change conferences and platforms were also organized by
is affecting many natural and human systems and poses UNISDR and its regional offices as multistakeholder fora
significant risks to human health, ecosystems, infrastruc- to support the delivery of government commitments by
ture, and agricultural production (IPCC 2014). This led to a improving coordination and implementation of DRR
call for DRR to enable critical public policies that are activities while remaining linked to national and interna-
informed by evidence from science and the use of tools tional efforts. Only the outcomes from two recent GPs of
from technology to address disaster risk (Aitsi-Selmi et al. 2011 and 2013 are discussed below.
2015). The 2011 GP gave greater attention to people’s health
In summary, the Hyogo Framework for Action than the previous two GPs due to a combination of factors,
2005–2015 helped to widen the remit of DRR activities including a larger number of health delegates ([60) from
beyond simply responding to disasters to include detailed many different countries and the establishment of a thematic
risk assessment, improving early warning and response platform devoted to DRR and health, which had been agreed
capacities, impact-based forecasting, better resource man- at the 2009 GP (WHO 2009). Participants at the 2011 GP
agement, knowledge creation and sharing, building public shared information on their projects and discussed a global
commitment, and developing supportive institutional plan of action to enhance multisectoral collaboration on DRR
frameworks (HIS 2011). However, challenges remained in for health to protect lives and livelihoods (WHO 2011) and
risk governance and assessment as well as monitoring, provided a launchpad for the discussions regarding the
dissemination, capacity development, and shifting the inclusion of DRR in the post-2015 development goals (WHO
culture from a hazard and response-driven culture to a risk- 2013). A joint statement on Scaling-up the Community-Based
driven, integrated culture that encompasses the full DRR Health Workforce for Emergencies was developed by the
cycle from prevention to recovery and rehabilitation (IFRC Global Health Workforce Alliance (GHWA) together with
2014). the World Health Organization (WHO), the International
Federation of Red Cross and Red Crescent Societies (IFRC),
5 Developing the Hyogo Framework for Action the United Nations Children’s Fund (UNICEF), and the
Successor Through International Consensus United Nations High Commissioner for Refugees (UNHCR)
Building (GHWA et al. 2011). Speakers from WHO and partner
organizations contributed to GP sessions that addressed the
The HFA clearly suggested that successful disaster resi- following issues (WHO 2011):
lience requires scientific and technical capacities with • Learning lessons for strengthening all-hazards pre-
inputs from physical, social, economic, health, and engi- paredness arising from the global experience of a
neering disciplines. As the process of developing the multisectoral approach to pandemic preparedness;
HFA’s successor began, the need for a more integrative • Identifying the health aspects of preparedness and
DRR process that incorporated bottom–up and top–down response to nuclear emergencies;
actions, local scientific and technical knowledge, and a vast • Progressing the implementation of safer hospitals
array of stakeholders became important (Gaillard and initiatives in more than 42 countries, which has resulted
Mercer 2012). In this section, we review the policy in the assessment of more than 630 health facilities
development process and how the global and regional assessed for their safety and ability to function in
UNISDR platforms, the preparatory committees, and other emergencies;
international technical and policy negotiation meetings • Effectively restoring health services and health facili-
helped to shape SFDRR. ties in the recovery and reconstruction for disasters;
• Improving the flow of climate-related information
5.1 The Global and Regional Platforms between hydrometeorological services and the health
sector for improved risk management and decision
The GPs for DRR were held biennially from 2007 to 2013 making in the context of the Global Framework for
and provided a forum for member states and other Climate Services;

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• Developing programs to enhance risk assessment at all articulate specific science requests, where science in this
levels to inform on risk management programming by context refers to knowledge obtained through systematic
communities and countries. observation, recording, testing, evaluation, and dissemina-
tion. These data are generated by physical, geographical,
In the Chair’s summary of the GP of 2013 emphasis was
engineering, environmental, social, health, psychological,
placed on targeting the root causes of risk where participants
management, and economic sciences to name but a few
raised the need to take concrete measures to tackle risk dri-
(Aitsi-Selmi et al. 2015).
vers including baseline levels of disease, inadequate health
The science, health, and technology call was maintained
services and infrastructure before, during and after disaster
by the member states at negotiations held in Geneva in June
events, and poor water and sanitation (GPDRR 2013). Sev-
2014, November 2014, and in January and February 2015
eral proposed actions for health were put forward (GPDRR
and finally in Sendai, Japan in March 2015. Through the
2013) including: full reporting of the health burden of dis-
various national and international DRR meetings, the call for
asters and the consequences for community development and
a stronger science element in policy also received support
the systematic application of the 2005 International Health
through the Major Group on Science and Technology,
Regulations (WHO 2005). Other important themes noted by
organized by the International Council of Science and
the Chair were the emphasis placed on ‘‘integrated, multi-
included many of the major science institutions of the world.
sectoral approaches to DRR, and to strengthening DRR in
key sectors, such as education, agriculture and health’’ and
5.3 Technical Meetings and Network Development
that ‘‘development and resilience are unlikely to be sustained
unless disaster risk is explicitly addressed in all development
Networks and international collaboration have become
initiatives’’ (GPDRR 2013, p. 2).
essential to the creation and dissemination of new knowl-
In addition, ‘‘The global economy’s transformation over
edge (Persson et al. 2004). Linking science and decision
the previous 40 years was recognized as leading to a
making requires a special effort. Science panels can be
growing accumulation of disaster risk and that countless
used to provide advice to decision-makers such as national-
everyday local events and chronic stresses involving mul-
level research councils, boards, and committees to facilitate
tiple risks are an ongoing burden for many communities.
science communication alongside the creation of public
Food security, livelihoods and people’s health were noted
participation processes and stakeholder panels and the
as being directly at risk in drylands and drought-prone
development of special communication materials (von
areas subject to desertification and in small island devel-
Wintderfeldt 2013).
oping states. Finally, the private sector was seen as an
As an example of such initiatives to close the science-
important piece in the risk reduction puzzle and that ‘‘re-
policy gap and in an effort to promote the integration of
silient business and investment go hand in hand with
science into the next DRR framework, Tohoku University
resilient societies, ecosystems and the health and safety of
established in 2012 the International Research Institute of
employees’’ (GPDRR 2013, p. 3).
Disaster Science (IRIDeS) to promote action-oriented
Statements of support for public health, science, and
research integrating and disseminating scientific discover-
technology from the UNISDR Regional DRR Platforms held
ies. The institute includes a multidisciplinary disaster
in 2014 in Africa (UNISDR 2014a), the Americas (UNISDR
medical science division. In preparation for the 2015 World
2014b), Asia (UNISDR 2014c), Europe (UNISDR 2014d),
Conference on Disaster Risk Reduction (WCDRR) in
and in the Arab League (UNISDR 2014e) have been
Sendai, IRIDeS co-organized the International Symposium
instrumental in shaping SFDRR’s commitments for DRR in
on Disaster Medical and Public Health Management:
public health, science, and technology.
Review of Hyogo Framework for Action in Washington
DC, May 2014. This symposium was officially supported
5.2 The Preparatory Committees by the Ministry of Health, Labour and Welfare of Japan.
More than 120 health professionals, researchers from var-
The Preparatory Committee meetings were open to gov- ious organizations including UN agencies such as
ernments and nongovernmental actors (scientists, the pri- UNISDR, WHO, the Office for the Coordination of
vate sector, civil society, intergovernmental organizations) Humanitarian Affairs (OCHA), the World Bank, and the
and facilitated formal member state negotiations on Pan American Health Organization (PAHO) participated.
SFDRR. Three Preparatory Committee meetings were held A position paper (ISDMPHM 2014) proposed a set of
between July 2014 and March 2015. An example of a recommendations reached by consensus including that the
successful policy process is captured in the strength of the consideration of health in DRR should be imperative by
call for science and greater evidence-informed DRR. The promoting the mutual understanding of health and non-
wider DRR community worked with member states to health sectors and capacity development through the

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education and training of health professionals regarding Reduction (UNISDR 2015), the successor to the HFA. It
DRR to protect people’s health and health infrastructure has a greater emphasis on health and gives a clearer
and reduce the vulnerability of communities to disasters mandate emphasizing the need for a more integrative DRR
(Egawa et al. 2014; Otomo and Burkle 2014; Sugawara and process that incorporates bottom-up as well as top-down
Yeskey 2014; Tomita and Ursano 2014; Pesigan and Cul- actions, local scientific and technical knowledge, and
lison 2014; Radjak and Redmond 2014). These recom- draws attention to synergies with health, climate change,
mendations were disseminated through various fora and sustainable development. This is a significant frame-
including the 6th Asian Ministerial Conference on Disaster work for health—for people’s health involving all sectors
Risk Reduction (AMCDRR 2014; Chatterjee et al. 2015). and for the health sector itself—with more than 30 explicit
references to health, which refer to implementation of an
5.4 Advocacy from the Health Sector all-hazards approaches (Kelman 2015) and link to epi-
demics and pandemics in addition to the 2005 International
WHO worked with a wide range of partners including Health Regulations (WHO 2005). This far-reaching new
member states through a multisectoral approach to improve framework for DRR has a clear outcome, goal, seven
health outcomes for people at risk of emergencies and global targets, and four priorities for action.
disasters. WHO has been committed to providing guidance Five of the seven global targets are particularly relevant
and assistance for developing country and community to health:
capacities in health and other sectors to manage the health
(a) Substantially reduce global disaster mortality by 2030,
risks associated with emergencies and disasters in an
aiming to lower average per 100,000 global mortality
integrated manner that involves all partners and operates at
between 2020 and 2030 compared to 2005–2015;
all levels of research and decision making.
(b) Substantially reduce the number of affected people
In the build up to WCDRR, WHO convened and par-
globally by 2030, aiming to lower the average global
ticipated in a number of fora to maintain the visibility of
figure per 100,000 between 2020 and 2030 compared
health, and influenced the policy and practice of emergency
to 2005–2015;
risk management for health broadly, and informed the
(d) Substantially reduce disaster damage to critical
health content of the post-2015 framework more specifi-
infrastructure and disruption of basic services, among
cally. As an example, at the 2011 GP, the issue of people’s
them health and educational facilities, including
health was given greater attention due to a combination of
through developing their resilience by 2030;
factors, including a larger number of health delegates from
(e) Substantially increase the number of countries with
many different countries and more presentations from the
national and local DRR strategies by 2020; and
health sector than in previous sessions as well as two
(g) Substantially increase the availability of and access to
meetings of a thematic platform devoted to health (WHO
multi-hazard early warning (UNISDR 2015, pp. 7–8).
2011). In the same year, WHO also released a document
that highlighted the vital role of community health work- The following paragraphs from SFDRR include actions
ers, including volunteers, in DRR (GHWA et al. 2011), and required by public health, which are agreed as priorities for
called for governments and all partners to invest in WHO to act on in partnership with UNISDR and the UN
strengthening their capacity. WHO also led the One Mil- system as well as local, national, regional, and global
lion Safe Hospitals and Safe Schools Campaign to make partners as relevant.
schools and hospitals safer from disasters (WHO n.d.).
• In Priority 3 At National and Local Level 30(i) ‘‘En-
WHO representatives have recognized that SFDRR is
hance the resilience of national health systems, includ-
‘‘[…]very different from what we saw in Hyogo because
ing by integrating disaster risk management into
it’s not just about protecting people’s health but the
primary, secondary and tertiary health care, especially
recognition that health is at the very centre of DRR’ and
at the local level; developing the capacity of health
also that ‘[h]ealth and DRR are deeply connected; healthy
workers in understanding disaster risk and applying and
people are resilient people and resilient people recover
implementing DRR approaches in health work; and
more quickly from disasters’’ (UN News Centre 2015).
promoting and enhancing the training capacities in the
field of disaster medicine; and supporting and training
6 SFDRR: An All-Hazards Approach community health groups in DRR approaches in health
programmes, in collaboration with other sectors, as
SFDRR is a voluntary agreement adopted on 18 March well as in the implementation of the 2005 International
2015 by 187 UN member states after extensive negotia- Health Regulations of the World Health Organization’’
tions at the Third World Conference on Disaster Risk (UNISDR 2015, p. 16);

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172 Aitsi-Selmi et al. Global Commitment to Resilience, Health, and Well-being

• In Priority 3 At National and Local Level 7 Implementing SFDRR: The Impact on Health
30(j) ‘‘Strengthen the design and implementation of
inclusive policies and social safety-net mechanisms, Like other wide-reaching policy frameworks, the effective
including through community involvement, integrated implementation of SFDRR, will require the integration of
with livelihood enhancement programmes, and access momentum for action across local, national, regional, and
to basic health care services, including maternal, international levels and will need to build on synergies
newborn and child health, sexual and reproductive across DRR, the Sustainable Development Goals, and the
health, food security and nutrition, housing and educa- climate change agreement in 2015. Mutually beneficial
tion, towards the eradication of poverty, to find durable capacity development and joint policy initiatives across
solutions in the post-disaster phase and to empower and these policy areas could considerably enhance the main-
assist people disproportionately affected by disasters’’ streaming of DRR in health (WHO 2014). This should
(UNISDR 2015, p. 16); improve alignment with shifts in the health sector from a
• In Priority 3 At National and Local Level 30(k) ‘‘People health-care focused, vertical-systems approach to an
with life threatening and chronic disease, due to their approach that strengthens health systems, promotes equity,
particular needs, should be included in the design of and collaborates closely with non-health sectors to influ-
policies and plans to manage their risks before, during ence the wider, societal determinant of health for the health
and after disasters, including having access to life- benefit of people and communities. A large part of the
saving services’’ (UNISDR 2015, p. 16); responsibility for linking health to DRR and implementing
• In Priority 3 At Global and Regional Level 31(e) ‘‘En- SFDRR with partners across the DRR community will be
hance cooperation between health authorities and other borne by the health sector through the leadership of the
relevant stakeholders to strengthen country capacity for Ministries of Health in countries and the World Health
disaster risk management for health, the implementa- Organization (UN News Centre 2015).
tion of the International Health Regulations (2005) and Working in partnership with the UNISDR STAG and
the building of resilient health systems’’ (UNISDR linking health to DRR to implement SFDRR will have
2015, p. 17); significant impact particularly when it has the following
• In Priority 4 At National and Local Level 33(c) ‘‘Pro- mandate in Priority 1, Paragraph 25(g):
mote the resilience of new and existing critical
Enhance the scientific and technical work on DRR
infrastructure, including water, transportation and
and its mobilization through the coordination of
telecommunications infrastructure, educational facili-
existing networks and scientific research institutions
ties, hospitals and other health facilities, to ensure that
at all levels and all regions with the support of the
they remain safe, effective and operational during and
UNISDR Scientific and Technical Advisory Group in
after disasters in order to provide live-saving and
order to: strengthen the evidence-base in support of
essential services’’ (UNISDR 2015, p. 18);
the implementation of this framework; promote sci-
• In Priority 4 At National and Local Level 33(n) ‘‘Establish
entific research of disaster risk patterns, causes and
a mechanism of case registry and a database of mortality
effects; disseminate risk information with the best use
caused by disaster in order to improve the prevention of
of geospatial information technology; provide guid-
morbidity and mortality’’ (UNISDR 2015, p. 19);
ance on methodologies and standards for risk
• In Priority 4 At National and Local Level 33(o) ‘‘En-
assessments, disaster risk modelling and the use of
hance recovery schemes to provide psychosocial sup-
data; identify research and technology gaps and set
port and mental health services for all people in need’’
recommendations for research priority areas in DRR;
(UNISDR 2015, p. 19).
promote and support the availability and application
SFDRR strongly endorses the role of science compared of science and technology to decision-making; con-
to other global policy frameworks and specifically delin- tribute to the update of the 2009 UNISDR Termi-
eates the role that the UNISDR’s Scientific and Technical nology on DRR; use post-disaster reviews as
Advisory Group (STAG) will play in implementation. The opportunities to enhance learning and public policy;
framework reflects the understanding that policies that are and disseminate studies (UNISDR 2015, p. 12).
formulated based on scientific evidence can play an
The need to communicate and understand the value of
essential role in these efforts by determining disaster risk
SFDRR widely so that all sectors, including health actors,
and thereby uncovering improved ways to prevent, miti-
embrace and implement SFDRR to protect people’s health
gate, prepare for, recover from, and respond to disasters
from the risks of emergencies and disasters should be
and therefore save lives and reduce disease related to dis-
shared by all, if progress on the health priorities is to be
asters (Carabine 2015).

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Int J Disaster Risk Sci 173

made. The initial implementation efforts taken by stake- monitoring process that is yet to be defined. It should
holders in the immediate wake of SFDRR include the ideally link to the Sustainable Development Goals and
following: climate change agreements due in 2015 (Kelman 2015;
Tozier de la Poterie and Baudoin 2015). Terminology,
(1) IRIDeS committed to establishing a Global Center for
targets, and indicators (UNISDR 2014e) and funding
Disaster Statistics in collaboration with the United
remain issues to be resolved.
Nations Development Programme (UNDP 2015). The
A new phase in DRR policy and implementation is
result of a long partnership, the new centre will help
beginning and provides an opportunity to align the post-
deliver quality, accessible, and understandable disaster
2015 DRR agenda with the global public health needs of the
data, including health-related data, to member states as
twenty-first century through evidence-based policy and sci-
they endeavour to achieve the goals of SFDRR;
entific activity that reflects the mandate given to the scien-
(2) A meeting organized by the Collaborating Centre for
tific community in SFDRR (see paragraph 25(g) above).
Oxford University and Chinese University of Hong
With efforts to build on synergies across health, sustainable
Kong for Disaster and Medical Humanitarian
development, and climate change, DRR can help to create
Response (CCOUC) and the Chinese University of
convergence between global policy frameworks—a con-
Hong Kong Centre for Global Health was held in
vergence that can be promoted and supported through better
Hong Kong on 23 March 2015. The purpose of the
population health and well-being as a focal point and
meeting was to bring together a group of local,
important outcome for the post-2015 UN agenda.
national, and international experts on DRR represent-
ing a wide range of fields and disciplines to discuss Acknowledgments The authors are very grateful to Jonathan
how to consider taking forward DRR science, tech- Abrahams and Cathy Roth at the World Health Organization for all
nology, and public health implementation in the Asia the work they have done to incorporate health in the Sendai Frame-
region and included a review of emergency prepared- work for DRR 2015–2030 and their comments on this and related
papers on the health aspects of the SFDRR. The authors are also
ness in mainland China (CCOUC 2015); and grateful to Public Health England for their support in carrying out this
(3) The World Conference on Disaster and Emergency work and to Andrew Maskrey at the United Nations Office for
Medicine held in Cape Town, South Africa on 21–24 Disaster Risk Reduction (UNISDR), for approving the use of a
April 2015 whose closing statement concluded that modified version of a figure he designed. The authors also thank
Osamu Shimomura in the Japan Society for the Promotion of Science
the conference participants should endorse the pre- Washington Office, Washington DC; Yuichi Ono and Takako Izumi
cepts outlined in SFDRR, and support continuing and in the International Research Institute of Disaster Science, Tohoku
renewed initiatives to assist in meeting the health- University, Sendai, Japan; Anthony Macintyre, School of Medicine &
related goals and priorities as outlined in SFDRR Health Sciences at the George Washington University, Washington
DC; Charles Beadling, Metin Demir, Kevin Riley, Geoff Oravec,
(WADEM 2015). David Tarantino, William Lyerly, Ramey Wilson, Maysaa Mahmood,
Center for Disaster and Humanitarian Assistance Medicine at Uni-
formed Services University of the Health Sciences, Bethesda,
Maryland; and John Walsh, David L. Wessel, Children’s National
8 Conclusions Health System, Washington DC for their tireless organizing effort to
make the International Symposium in Washington DC possible.
SFDRR includes health as an indivisible component of
Open Access This article is distributed under the terms of the
DRR. Its perspective is to mainstream and integrate DRR Creative Commons Attribution 4.0 International License (http://cre-
within and across all sectors, including health, and at the ativecommons.org/licenses/by/4.0/), which permits unrestricted use,
same time to evaluate health outcomes from DRR imple- distribution, and reproduction in any medium, provided you give
appropriate credit to the original author(s) and the source, provide a
mentation and to align the implementation of DRR
link to the Creative Commons license, and indicate if changes were
approaches with other relevant health frameworks such as made.
the 2005 International Health Regulations (WHO 2005).
This article reviewed the latest developments in DRR UN-
based global policy and identifies how the public health
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