Recovering from the pandemic: lessons from other disasters
And key to managing recovery will be putting communities in the lead, helping to build their resilience.
The report Covid-19 recovery and resilience: what can health and care learn from other disasters? draws on research from 12 other disasters over the past 20 years or so.
It is a significant document because dealing with an emergency is a different process to recovering from it and disaster recovery is both an under-researched and under-resourced area of emergency planning.
The report seeks to answer the following. “How do individuals, communities and countries recover from catastrophic events? How do we know what support is needed, which groups should be prioritised and how should efforts be co-ordinated and managed? And what role should the health and care system play in recovery?”
The other disasters studied were very different, ranging from the Christchurch earthquakes in New Zealand, the Grenfell Tower, to Hurricane Katrina and 9/11. But clear themes emerged which should help define priorities for recovering from the pandemic.
Mental Health and Wellbeing
In the aftermath of any disaster large number of people will be distressed. This is inevitable. We’re seeing some signs of this already with the pandemic. We can expect the full scale of it to emerge in the coming months.
For many people this will be short-lived, typically characterised by sleeplessness and anxiety. This is a normal response. Most in this category will not seek formal help and even if they do they are not likely to reach the threshold for accessing mental health services.
However the report warns: “In the long term, if left unaddressed, these anxieties can escalate into more serious situations requiring specialist support and significantly increase demand for mental health services.”
This provides a significant challenge. How do health care professionals, policy-makers and communities predict who will be most affected in the longer term?
The aftermath of the pandemic will mean that most of us will be living with greater uncertainty and risk. This creates a background level of stress – but then add on job and housing insecurity and you can see how people can struggle to cope.
When this happens past experience suggests that many people don’t seek help when they need it, often because other people they know have the same symptoms, like drinking too much and sleeping less.
In addition the economic impacts can follow many weeks or months later. Disasters like 9/11 and the major rail disaster that destroyed Lac-Mégantic, Canada in 2013 exposed the vulnerability of middle aged men who were financially secure before the disaster. Months later many found themselves jobless, homeless with no financial buffer and no experience of how to find support.
Another especially vulnerable group which can slip under the radar are children. It’s not just the direct experience of the disaster that affects them but also all breaks in routine, stresses on relationships and the impacts on the protective family environment.
It is therefore vital that the level of need within communities is accurately identified and assessed.
Disaster experts stress that community support is essential – and can be more effective than professional interventions. Dr Melanie Irons who was involved in the aftermath of the Tasmanian bushfires of 2013 is quoted: “I had psychologists calling me saying, ‘I’ll do free sessions, just let them know…’ And of course, no one did [take up that offer].” However she said that people within the community who helped each other out were effectively offering “psychological first aid.”
The report is unequivocal about the importance of the community in disaster recovery. “Local community groups and grassroots organisations play a critical role in creating and maintaining those human connections that are essential for successful recovery. In the UK, many of these groups will struggle to survive and sustain their impact during Covid-19 and beyond, so infrastructure, funding and support that can anticipate and manage that risk is essential. Recovery can take many years, if not decades, so it’s important to consider how this support will be maintained in the long term.”
It cites many examples which demonstrate why meaningful community engagement at a local level is as an essential part of successful recovery.
It states: “This means getting up close and personal with communities to really understand what’s needed and empowering communities to identify those groups who are missing out or struggling themselves.”
A single quote from Marcie Roth, Chief Executive and Executive Director for the World Institute on Disability brings this forcefully to life: “Successful recovery… [is when] the people who are actively at that table look like the people in the community.”
This is familiar territory to those both in public health and community activism who understand how to build community resilience.
There has been much praise during the pandemic for the way in which the public, voluntary and community sectors have developed strong partnerships to deal with the many issues that have arisen during the present crisis.
The report finds evidence that this will also be essential to navigate our way to recovery.
“National and local health services, local authorities, voluntary sector organisations and community groups all bring different perspectives that help ensure that the needs of the local community are genuinely heard and acted on. Community groups in particular bring vital insights and connections that should be central to planning and delivering recovery programmes, alongside local government which has significant experience in community engagement and public health. By working with the right people, you can get a richer understanding of the issues people face, have greater legitimacy in determining priorities for recovery and ultimately provide support that will be more likely to make a difference.”
This builds resilience for future crises as well. Collaboration was the key when Canterbury in New Zealand was devastated by earthquakes in 2010 and 2011. Relations were so strong that when a mosque was attacked in Christchurch years later, local leaders were able to respond at incredible pace. Carolyn Gullery, former Executive Director of Planning, Funding and Analytics at Canterbury District Health Board, said: “Health and education spent the weekend designing our response so that on Monday, when the kids turned up at school, the teachers were all equipped to know exactly how they needed to work with the class…”
The report stresses the importance of investing in community infrastructure not just over the next decade but beyond as well so that communities can continue to recover and build their resilience after the immediate needs have passed.
Finally we cannot ignore the workforce. Covid-19 is already heaping pressure on the health and care workforce, with increasing stress, exhaustion and burnout. Experience elsewhere tells us we ignore this at our peril.
In Fukushima, Japan, following the earthquake in 2011 this culminated in high levels of absenteeism among health care workers for up to 18 months after the disaster, with nurses experiencing significantly greater stress levels than the general population four years after the disaster.
We have come to regard health and social care workers as heroes, which of course they are. But that does not mean that they are not vulnerable when they clearly are. We can expect them to suffer psychological damage – and their employers need to be aware of this and to put staff wellbeing at the heart of everything that they do.
The King’s Fund report is a must read for the community and voluntary sector, for policy-makers and for the health sector. There are lessons from elsewhere, they need to be learned. It is going to be a long, hard road ahead and we should take direction from those who have trod it before.
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