World Health Organisation. (Pp 141; Sw Fr 42). 1999. Geneva: World Health Organisation. ISBN 92 4 154519 4

• emergency
• disaster

Human and economic losses from natural disasters continue to rise around the world, a trend punctuated by highly devastating events such as Hurricane Mitch in Central America (1998) and the earthquake in Gujarat in India in 2000, when tens of thousands of people were killed or severely injured and communities containing hundreds of thousands of people have still not recovered from the inflicted damage. The International Decade for Natural Disaster Reduction (IDNDR) was launched by the United Nations in the 1990s, in a bold attempt to reduce such losses by transferring knowledge to mitigate hazards to the developing world where 90% of natural disasters and 96% of the deaths occur. The IDNDR did have the effect of focusing the attention of many scientists, especially those involved in the earth and meteorological sciences and engineering, towards the application of their work in reducing natural hazards. The concepts of mitigation, or disaster prevention, also spread to a much wider audience, including national and local government policy makers charged with emergency management. This book is timely in summarising disaster reduction in the terms of emergency preparedness and in a way that can be used to support the development of policies and enlisting the involvement of a wide range of local and national agencies. It might therefore be expected to be useful reading for an even wider audience, such as health practitioners in occupational and environmental health, public health workers, and groups involved in emergency response. Disaster planning is slowly moving up the agenda of global public health, partly because of growing awareness that climate change will worsen the risk of floods and windstorms in many countries, but also because they are “unexpected events”, in the same bracket as emergent diseases and biochemical terrorism incidents. Parallels are also seen in industry, such as the Bhopal chemical release in India in 1984, and the undermining of consumer confidence in Belgium in 1999 when dairy products became contaminated with dioxin. These and similar toxic incidents have wide industrial and political reverberations, making corporations extend their risk management strategies from occupational hazards to a wider environmental remit. This is not all: business is now increasingly being perceived as a process of risk management in which “salient events” can provoke sudden, seismic shifts in the financial and customer markets that threaten the viability of corporations and even governments.

Unfortunately, however, this book has overshot the zeitgeist in its attempts to unify the disaster field by generalising its approach to what are quite different phenomena. Thus the impacts and planning issues for floods are very different from chemical releases, for example. The authors have obviously been attracted to applying the language of mitigation across the board, while ignoring the large practical differences of dealing with the separate hazards. This superficial approach seriously underestimates the scope of natural and technological disaster reduction and hence the measures needed for coping with catastrophe. The book does make a laudable attempt to put the different disaster impacts into risk scales and scoring systems, and these will at least make the reader reflect on the way in which scientific advances in understanding extreme natural processes can illuminate what for many is an arcane subject. Indeed, computer modelling of natural processes, including meteorological and climate phenomena, are starting to drive our understanding of the ways in which the natural world behaves and causes damage, together with loss of life, in extreme events. Since the 1980s it has been possible to model technological hazards, such as the dispersion of dense gases and the effects of explosions of flammable substances, a development that has enabled major incident planning for chemical hazards to be a regulatory requirement. We are on the verge of similar breakthroughs with floods and volcanic eruptions using numerical simulation on a more scientific footing. By analogy, world financial markets cannot run their risks without mathematical models to help reduce uncertainty to manageable levels. But learning to come to terms with scientific uncertainty is an essential prerequisite of disaster mitigation work and no manager should set about emergency preparedness unless he or she understands this. Unfortunately this book shows little awareness of the scientific tools needed for the job in hand and their limitations. Who plans for a publication devoted entirely to health sector preparedness should include drawing on a wider diversity of interdisciplinary expertise than is evident in this volume.