Dyson College of Arts and Sciences

Discussion: According to the Resilience Alliance, resilience is defined as the ability to absorb disturbances as well as to learn from disturbances (Resilience Alliance 2002). The flexibility and elasticity inherently built into a system is predictive of the systems level of resilience. In terms of vulnerable/underserved populations, there is a pre- existing reduced level of system flexibility and infrastructure to adequately support the members of their population. In the effort to be better prepared for emergencies and disasters, The United Nations has been providing toolkits specifically for emergency preparedness and disaster relief for decades. For the purpose of this discussion, I refer to two specific documents/tools: 1. The Ten Essentials for Making Cities Resilient, which was developed and published by UNIRDS to help cities and their organizations assess and prepare for disasters in order to become "resilient cities" (The United Nations Office for Disaster Risk Reduction (UNISDR) 2012). The most pertinent essential for this discussion is the Fifth Essential: "Assess the safety of all schools and health facilities and upgrade these as necessary." The Fifth Essential mandates that vital facilities, such as schools and health facilities, continue to operate post-emergency. It is more than likely that these facilities will not function as they did prior to an emergency or disaster; moreover it is likely that they may have sustained physical damage and are rendered dysfunctional (e.g. Hurricane Katrina, Hurricane Sandy). To this end these vital facilities need to plan to continue providing services without "walls" or technology. 2. The Hospital Safety Index is a tool developed by PAHO and a group of Caribbean and Latin American experts. It is used by health authorities to gauge the probability that a hospital or health facility will continue to function in emergency situations. "The Hospital Safety Index provides a snapshot of the probability that a hospital or health facility will continue to function in emergency situations, based on structural, nonstructural and functional factors, including the environment and the health services network to which it belongs. By determining a hospital's Safety Index or score, countries and decision makers will have an overall idea of its ability to respond to major emergencies and disasters. The Hospital Safety Index does not replace costly and detailed vulnerability studies. However, because it is relatively inexpensive and easy to apply, it is an important first step toward prioritizing a country's investments in hospital safety." (The United Nations Office for Disaster Risk Reduction (UNISDR) 2012) This index is limited to the evaluation of the inpatient setting and yet again highlights the need for a tool to evaluate the resources and facilities available for vulnerable populations in the community setting. The underlying assumption of these tools and frameworks is that the complexities and risks are reasonable and do not extend beyond the needs of an "average" person. The tools do not plan for the complexities and needs of vulnerable/underserved populations. 54

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