World Health Organization

Sustainable Human & Social Development – Reloaded !

2014-04-13:  Further to the Post, dated 2013-01-13

There are many essential qualities and features belonging to and representative of a Sustainable Human Environment (including the Social, Built, Virtual and Economic Environments).  As discussed here many times before … Accessibility-for-All is one fundamental attribute, under Social and Legal Aspects of Sustainable Human and Social Development.

Another fundamental attribute … Urban Resilience … is now moving centre stage in the world of International Construction Research & Practice.  WHEN, not if … this concept is fully elaborated and understood, it will have a profound impact on All Tasks, Activities and Types of Performance in the Human Environment … under All Aspects of Sustainable Human and Social Development.

After working for many years on Climate Change, particularly Adaptation … it was quite natural for me to encounter the concept of Resilience.  But the aim of a newly established Core Task Group within CIB (International Council for Research & Innovation in Building & Construction) is to widen out this concept to also include Severe Natural Events (e.g. earthquakes, typhoons, tsunamis), Complex Humanitarian Emergencies, (e.g. regional famines, mass human migrations), Extreme Man-Made Events (e.g. 2001 WTC 9-11 Attack, 2008 Mumbai ‘Hive’ Attacks), and Hybrid Disasters (e.g. 2011 Fukushima Nuclear Incident) … to set down Resilience Benchmarks … and to produce Resilience Performance Indicators.  An imposing challenge !

AND … as Urbanization is proceeding at such a rapid pace in the BRICS Countries (Brazil, Russia, India, China & South Africa) and throughout the rest of the Southern Hemisphere … ‘practical’ and ‘easily assimilated’ trans-disciplinary output from this CIB Task Group is urgently required.  In other words, the work of the Task Group must not be permitted to become an exercise in long drawn out pure academic research … the clear focus must be on ‘real’ implementation … As Soon As Is Practicable !!

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A New and Updated Groundwork …

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SUSTAINABLE DESIGN

The ethical design response, in resilient built and/or wrought form, to the concept of Sustainable Human & Social Development.

SUSTAINABLE HUMAN & SOCIAL DEVELOPMENT

Development which meets the responsible needs, i.e. the human and social rights*, of this generation – without stealing the life and living resources from the next seven future generations.

*As defined in the 1948 Universal Declaration of Human Rights … and augmented by UN OHCHR Letter, dated 6 June 2013, on the Post-2015 Development Agenda.

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The CITY (as Region)

A geographical region, with open and flexible boundaries, consisting of:

(a)              An interwoven, densely constructed core (built environment) ;

(b)              A large resident population of more than 500,000 people (social environment) ;

(c)              A supporting hinterland of lands, waters and other natural resources (cultivated landscape) ;

together functioning as …

(i)                 a complex living system (analogous to, yet different from, other living systems such as ecosystems and organisms) ;     and

(ii)               a synergetic community capable of providing a high level of individual welfare, and social wellbeing for all of its inhabitants.

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SOCIAL WELLBEING

A general condition – in a community, society or culture – of health, happiness, creativity, responsible fulfilment, and sustainable development.

INDIVIDUAL WELFARE

A person’s general feeling of health, happiness and fulfilment.

HUMAN HEALTH

A state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.     [World Health Organization]

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SOCIAL ENVIRONMENT

The complex network of real and virtual human interaction – at a communal or larger group level – which operates for reasons of tradition, culture, business, pleasure, information exchange, institutional organization, legal procedure, governance, human betterment, social progress and spiritual enlightenment, etc.

The social environment shapes, binds together, and directs the future development of the built and virtual environments.

BUILT ENVIRONMENT

Anywhere there is, or has been, a man-made or wrought (worked) intervention by humans in the natural environment, e.g. cities, towns, villages, rural settlements, service utilities, transport systems, roads, bridges, tunnels, and cultivated lands, lakes, rivers, coasts, seas, etc … including the virtual environment.

VIRTUAL ENVIRONMENT

A designed environment, electronically generated from within the built environment, which may have the appearance, form, functionality and impact – to the person perceiving and actually experiencing it – of a real, imagined and/or utopian world.

The virtual and built environments continue to merge into a new augmented reality.

ECONOMIC ENVIRONMENT

The intricate web of real and virtual human commercial activity – operating at micro and macro-economic levels – which facilitates, supports, but sometimes hampers or disrupts, human interaction in the social environment.

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And So To Work !!

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Mainstream Good Design & Accessibility for All Signage ?

2013-03-06:   Further to an earlier Post, dated 30 November 2012 … on Sustainable Accessibility for All

Accessibility IS a Fundamental Human Right !

‘ For many Weak and Vulnerable People, today’s Complex Human Environment is inaccessible and unsafe … a hostile ‘reality’ which prevents independent functioning and participation in a local community;  it is a blatant denial of their human rights.’

Relevant Human Environment (social – built – virtual – institutional) Factors … factors which are external, or extrinsic, to the context of a person’s life and living situation … include policies and standards, negative attitudes and stigma, lack of services, problems with service delivery, inadequate funding, lack of accessibility in the built environment and to electronic, information and communication technologies, lack of consultation and involvement, and an absence of reliable data and evidence.

Accessibility for All …

Take a really close look at the photograph below … and see a staircase which, in spite of all the legislation in the EU Member States, contravenes almost every accessibility-related design guideline.  It is far from being an unusual scene in our European Built Environment …

Staircase Egress - Unsafe, Difficult Accessibility !!

Photograph taken by CJ Walsh. 2009-10-31. Click to enlarge.

Now, imagine the consequences of one, tiny slip …

Which is why our concern must be with Accessibility for All … which includes consciously thinking about children under the age of 5 years, women in the later stages of pregnancy, and frail older people (not all older people !) … and how they use and interact with their surroundings.

In addition, however … our attention must also turn to the large numbers of people, in all of our societies, with health conditions which result in serious impairments, activity limitations and participation restrictions.  As a prime example, consider the Big-4 Non-Communicable Diseases (NCD’s): Cardiovascular Diseases (e.g. heart attacks and stroke), Cancers, Diabetes, and Chronic Lung Diseases.

These 4 NCD’s – targeted in a World Health Organization (WHO) Global NCD Campaign – share health risk factors (tobacco use, unhealthy diet, lack of physical activity, harmful alcohol use) … cause more than 36 million deaths annually (almost 80 % of deaths, from such diseases, occur in low and middle-income countries) … and result in a high proportion of disability (66.5 % of all years lived with disability in low and middle income countries).

NCD’s can limit one or more of a person’s major life and living activities … such as walking, eating, communicating, and caring-for-oneself.  Examples of common NCD-related impairments include paralysis due to stroke, and amputation as a result of diabetic neuropathy.

When Easily Assimilated Signage IS Essential in Buildings …

Good Architectural Design IS ‘intuitive and obvious’ for building users … design characteristics which are critical in the case of Fire Engineering Design.  However, what is intuitive and obvious in Ireland may not be so intuitive and obvious in Turkey … and what is intuitive and obvious in Europe will certainly not be intuitive and obvious in Africa, India, or China.

Architectural & Fire Engineering Design must, therefore, be adapted to Local conditions … culture, social need, etc., etc.

When a building is NOT ‘intuitive and obvious’ for the broad range of potential building users … easily assimilated signage IS essential …

International Standard ISO 21542: ‘Building Construction – Accessibility & Usability of the Built Environment’ was published in December 2011, as a full standard.  In its Introduction, ISO 21542 is linked to the U.N. Convention on the Rights of Persons with Disabilities (CRPD) … almost like an umbilical cord.

The scope of ISO 21542 covers public buildings.  The Accessibility Agenda in the U.N. Convention is very broad … so much standardization work remains to be completed at international level.

Concerning Accessibility Symbols and Signs … reference should be made to ISO 21542: Clause 41 – Graphical Symbols … and on Pages 106, 107, 108, and 109 … the following will be found:

  • Figure 66 – Accessible Facility or Entrance ;
  • Figure 67 – Sloped or Ramped Access ;
  • Figure 68 – Accessible Toilets (male & female) ;
  • Figure 69 – Accessible Toilets (female) ;
  • Figure 70 – Accessible Toilets (male) ;
  • Figure 71 – Accessible Lift / Elevator ;
  • Figure 72 – Accessible Emergency Exit Route.

I use the word ‘accessibility’, and not ‘access’ … because Accessibility has been defined in ISO 21542 as including … ‘access to buildings, circulation within buildings and their use, egress from buildings in the normal course of events, and evacuation in the event of an emergency’.

A note at the beginning of the standard also clarifies that Accessibility is an independent activity, i.e. assistance should not be necessary … and that there should be an assurance of individual health, safety and welfare during the course of those (accessibility-related) activities.

During the very long gestation of ISO 21542, an overwhelming consensus emerged in favour of using the term Accessibility for All … thereby sidestepping the thorny issue of different design philosophies which are described as being accessibility-related but, in practice, are limited and/or no longer fit-for-purpose.

'Accessibility for All' Symbol ?The Accessibility Symbol used throughout ISO 21542 is shown above.  I know that a small group of people from different countries worked very hard on this particular part of the standard.  My only contribution was in relation to the inclusion of Figure 72, concerning Fire Evacuation.

This ‘accessibility’ symbol is an attractive, modern and, of course, abstract representation of a concept … a person with an activity limitation using a wheelchair.  The symbol succeeds very well in communicating that concept.

However … as an Accessibility for All Symbol … encompassing people with other than functional impairments, e.g. hearing and visual impairments … and children under the age of 5 years, women in the later stages of pregnancy, frail older people … and people with the four main types of non-communicable disease discussed above … is this symbol, also, limited and no longer fit-for-purpose ??

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Proposed New Sign for 'Area of Rescue Assistance'

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Shown next, above, is the proposal for a new Area of Rescue Assistance Sign … which is contained in ISO 7010:2011 / FDAM 115 (2013).  While it is nice to finally see this Safety Sign appear in the mainstream of safety signage … the title being proposed for the sign and the explanatory texts which accompany it are very problematic …

  • The technical term being proposed – Evacuation Temporary Refuge – is too long and too difficult to understand ;
  • The explanatory texts which accompany this Sign are very confusing and misleading.

This problem has arisen because the people who drafted ISO 7010:2011 / FDAM 115 (2013) hadn’t a bull’s notion that ISO 21542 even existed !

In ISO 21542, we use the term Area of Rescue Assistance … which is easy for everybody to understand, including building users, building managers and firefighters, etc., etc.

We also explained, in ISO 21542, that a Place of Safety is a remote distance from the building … not anywhere inside the building !

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Mainstreaming Disability …

U.N. CRPD – Preamble

(g)  Emphasizing the importance of mainstreaming disability issues as an integral part of relevant strategies of sustainable development,

As ‘disability’ moves closer towards … and is integrated and fully included in the ‘mainstream’ of sustainable community life and living … it is absolutely imperative that individuals and organizations who make up the Disability Sector become much more cohesive (far less fractious within) … that they begin to fully understand the practices and procedures of the mainstream … and actively and robustly engage with that mainstream.

It is ridiculous, for example, that a large amount of the Sector’s energy is still being diverted into meaningless meditations and endless tracts on whether it is ‘universal design’, or ‘design-for-all’, or ‘inclusive design’, or ‘facilitation design’, etc … when an entirely new design paradigm is being demanded by a world (our small planet when seen from the moon !), which is experiencing enormous levels of human poverty, natural resource shortages, human rights violations, and severe weather events.  The overriding priority must be ‘real’ implementation … Effective Accessibility for All !

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'Earthrise' from Apollo 14

Colour photograph – ‘Earthrise’ – taken from the Apollo 14 Spacecraft … showing a bright colourful Earth, in a dense black ‘sky’, rising above the pale surface of the Moon. Click to enlarge.

NASA’s Gateway to Astronaut Photography of Earth

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And … Effective Accessibility for All is but one component of …

‘Social Wellbeing for All in a Sustainable Built Environment’

Refer also to …

2004 Rio de Janeiro Declaration on Sustainable Social Development, Disability & Ageing

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Update:  2013-05-31 …

While the wider international design community is working hard on developing an array of Accessibility Symbols to facilitate different health condition and impairment categories, and to suit different environmental situations, e.g. a fire emergency in a building … I recently encountered another interesting contribution …

Alternative Accessibility Symbol (USA-2011) - Functional Impairment

Click to enlarge. For more information: www.accessibleicon.org

Any comments ??

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Older People in Emergencies – Action & Policy Development (II)

2009-11-25:  In 2008, the World Health Organization (WHO) Report: ‘Older People in Emergencies – Considerations for Action & Policy Development’ was published.

The following are short extracts from that Report …

Older People

Until recently, older peoples’ needs in disasters and conflicts were addressed only by broader adult health and humanitarian programmes.  This has changed, as several recent emergencies highlighted this population’s vulnerabilities.  Of the 14,800 deaths in France during the 2003 heat wave, 70% were people over 75 years of age.  Of the estimated 1,330 people who died in the wake of Hurricane Katrina, most were older people.  In Louisiana, 71% of those who died were older than 60 years;  47% of this group were over 77 years old.  Worldwide, the United Nations High Commissioner for Refugees (UNHCR) has estimated that older people make up 8.5% of the overall refugee population, and in some cases comprise more than 30% of caseloads.  In 2005, approximately 2.7 million people over the age of 60 were living as refugees or internally displaced persons.

Globally, the proportion of older people is growing faster than any other age group.  In 2000 one in ten, or about 600 million, people were 60 years of age or older.  By 2025, this figure is expected to reach 1.2 billion people, and in 2050 around 1.9 billion.  In developing countries, where 80% of older people live, the proportion of those over 60 years old in 2025 will increase from 7% to 12%.  Moreover, life expectancy at birth has increased globally from 48 years in 1955 to 65 in 1995, and is projected to reach 73 in 2025.  By 2050, people over 80 years old are expected to account for 4% of the world’s population, up from 1% today.

Disability & Older People

Worldwide, it is estimated that more than 80% of the disabled population lives in developing countries, where the prevalence of disability is approximately 20%.  That rate is expected to increase dramatically as populations age.  By 2050 in India, the incidence of disability is expected to jump by 120%, in China by 70% and in sub-Saharan Africa by 257%.

Emergency Planners must consider these trends, because poor health and reduced mobility increase the risk of serious injury and illness in disasters.  Older people have sustained more injuries in disasters than other groups because of functional limitations such as poor balance, muscle weakness and exhaustion.  Older people have higher rates of coronary heart disease, diabetes, stroke, cancer, respiratory diseases and rheumatism.  A study in China found that 74% of those over 80 years old had chronic diseases, 1.5% were physically disabled, and 3.46% had Alzheimer’s disease.  In Iraq, more than half of 340 older people surveyed by HelpAge International had chronic joint and bone problems, hypertension, heart problems, diabetes and reduced eyesight and hearing.  In West Darfur, Sudan, 34% of surveyed refugees 50 years of age and over were disabled, 27% could not move without help and 19% had severely impaired vision; while 61% reported chronic diseases that required specialized treatment and/or medicines that were not available.

Objective 1:   Increase Visibility and Raise Awareness among Health Agencies and Humanitarian Organizations about Older Peoples’ Needs and Priorities in Emergencies.

  • Mainstream and integrate issues related to older people and emergencies into existing policies and guidelines (i.e. emergency medicine, nutrition, protection, gender-based violence, participatory assessments and programming).  Include plans for older people in national policy and guideline documents.
  • Highlight the need to assist and protect older people as well as their capacities and contributions in rebuilding affected communities.
  • Develop inter-agency efforts to identify gaps, develop practice guidelines and provide training and education.
  • Promote better practice policies and documents among all stakeholders.
  • Collaborate with funders to increase humanitarian assistance to older people based on needs assessments and reflect these in funding proposal criteria.
  • Involve older people in developing emergency management activities to increase their visibility and ensure their needs are taken into account, for example, in shelter plans and locations.

Objective 2:   Develop Essential Medical and Health Resources for Older People in Emergency Practices.

  • Identify and include essential medicines for older people in emergency kits.  Include medicines for chronic diseases and other illnesses common among this social group.
  • Develop disability aid packages with equipment such as eyeglasses and walking sticks.
  • Develop education modules for health professionals on diseases common among older people, including HIV/AIDS.
  • Develop and disseminate guidelines for geriatric medicine in emergencies and humanitarian crises.
  • Within the health care system, ensure that conditions and needs common to older people are integrated into patient triage, clinical evaluation, treatment, the emergency medical response system and access to specialty care.
  • Ensure that nutritional guidelines for food distribution suitable for older people are integrated into health planning and response plans.
  • Ensure local development of guidelines for feeding older people, using locally available foods to the extent this is possible where populations depend on external food aid.
  • Implement gender-based analyses in planning and programme design to account for differences between older men and women in terms of both health needs and access issues.

Objective 3:   Develop Emergency Management Policies and Tools to Address Older Peoples’ Health-Related Vulnerabilities.

  • Integrate older peoples’ health needs and related issues into assessment tools and practices.
  • Develop community-based tools using disaggregated data to identify vulnerable older people.  Include formats to identify chronic health conditions, disabilities and nutritional needs.
  • Develop procedures to identify hidden and stay-behind older people.
  • Develop standardized tools to assess support needs of older people, including inter-generational and community care options.
  • Develop age-friendly standards and guidelines so that service and care environments are accessible to older people with disabilities.
  • In collaboration with older people, their families and communities, develop personal and household preparedness kits in areas of predictable disasters.
  • Collaborate with communities in identifying and implementing community-based home care and support strategies which may reduce older peoples’ isolation and vulnerability during crises.
  • Develop guidelines and evacuation plans that include mechanisms to identify and transport frail, disabled and older people with special medical conditions.  Identify procedures to ensure adequate care and treatment as necessary.
  • Develop guidelines to ensure safe and adequate treatment of older people in evacuation centres and refugee camps.
  • Ensure that health facilities have feasible plans to care for older people during disasters and humanitarian crises.
  • Develop monitoring and evaluation tools to measure the performance of health care services and humanitarian interventions targeting older people.  These measures should be integrated into existing monitoring and evaluation procedures where possible.

Objective 4:   Ensure that Older People are Aware of and Have Access to Essential Emergency Health Care Services.

  • Use established assessment tools to identify and locate frail and disabled older people and those with chronic diseases and special medical conditions, as well as older caretakers of orphaned children.
  • Ensure that assessments are participatory and target all older populations.  Assessments should include information on health conditions, social support needs, caretaking responsibilities and available means to meet basic living needs, including access to food and health services, treatment and medicines.
  • Ensure that assessments are coordinated across primary health care, rehabilitation, long term care and social services to meet the needs of older people.
  • Implement outreach services and referral mechanisms to identify and ensure care for hidden or stay-behind older people.
  • Coordinate primary health care, rehabilitation, long-term care and social services to establish system referral mechanisms that older clients may require.
  • Assess and organize training for health staff to ensure knowledge of geriatric nutritional, health and medical care needs.
  • Establish information programmes to educate older people, families and caregivers about nutritional needs, medical conditions and health care options.
  • Use disaggregated data to assess services by age and gender.

Objective 5:   Provide Age-Sensitive and Appropriate Health and Humanitarian Services to Maintain Older Peoples’ Health.

  • Ensure that equitable access to shelter, clothing, food and sanitation prevent deterioration of health through integrated individual assessments and referrals to health and humanitarian agencies.
  • Ensure that age-friendly practices are used to promote services to older people with disabilities.
  • Provide access to appropriate health care, including medicines for chronic diseases and disability/restorative aids.
  • Collaborate with communities in identifying community-based home care and support options for frail and disabled older people.
  • When appropriate and feasible, develop mobile clinics to extend health services to older people living in remote locations.
  • Implement mechanisms to assess nutritional balance and ensure access to supplementary food programmes when appropriate, taking into account that many older people also care for children.  Provide education on food preparation using supplementary or locally available foods.
  • Ensure that protection needs of older people are integrated into programming (e.g. social welfare or community services) to identify persons at risk and prevent abuse and exploitation.
  • Undertake monitoring to assess continuing effectiveness of services to older people.
  • Use disaggregated data to assess efficiency of implemented activities by age and gender.

Objective 6:   Promote Cross-Sectoral Planning and Co-Ordination to Raise Awareness of Older Peoples’ Needs in Crises and Reduce Their Risk of Marginalization and Deteriorating Health in Emergencies.

  • Raise awareness among agencies and organizations concerning physical and health issues specific to older people and of ways to adapt basic need support to their requirements (e.g. supplementary food rations, livelihood needs and impacts of protection issues on older peoples’ physical and psychological health).
  • Where possible, include older people in planning and programming committees to increase their visibility and ensure their needs and priorities are integrated.
  • In coordination with appropriate partners, establish community self-help groups to facilitate community care for more vulnerable older people.
  • Recognize self-sufficiency as key to maintaining health and encourage the inclusion of older people in training programmes, income-generation schemes, and community development projects.
  • Establish older peoples’ committees to facilitate self-advocacy and communication with authorities and ministries of health to increase access to existing services and entitlements.

Objective 7:   Build Institutional Capacity and Commitment towards Ensuring the Health and Safety of Older People in Emergencies.

  • Integrate cross-cutting health emergency management issues into global/regional/country strategic plans.
  • Promote inter-agency and cross-sectoral consultation on cross-cutting policy and programming issues to build consensus, commitment and capacity to respond to older peoples’ needs in disasters and humanitarian crises.
  • Collaborate with ministries of health to establish mandates and legislation ensuring the provision of care to older people; apply a human rights framework to these issues.
  • Collaborate with ministries of health to develop options to increase older peoples’ access to affordable health care services, including the implementation of subsidized medical and medicine programmes.
  • Advocate for enhanced funding and humanitarian assistance to older people in emergencies and conflicts.  Encourage funding agencies to recognize older people as a priority.
  • Develop frameworks to promote participatory, transparent and accountable processes to advance the needs of older people.
  • Develop sustainable mechanisms to maintain advocacy and consultation of older people within the health care-system.  Establish and involve advocacy committees in the planning, implementation and evaluation of emergency management practices when appropriate, for example regarding the design of community shelters that may be accessed by older disabled people.

Objective 8:   Strengthen the Capacity of Ministries of Health and Health Care Systems to Meet the Needs of Older People in Emergencies.

  • As required, integrate the medical and nutritional needs of older people into local public health and emergency preparedness and response strategies.
  • Develop strategies to ensure that existing health care systems develop capacity (infrastructure and knowledge) to meet the increasing proportion of older people who will be impacted by disasters in the future, taking into account medical, disability and mental health needs, including dementia and Alzheimer’s disease.
  • Collaborate with communities in identifying community-based home care and support strategies for older people as an option to reduce older peoples’ isolation and vulnerability to disasters.
  • Collaborate with communities to develop and maintain disaster reduction committees.  Assist in the implementation of strategies to strengthen community support to older people and reduce their levels of risk during disasters (e.g. development of community emergency response teams or mutual assistance groups among more vulnerable older people).
  • Integrate older peoples’ needs into exercise designs and facilitate the dissemination of lessons learned.
  • Develop performance frameworks and monitoring mechanisms to assess medical response systems and older peoples’ access to specialty care in emergencies.

Objective 9:   Develop Mechanisms to Ensure Continuing Development and Exchange of Expertise as these Relate to Older People in Emergencies.

  • Develop and provide ongoing training and education to staff on the needs and priorities of older people, including responsibility to include this population in planning and policy development.
  • Integrate issues related to older people in emergencies into relevant university curricula.
  • Undertake comparative research to assess the health status (including access to assistance) of older people in emergencies vis-à-vis other age groups.
  • Undertake research to address demographic shifts and the increasing proportion of older people in disasters as this relates to health care and infrastructure/facility development.
  • Ensure emergency preparedness and response considerations are integrated into relevant services and institutions (e.g. facilities caring for frail and disabled older people are required to develop and practice evacuation and emergency care plans).

Objective 10:   Promote Active Ageing as a Strategy to Reduce Vulnerability and Develop Resiliency to Disasters.

  • Promote a wider understanding among ministries of health and humanitarian organizations of the economic and social factors contributing to the vulnerability of older people, including issues related to livelihoods, inter-generational dependence and social pension.
  • Develop policies that recognize active ageing and resiliency as facilitating older peoples’ capacity to prepare for, cope with and respond to the affects of disasters and conflicts.
  • Include a life course perspective that recognizes health promotion and prevention of disease and disability.
  • Support cross-sectoral forums and activities which link the risks of older people in emergencies to frameworks for livelihoods, protection and gender-based equality, health promotion and social pension.
  • Collaborate with relevant organizations to mainstream the health needs of older people into existing humanitarian programmes addressing shelter, nutrition, livelihoods, protection and gender-based violence.
  • Develop information campaigns and encourage media to highlight both the needs and capacities of older people and to increase their visibility.
  • Collaborate with funding bodies to integrate active ageing as a criterion in funding proposals targeting older people.

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Older People in Emergencies – Urgent Action Required !! (I)

2009-11-25:  In the midst of an economic, financial and fiscal crisis in Ireland … the country has recently been hit by a Major Flood Emergency in the West and South … extending inland almost to the centre.  The emergency will continue over the next few days.

There appears to be no central co-ordination of the response to this National Emergency.  No public guidance or other announcements have been published in the national media.

Further to the full page advertisement promoting the National Older & Bolder Campaign, which was printed on Page 7 of The Irish Times (2009-11-19) … the contents of World Health Organization (WHO) Fact Sheet: ‘Older Persons in Emergencies’, drafted following the 2006 Lebanon Humanitarian Crisis, are both appropriate and particularly relevant for Ireland now …

When dealing with older people in emergencies, a number of issues which might affect them will require special consideration.  Apart from specific chronic disease and disability related issues, two major factors contribute to increased vulnerability of older people in emergencies: the ‘normal’ challenges of physical ageing and social loss, and the ‘environmental’ challenges.  In a crisis, minor impairments which do not interfere with daily functioning in the normal environment can quickly become major handicaps that overwhelm an individual’s capacity to cope.  For instance, an older person with arthritic knees and diminished vision, living alone in a high-rise apartment with no family members or friends nearby, can become incapable of getting food or water or of fleeing danger, and may be overlooked by neighbours.

Specific Issues

There are several specific issues that affect older people, separately or in combination, and which can impact on their ability to respond or react in an emergency.  Awareness of these specific issues by all those giving aid, or surrounding them, will improve interactions.  Knowledge of the age profile in an affected community, as an emergency response is prepared, will help to ensure that older people at risk are identified and that appropriate supplies and services are provided on-site.

The specific issues affecting older people are:

1.   Sensory Deficits (especially vision and hearing)

  • reduced awareness ;
  • difficulty accessing and comprehending visual and auditory information, and responding appropriately ;
  • reduced mobility and risk of disorientation.

2.   Slower Comprehension and Retention of Information (especially new, complex or rapidly delivered information)

  • difficulty accessing information ;
  • difficulties in understanding and acting on risks, warnings, directions ;
  • reduced capacity for self-protection and avoidance of harm ;
  • disorientation in unfamiliar environments ;
  • greater risk for abuse and exploitation ;
  • provision of information in more accessible and structured formats.

3.   Less Efficient Thermoregulation

  • greater susceptibility to hypothermia, hyperthermia and dehydration ;
  • appropriate shelter, clothing and food, as well as adequate fluid intake.

4.   Reduced Functional Ability (poorer balance and reduced speed, psycho-motor co-ordination, strength and resistance)

  • reduced mobility and risk of being housebound ;
  • increased risk of falling ;
  • decreased capacity for self-protection and harm-avoidance ;
  • difficulty getting basic necessities and accessing health facilities, e.g. local clinics ;
  • increased vulnerability to abuse and exploitation.

5.   Difficulties in Urinary Continence

  • need for adequate toilet facilities and continence supplies.

6.   Oral Health & Dental Problems

  • easy-to-eat soft food and fluids may be necessary.

7.   Changes to Patterns of Digestion 

  • need for smaller, more frequent portions of easily-digestible, nutrient-dense food and adequate fluids.

8.   Increased Body Fat Composition, with Decreased Muscle Mass and Metabolic Rates

  • greater sensitivity to certain medications with potential adverse effects on functional ability and cognition.

9.   Greater Prevalence, and Co-Morbidity of Ageing-Related Chronic Disease and Disability (e.g. coronary heart disease, hypertension, stroke, cancers, diabetes, chronic obstructive pulmonary disease, osteoarthritis, osteoporosis, cognitive impairment)

  • need for condition-specific medications, treatments, medical device and assistance aids (oxygen, crutches, walkers, wheelchairs, glasses) ;
  • higher risk for adverse drug reactions.

10.  Weaker and Smaller Social Networks (e.g. widowed, living alone, minimal contact with neighbours, dispersion of family)

  • reduced awareness and comprehension of the situation ;
  • greater risk of social isolation, neglect, abandonment, abuse and exploitation.

11.  Heavy Reliance on Care and Support by Very Few Family Members

  • when essential family support is disrupted, physical and psychological functioning can deteriorate rapidly ;
  • reunification with family is particularly important.

12.  Psycho-Social Issues

  • reactions to loss of home, family and possessions can be more acute for older people who cannot rebuild their lives ;
  • resistance to leaving, and grieving, may be strong.

13.  Reliance of Other Family Members on Older People

  • older people often care for other dependent adults and children and may require resources for others as well as themselves.

Last but not least: Older People should not be considered solely as a Special Needs Group.  From numerous accounts of natural disaster and armed conflict situations, it is known that their knowledge of the community, previous experiences with such events, and position of respect and influence within their families and communities are critical resources in dealing effectively with emergencies.

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Sustainable Fire Engineering & Fires in Buildings ?

2009-07-11:   Practical Implementation of Sustainable Human & Social Development … transforming our Human Environment by gradually improving and monitoring ‘Real’ Sustainability Performance … depends entirely on directly applying a Multi-Aspect Understanding of ‘Sustainability’, in a manner which is both balanced and equitable, to all of the many different facets of Sustainable Design.

Therefore … responding ethically and professionally, in built and/or wrought (worked) form, to the still evolving concept of Sustainable Human & Social Development …

        … the specific aim of Sustainable Fire Engineering shall be to design for Maximum Credible Fire & User Scenarios … in order to maintain a proper and satisfactory level of fire safety and protection over the full life cycle of a building.

[Sustainable Fire Engineering can be applied, equally, to other elements of the Built Environment, e.g. means of transport on land or sea.]

As discussed in a previous post … the Minimum Life Cycle of a Sustainable Building is 100 Years.  AND, to prolong Building Life Cycle and maximize Building Usability … such a building must be Flexible and Adaptable with regard to internal layout, Accessible for People with Activity Limitations (2001 WHO ICF) … and Structurally Robust.

 

Maximum Credible Fire Scenario:

A sequence of events during a ‘real’ fire incident in a building – related to design, construction, occupancy, fire loads, ignition sources, spatial geometry, fire protection measures (both passive and active) … and an adverse, but reasonable to anticipate, operation and management status – which culminates in fire conditions which are severe, but reasonable to anticipate over a complete building life cycle.

 

Maximum Credible User Scenario:

Indicates building user conditions which are also severe but reasonable to anticipate over a complete building life cycle, i.e. …

  • the Number of People Using a Building increases, on occasions which cannot be specified, to 120% of Calculated Maximum Building Capacity ;

             and

  • 10% of People Using the Building (occupants, visitors & other users) have an Impairment (visual or hearing, physical function, psychological, mental or cognitive … with some impairments not being identifiable, e.g. anosognosia).

 

Sustainable Fire Engineering Strategy:

A coherent and purposeful arrangement of fire protection and fire prevention measures which is developed in order to meet specified Sustainable Fire Engineering Design Objectives.

In designing a building for conditions of fire, and its aftermath, project-specific Sustainable Fire Engineering Design Objectives typically cover the following spectrum of concerns …

  • Protection of the Health and Safety of All Building Users … including people with activity limitations, visitors to the building who may be unfamiliar with its layout, and contractors or product/service suppliers temporarily engaged in work or business transactions on the premises ;
  • Protection of Property … including the building, its contents, and adjoining or adjacent properties, from loss or damage ;
  • Protection of the Health and Safety of Firefighters, Rescue Teams and other First Response Personnel ;
  • Protection of the Natural Environment from Harm, i.e. adverse impacts ;
  • Facility, Ease and Cost of carrying out Effective Repair, Refurbishment and Reconstruction Works after the Fire ;
  • Sustainability of the Human Environment (Social, Built, Virtual, Economic … ).

 

Human Health:

A state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.   (World Health Organization)

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People with Activity Limitations (2001 WHO ICF) ?

2009-05-12:  Or … in French: Personnes à Performances Réduites … a term which should be used much more often !

 

For many decades, the language of ‘disability’ has been all over the place, to put it mildly … others might suggest, however, that it lacks coherence, and is fragmented and chaotic !   As a result, it has been difficult to make any sort of solid progress on harmonization … at a technical level … in Europe.

 

Adopted on the 22nd May 2001, the World Health Organization’s International Classification of Functioning, Disability & Health (ICF), changed that situation for the better.  It is important to emphasise that the ICF is a classification of ‘Health’ … not of ‘Disability’.

 

 

People with Activity Limitations (English) /

Personnes à Performances Réduites (French):

Those people, of all ages, who are unable to perform, independently and without aid, basic human activities or tasks – because of a health condition or physical/mental/cognitive/psychological impairment of a permanent or temporary nature.

 

This term includes …

 

         wheelchair users ;

         people who experience difficulty in walking, with or without aid, e.g. stick, crutch, calliper or walking frame ;

         frail, older people ;

         the very young (people under the age of 5 years) ;

         people who suffer from arthritis, asthma, or a heart condition ;

         the visually and/or hearing impaired ;

         people who have a cognitive impairment disorder, including dementia, amnesia, brain injury, or delirium ;

         women in the later stages of pregnancy ;

         people impaired following the use of alcohol, other ‘social’ drugs, e.g. cocaine and heroin, and some medicines, e.g. psychotropic drugs ;

         people who suffer any partial or complete loss of language related abilities, i.e. aphasia ;

         people impaired following exposure to environmental pollution and/or irresponsible human activity ;

 

and

 

         people who experience a panic attack in a fire situation or other emergency ;

         people, including firefighters, who suffer incapacitation as a result of exposure, during a fire, to poisonous or toxic substances, and/or elevated temperatures.

 

 

Anosognosia:

A neurological disorder marked by the inability of a person to recognize that he/she has an activity limitation or a health condition.

 

 

 

What is the big deal here ?

 

Because of the stigma which still attaches to ‘disability’ … and because some people are unable to recognise that they have an activity limitation or a health condition … depending on self-declaration, alone, for the purposes of developing suitable Fire Safety Management Procedures in a building (of any type) is a recipe for certain failure of those procedures.

 

And … of very direct relevance to design practice generally … compare the weak and inadequate definition of people with disabilities in Part M4 of the Irish Building Regulations (there is no reason to suspect that there will be an earth shattering improvement to this definition in the Revised Technical Guidance Document M … whenever it eventually sees the light of day !) … with the definition of disability in Irish Equality Legislation.

 

Chalk and Cheese !   Or … from the ridiculous to the sublime !   Check it out for yourself.

 

The consequence of this remarkable difference in definitions for anyone involved in the design and/or construction of a building is that … while they might very well be satisfying the Functional Requirements of Parts M and B in the Building Regulations … they will, more than likely, be still leaving the owner and the person who controls or manages the new building open to a complaint under our Equality Legislation.

 

In the case of Workplaces … truly brave is the person who will design a ‘place of work’ just to meet the minimal performance requirements of Building Regulations !

 

 

As a Rule of Thumb, therefore … architects, engineers, facility managers, construction organizations, etc, etc … should become more comfortable working with the concept of People with Activity Limitations.

 

 

This practical Rule of Thumb is also what lies behind the concept of Maximum Credible User Scenario, i.e. building user conditions which are severe, but reasonable to anticipate …

 

         the number of people using a building may increase, on occasions which cannot be specified, to 120% of calculated maximum building capacity ;   and

         10% of people using the building (occupants, visitors and other users) may have an impairment (visual or hearing, physical function, mental, cognitive or psychological, with some impairments not being identifiable, e.g. in the case of anosognosia).

 

 

 

[ Please note well … that miserable piece of legislation … or, bureaucrats’ charter .. the 2005 Disability Act (Number 14 of 2005) … is irrelevant to the above discussion.  But … when Irish Politicians, Senior Civil Servants and the National Disability Authority begin to take seriously the 2006 United Nations Charter on the Rights of Persons with Disabilities … the 2005 Act will have to be scrapped altogether and/or dramatically re-drafted ! ]

 

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