Skip to main content Accessibility help

Determining Key Influences on Patient Ability to Successfully Manage Noncommunicable Disease After Natural Disaster

  • Benjamin J. Ryan (a1) (a2), Richard C. Franklin (a2) (a3), Frederick M. Burkle (a2) (a4), Erin C. Smith (a2) (a5), Peter Aitken (a2) (a6) and Peter A. Leggat (a2) (a3) (a6)...



Natural disasters often damage or destroy the protective public health service infrastructure (PHI) required to maintain the health and well-being of people with noncommunicable diseases (NCDs). This interruption increases the risk of an acute exacerbation or complication, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of NCDs will continue, if not increase, due to an increasing prevalence and sustained rise in the frequency and intensity of disasters, along with rapid unsustainable urbanization in flood plains and storm-prone coastal zones. Despite this, the focus of disaster and health systems preparedness and response remains on communicable diseases, even when the actual risk of disease outbreaks post-disaster is low, particularly in developed countries. There is now an urgent need to expand preparedness and response beyond communicable diseases to include people with NCDs.


The developing evidence-base describing the risk of disaster-related exacerbation of NCDs does not incorporate the perspectives, concerns, and challenges of people actually living with the conditions. To help address this gap, this research explored the key influences on patient ability to successfully manage their NCD after a natural disaster.


A survey of people with NCDs in Queensland, Australia collected data on demographics, disease, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with a Bonferroni-adjustment were used to analyze data.


There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatigue, and shortness of breath were common concerns for all patients with NCDs. Those dependent on care from others were most worried about shortness of breath and slow healing sores. Accessing medication and medical services were priorities for all patients post-disaster.


The key influences on successful self-management post-disaster for people with NCDs must be reflected in disaster plans and strategies. Achieving this will reduce exacerbations or complications of disease and decrease demand for emergency health care post-disaster.


Corresponding author

Correspondence: Benjamin J. Ryan, PhD, MPH, BScEH, Daniel K. Inouye Asia-Pacific Center for Security Studies, 2058 Maluhia Road Honolulu, Hawaii 96815 USA E-mail:


Hide All
1. UNISDR. Sendai Framework for Disaster Risk Reduction 2015–2030. Geneva, Switzerland; 2015.
2. WHO. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. Geneva, Switzerland; 2013.
3. Australian Department of Health. Chronic disease. Published 2014. Accessed June 25, 2015.
4. WHO. Noncommunicable diseases - fact sheet. Published 2015. Accessed September 16, 2016.
5. AIHW. Australia’s Health 2014. Canberra, Australia: Australian Institute of Health and Welfare; 2014.
6. CDC. Chronic Diseases and Health Promotion. Published 2014. Accessed October 25, 2014.
7. WHO. Major NCDs and their risk factors. Published 2016. Accessed September 16, 2017.
8. Ryan, BJ, Franklin, RC, Burkle, FM Jr, et al. Ranking and prioritizing strategies for reducing mortality and morbidity from noncommunicable diseases post disaster: an Australian perspective. International Journal of Disaster Risk Reduction. 2018;27:223238.
9. WHO. Background Paper: Non-communicable diseases in low- and middle-income countries. Published 2010. Accessed April 11, 2012.
10. Watson, JT, Gayer, M, Connolly, MA. Epidemics after natural disasters. Emerging Infectious Diseases. 2007;13(1):1.
11. Ryan, BJ, Franklin, RC, Burkle, FM Jr, et al. Reducing disaster exacerbated non-communicable diseases through public health infrastructure resilience: perspectives of Australian disaster service providers. PLOS Curr. 2016;8.
12. Ryan, BJ, Franklin, RC, Burkle, FM Jr, et al. Defining, describing, and categorizing public health infrastructure priorities for tropical cyclone, flood, storm, tornado, and tsunami-related disasters. Disaster Med Public Health Prep. 2016;10(4):598610.
13. Ryan, BJ, Franklin, RC, Burkle, FM, et al. Identifying and describing the impact of cyclone, storm and flood related disasters on treatment management, care and exacerbations of non-communicable diseases and the implications for public health. PLOS Curr. 2015;7.
14. Gnanapragasam, S, Aitsi-Selmi, A, Rashbrook, E, Murray, V. Addressing non-communicable diseases in disaster risk reduction–an issue of equity. J Epidemiol Glob Health. 2016;6(2):119121.
15. WHO. Noncommunicable Diseases in Emergencies. Geneva, Switzerland: World Health Organization; 2016.
16. AIHW. Australia’s Health 2006. Canberra, Australia: Commonwealth of Australia; 2006.
17. Queensland Health. The Health of Queenslanders 2014. Published 2014. Accessed November 14, 2015.
18. Evans, J. Mapping the vulnerability of older persons to disasters. Int J Older People Nurs. 2010;5(1):6370.
19. Swerdel, JN, Janevic, TM, Cosgrove, NM, Kostis, JB. The effect of Hurricane Sandy on cardiovascular events in New Jersey. J Am Heart Assoc. 2014;3(6):e001354.
20. COAG. National Strategy for Disaster Resilience– Building the Resilience of Our Nation to Disasters. Barton, ACT: Commonwealth of Australia; 2011.
21. McMichael, AJ, Woodruff, RE, Hales, S. Climate change and human health: present and future risks. Lancet. 2006;367(9513):859869.
22. CRED. The Human Cost of Natural Disasters - A Global Perspective. Brussels, Belgium: Centre for Research on the Epidemiology of Disasters; 2015.
23. Demaio, A, Jamieson, J, Horn, R, de Courten, M, Tellier, S. Non-communicable diseases in emergencies: a call to action. PLoS Curr. 2013;5.
24. ADEA. The Needs of People with Diabetes and other Chronic Conditions in Natural Disasters: A Guide for Emergency Services, Local Councils and the Not-for-Profit Sector. Canberra, Australia: Diabetes Australia and the Australian Diabetes Educators Association; 2015.
25. Ryan, BJ, Franklin, RC, Burkle, FM, et al. Analyzing the impact of severe Tropical Cyclone Yasi on public health infrastructure and the management of noncommunicable diseases. Prehosp Disaster Med. 2015;30(1):2837.
26. WHO. Disaster Risk Management for Health - non-communicable diseases. Published 2011. Accessed May 21, 2015.
27. Queensland Health. Queensland Health Organisational Structure. Published 2017. Accessed May 25, 2017.
28. Queensland Government. Queensland State Disaster Management Plan - Reviewed September 2016. Brisbane, Australia: The State of Queensland (Queensland Police Service); 2016.
29. Queensland Health. The Health of Queenslanders 2016. Published 2016. Accessed April 1, 2017.
30. Australian Bureau of Statistics. 3101.0 - Australian Demographic Statistics. Published 2016. Accessed May 30, 2017.
31. Queensland Government. Interesting facts about Queensland. Published 2014. Accessed May 30, 2017.
32. Australian Government. Area of Australia - States and Territories. Published 2017. Accessed May 30, 2017.
33. Creswell, J. Qualitative Inquiry and Research Design. Washington, DC USA: SAGE Publications; 2013.
34. Aiken, LH, Clarke, SP, Sloane, DM, Sochalski, J, Silber, JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):19871993.
35. Dawson, D, Trapp, R. Basic & Clinical Biostatistics. Singapore: McGraw-Hill; 2001.
36. Armstrong, RA. When to use the Bonferroni correction. Ophthalmic Physiol Optics. 2014;34(5):502508.
37. McDonald, JH. Handbook of Biological Statistics. Baltimore, Maryland USA: Sparky House Publishing; 2009.
38. Asian Disaster Preparedness Centre. Total Disaster Risk Management: Good Practices. Asian Disaster Preparedness Center (ADPC); 2005.
39. Grady, PA, Gough, LL. Self-management: a comprehensive approach to management of chronic conditions. Am J Public Health. 2014;104(8):e25-e31.
40. Kim, SJ, Lim, GJ, Cho, J, Côté, MJ. Drone-aided healthcare services for patients with chronic diseases in rural areas. J Intel Robot Syst. 2017:118.
41. Burns, PL, Aitken, PJ, Raphael, B. Where are general practitioners when disaster strikes? Med J Aust. 2015;202(7):356358.
42. FNQ Carers Group. Navigating the Mental Health System. Cairns, Australia; 2016.
43. Far North Queensland Partners in Recovery. Remedy, Ritual and Recovery: A Comparison of Remote and Urban Traditional Healing Models. Cairns, Australia; 2016.
44. Mitchell, RD, Aitken, P, Franklin, RC. The physical health impacts of tropical cyclones. Annals of the ACTM. 2014;15(1):2.
45. Ryan, BJ, Bhatia, SB. Disaster Risk Reduction - Workshop Delivery for Primary Health Care. Published 2016. Accessed October 7, 2016.
46. Hughes, RT, Trantham, P. When disaster strikes, humanity becomes our patient. Perm J. 2011;15(3):e118.
47. Geiling, J, Burkle, FM, West, TE, et al. Resource-poor settings: response, recovery, and research: care of the critically ill and injured during pandemics and disasters: CHEST Consensus Statement. Chest. 2014;146(4):e168Se177S.
48. Harwood, RH, Sayer, AA, Hirschfeld, M. Current and future worldwide prevalence of dependency, its relationship to total population, and dependency ratios. Bull World Health Organ. 2004;82(4):251258.
49. Ortman, JM, Velkoff, VA, Hogan, H. An Aging Nation: The Older Population in the United States. United States Census Bureau, Economics and Statistics Administration, US Department of Commerce; 2014.
50. Queensland Government. Disaster management arrangements. Published 2016. Accessed March 23, 2016.
51. Slama, S, Kim, HJ, Roglic, G, et al. Care of non-communicable diseases in emergencies. Lancet. 2017;389(10066):326330.
52. WHO. Social determinants of health. Published 2017. Accessed April 8, 2017.
53. AIHW. Australia’s Health - Social Determinants of Health. Published 2016. Accessed September 26, 2017.
54. Jarvis, MJ, Wardle, J. Social Patterning of Individual Health Behaviours: The Case of Cigarette Smoking. Oxford University Press; 2005.
55. Australian Government. National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Canberra, Australia: Department of Health; 2013.
56. Donahue, JD. On collaborative governance. Corporate Social Responsibility Initiative Working Paper. 2004;2.
57. O’Flynn, J, Wanna, J. Collaborative Governance: A New Era of Public Policy in Australia? Canberra, Australia: ANU Press; 2008.
58. Queensland Government. Disaster Management Strategic Policy Framework. Brisbane, Australia: Queensland Government; 2010.
59. The Sphere Project. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. Geneva, Switzerland: The Sphere Project; 2011.
60. WHO. Global Health and Ageing . Geneva, Switzerland: World Health Organization; 2011.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed