>> From the Library of Congress in Washington DC. >> Okay, good afternoon all and welcome to this conference presented jointly by the Office of Science for Technology and Business and the Office of Health Services. We are very pleased to have today as our distinguished guest Dr Virginia Murray, Professor Virginia Murray from Public Health England. And also I think we have some guests from Health and Human Services, as well as our distinguished colleagues here from the Library of Congress. And have been co-sponsoring some of these programs with Dr Tomoko Steen for several months and always find them so enlightening and it gives us an opportunity of partnering and networking beyond the walls of the library. And today's conference talking about disaster management and public health is really very timely as we all know disasters come out of the blue and happen naturally when we least expect it, and we're always trying to plan and be sure that we are able not only to meet those disasters but, as I was discussed with Dr Murray, also to reduce our risk of having them to the extent that we can. But where we cannot we also want to be prepared to be able to meet them. So given Dr Murray's vast experience in following these and working with various areas, we are really interested in knowing what we can learn from the policies that she has been able to establish or to influence in some way. So I'm going to ask Dr Steen to come up and introduce Dr Murray and proceed with our conference. Thank you so very much. >> Dr Steen: Hi everyone it's my pleasure to introduce today's distinguished speaker. Dr Virginia Murray is a Public Health doctor at the England Public House, England, which is the new health office. Used to be different name and now it's focusing on the, hard work is focusing on disaster management and the international strategy for disaster deduction. That's a project she's the vice chair of that program of the UN as well. And Dr Murray is the, also the visiting professor for the UN university as well as various universities, prominent universities in the UK. And especially for the UCL, University College London and the United Nations Library, the United Nations University also I have mentioned. And also a [inaudible] PHC center for environmental and health, Imperial College and the King's College, London, which is, there is a textbook I use for the environmental health class. And also she was involved in [inaudible] framework for disaster risk deduction, the RR 2015 and 2030. And this is one of the three major UN 2015 landmark agreements. So it's a prestigious agreement and she had a few copies over here and here. I was looking at the slide with Dr Murray and there's so much rich information she can provide you all. So before further ado please join me welcoming Dr Murray. >> Dr Murray: Tomoko, thank you so much for inviting me. It is such a privilege to be here at the Library of Congress and to be working with you all. It is a real opportunity to share with you disaster management and public health and how we can perhaps, as every country in the world is considering, and obviously as I'm in the United States today, learn from how we can perhaps implement some of these incredible United Nations policies. As Tomoko has already said, and thank you for your very kind introduction, I am the vice chair of the United Nations International Strategy for Disaster Risk Reduction, a scientific and technical advisory group. And that has been a huge privilege and I will try to share some of the findings of the work from there and from the many other groups that I am now a part of. My talk today will therefore outline the 2015 frameworks and particularly focus on the Sendai framework and why it matters so much. But also give you four examples of work that I think is really important to share to try and illustrate how the Sendai framework matters to us all and take you on to a few concluding comments that may be of interest to you all. 2015 in the United Nations, at the driving force of the member states itselves, agreed three incredible landmark agreements. The Paris Agreement, which is now being implemented and the green light came through very recently on the 4th of November on climate change, the Sustainable Development Goals which links directly to a lot of the work that are so important for alleviating poverty, but making people better much more widely and their circumstances in which they live, and most importantly to me, the Sendai framework for Disaster Risk Reduction. The Sendai framework probably has the longest history of its implementation through the UN system. Moving in the over the last 25 years from the Yokohama agreement through to the Hyogo framework for Disaster Risk Reduction to finally to the Sendai framework. And that framework also links now very closely to the international health regulations which are the legal leg, or one of them, on which so much of this work must stand. Disasters have a major impact some people. Trillions of damage, billions affected and unfortunately millions killed. They are really frightening events that cause huge harm to people and are often very hard to document fully. So I was very interested to see that Noah, from the beginning of this year to September, reported these billion dollar weather and climate disasters. So I think that these disasters are not just something that hit the developing world, they hit well of us, and they're really important that we all learn from each other and try and develop better systems in my view. Every two years the UN sets off a global platform to discuss how we move forward. How we can possibly take these frameworks and deliver them better. And I have the great privilege of being much in gauged in the one in 2013 where the strong message came through that there was a clear recognition for the next framework, ie the Sendai framework, to have a central role for science in the heart of its work. This very much reflected the regional meetings in Africa, in Ecuador for the whole of the Americas where the US was well represented, in Asia where they have many disasters unfortunately, in the League of Arab nations in the Arab states, but also in the Pacific in their disaster risk management. But I want to take you to the European forum because they produced a statement which I thought was really helpful which I share with you now. There was a real need to champion, reinforce and better connect existing in future initiatives for integrated research and scientific assessment of disaster risk to strengthen the evidence base to inform decision making, to make it easier to understand how we can try and make sure that people have access to the data they need, both in preventing disasters but also in times of crisis and recovery. The whole of the Sendai framework was driven by the UN member states. The negotiations have lasted well over three years. It was an incredible process that I had the privilege to observe as a member of the scientific and technical advisory group to try and see how these frameworks could be delivered and how each statement was agreed. So the Sendai framework was actually based in Sendai, really unfortunately because of the earthquake tsunami and the radiation release that we will be discussing later. But the Japanese government have been really influential in making sure that they felt that they should show leadership to change how we think. So this is the Sendai framework. A simple thin, blue document. Each word inside it is something that is worth considering. It has been discussed, debated and considered so carefully that I think it's produced an incredible piece of work that will help us over the next 15 years to try and deliver a better way forward. There is a global outcome, there are guiding principles, there is four priorities of action, there is seven global targets. The targets are there to reduce mortality affected people and economic loss and damage to critical infrastructure. But it's there to increase how countries plan, prepare and consider how they can deal with disaster risk reduction strategies, build international cooperation, and also improve early warning systems. Most importantly health resilience is promoted throughout. This is a see change in our whole, in the development from the Hyogo framework. It's been an incredible action that's been going on. And in the main outcome message there's now a call for the substantial reduction of disaster risk and losses in lives, livelihoods and health, right in the first few lines. Really important that health is recognized to be critical, and obviously it links to the economic, physical, social, cultural and environmental assets of persons, businesses, communities and countries. As somebody who sat through the negotiations I decided to highlight in yellow where science came in. And you'll see that science is throughout. It's incredible how much they've asked for us. So I'm going to take you to that big paragraph that you see right on the right hand side of the screen. And that is the call, the mandate for the work that I do as the vice chair of the UN ISTR scientific and technical advisory group, is to enhance the scientific and technical work on Disaster Risk Reduction and it's mobilization through the coordination of existing networks and scientific research institutes at all levels and in all regions, and obviously the Library of Congress is critical to taking this forward with us. Why do we need to do it? Well we need to strengthen the evidence base. We need to promote the understanding of scientific research in disaster risk patterns causes and effects. We need to disseminate the risk information, make sure we share it with the people who need it. We need to support the availability and application of science and technology for decision making. And we need to undertake post disaster reviews, but also disseminate the studies. We need to share what we can across the world. So what do I mean by science? It was OECD who produced this really helpful report, and they so showed there are six main categories of science in the world. So there's natural sciences, engineering and technology, for us today obviously medical and health care sciences are critical, but agricultural sciences, social sciences and humanities are all there and all important. So looking at the health side just to give you four examples of some of the really critical things, there's the call for the resilience of national health systems, developing the capacity of health workers, sharing the training for disaster medicine, implementing the international health regulations. There's also the need for people with life threatening and chronic diseases to be carefully cared for, both before, during and after disasters. And to establish a mechanism of case registries so that we have better surveillance and understanding of the risks of mortality and morbidity. And we need to have better psych, social support in mental health services for all the people in need. Now the UN decided that it was really important that we should have a Science and Technology Conference to mobilize science to implement the Sendai framework. And in January I had the great privilege over a period of some months of work to be the chair of the organizing committee for delivering this conference. What did we learn? Well we delivered a road map. And the road map is really important. It has many statements in it of what we will achieve. And there are two key statements I wanted to share with you. There is to establish a global database of existing hazards and to make sure public health emergencies are absolutely included in the heart of this work. And we need to promote the scientific focus on disaster risk factors scenarios including emergency disaster risks and public health threats, all things that I know this audience care about. But as a scientist, and none of us can leave these messages just within the UN frameworks. They need to be shared in a form that scientists are used to using. So this is the peer review publication from that conference, a super paper with over 100 contributing authors that we have produced, and that had some points that are also important and I'll give you one. There is a need for a formal National Disaster Risk Reduction Science Policy Council platform. And I know you have facilities of this, most of them based in the White House, and I hope that this will be something that it will be ready celebrated and useful, usable and used in delivering how we make sure that science can inform and support Disaster Risk Reduction and management plans. We also had a health conference in March which was critical in Bangkok, and one of the things that came out of it were the Bangkok principles. I give you one of them, this is 7.B, which is to ensure coherence and alignment of national, regional and global Disaster Risk Reduction frameworks, and those related to emergency and disaster risk management for health, again including the international health regulations but also the global health security agenda. All things that are essential these days. And this now ties in and links to the sustainable development goals and the indicators that are being agreed at the moment in Geneva will be shared through the sustainable development in exactly the same way for each country to implement as we would do with the rest of the STG's. Next year in Cancun we'll have a meeting to review exactly what we've achieved in the two years since Sendai was agreed. And we hope that this will be of import to all the countries and all the scientists and all the participants in delivering this be it at local level, national level, regional or global. So I'm now going to move on to some examples. And I think the examples are really what Tomoko was interested in, because that explains why Sendai matters. But I also think that these are very select examples because disasters happen all the time everywhere. So I'm going to talk about the earthquake and tsunami in the radiation release in Japan. I'm going to give you an example from England. I gave to take you through the tropical cycling Winston in Fiji, and finally consider some of the things that have been happening in New Zealand over the last weekend but also more recently. So let's think about that triple disaster in Japan. They had an earthquake, a magnitude nine. Very big. It happened off the shore. And it led to a tsunami where a death toll of over 20,000 occurred, and then to the nuclear accident at Fukushima. One of my colleagues, [inaudible], who came to work with me in London from Japan was absolutely tremendous. We worked on many papers, but I thought I would share a few with you just to show how the UK has been linking to Japan. What we did was to look at literature review on the health needs and relief activities between March 2011 and September 2012. We were very surprised that when we did this work that we could see a pattern coming through very clearly almost at once of what happened on the first day, the next ten days, the ten to 30 days and what happened after 30 days. You'll notice something that really worried us, which was after 30 days the increased incidence of deep vein thrombosis and pulmonary embolus. But there were many things that occurred that caused us a great deal of anxiety. But throughout there was this real issue of managing non-communicable diseases. People have hypertension, diabetes, chronic renal failure, cancer and other things, all things that matter. And then we had that suspect group of mental health issues. In our recommendations we reported that there was a real need for public health research after disasters to understand that there was often a lack of baseline information and we need to improve that. So data is key. We need to support the most vulnerable with real time health impact data as needed. But we also need to share the information really quickly and clearly so we can improve the cooperation between the response teams. And finally public health and academic research is needed to address on site needs at the time of the disasters, needs to be taken up, needs to be undertaken as required. But one of the consequences was to understand why so few people took their medications with them. And I don't know if any of you are, in the audience are on medicines. But do you know what you take? Do you have a list of it? Can you take it with you? Would you be able to do it now if we had to evacuate the Library of Congress? It is absolutely critical that you don't say to a doctor, "I need a white one now and a pink one in two hours", because none of us will know quite what you're meaning. So we've been considering through a complex and difficult systematical literature review how do we change this? And the main finding was that we know that patients are the key. Patients must bring the medication with them. That health professionals must share the information that they need. The policymakers must make sure that the data is there for community emergency plans and insurance schemes. And researchers are there to make sure we build the evidence to show that we're making a difference. And now I see across the world the call whenever there's an evacuation to make sure people take their medicines with them, but I hope people remember to do so. We also looked at the consequences to hospitals and the hospital damage in the Miyagi prefecture, and just to remind you this is the prefecture so you can see exactly where it is and again see where the original earthquake occurred. We could show you exactly where the hospitals were by seismic intensity, by the inundated area from the tsunami. And by pulling this data together we then worked with [inaudible] leading the way showing that primary care was at greatest risk for having hospitals and facilities closed, which are the crosses on this map. For the secondary care there were fewer facilities that were closed. And by the time we got to tertiary care we could see that they were much better built and the resources were there. But there was something that worried us. The proportion of psychiatric care beds were very frighteningly damaged relatively. And so that caused us a great deal of concern because people hadn't planned so much for these consequences in psychiatric care. We also, I was delighted when Si shared this with me. She reported on this paper that she had just published M plus One. It showed something that was frightening. That in the Somo region, which is part of the area we're talking about, there was a massive drop in the numbers of doctors, nurses, clerks and other paramedical people in attending patients immediately after the earthquake, tsunami and the radiation release. And you'll notice that even by the time the study was completed in 2012 there wasn't the 100% needed of all the staff to support the hospital facilities. A worrying and unexpected finding. So there's a real call from the World Health Organization to keep hospitals safe from disasters. Much of this has been led by the Para American Health Organization which of course sit in Washington, and they are critical to us. And we've just released a new hospital safety in text guide for evaluators to try and make sure people understand how we make hospitals, resources that are so vital to us all, better prepared for these events. But it wasn't just of course the hospitals and the health care facilities that mattered. It was also the evacuation zones. And over 80,000 people in the Fukushima prefecture were forced to evacuate their homes following the nuclear accident. Up to 20 kilometers there was mandatory evacuation with no entry. Between 20 and 30 there was a voluntary evacuation with indoor evacuation. So what did not mean to the people? Well the mandatory evacuation meant the people moved. They had to move. And there was widespread social disruption and breakdown of communities, social stigma attached to being somebody from Fukushima, and there was a lot of distress, and I'll tell you more about those later. But those who were indoor evacuated, they were often left. There was often no food supply immediately nearby. There were often no medical resources. And the most vulnerable may not have had food easily. So in a, in fact in a study which looked at 1,215 elderly residents of a care home followed up until 2013 which shows those who were evacuated had a higher risk of mortality compared to those who were not, which was something that was not expected. But as this statement, which I haven't managed to verify that Si shared with me, that told me something that I was really very concerned about. A medical doctor did a death investigation for a month after the disaster. Several elderly people apparently died from starvation or dehydration at home. We mustn't let this happen in the future. We need your help. So those who were mass evacuated and displaced in long term housing, there were a lot of problems. They lost their jobs. They had small places for exercise, it was very noisy where they went to. There was an increased car dependency. And there was deterioration in how people felt. And most importantly when they compared the health versus the control groups, people became fatter, they have more high blood pressure, diabetes increased, and people weren't able to stand as well, which I thought was a very interesting finding that Si shared with me. So it was increasing awareness of knowledge on the health risks, the most effective way to protect prevent indirect health impact after a disaster is to improve basic health status before disasters. So we need people to be well. Fukushima, the Fukushima prefecture is now doing amazing things. It's providing medical outreach. It's making exercise centers and parks. It's improving health conditions by evacuees and may make society healthier. So Si tells me how pleased she is that this change has happened. But in a World Health Organization bulletin report of two pages there was a very interesting little summary of some of the points that came out from the public health after the nuclear disaster beyond age, beyond radiation risks that was published this year in 2016. The main message was the deaths or acute health effects related to radiation exposure in the general public. But there was confusion over public health messages, particularly from research findings. For instance in October 2015 the results of two studies concerning the children of Fukushima were reported in two days of each other, giving very contradictory findings. One saying that there was no internal source of contamination identified, and the other finding there was an increased risk of thyroid cancer. So for the health care professionals, which one do you pick? Which one do you follow? So the final comment that I think is really key in this paper is the need for a comprehensive perspective on Fukushima to continue the process of local disaster recovery and to improve preparation for any future nuclear disaster. Now Fukushima was not just something that happened in Japan. Even in the UK we could find the radiation. We have an integrated emergency management plan in the UK where we have science and technical advice built into every step. But particularly on national risk assessment in our crisis response arrangements. And part of that is that we have a scientific and advisory group which provides for emergencies, which provides cross government coordinated advice. And this group was called indeed for Fukushima. To provide that evidence Fukushima required the use of our UK Recovery Handbook for radiation instance which are published by Public Health England, and I show you version four that's recently come out this year which covers food production systems, it covers inhabited areas, and it also covers drinking water supplies. Trying to reflect the very best evidence to make sure we can provide information that might be needed to inform policy. But I thought in order to show you we do things more wise, more widely I thought I'd just tell you about heat waves. I know you think England's wet and cold, but actually it can be hot. In 2003 we were part of a panEuropean issue of a heatwave in August. We had a heatwave spike in excess deaths of over 2,500, and across the whole of Europe which is thought that there were probably in excess of 70,000 unexpected deaths. What did we do about it? Well over a lot of deliberation and debate an annual heat wave plan is now published and updated, including the evidence about why it is needed in its own annex. So evidence base is critical for what we do. But also specific advice including looking after yourself and others during hot weather. So let's go back to 2013. It was hot. It was really pretty hot. And it continued to be hot for quite a long time. So using our syndrome mixed surveillance systems, which are really critical for looking at general practitioners over the counter pharmaceutical cells, telehealth, the emergency departments, the ambulance, our general practitioners out of ours but also in hour services, social media, work absenteeism, work activity, we were able to produce data like this. This doesn't look like much, but that dark line is the central England temperature. But if you understand how it relates to the heatwave alerts you'll start spotting that it went from level one to level three. And back to level two. And then you see the number of calls in our telehealth systems. And the numbers of emergency department visits. And indeed the GP in hours and out of hours calls. You see they begin to match and we begin to see the patterns. By putting this together we looked particularly at GP in hours, daily heat and sunstroke consultations, and you'll notice in the gray boundaries where we were at level two and three and where the heatwave plan was called, there's a little dotted line which goes up far too high in my view. That dotted line relates to the children aged five to 14. Why would you be concerned? Because we didn't get to the schools. We didn't get to inform them in time that wearing a hat, sunscreen and drinking extra water was critical to reduce the risk during sports days of adverse health effects. But death is obviously the thing that really frightens us. Excess deaths, unexpected deaths. So again using those gray bars you can see that we stayed within the lines of what we expected. Not perfectly, but we stayed there. But when we compare it between 2003, 6, 9, 11 and 13 heatwaves you'll see that the number of excess deaths in the over 65 year olds is fortunately dropping and we hope this is related to our plan. So let me move to Fiji. February the 20th 2016. Tropical cyclone Winston hit along a pathway that took these islands really by surprise and caused massive damage. About 62% of Fiji's population were impacted. Over half a million. Powerlines and communication systems came down with 80% of the whole of the nation losing their power. 44 fatalities were subsequently confirmed. Entire communities were destroyed and approximately 40,000 people required immediate assistance. But look at the numbers of medical facilities, schools and houses that were damaged or destroyed. The things that really worry us. And agriculture affected 60% of the population where it was the main source of livelihoods. So let's turn that into images. Yes, devastating. Destructive. But where do you hang your clothes after you wash them? Unfortunately on fallen overhead power lines. Not a best solution because the power might get turned on. Very dangerous. I also went two weeks ago in Fiji when I was there to visit a community that was really badly hit by Winston. You'll notice it has a marvelous mangrove forest, but also dikes around the village. Why have they got their dikes? Thank you USAID. You've helped. The dikes could do with being a bit higher though, they're a bit low because Winston really got over that, those dikes and that was frightening. And these magical little villages need to be careful. So the villages have signed up to do something. They are going to be our pilot trainees for the Pacific Regional Federation for Resilience Professionals. They have volunteered to be trained to make sure that that training will influence not only themselves, but also others. So it's to enhance the professionalization of practitioners in the diverse fields of climate change adaptation, of disaster risk management and disaster risk reduction, remembering that health is at the heart of all of this. To maintain a register of certified professional resilience practitioners. To provide a code of ethics for resilience practitioners to abide by, all things we need. And to support this we've published the relevant paper on accredited qualifications for capacity development in disaster risk reduction and climate change adaptation of which I'm delighted to be the final author, and very much a proposer and sponsor of this whole program to support those who are leading it in the Pacific region. But I can't not talk about New Zealand. This weekend they've had a terrible time. Many earthquakes again, and the damage enormous. I was there in February five years after the Christchurch earthquake. The population has been living since 2010 all the way through to out there in February 2015 with continuing seismic activity. There were quite a few earthquakes which they all noticed, they were all concerned about. If that's not something that will damage people's resilience I don't know what will. There was a real concern about cultural heritage and wellbeing and how people felt about it. And the cathedral, even when I was there, still looked very damaged and the plans to restore it are not clear. But this message of those who died, through the use of white chairs and red carnations, was really evocative and it made us all remember what had happened. But there was hope as well. This incredible mural, where the walls were so badly damaged there were many murals and this is just one of them that I took a photograph of that I just wanted to show you what it, what resilience can mean and how do you get it. What they have done in Christchurch is to build an alright campaign with a question mark, alright? Because you can ask that of anybody. Why? Because you have to be able to improve your mental health and wellbeing to recover from these earthquakes. Find your spark, share the love, mind your head, sort your habits. What a great message. And the evaluation looks pretty positive to. But in September I was there again because of course building resilience to address the unexpected is critical throughout New Zealand as it is frankly throughout the world, because the West Coast of the United States sits on the Pacific Rim of fire. You too are at risk. But the best way to improve that is to have the best evidence. So in the audience we have the chief executive of evidence aid. How do we get the best evidence to those who need it at a time critical point so it can be used usefully in a way that is simple, clear and helpful? How do we improve our research? This is just an example of a ten year program which the World Meteorological Organization are doing called High Weather to try and improve the forecasting of the two weeks before an event to make sure that people know what the risks are. Absolutely essential. The European Commission is doing something amazing. It's set up a disaster risk management knowledge center to bridge science and policy. There's a huge amount of work that's going on and I'm very happy to be participating in that. But last week I was in China where they launched the scientific end of the Belton Road initiative to bring together the countries who are at disaster risk in Asia and along their Belton Road program. Probably 100 countries who are interested in joining this and over four billion people. That's something. What a great leadership role China is taking on. But the US has done amazing things too. In April this year you published the impacts of climate change on human health in the United States, a really valuable document, something that we found very helpful across the world and I have shared it with many. And every time I print it out somebody, a student, removes it from me. Not a successful strategy when they can go and help themselves online. But well done United States. But to share with you that climate change is an issue for us in the UK, let me just report on where we think we need to build our research. Flooding and coastal damage risk to communities, businesses and infrastructure is in deep red. Risks to health and wellbeing, productivity from high temperatures we're getting increasingly concerned about this. Risk of shortages in public water supply. Risk to natural capital. Risk to domestic and international food production. But now the new and emerging pests and diseases and invasive non-native species affecting people, plants and animals is seen as a critical research program. Why does it matter? Because it's not just the scientists doing it, we're doing it at the request of Parliament. We're doing it for the people who will make the decisions. That to me is the way forward we need to go. We need to work hand in hand with those who implement the outputs. So the privilege of speaking with you today is huge. To me disaster risks and disaster management and public health and what can the US learn from the UN policies is extraordinary. The US voice in the Sendai negotiations was loud, clear and impressive. Did it matter? Yes. But now we need to implement these. We need to make sure that they ensure coherence and alignment of national, regional and global disaster risk reduction of emergency and disaster risk and management for health. And for me, as a scientist and academic, as a practitioner, as a government worker, evidence base is key to scientific implementation. Let's do it better. Let's get the Library of Congress to support what we do. But also I wanted to acknowledge so many friends around the world, and this is just a few of them. There are many, many more that I've had the privilege of working with but I've tried to choose a few to highlight how important they all are. Thank you. >> I'm just interested in New Zealand, you talked about the cultural heritage and the damage and how that affected the mental wellbeing of the people there. Could you just speak a little bit more to that? >> Dr Murray: Thank you for that question about cultural heritage and the Christchurch community and what happened, what, how the damage to the cathedral and other bits seem to have affected how people feel in New Zealand, and indeed in Christchurch. To me when I was there I was really quite surprised how difficult people found living in a city that was still not recovering. Did you know that their logo, their message for the recovery of Christchurch is literally a cone? The type of cone you put on the road to show things are being built, recovered. And they put roses and geraniums and things in them just to remind people that they have to have hope to recover. But the strong message was that a lot of the city was so badly damaged it's going to take a very, very long time to recover. And I think there was a message there that this cultural heritage issue has caused real concern, and it was certainly brought up very clearly in the conference in September in Auckland. And in fact the prizewinner for all the work that was going on there was somebody who'd been doing that work in cultural heritage. I don't think we understand how important cultural heritage is, be it obviously in things, but also in rituals, but also in how we all behave with each other that needs to be reflected on. And I think that's something we're just beginning to learn. And cultural heritage has a very strong role in the Sendai framework, and there has been a huge call from the inter-Academy partnership, ie all the national academies of science of the world, with the charter of Rome to make sure it's properly recognized, and UNI and CR in their words into action will include a very strong message on cultural heritage and how important it is. So I know you're interested particularly in the recovery of books who've been suffering from mold from flooding and many other things, but I'm interested in the whole concept of cultural heritage. >> Mine too, actually. >> Dr Murray: Great. Thank you for your question. >> It's just I have a couple, the first would be rather specific to your presentation. Fukushima, you have a sort of a [inaudible] action there, but did the earthquake really do much other than create the tsunami? Was there any structural damage to the power plants [inaudible]? >> Dr Murray: Thank you for your question about Fukushima and the impact of earthquake and tsunami on the Fukushima power plant. Yes it did do structural damage. There was a real concern at the time. And it would seem to be very helpful that our government chief scientific adviser in the UK should link to the Japanese system for scientific advice to try and share information about what was going on. And we did a lot of this through our embassy in Japan to make sure that the data was there. I think there's a lot of concern about the amount of evacuation and the activities that went on. But everybody tries to do their very best at a time of crisis. And I think that the Japanese did an amazing piece of work. I think they've really tried to understand what the risks are. But my colleague Siochi and many others who I've been working with in Japan I think you very much aware that there's a lot more to be learnt, and that I think is the role that we need to encourage them in. >> This distinction that I'm trying to point to is the radioactive releases. As far as I understood it the structural integrity is sufficient in those constructions to withstand the shake of the earthquake itself, which was after all distant and offshore. It was really the impact of the water pressures on those structures which was to be highlighted, not the earthquake shaking. Am I correct or not? >> Dr Murray: I think it was, I think it was the tsunami that caused the greatest impact. And I think the real problem as far as I can understand having been in that area was that the protective wall was not high enough. And I know Japan has been investing a lot of resource in building higher coastal walls to try and protect people and property, lives and livelihoods in the event of a further tsunami. A very difficult task and very difficult decisions to make. But very brave ones for a country that is so disaster prone and lives on the Pacific Rim of fire. >> Thank you for a wonderful talk. I know you were talking about in [inaudible] approach you mentioned about caring for the mental resilience of people due to the impact of disasters. Has there been any talk in education from the standpoint of providing psychological first aid for example or mental health first aid? I know there are avenues with this happening. Have there been conversations around educating the public and empowering people in the community to be prepared for an event as well as recover from it? >> Dr Murray: I think there's a huge amount, thank you for your question about mental health and mental wellbeing both before, during and after a disaster, is really critical to trying to live with this better. There's a lot of work that's been going on. But one of the problems we have with some of the techniques for mental wellbeing or psychological first aid is that there's not enough evaluation of some of this work to make sure that it's actually evidence based and imbedded throughout in some of this work. We've been working very closely with the World Health Organization and many others around the world to try and find which might be the best solution, and I know that they're doing an extensive piece of work on this. So hopefully we'll do better soon and educating people about what they need to do is very important. Now when we've had our floods in the UK we have certainly produced fact sheets on the mental health impacts of flooding, both for the people who experience it but also for the responders. We find that the responders too suffer from the mental health impacts of these flooding events. So there's been a huge piece of work that's been going on by my colleagues in the UK. >> Thank you again for your presentation. Just to your point, my question, I'm curious to your thoughts, the challenge we have with mental health surveillance following disaster, evaluation of interventions, a huge problem I see is that lack of baseline information and you mentioned this. And I'm just curious as to, particularly for the psychological aspect, are you aware of or can you share your thoughts on how do we do a better job of getting that pre-disaster snapshot in systems that are so desperate so that we really understand what the effects are? >> Dr Murray: Well I think that's a really fascinating question about how we improve the baselines for mental health understanding from the consequences before, during and after a disaster. The Cochrane Collaboration, I don't know whether you're aware of it, is leading on a public mental health, mental wellbeing program, which I think is going to emerge and be very interesting to look at. But I think one of the things we really need to know much more about is proper data. So it's understanding managed data in this area, or open data, and how we link to this and how we use it. We did a systematic literature review in the UK on what we could find out about the mental health impacts of flooding. And that's something that we found very difficult to pull together because there really isn't much information on it anywhere. But we've published on it. But we've also looked at something that really surprised me, which was a system in the systematic literature review of the health impacts of windstorms that, although we found that mental health is really key the whole way through, the publications on it, even from the United States, is pretty thin. We need your help. We need you to help us to deliver this and we need to learn from you because I think you can help us really understand more about how we can do this better. >> Thank you. So the risk and reduction program must have a lot of [inaudible] to evaluate the risks of disasters of all sorts. So I wonder are there, have there been discussions or even guidelines for threshold of our risk tolerance, because for example to do the radiation study we have planned in the certain places in Japan will be under risk that for example if the risk commences zero then there will be no construction of nuclear reactor there. But you know some factors contribute in the balance in this decision making which I wonder if we have any guidelines [inaudible]. >> Dr Murray: Thank you for your question on risk tolerance and the building of nuclear power plants, particularly in Japan, if I can summarize your question clearly. For the benefit of the audience sorry, I have to repeat the questions, you must be getting rather bored of me doing this. Apologies. As far as I'm aware, I don't, I'm not aware of those types of discussions. But I know I'm certain that they're being held in Japan. They have an incredibly powerful group who do a lot of thinking on these things in their scientific domain and I'm certain that they would be leading on this. And I don't think I can add anything useful, particularly as I'm not, as I am only a healthcare professional. But what I would like to suggest is that there's a huge amount on evaluation that is being done routinely in public health. And I don't think we should forget that. Public health is probably one of the richest resources for making sure we understand how to evaluate our impact from decision making. And that's been something that has been really clear. For instance one of the easiest ways to measure impact is to think about the vaccination uptake rates for immunization diseases, be it congenital rubella or whatever you choose. But if we can get really good uptake for the relevant groups then we know we will be saving lives. Now risk tolerance and risk understanding is something that is really important. And Sendai framework points to the fact that understanding risk is absolutely critical to how we deal with the whole of the preparedness for disaster risk reduction. So I can refer you to that splendid three pages that are so yellow when I look at them for the science evidence based, science calls of what we must do to see how you'd like to take that forward. >> I have a question that goes back a little bit more to the United Nations' involvement here. I look upon this sort of natural hazard risks a little bit like a natural experiment. We can proceed in science a lot of times by data management, by simulation, by [inaudible], but most science advance is really by controlled experiments. Well these disasters [inaudible] uncontrolled and rather spontaneous events. And I wonder if we couldn't prepare for that a little better. And I'm thinking of an analogy here. In the, what is it called, the UAE, see the United Nations Environmental and Economic control group, when they were concerned about the possibility of proliferation they developed in the end a team, well first of all a set of equipments to deploy quickly and a team to maintain them. And then developed a cadre, an international cadre who could respond quickly to a possible event like that. And in fact they did such a simulation I think two summers ago in Jordan. Has there ever been talk of assembling the types of monitoring equipment that enable the people to respond [inaudible] to disasters like this, proactive instead of reactive? >> Dr Murray: I love your question about being more proactive to disaster preparedness rather than reactive. I love your idea of having a cadre of experts who can go and contribute to make sure that we understand what's happening with these disasters and learn from them fully and effectively. To me I want to remind you that Sendai calls for an all hazards approach. It is not just natural hazards. It is technological, environmental, infectious. It can be climatological, it could be even global mass ejections from the sun which we're all concerned about affecting our power supplies. I think one of the things that I found so interesting recently, I went to the International Association of National Public Health Institutes conference in Shanghai in October where all the national public health institutes come together. They even talked about a real all hazard approach that they weren't expecting which was financial shock. And that had a major impact upon how the National Institutes of Public Health were developing. Without a doubt all of us are vulnerable to all sorts of different types of hazards. And documenting and monitoring these is increasingly important. Possibly the strongest system we have in the world now are the international health regulations where each country is called upon to report every event that is, that needs to be reported under these regulations. At a meeting this morning it was interesting to hear the difficulty in trying to make sure the United States reported all the concerns that they had in a timely fashion. To me rather than necessarily having a cadre of experts who get flown in or [inaudible] in or whatever you want, suddenly there, perhaps like Batman, to me is not something that would be ideal. I think it would be helpful but I think the most important thing is to make sure that we've educated and trained and done the capacity development to make sure that the systems within each country are as adequate and as complete as possible to deal with these events, even for the rare types of events that are so difficult to manage. So is a cadre the answer? I don't know. But certainly UNISDR does call for a roster of experts so we know that there will be a call sometimes for the type of suggestion that you've had, be it for chemical, biological, radiological or any other type of event that causes us concern. [ Inaudible Question ] Wow, that's nice of you. So if I can just reflect, how can we best use science to inform decision making I think is a quick summary of your question, is that right? >> Well, where can I find out more about having technology [inaudible]? >> Dr Murray: Well there are certain issues about technology, but let's just go back to how we can best use science to inform decision making. Under the International Council of Science, which is the parent of all the science institutions and organizations in the world, which is based in Paris, they have set up a new group called the International Network for Government Science Advice. I strongly commend this organization to you and I've had the privilege of being a member of it and being very much involved in how we try and deliver science that is needed by policymakers, is provided in a timely and appropriate fashion to deliver the things that they need. There are a whole series of papers published in Nature and other places about how science can inform policy in practice and what are the pitfalls and what are the successes. But perhaps the most important piece of work that you need is the best evidence. Do we have the best systematic literature review that is most applicable that will deal with the issue that is of greatest concern at the time, which is why I'm so pleased that we have evidence aid here with us in the audience to try and take forward some of the skills that we need on systematic literature reviews, on understanding what the science might be to help to inform these decisions in a timely fashion. You ask about technical tools. They're fab but they're not perfect. It really depends what the problem is. And so often trying to provide the right evidence at the right time often means that you need to know a lot about the problem in the first place. So probably the best people to provide it are those who work within a country who have access to the multitudinous resources that may be there to help them to deliver the best advice. Now Library of Congress, you want to help us to deliver some of these. I'm thrilled. I met Tomoko at a [inaudible] conference in Denver in September. She and I just hit it off. The fact that she was at the same conference as me meant that we were working on the same topic, which is how do we improve access to open data to make it much more useful, usable and used for those people who need it. In the Library of Congress you are in such a privileged position. You provide information and evidence not only to your policymakers over the road, but also to evidence, to people who need the evidence across the world. That is a critical role. But if you can focus on how we can try and deliver it better, working with perhaps the National Academies of Science around the world which I've had great privilege in working with, but also other government science organizations, we even had systems within our own government in the UK that you might wish to partner with to see how we can deliver the best information. In the UK we have a system by which we take students who are doing their PhD's who get seconded to government for three months to answer specific questions. And what they do is to write parliamentary Office of Science and Technology notes, they're known as post notes. They're never more than four pages and they are as clear as possible about what is needed to try and help policymakers to try and make decisions. And we find it a wonderful training for our scientists to understand what the needs are of the policymaker, but also how you share that information in a way that is really accessible, transparent and available. Maybe that's an idea. If you do that, let's partner. >> Dr Steen: Please join me in thanking Professor Murray again. >> This has been a presentation of the Library of Congress. Visit us at loc.gov.