The human health poverty trap

The human health poverty trap

Poor people are at greater risk of ill healthand …

… poor health increases the likelihood of becoming poor.

Establishes a self-perpetuating state that differs from health issue for the rich

Is there a natural disaster-poverty trap?

Poor people are at greater risk of disaster situations

but ……

do disasters increases the likelihood of becoming or remaining poor?

Disasters drive lower growth - meager savings lost to recovery efforts

Disaster events

More likely to result from erratic growth and set backs creating a “recovery gap”

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Environmental factors and economic performance

Climate variability and Malaria risk in Botswana

SST control of MaizeYield and food security in Zimbabwe

Disaster mortality risk from combined hazardsDisaster mortality risk from combined hazards

(World Bank Hot Spots: Dilley, Chen, Lerner-Lam et al)

Poor country disaster characteristics

• Large mortality relative to intensity of event, exposure levels and population density

• Large mortality uncertainty - order of magnitude

• Gender and age usually play a large roll

• Economic impact variable

0.01

0.10

1.00

10.00

100.00

1000.00

0.01 0.10 1.00 10.00 100.00 1000.00 10000.00Annual Disaster-Related Deaths

Annual Disaster-Related Deaths per Million Pop.

Bottom 40% HDI

Bottom 40% Average

Middle 40% HDI

Middle 40% Average

Top 20% HDI

Top 20% Average

Aggregate Natural Disasters

Source UNDP 2004

Distribution of fatalities

Flood disaster economic losses

Flood disaster mortality

Global increase in disasters

Reported Disasters, 1993 – 2002, by HDI Level

0

200

400

600

800

1000

93 94 95 96 97 98 99 0 1 2

1

2

3

Relative Cyclone Vulnerability

India

Pakistan

Papua New Guinea

Viet Nam

Bangladesh

Honduras

Nicaragua

SwazilandComoros

Lao

China

Philippines

El Salvador

Malaysia

Fiji

Cape Verde

Belize

Costa RicaJamaica

Venezuela

Colombia

Thailand

Mexico

US

Japan

Australia

New Zealand

Rep. of Korea

0.10

1.00

10.00

100.00

1,000.00

10,000.00

1,000 10,000 100,000 1,000,000 10,000,000 100,000,000 1,000,000,000

Average population exposed to cyclones

Average annual deaths

Bottom 40% HDI

Middle 40% HDI

Top 20% HDI

Very old and young and women are at greatest risk

Relative Cyclone Vulnerability

India

Pakistan

Papua New Guinea

Viet Nam

Bangladesh

Honduras

Nicaragua

SwazilandComoros

Lao

China

Philippines

El Salvador

Malaysia

Fiji

Cape Verde

Belize

Costa RicaJamaica

Venezuela

Colombia

Thailand

Mexico

US

Japan

Australia

New Zealand

Rep. of Korea

0.10

1.00

10.00

100.00

1,000.00

10,000.00

1,000 10,000 100,000 1,000,000 10,000,000 100,000,000 1,000,000,000

Average population exposed to cyclones

Average annual deaths

Bottom 40% HDI

Middle 40% HDI

Top 20% HDI

Very old and young and women are at greatest risk

Relative Drought Vulnerability

Guinea

Burundi

KenyaPapua New Guinea

UgandaMadagascar

Pakistan

India

Indonesia

MauritaniaChad

MozambiqueSudan

Ethiopia

Philippines

Brazil

China

0.10

1.00

10.00

100.00

1,000.00

10,000.00

100,000.00

1,000 10,000 100,000 1,000,000 10,000,000 100,000,000

Average population exposed to droughts

Average annual deaths

Bottom 40% HDI

Middle 40% HDI

Top 20% HDI

Females have small survival advantage

Relative Earthquake Vulnerability

India

Guatemala

Indonesia

Nicaragua

Yemen

Uganda

PhilippinesChina

Chile

Armenia

Iran

Turkey

Brazil

Kazakhstan

Romania

Argentina

Italy

US

Japan

Australia

New Zealand

Germany

Belgium

0.01

0.10

1.00

10.00

100.00

1,000.00

10,000.00

1,000 10,000 100,000 1,000,000 10,000,000 100,000,000

Average population exposed to earthquakes

Average annual deaths

Bottom 40% HDI

Middle 40% HDI

Top 20% HDI

Men have a smalladvantage

-70

-50

-30

-10

10

30

50

70

0 1 10 100 1000

Flood Vulnerability

-70

-50

-30

-10

10

30

50

70

0.0 0.2 0.4 0.6 0.8 1.0

HDI (1980-2000)

HDI lowest 40%

HDI middle 40%

HDI highest 20%

Amenabad India

-70

-50

-30

-10

10

30

50

70

0 1 10 100 1000

Flood Vulnerability

-70

-50

-30

-10

10

30

50

70

0.0 0.2 0.4 0.6 0.8 1.0

HDI (1980-2000)

HDI lowest 40%

HDI middle 40%

HDI highest 20%

Islamanbad Pakistan 2005

Northridge California

Relative Flood Vulnerability

Indonesia

Nepal

Morocco

Egypt

Djibouti

Gambia

Botswana

India

Kuwait

Argentina

Venezuela

Kyrgyzstan

Kazakhstan

China

Switzerland

Japan

New Zealand

U.S.

Norway

UK

Germany

0.01

0.10

1.00

10.00

100.00

1,000.00

10,000.00

1,000 10,000 100,000 1,000,000 10,000,000 100,000,000 1,000,000,000

Average population exposed to floods

Average annual deaths

Bottom 40% HDI

Middle 40% HDI

Top 20% HDI

Mortality risk is a combinationof physical and social Vulnerabilities: fragile dwellings in risky places.

Relative Flood Vulnerability

Indonesia

Nepal

Morocco

Egypt

Djibouti

Gambia

Botswana

India

Kuwait

Argentina

Venezuela

Kyrgyzstan

Kazakhstan

China

Switzerland

Japan

New Zealand

U.S.

Norway

UK

Germany

0.01

0.10

1.00

10.00

100.00

1,000.00

10,000.00

1,000 10,000 100,000 1,000,000 10,000,000 100,000,000 1,000,000,000

Average population exposed to floods

Average annual deaths

Bottom 40% HDI

Middle 40% HDI

Top 20% HDI

LOW RISK

HIGH RISK

PovertyTrap

Economic Growth

Disaster shock moves economy into poverty trap region

Matthew Bonds Poverty Trap Theory

M*(I): Per capita income as a function of disease prevalence, I.

I*(M): Equilibrium disease prevalence as a function of income, M.

Shock eventin growth zonemoves economyinto zone ofPoverty Trap

Were the people of New Orleans caught in a disaster-poverty trap?

Typical levee failures

Sources: http://www.katrinadestruction.com/images/v/mapping/Flood+Depth+Estimation.html; http://en.wikipedia.org/wiki/Levee_and_flood_wall_failure_in_New_Orleans_(following_hurricane_Katrina)

Metairie

New Orleans

Jefferson Parish

St. Bernards Parish

East Orleans

Algiers

(Lower Ninth Ward)

Outcomes of Social and Physical Vulnerability

Lower ninth wardNOLA

Total “official” deceases victims to date 1698.

But there are very large uncertainties:

Who keeps the official count How do you define a Katrina victim? Does it include those who died during or after moving to a different

state. There are still approx 500 who remain unaccounted for.

Total may be as many as 3000

How many died?

How do we count: who are the victims?

• Traffic accident victims?

• How should we consider suicides?

• Should we consider those shot for “looting” and other crimes?

• Should we include frail people who died from prior conditions long after Katrina (harvesting issue)?

• How do we count (or even know about) people who died after being displaced from the disaster’s location? People who die from illnesses contracted in refugee camps having been displaced by armed conflict are counted as the victims of conflict. Those who die in FEMA trailer camps are not considered Katrina victims.

Flood vulnerability

Flood vulnerability

Sources: http://www.katrinadestruction.com/images/v/mapping/Flood+Depth+Estimation.html; http://en.wikipedia.org/wiki/Levee_and_flood_wall_failure_in_New_Orleans_(following_hurricane_Katrina)

Outcomes of Social and Physical Vulnerability

910 deceased victims processed at St Gabriel Morgue as of Jan 18th, the main receiving center for New Orleans deceased

786 identified with age, gender and race (approx one third the total deceased victims; 124 unidentified)

629 released to families

Demographic and Geographic selectivity of deceased victims

Gender not a factor 51% male 49% femalePopulation density Not a factor: fatality rates not related to pop. density

Racial factor 50% African American 42% Caucasian All other groups less than 4%` But AA’s were represented > 85% pre-flood

Age played the greatest role: 64% older than 60 yrs (15% pre flood)

39% older than 75 yrs1% less than 5 yrs (one child less than 3yrs)less than 4% younger than 20 yrsless than 20% younger than 50 yrs

Demographic and Geographic selectivity of deceased victims

Families blame more deaths on Katrina

By MICHELLE ROBERTS, Associated Press Writer Wed Dec 13, 1:56 PM ET

NEW ORLEANS - You won't see Sylvester Major's name among the 1,698 listed officially as Hurricane Katrina victims.

He survived the floodwaters that gushed through the windows and door of his house. He persevered through miserable, fearful days at the convention center. He endured separation from family and the only hometown he had ever known. And he lived more than a year after the Aug. 29, 2005, tragedy.

Officially, he died of congestive heart failure at 59. But his family and a social worker who was with him when he died say the real cause was a broken heart, inflicted by Katrina and the loss of his elderly mother, who also died after being evacuated.

• From direct result of storm – drownings, impact trauma, fire, explosions etc during hurricane impact

• From indirect causes – traffic accidents, shootings associated with looting or other acts declared criminal, other types of accidents, suicides, increases in crime etc

• From prior conditions – those who had conditions such as heart disease or respiratory illness and those conditions fatally exacerbated by the trauma of the storm or its aftermath.

• Include a long (at least a year) harvesting period

Katrinalist.columbia.edu objective

A web-based search for ALL Katrina-related mortality