Investment in social infrastructure and disaster preparedness

By: Monica Kao

With the world’s eyes riveted on the aftermath of Japan’s historic 9.0-magnitude earthquake and resulting tsunami on March 11th, a number of comparisons have been drawn between this natural disaster and others preceding it, particularly the January 12, 2010 earthquake that rocked Haiti and the one-two earthquake-tsunami combination that ravaged Indonesia and other Indian Ocean nations on December 26, 2004.  Seismologists point out that the earthquakes responsible for triggering the two tsunamis were geologically similar, with epicenters that were a roughly equivalent distance offshore.  And in terms of its natural force, there is nothing particularly special about the Sendai earthquake/tsunami that sets it apart from its predecessors.  Having recently been upgraded from 8.8 to 9.0 on the Richter scale, the earthquake in Japan ranks above the 2010 Haiti quake (7.0) but below the 2004 Sumatra-Andaman earthquake (9.2) in magnitude.  Knowing this, it could reasonably be inferred that a natural disaster of comparable magnitude would also have a comparable impact on social infrastructure and on human health.  In fact, physicians and public health officials anticipate that they will face many of the same health crises as those experienced in Indonesia, Sri Lanka, India, Thailand, and Haiti, with many of casualties being blunt trauma injuries (crush wounds, head injuries, fractures, and cuts) inflicted by floating or falling debris.  After the initial trauma, health workers must rise to meet the challenge of food and water shortages, aspiration-related illnesses, foul-smelling infections, elevated risks of heart attack or stroke, and the threat of disease from contaminated water sources.  Yet, even with the current death toll in Japan having just surpassed the 2000-mark, thousands of Japanese still missing, and the death toll predicted to reach the tens of thousands, the level of devastation is still not expected to come close to the staggering death tolls of 230,000 and 316,000 seen in Indonesia and Haiti, respectively.  The differences in outcomes may be viewed as a manifestation of systematic disadvantage and the impact of investment in social infrastructure on a grand, macroeconomic scale.

According to 2010 GDP (gross domestic product) estimates made by the International Monetary Fund, Japan, Indonesia and Haiti ranked 3rd, 18th, and 132nd, respectively.  By the World Health Organization’s 2000 rankings of the world’s health systems, Japan, Indonesia, and Haiti ranked 10th, 92nd, and 138th.  By death toll numbers in increasing order—Japan comes in first with the lowest death toll, then Indonesia, then Haiti.  The inverse relationship between wealth and the impact of natural disaster on health (measured in human lives) is no coincidence—engineering experts and public health officials hail Japan’s emergency preparedness system and its support for social infrastructure as what spared it from catastrophic destruction and losses on a more massive level [Japan ‘the Most Prepared Place in the World’ for a Tsunami and Did Engineering Save Lives in the Japanese Earthquake?].

When a 7.4-magnitude earthquake rocked the Japanese city of Kobe and its surrounding cities in 1995, a number of buildings (most built before the 1980’s, when stringent building regulations were developed) collapsed and killed thousands of people within minutes of the initial quake.  Japanese officials were compelled to invest in building infrastructure, providing the funding for engineers to revise building codes, tighten regulations, and outfit buildings with technology that allowed them to absorb seismic energy and to remain standing.  Japan also invested millions of dollars in preventative measures against tsunamis, which included concrete sea walls, levy banks, ports with raised platforms, advanced sensor buoys, and a high-tech detection and warning system.  Lastly, Japanese citizens underwent regular earthquake drills designed to familiarize them with the potential dangers (i.e., tsunami risk) and the safest procedures.

Few would stand to argue against the fact that the death toll of Haiti’s 2004 earthquake would have been significantly reduced if its government had invested a fraction of what Japan had invested in its building infrastructure, to update its regulations and to correct poorly constructed buildings.  Fewer still would deny that thousands of Japanese lives were saved by tsunami warnings that afforded them enough time to escape to higher ground—warnings that came too late for hundreds of thousands of people in Indian Ocean nations.  Many of the people who perished in the 2004 tsunami were not even equipped with the general knowledge that earthquakes often trigger tsunamis, and therefore it cannot be said that they were properly informed about the dangers at hand.  In other words, the natural disasters in Indonesia, Haiti and Japan have made it apparent that wealth is an important social determinant of health, and countless lives could have been spared if national governments had had more funding available to invest in public expenditures.  It is my hope not only for Japan to be able to recover quickly and completely from the humanitarian, economic and nuclear crises that it faces, but also for other nations to learn from the past so that future destruction and loss of life can be avoided to the greatest extent possible.

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