Impacts of flooding on health Dr Lorna Fewtrell www.floodrisk.org.uk EPSRC Grant: EP/FP202511/1
DALYs 50 45 40 35 30 25 20 15 10 5 0 Mental health Death Serious harm Minor injuries Asthma GI Earache Health outcome Outline Health impacts Research areas Brief results Thoughts to ponder
Flooding has health impacts
Health impacts
Everyone is an individual Media reports Age & health status EXCLUSIVE: Hundreds could die, says scientist HUNDREDS of flood victims could be killed by a brew of terrifying bugs lurking in the murky water. HEALTH IMPACTS Socio-demographic factors Behaviour
Research areas Contamination profile Media analysis Mental health study Flood withdrawal & clean-up behaviour
Contamination profile
Flood withdrawal & clean-up
Questionnaire survey Mental health study Building on large survey conducted by the Health Protection Agency Number of standard instruments Psychological distress Anxiety Depression Probable post traumatic stress disorder Three years after flooding
Media analysis Don t let kids go in the water Killer bugs in flood waters EXCLUSIVE: Hundreds could die, says scientist HUNDREDS of flood victims could be killed by a brew of terrifying bugs lurking in the murky water. Virus expert Dr Ken Flint said potentially lethal bacteria like e.coli and salmonella would be left behind in the sludge in houses and streets for weeks or even months after the floods recede. And he claimed the elderly, the very young and the infirm were at serious risk from gastroenteritis. Microbiologist Dr Flint added: "I expect to see three to four times the normal rate for these diseases in coming weeks. That would mean the potential for low hundreds of people dying." Peril... kids brave Oxford flood water that contains bacteria and viruses Signs of E. coli in Mud After Cumbria Floods A sample of mud from a house hit by the recent flooding in Cumbria has been found to contain the DNA signature of bacterium E. coli 0157 His stark warning came as scientists found evidence of around a dozen dangerous viruses in flood water samples taken from swamped Gloucestershire streets.
Health picture Gastrointestinal illness Overall health impact
Gastroenteritis and flooding Quantitative microbial risk assessment (QMRA) Standard method is to use reference pathogens, usually representative: bacteria, protozoa, and virus
QMRA of gastrointestinal illness Reference pathogens Campylobacter Cryptosporidium Rotavirus Pathogen levels in floodwater Dose-response relationships 725 homes 1550 people Caldew flooding Flood phase Clean-up phase Exposure scenarios
Disability adjusted life years (DALYs) Summary measures of health Combines the length of time lived with a disability with (if applicable) years of life lost through premature death Different levels of disability are accounted for using severity weights
DALYs Results gastrointestinal illness 0.035 0.03 0.025 0.02 0.015 0.01 0.005 0 Flood phase Clean-up Flood phase Clean-up Flood phase Clean-up Campylobacter Cryptosporidum Rotavirus
DALYs Results gastrointestinal illness 0.035 0.03 0.025 0.02 0.015 0.01 0.005 0 Flood phase Clean-up Flood phase Clean-up Flood phase Clean-up Campylobacter Cryptosporidum Rotavirus
DALYs Results gastrointestinal illness 0.035 0.03 0.025 0.02 2.5% 0.015 0.01 41 0.005 0 Flood phase Clean-up Flood phase Clean-up Flood phase Clean-up Campylobacter Cryptosporidum Rotavirus
Health impact assessment Lots of identified health impacts Some are quantifiable Apply to a case study population either as a retrospective exercise or a what if Carlisle flooding 2005, river Caldew, Denton Holme area of Carlisle retrospective 725 homes flooded, affecting ~1550 people
DALYs Health impact assessment results 50 45 40 35 30 25 20 15 10 5 0 Mental health Death Serious harm Minor injuries Asthma GI Earache Health outcome
DALYs Context 250 200 150 100 50 0 Road traffic accidents Respiratory infections Cardiovascular disease Neuropsychological conditions Caldew flooding Non communicable diseases All causes Cause FRMRCII_Talks_ DALY Context
Thoughts to ponder Impacts and their level will be event specific Actual contaminants, depth, velocity, duration However, flooding does makes people ill Impacts actually pretty significant Deaths (obvious) Mental health (insidious, private, stigma, various coping methods, delayed, not a juicy subject) GI (~50 cases, public anxiety, media interest) Given that, does it matter what the actual levels are? No!
Thoughts to ponder Prepare for the health impacts Death education/raise awareness? possibly difficult to influence Gastrointestinal illness Not a big problem in the scheme of things but easily (and best) avoided Timely hygiene advice Mental health Good advice at the withdrawal phase It is normal to be depressed after flooding let people know this Manage expectations
Thoughts to ponder Avoid (minimise) the second disaster Train staff (who will also be under a lot of strain), especially those within the insurance industry Standard method for assessing flood damage required? Accreditation system for builders?
And finally Flooding is a complex process and its impact on people cannot be reduced to simply their property being inundated with (often dirty) water, dried out and restored.
Acknowledgement The research reported in this presentation was conducted as part of the Flood Risk Management Research Consortium with support from the: Engineering and Physical Sciences Research Council Department of Environment, Food and Rural Affairs/Environment Agency Joint Research Programme United Kingdom Water Industry Research Office of Public Works Dublin Northern Ireland Rivers Agency Data were provided by the EA and the Ordnance Survey. www.floodrisk.org.uk EPSRC Grant: EP/FP202511/1