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"Third, we have seen that structural interventions can have an enormous impact on outcomes, even in the face of cost­effectiveness analyses and the flawed policies of international bodies"

"These are not the tasks for which clinicians were trained, but they are central to the struggle to reduce premature suffering and death. The importance of structural interventions for the future of health care means that practitioners of medicine and public health must make common cause with others who are trained to intervene more proximally."

"Pioneers of modern public health during the nineteenth century, such as Rudolph Virchow, understood that epidemic disease and dismal life expectancies were tightly linked to social conditions"

The author is Sonja D. Schmid, an associate professor at Virginia Tech in the Department of Science and Technology in Society. She specializes in STS (science, tech, and society) analysis, nuclear industries, and energy policies. In respect to emergency response, Schmid is able to use her knowledge of previous disasters, current energy technologies, and societal influences to address what we need nationally/ internationally for how we should respond to emergencies. The ability to identify the multifaceted levels of what causes disasters is important to properly responding to them- by changing technologies, training and education of communities, and changing energy policies to avoid and handle more disaster.

Publications relevant to the DSTS Network: "Evacuation from a nuclear disaster" (http://www.jstor.org/stable/214548?seq=1#page_scan_tab_contents), "A comparative institutional analysis of the Fukushima nuclear disaster: Lessons and policy implications" (http://www.sciencedirect.com/science/article/pii/S0301421512009433)

Research focusing on nuclear waste management, developments for safer nuclear energy and studies of the nuclear arms race are also relevant to DSTS Network.

1) "Approaches based on preparedness may not be guided by rigorous cost-benefit analysis. Rather, they are aimed at developing the capability to respond to various types of potentially catastrophic biological events"

2) "This analytical approach, when turned to the field of biosecurity, makes neither broad prescriptions for the improvement of health and security, nor blanket denunciations of new biosecurity interventions. Rather, it examines how policymakers, scientists, and security planners have constituted potential future events as biosecurity threats, and have responded by criticizing, redeploying, or reworking existing apparatuses"

3) "But increased attention and funding to health preparedness by no means implies consensus around a single approach. The existing institutions of public health are not easily reconciled with the new demands and norms of health preparedness and there is considerable disagreement about the appropriate way to achieve preparedness."

1. USAID and their contributions to Haiti

2. The Institute for Justice and Democracy in Haiti and their impact

3. The United Nations and if they've been sued by Haiti for cholera epidemic

1) "The most bizarre, and perhaps most telling, moment in the hearing occurred when Rep Anthony D. Weiner of New York, addressing the panel of experts, asked for the person in charge of the investigation to raise his hand. When three hands went up..."

2) "Clashes over authority among powerful institutions both public and private, competition among rival experts for influence, inquiry into a disaster elevated to the status of a memorial for the dead: these are the base elements of the World Trade Center investigation. And yet, even a brief historical review shows us that these elements are not unique."

3) "They were not reassuring, or especially enlightening answers. Some things were already known."

The report implies that technical professionals have to be more careful when responding to large scale disasters; staff responding to emergencies need to have more training for the many internal challenges that would lmit care and assistance to victims. MSF discussed how they had limited man power, labs, and resources.

1) "In this new state of social world, the body of the immigrant has become illegitimate as labor force, since it is always suspected of deleteriously affecting the job market, but the body of the foreigner has found a new source of legitimacy through illness, which, under certain conditions of seriousness and impossibility of receiving treatment in the country of origin, makes it possible to obtain a residence permit on "humanitarian grounds."

2) "Yet the variation in medical opinions observed was due less to the form of the procedure than to the use the medical officer made of it."

3) "Evaluation of this criterion, however, was not the outcome of a unilateral decision by the examining doctor or the social worker. Foreigners and their families might also develop tactics once they knew how the system worked."

Disaster investigations look at the emergency response that followed the incident, either the timing or actions taken to save human lives. There's more about the investigations calling for improved emergency preparedness; policies and technology development to prevent disasters such as the Hague Street Explosion (1850) which involved a faulty boiler (and other factors) and the Iroquois theater fire (1903) which led to changed theater building policies. 

The overarching goal of the report appears to be an overarching analysis of the current systems in place to address and research mental health outcomes in disaster events. The article firstly presents comorbidities known to predispose individuals to development of mental illness.This would be in the hands of the response team to recognize that a certain population may be more predisposed to developing PTSD from the event-- such as children or females, who have shown increased levels of PTSD and MDD. Recognizing that students from an all-girl's K-12 School who have just come from, say, a forest fire will be more likely to develop mental health complications after the disaster than a population of older, male welders will help streamline appropriate responses.

Secondly, by exploring and recognizing these factors (pre, peri, post), emergency responses can help prepare and minimize mental health effects. For example, by implementing PFA in all government agencies, this help mitigate the traumatic effects of experiencing a disaster; PFA includes three distinct goals in treating these patients, including limiting stress reactions and regaining feelings of control. 

Thirdly, while studying mental health in the wake of disasters is crucial to ensuring successful and adequate interventions, there are four major challenges, all discussed in the report (defining target population, obtaining representative sample, implementing an appropriate study design, and measuring key constructs). The authors contend that for future research, several key changes can be made to benefit overall research outcomes. These include widening the scope of psycho-pathological inquiry from to include other disorders such as GAD and panic disorder, the time ranges studied (with higher emphasis on pre/peri factors to help tailor interventions), other factors that create predisposition, and further intervention implementation.