ResearchOnline@JCU This file is part of the following work: Ryan, Benjamin J. (2018) Addressing the impact of disasters on public health infrastructure and noncommunicable diseases. PhD thesis, James Cook University. Access to this file is available from: https://doi.org/10.25903/5b5e8fdb27fb0 Copyright © 2018 Benjamin J. Ryan. The author has certified to JCU that they have made a reasonable effort to gain permission and acknowledge the owner of any third party copyright material included in this document. If you believe that this is not the case, please email [email protected] Addressing the impact of disasters on public health infrastructure and noncommunicable diseases Benjamin J. Ryan Bachelor of Science in Environmental Health Master of Public Health 25 June, 2018 A thesis submitted for the degree of Doctor of Philosophy In the College of Public Health, Medical and Veterinary Sciences James Cook University, Australia This page deliberately left blank. ii Student Biography Benjamin J. Ryan, PhD Candidate, MPH, BSc (Environmental Health) Associate Professor, Daniel K. Inouye Asia-Pacific Center for Security Studies Honolulu, Hawaii, USA Benjamin J. Ryan joined the Daniel K. Inouye Asia-Pacific Center for Security Studies (APCSS), Honolulu, United States of America, from Queensland Health, Australia, in August 2017. His areas of focus at APCSS are community resilience, disaster management, environmental security, global health and regional disaster coordination. He has led workshops, training, lectures and activities in his areas of focus across the Asia-Pacific, Europe and North America. This includes representing the United States Government in engagement with the Association of Southeast Asian Nations (ASEAN) on humanitarian assistance and disaster relief, responding to natural disasters and disease outbreaks (including Ebola and Dengue), leading health preparations for the G20 Finance Ministers meetings in Australia, managing projects in Indigenous communities and facilitating health services for asylum seekers. He has worked at local, state, federal and executive levels of government in Australia. Mr. Ryan’s PhD research has focused on developing strategies for reducing the impact of disasters on people with noncommunicable diseases. He has completed a Master of Public Health at the University of Wollongong, Australia, and a Bachelor of Science in Environmental Health at Griffith University, Australia, where he received an award for academic excellence. He has collaborated with researchers in Australia and Japan to improve evacuation centre standards for vulnerable groups and supported the United Nations Office for Disaster Risk Reduction Global Education and Training Institute (UNISDR-GETI) efforts to implement the Sendai Framework for Disaster Risk Reduction 2015-2030. Mr. Ryan also assisted the World Health Organization’s review of the disaster risk management for health fact sheet on noncommunicable diseases. Mr. Ryan has: published 11 peer-reviewed articles, two guidelines and a textbook chapter; delivered 17 conference presentations (ten international, two national, one state and four regional); facilitated seven disaster risk reduction workshops for UNISDR-GETI; and conducted seven media interviews relating to noncommunicable diseases, disaster management and the environmental health aspects of disasters. iii Acknowledgements I would like to sincerely thank the many people who have provided encouragement, guidance and support throughout this research. The people I wish to express my gratitude to expands beyond this acknowledgements section, however, there people that I would like to thank individually. To my wife Peta and children Lara, Hudson and Ella. Without your patience and support, I would not have been able to complete this research and be where I am today. You have kept me in touch with the “real world” while I have been focused on this research. Your love and support mean the world to me and has kept me rational during the challenging times of this study. For being there for me, a big thank you! To my parents, John and Robyn. Your ongoing support, encouragement, guidance and opportunities you made possible over the years have allowed me to be where I am today. I am forever grateful for the sense of self-confidence, belief and resilience you have instilled in me. I hope completion of this research and awarding of a PhD is in some small way as joyful for you as it is for me. My primary advisor Associate Professor Richard Franklin. I would like to express my gratitude and thanks for your guidance, advice and commitment to this research. You have definitely enriched the research experience and I now see how all the queries, challenges and tests along the journey were necessary. Sincerely, thank you for all your support, leadership and vision. It has been a great journey and without you, I would not be here today. To “Uncle Skip” Professor Frederick Burkle Jr. mentor and advisor. It has been an honour having your incredible insights, expertise, leadership and support throughout this research. You have made this journey a truly rewarding experience. Thank you for guiding the research topic, enthusiasm to share the findings and connecting me with other researchers and professionals across the world. You are truly an inspirational mentor and humanitarian leader. Associate Professor Peter Aitken. I greatly appreciate you sharing your knowledge, experience, passion for disaster health and willingness to help translate this research into action. I have truly valued not only your academic support but also the professional advice you have provided. Without you, I would not have completed this PhD. Thank you. iv Professor Peter Leggat. You were with me at the beginning of the PhD journey and through all the milestones, challenges and tests along the way. Thank you for sticking with me. I greatly appreciate the time you made available, contributions and willingness to support the research. It was great to have you involved. To Dr. Erin Smith. Thank you for your assistance, particularly helping me at the start of the research and sharing your knowledge, expertise and contacts in the field of disaster health. I would not have navigated the challenges and tests along the way without your ongoing guidance and enthusiasm. I am honoured to have you as part of this research. Associate Professor Kerrianne Watt. Thank you for your assistance developing and enriching the methodology used for this research. It was a privilege having you involved in this project. I greatly appreciate your contributions. The late Professor Ross Spark. Without your encouragement and advice, I would not have contemplated undertaking PhD studies. Also, thank you for the encouragement to start and complete a Master of Public Health, which led me into postgraduate studies. Thank you to the Cohort Doctoral Studies Program at James Cook University, particularly Dr Melissa Crowe. Without your support, workshops, writing retreats and nurturing throughout the studies, I would not have been able to complete this research. Thank you to the Australian Centre for Health Services Innovation (AusHSI), Toowoomba Hospital Foundation and Cunningham Centre, Far North Queensland Hospital Foundation, Higher Degree Research Enhancement Scheme at James Cook University and the Northern Queensland Primary Health Network. The funding and support you gave provided the confidence and mechanisms required to complete this research. I am truly grateful. To the Cairns and Hinterland Hospital and Health Service, Queensland Health, Australia, my employer throughout the majority of the PhD journey. Thank you for your support, encouragement and willingness to give me time off to complete the studies. Thank you to the Daniel K. Inouye Asia Pacific Center for Security Studies, United States of America, my employer at the time of submission. I am truly thankful for the encouragement, support and motivation you provided as I finalised the thesis. v Finally, the people with noncommunicable diseases and disaster service providers who participated in this project. Thank you for making the time available to participate. I truly hope the research findings capture your insights and recommendations. vi Statement of the Contribution of Others Assistance Contribution Contributors Supervision Primary advisor A/Prof Richard Franklin, James Cook University Advisors Prof Frederick Burkle, Harvard University A/Prof Peter Aitken, James Cook University Dr Erin Smith, Edith Cowan University A/Prof Kerrianne Watt, James Cook University Prof Peter Leggat, James Cook University Intellectual Proposal writing A/Prof Richard Franklin, James Cook University support Data Analysis A/Prof Richard Franklin, James Cook University Ranking and prioritising A/Prof Richard Franklin, James Cook University public health infrastructure Prof Frederick Burkle, Harvard University A/Prof Peter Aitken, James Cook University Statistical support A/Prof Richard Franklin, James Cook University Editorial assistance A/Prof Richard Franklin, James Cook University (manuscripts) Prof Frederick Burkle, Harvard University A/Prof Peter Aitken, James Cook University Dr Erin Smith, Edith Cowan University A/Prof Kerrianne Watt, James Cook University Prof Peter Leggat, James Cook University A/Prof Richard Franklin, James Cook University Editorial assistance (thesis) Ms. Katharine Fowler, Copy Editor Financial Research grants Infront Outback Grant, Toowoomba Hospital support Foundation and Cunningham Centre