Public Nutrition from an Approach to a Discipline: Concern's Nutrition Case Studies in Complex Emergencies

The Public Nutrition approach, like that of Public Health, is context specific. It places an emphasis on populations rather than individuals and is inter-disciplinary in nature. Both approaches seek to understand the complex aetiology of a clinical outcome such as malnutrition within the widest possible framework. Public Nutrition uses the UNICEF conceptual framework and adapts and expands it. The authors of this article argue – through the examination of a number of case studies taken from the work of Concern Worldwide (hereafter referred to as Concern) in southern Sudan, Rwanda, Angola, Tanzania and DRC – that there are two critical constituents of the Public Nutrition approach. These are: a contextual analysis (including the use of surveillance information for programme design and advocacy) and community involvement at all stages of the project cycle. Some of the key obstacles to the adoption of the Public Nutrition approach are identified by illustrating two practical programme settings. For the Public Nutrition approach to be more widely used, the authors recommend a number of key strategies including the further dissemination of case studies and the clarification of the scope and boundaries of the approach. These strategies will enable Public Nutrition to evolve both as a practical programme framework as well as an academic discipline.     

The views of experts and residents on social vulnerability to flash floods in an Alpine region of Italy

This paper reports on research work performed for Floodsite a European Community-funded project on the social aspects of vulnerability in the Adige/Sarca river basin of the Trentino-Alto Adige region, Italy. It identifies some limitations to the use of a fixed set of indicators, which fail to account for either local peculiarities or the intangible aspects that contribute to the shaping of social vulnerability. The authors employed a number of methods to investigate the opinions of professionals and residents on risk and safety, distinguishing between the individual and the institutional components of social vulnerability. Adopting a systemic perspective, they explored the interactions between these two elements, showing how they may give rise to unexpected phenomena. The 'safety paradox' and the 'efficiency paradox' are discussed, emerging when increased protection provided by structural devices and dedicated institutions translates into a lack of awareness and agency on the part of residents.     

Chronic institutional failure and enhanced vulnerability to flash‐floods in the Cuenca Altadel Río Lerma,Mexico

The dominant paradigm in disaster risk reduction (DRR) policies has been seriously contested because of its reliance on interventions based on technocratic expertise. In the Mexican context, the influence of informal practices such as clientelism and cartelisation of the political system produces environmental degradation and vulnerability to disasters within the communities in the study site. This paper contributes to understanding of failed institutional processes and parallel practices that intensify vulnerability to disasters by contrasting the discourses of agents within a peri‐urban community in central Mexico. Employing the Situational Analysis Approach as a methodological framework, the study identifies divergent views and practices within the community, leading to different responses to disasters and to different perceptions regarding institutional performance. In addition, it finds that institutional decision‐making, based only on scientific and technical expertise, has resulted in unintended consequences that influence ongoing vulnerability to floods in the site under review.     

Constructing vulnerability: the historical, natural and social generation of flooding in metropolitan Manila

Flooding is not a recent hazard in the Philippines but one that has occurred throughout the recorded history of the archipelago. On the one hand, it is related to a wider global ecological crisis to do with climatic change and rising sea levels but on the other hand, it is also the effect of more localised human activities. A whole range of socio-economic factors such as land use practices, living standards and policy responses are increasingly influencing the frequency of natural hazards such as floods and the corresponding occurrence of disasters. In particular, the reason why flooding has come to pose such a pervasive risk to the residents of metropolitan Manila has its basis in a complex mix of inter-relating factors that emphasise how the nature of vulnerability is constructed through the lack of mutuality between environment and human activity over time. This paper examines three aspects of this flooding: first, the importance of an historical approach in understanding how hazards are generated; second, the degree of interplay between environment and society in creating risk; and third, the manner in which vulnerability is a complex construction.     

Remaking the world in our own image: vulnerability,resilience and adaptation as historical discourses

A warming climate and less predictable weather patterns, as well as an expanding urban infrastructure susceptible to geophysical hazards, make the world an increasingly dangerous place, even for those living in high‐income countries. It is an opportune moment, therefore, from the vantage point of the second decade of the twenty‐first century, to review the terms and concepts that have been employed regularly over the past 50 years to assess risk and to measure people's exposure to such events in the light of the wider geopolitical context. In particular, it is useful to examine ‘vulnerability’, ‘resilience’, and ‘adaptation’, the principal theoretical concepts that, from an historical perspective, have dominated disaster studies since the end of the Second World War. In addition, it is valuable to enquire as to the extent to which such discourses were ideological products of their time, which sought to explain societies and their environments from the stance of competing conceptual frameworks.     

Social vulnerability and pneumonic plague: revisiting the 1994 outbreak in Surat,India

The 1994 outbreak of pneumonic plague in Surat, India is revisited and analyzed using the pressure and release (PAR) model. Overviews of the outbreak, of India's experience with plague, and of the disease are provided and the PAR model is used to trace the production of vulnerability via root causes, dynamic pressures, and unsafe conditions and to explain the why, when, and where of the epidemic. The emergence of plague in Surat was an unfortunate amalgam of prior hazard events and of factors generating vulnerability. Root causes include the country's colonial legacy and a complex and pervasive social hierarchy promoting caste and class interests over the common good. Dynamic pressures include: a curative-focused healthcare system; a weak civil society; misplaced spending priorities; and public and private corruption that deprived public health programs of needed funds and which compelled workers to live and labor in unhealthy environments. Unhealthy public, residential and workplace environments; fragile economic conditions; and a lack of surveillance and preparation are immediately linked to the outbreak and to the transmission of pneumonic plague.     

Women and children last: An essay on sex discrimination in disasters

In general, little attention has been given to differential survival between the sexes in disasters. Consideration of physiological differences between males and females would suggest that, all things being equal, morbidity and mortality after disaster, particularly where food shortage is involved, should indicate an excess male mortality. Such statistics as exist in disasters, as in chronic underdevelopment, show that it is females and especially girl children who are at highest risk. The basis of this lies in sex discrimination which is implicit in most social systems.     

Pinning down social vulnerability in Sindh Province,Pakistan: from narratives to numbers,and back again

This paper reflects critically on the results of a vulnerability assessment process at the household and community scale using a quantitative vulnerabilities and capacities index. It validates a methodology for a social vulnerability assessment at the local scale in 62 villages across four agro‐ecological/livelihood zones in Sindh Province, Pakistan. The study finds that the move from vulnerability narratives to numbers improves the comparability and communicational strength of the concept. The depth and nuance of vulnerability, however, can be realised only by a return to narrative. Caution is needed, therefore: the index can be used in conjunction with qualitative assessments, but not instead of them. More substantively, the results show that vulnerability is more a function of historico‐political economic factors and cultural ethos than any biophysical changes wrought by climate. The emerging gendered vulnerability picture revealed extremes of poverty and a lack of capacity to cope with contemporary environmental and social stresses.     

Interactions in hazard management policies: the case of drought in Nicaragua, 1976–2010

The literature on adaptive and multi‐level governance calls for interactive hazard management to increase societies’ resilience. This paper maps the hazard management policies in a poor and hazard‐prone country—Nicaragua—and examines what role the government gives to interactions among different actors at different societal levels. A new analytical framework is developed that includes scope and direction to capture unidirectional or mutual interactions that are either horizontal or vertical. This enables a more complex analysis of interactions than that found in previous research. The review shows that the historical change in the role given to interactions, as a result of a focus on short‐term emergency response being complemented by long‐term risk management, mainly lies in how they are characterised—with more participants and other types of content categories—and the awareness that interactions other than mutual ones can be positive. This illustrates the complexity of the issue of interactions.     

Flood vulnerability and commercial activities: the case of the city of Girona, Spain

This paper is based on a case study of the city of Girona in Catalonia, Spain, and analyses the vulnerability of commercial establishments to floods caused by the Onyar River. A mapping and statistical approach (cluster analysis) was applied to the information obtained from 568 questionnaires answered by the shops and the workshops located in the flood risk area. The results obtained allowed the authors to determine five different flood vulnerability profiles of the commercial establishments analysed. These profiles paint a picture of little individual adaptation to the risk and the possibility of suffering, sooner or later, large economic losses due to overflowing of the Onyar River. The authors established a methodology for carrying out a detailed multidimensional analysis of the flood vulnerability of the city's commercial establishments in order to provide the foundations for local government policies and for strategies for shop owners to reduce flood vulnerability.     

Mapping cultural vulnerability in volcanic regions: The practical application of social volcanology at Mt Merapi,Indonesia

Protecting at-risk communities from geological hazards requires both knowledge of the physical hazard and an understanding of the community at risk. Interdisciplinary disaster research therefore explores the interface between hazards and society in order to improve disaster risk reduction strategies. At this interface there exist disaster sub-cultures that are produced through hazard experience and can be developed as a coping mechanism for the at-risk communities. Therefore, disaster sub-cultures could contribute to either social resilience or vulnerability. The fluid nature of the term culture and the difficulty in quantifying these important human traits mean that the local sub-cultures are complex and often not included within conventional risk management tools such as risk maps. However, this paper demonstrates how a disaster sub-culture found at Mt Merapi volcano, Indonesia, can be examined using interdisciplinary methods. The distinctive Mt Merapi sub-culture influences local community actions during the frequent eruptions. The findings from ethnographic studies completed on Mt Merapi in 2007 and 2009 have been translated and mapped in order to be incorporated within a holistic risk assessment. The key findings, methods of translation and maps are presented here, and demonstrate the potential for interdisciplinary research applications in disaster risk reduction.     

"We all knew that a cyclone was coming": disaster preparedness and the cyclone of 1999 in Orissa, India

Imagine that a cyclone is coming, but that those living in the affected areas do nothing or too little to protect themselves. This is precisely what happened in the coastal state of Orissa, India. Individuals and communities living in regions where natural hazards are a part of daily life develop strategies to cope with and adapt to the impacts of extreme events. In October 1999, a cyclone killed 10,000 people according to government statistics, however, the unofficial death toll is much higher. This article examines why such a large loss of life occurred and looks at measures taken since then to initiate comprehensive disaster-preparedness programmes and to construct more cyclone shelters. The role of both governmental organisations and NGOs in this is critically analysed. The good news is that, based on an assessment of disaster preparedness during a small cyclone in November 2002, it can be seen that at community-level awareness was high and that many of the lessons learnt in 1999 were put into practice. Less positive, however, is the finding that at the state level collaboration continues to be problematic.     

Why the poor pay with their lives: oil pipeline vandalisation, fires and human security in Nigeria

Since its discovery in Nigeria in 1956 crude oil has been a source of mixed blessing to the country. It is believed to have generated enormous wealth, but it has also claimed a great many lives. Scholarly attention on the impact of oil on security in Nigeria has largely focused on internal conflicts rather than on how disasters associated with oil pipeline vandalisation have impacted on human security in terms of causing bodily injuries and death, destroying livelihoods and fracturing families. This paper examines how pipeline vandalisation affects human security in these ways. It identifies women and children as those who are hardest hit and questions why the poor are the most vulnerable in oil pipeline disasters in this country. It recommends the adoption of a comprehensive and integrated framework of disaster management that will ensure prompt response to key early warning signs, risk-reduction and appropriate mitigation and management strategies.     

Review of Policies and Guidelines on Infant Feeding in Emergencies: Common Ground and Gaps

Recent crises in regions where exclusive breastfeeding is not the norm have highlighted the importance of effective policies and guidelines on infant feeding in emergencies. In 1993, UNICEF compiled a collection of policy and guideline documents relating to the feeding of infants in emergency situations. In June 2000 Save the Children, UK, UNICEF and the Institute of Child Health undertook a review of those documents, updating the list and identifying the common ground that exists among the different policies. The review also analysed the consistency of the policy framework, and highlighted important areas where guidelines are missing or unclear. This article is an attempt to share more widely the main issues arising from this review. The key conclusions were that, in general, there is consensus on what constitutes best practice in infant feeding, however, the lack of clarity in the respective responsibilities of key UN agencies (in particular UNICEF, UNHCR and WFP) over issues relating to co-ordination of activities which affect infant-feeding interventions constrains the implementation of systems to support best practice. Furthermore, the weak evidence base on effective and appropriate intervention strategies for supporting optimal infant feeding in emergencies means that there is poor understanding of the practical tasks needed to support mothers and minimise infant morbidity and mortality. We, therefore, have two key recommendations: first that the operational UN agencies, primarily UNICEF, examine the options for improving co-ordination on a range of activities to uphold best practice of infant feeding in emergencies; second, that urgent attention be given to developing and supporting operational research on the promotion of optimal infant-feeding interventions.     

Social vulnerability and the natural and built environment: a model of flood casualties in Texas

Studies on the impacts of hurricanes, tropical storms, and tornados indicate that poor communities of colour suffer disproportionately in human death and injury.(2) Few quantitative studies have been conducted on the degree to which flood events affect socially vulnerable populations. We address this research void by analysing 832 countywide flood events in Texas from 1997-2001. Specifically, we examine whether geographic localities characterised by high percentages of socially vulnerable populations experience significantly more casualties due to flood events, adjusting for characteristics of the natural and built environment. Zero-inflated negative binomial regression models indicate that the odds of a flood casualty increase with the level of precipitation on the day of a flood event, flood duration, property damage caused by the flood, population density, and the presence of socially vulnerable populations. Odds decrease with the number of dams, the level of precipitation on the day before a recorded flood event, and the extent to which localities have enacted flood mitigation strategies. The study concludes with comments on hazard-resilient communities and protection of casualty-prone populations.     

Cyclone mitigation, resource allocation and post-disaster reconstruction in south India: lessons from two decades of research

This paper opens with a history of development and disaster-prevention strategies in a cyclone-prone area of the east coast of India and traces the evolution in the area of British and Indian governments' programmes and policy over a century. Research over the last 20 years has shown, however, that the programmes and policies have failed to balance economic growth with safety. Resources intended for the benefit of all have been diverted by alliances of powerful people to a small minority, and recent developments have reduced the physical protection of the area. The result is that increasing numbers of people are vulnerable to the effects of cyclones and floods. The findings suggest that the best way to reduce vulnerability is to improve the socio-economic standing of the most vulnerable and for this to happen these people must have an assured income based on assets that will enable them to acquire social and economic credit-worthiness within the local economy. This paper presents evidence that suggests that non-governmental organisation (NGO)-supported co-operatives are the best way to achieve this through self-help and self-employment schemes. It also suggests that NGOs should be encouraged to take up environmentally and ecologically beneficial activities involving the poorest groups in the communities, in this way combining sustained self-employment with environmental protection.     

Conflict, the Continuum and Chronic Emergencies: A Critical Analysis of the Scope for Linking Relief, Rehabilitation and Development Planning in Sudan

The concept of the ‘relief-to-development continuum’ has been the subject of renewed interest in recent years. Concerned by the rise in relief budgets over the past decade and the absolute fall in development aid resources, support has been growing for the concept of developmental relief. In the context of complex political emergencies, it has been argued further that as effective development aid can reduce vulnerability to the impact of natural hazards, so it might also be used to contribute to a process of conflict prevention. In this way, the concept of the relief-development continuum has become entwined with broader discussions about the contribution of official development assistance to conflict management. Drawing on a Review of Operation Lifeline Sudan (OLS), this paper cautions against uncritical application of the concept of the continuum in complex political emergencies, and of rehabilitation in particular, in the current Sudanese context. It argues that in order to move legitimately from relief aid programming to development aid programming, three fundamental conditions must be in place: first, a minimum level of security, respect for human rights and humanitarian access. Second, empirical evidence from the field needs to demonstrate that the emergency is over. Finally, moving from relief to development aid programming is contingent on donor governments accepting the legitimacy of national governmental structures and of the rebel movements. In other words, for donor governments, moving along the continuum is in significant part determined by foreign policy considerations, not only technical ones. Consideration needs to be given to the actual and perceived legitimation of the different movements that a move to rehabilitation might be seen to imply. The paper argues that none of these conditions had been satisfied in Sudan by mid-1997. Instead of a process of normalisation paving the way to long-term development, the current situation in Sudan is better described as a chronic political emergency. In such a context, uncritical pursuit of developmental strategies may negatively affect the welfare of conflict-affected populations.     

Risk,vulnerability, and pragmatic inevitability: the conflict–disaster nexus and urban governance in Johannesburg,South Africa

This paper spotlights post-disaster relief provision in Johannesburg, South Africa, following the floods of 2016 in a bid to explore how local government and non-governmental actors in the country conceive of compounding vulnerability and conflict within urban disaster governance. It reveals the diverse strategies employed to navigate violent conflict during the cyclical occurrence of disaster and reconstruction that the predominantly migrant population experiences in the Setswetla informal settlement, adjacent to the Alexandra township in northern Johannesburg. Rendered visible in moments of disaster and recovery are the spatial politics and multidimensional nature of conflict. These phenomena unfold across various levels of urban governance and in the affected community and effectively construct a disaster citizenship that makes risk reduction and community cohesion impossible in the eyes of disaster managers. This research, based on a set of expert interviews, integrates conflict and disaster studies to shed light on how the conflict–disaster interface materialises, and is operationalised, in an urban setting.     

The rise of politics and the decline of vulnerability as criteria in disaster decisions of the United States, 1953–2009

This paper examines the shift from vulnerability to political responsiveness in presidential and gubernatorial disaster decisions in the United States from 1953–2009 (President Dwight D. Eisenhower to President Barack Obama) using annual request, declaration, and approval data from multiple sources. It makes three key conclusions: first, the 1988 Stafford Act expanded federal coverage to all categories of disasters, added a significant range of individual types of assistance, and provided extensive funding for recovery planning. Second, the election effects on disaster decisions increased over time whereas the impact of social and economic vulnerability (measured by scope of disaster) declined. Third, the changes affected governors more than presidents, and the choices of governors drove those of presidents. The analysis underscores the increasingly political nature of the disaster decision‐making process, as well as the difficulty in emphasising mitigation and preparedness as intensively as response and recovery. Proactive intervention yields fewer political rewards than responsiveness.