Posted December 1999

Population, poverty and vulnerability: Mitigating the effects of natural disasters, Part 1

I. Introduction ^[1]

Mitch is, however, not an isolated incident. The Central-American region is perennially exposed to natural hazards of a physical, geological or meteorological nature. These hazards are transformed into disasters by the fact that the zone is extremely vulnerable for social reasons (high levels of poverty), economic reasons (failure to consider natural disasters in the location and characteristics of economic activity), and environmental reasons (inadequate land use on steep slopes, deforestation, erosion, inappropriate location of settlements, occupation of watersheds, etc.) (SICA 1999). Table 1 portrays the frequent loss in human lives that has resulted over time from the combination of these different types of vulnerability and various forms of natural hazards in the region.

Given this blending of natural and social conditions in the region, the recurrence of Mitch-type events is to be expected in Central America and the Caribbean. Unfortunately, attention to such threats tends to wane rather quickly, with assistance being focused principally on issues of short-term recuperation, rather than on prevention for the medium and long range. More effective contributions will require a long-range preventive approach directed to structural issues, rather than short-term remedial actions.

It is the contention of this paper that, within this perspective of longer-range prevention, greater attention should be paid to population dynamics. It would seem obvious that demographic processes are fundamental in shaping the nature and gravity of the impacts caused by natural disasters. Yet, they are rarely taken into account. Even the UN International Decade for Natural Disaster Reduction apparently paid scant attention to population dynamics in its campaign. True, policymakers and specialists alike routinely assert that population growth and rapid urbanization increase the negative effects of natural occurrences. However, this truism does not lead to effective action since the nature and characteristics of the relations between population growth and distribution on the one hand, and natural disasters on the other, are rarely identified with clarity. At most, a vague wish for reduced population growth or an end to city-ward migration is expressed. This is largely ineffective since the underlying rationale for people's demographic behaviour, whether with respect to growth or distribution, tends to be overlooked.

The present paper proposes to help breach this gap by analyzing the relationship between demographic dynamics and Hurricane Mitch in Central America, and extracting from this experience lessons that can help reduce vulnerability in the long run. Specifically, it centers on three aspects: How did demographic processes condition the area's vulnerability prior to Mitch? What are Mitch's consequences for population dynamics in the short and long term? What changes must be introduced in population dynamics if the effects of future natural disasters are to be mitigated?

As seen from the Table 2, every Central American country was affected by Mitch, but the worst hit were Honduras and Nicaragua. Although the frame of reference for this paper is the entire region, many of the illustrations are taken from Honduras, the country most affected by this hurricane.

Socio-demographic conditioners of vulnerability

The relation between socio-economic conditions and the impact of natural disasters can be expressed in this way: due to economic constraints, the poor are forced to live in precarious homes, made of flimsy, non durable materials, on the least-valued plots of land. They build their shacks on steep hillsides, on floodplains, in fragile ecosystems and watersheds, on contaminated land, right-of-ways and other inappropriate areas. Even government housing and urban development policies tend to overlook environmental constraints and lack adequate information for land use planning. Inappropriate location evidently invites serious social and environmental problems. Moreover, it is aggravated by deforestation, as well as by inadequate management of rainwater and wastes. During disasters, inadequate services and infrastructure further complicate survival efforts. Health risks are similarly accentuated. By comparison, the homes of the upper and middle classes are better constructed, built with hardier materials on more stable terrain and their residents enjoy better services; furthermore, they have more resources with which to rebound from disasters ^[2].

In short, poverty is a central component of vulnerability. This was again borne out in the case of Hurricane Mitch. A task force, formed by INCAE (Instituto Centroamericano de Administración de Empresas) and by Harvard University's Institute for International Development, concluded that "the conditions of poverty in Central America are the fundamental cause of their vulnerability in the face of natural disasters" (in Hernández 1999:8). In turn, poorer areas are most significantly affected. In the case of Nicaragua, the municipalities affected by Hurricane Mitch have been those with the highest levels of poverty in the country, especially in rural zones. "According to the FISE (Fondo de Inversion Social de Emergencia) classification, of the 58 poorest municipalities in the country, 40 are located in the provinces worst affected by Hurricane Mitch" (UNDP 1998: 2). In Guatemala, the Vice-president affirmed that "the tragedy highlighted accumulated needs and deficiencies as well as shoddy handling." (in Hernández 1999:8). "In Honduras, although the damage spread to all social strata, there is no doubt that the greatest number of victims emerged from the most humble communities such as those of the Municipality of Choloma, La Lima and El Progreso, its towns and banana fields" (op. cit.).

Demographic processes are, in turn, important elements in the makeup and persistence of poverty. It will be recalled that demographic dynamics (growth and population distribution) are the result of interaction between three variables: fertility, mortality and migration. Levels and patterns of these three variables together generate the basic scenario of vulnerability, its size, and its spatial location, in given social and economic contexts. Even though the path of natural phenomena such as tropical storms is difficult to anticipate, the occupancy and utilization of a given territory conditions, to a great extent, the gravity of threats represented by natural disasters. Similarly, varying reproduction patterns among different social groups determine the relative size of their families and, to a certain extent, also condition their levels of poverty, housing characteristics, crowding, access to services, infrastructure and other elements. These predestine not only their susceptibility but also their capacity to face natural disaster. Following is a brief analysis of demographic processes and their relation to vulnerability in the case of Hurricane Mitch.

Concerning fertility, the three Central American countries most affected by Mitch are, coincidentally, those characterized by the highest fertility levels in the region: Honduras, Guatemala and Nicaragua. However, in all these countries there are significant differences in patterns of fertility per social groups with the poorest showing much higher levels. Of all these groups, the poor living in rural areas have the highest birth rate.

These fertility patterns reflect the fact that the poorest have the least capacity to exercise their reproductive preferences. As shown in Table 3, surveys conducted among the female population show that women from the lowest socio-economic level in Honduras have twice as many children as they would like ^[3]. This inability to exercise their reproductive rights is the starting point for a vicious circle centered on the intergenerational transmission of poverty. Because they are poor, women have limited information and resources to limit procreation as they would wish. Forced to bring up many children, women cannot obtain paid employment and the family has a low per capita income. Children born to these poor families have less possibility of receiving an education and when they begin their sexual life - often at an early age - they also have little information and resources, thus setting conditions for the recreation of the poverty cycle.

Mortality levels are also clearly differentiated according to socio-economic strata. According to the 1996 ENESF Survey in Honduras, a child's probability of dying before the age of 5 is 64 per thousand in strata defined as "low", compared to 38 per thousand in children from the "high" strata. Such evidence does not require further analysis here. The point is that the factors which underlie differential mortality prior to Mitch - malnutrition, lack of access to services, poor water and sanitation, and so forth - also condition differential susceptibility to disaster. But perhaps the most visible and direct relation between demographic dynamics, poverty and vulnerability relates to patterns of spatial redistribution of the population. Urban-rural migration and urban growth are partly the result of poverty, while also constituting factors that aggravate and heighten the impact of natural disasters. Over the last decades, all Central American countries have witnessed a process of population concentration in urban areas due to migration currents, particularly in the most important cities. In Honduras, during the five years prior to the Population Census of 1988, the majority of internal migration went to the northern and north-central part of the country - the Provinces of Cortés and Francisco Morazán. Although these provinces were not the worst hit, they are, according to an ECLAC report (1999a), those in which the greatest number of people were directly or indirectly affected by Mitch.

Migration currents have been differentiated by gender. Thus, female migration is primarily directed to urban centers, while men move more frequently to agricultural areas (Atlántida y Colón). An important element attracting female labour has been the sweatshop manufacturing industry concentrated in San Pedro Sula and Puerto Cortés.

Rural-urban migration results from both factors of expulsion and factors of attraction. In rural areas, agriculture can no longer deal with demographic growth, despite some migration to frontier areas: this creates a relative surplus. Concomitantly, a greater relative availability of jobs (whether real or perceived), higher incomes and a greater accessibility to services in the cities serve to attract migrants. The concentration of population in the cities has resulted in a scarcity of land for housing of these new inhabitants. As spatial utilization and access to land are determined by capricious market factors, the throng of new poor migrants cannot be conveniently accommodated. Considering the probability that rural-urban (as well urban to urban) migration will continue to increase, as discussed below, urban marginality can be expected to grow significantly. As a result, vulnerability will also increase significantly, unless specific measures are taken to counter current trends.

In its report on the effects of Mitch, ECLAC considers the case of Honduras' capital, Tegucigalpa, noting that what has happened there is similar to the experiences of other Latin American cities, where there is "inappropriate territorial occupation and utilization with a lack of regulations for urban organization and construction. These factors, coupled with urban growth and a high incidence of poverty, result in conditions which could imply that a significant part of the population of this city may be exposed to the serious risks as experienced with hurricane Mitch" (ECLAC 1999).

II. Socio-demographic effects of Hurricane Mitch

Quantifying the demographic effects of disasters is a complex task. The effects may be direct or indirect, and they can be immediate or longer term. Long-term effects may be difficult to predict and may themselves be the result of the interaction between demographic variables and a number of other factors also affected by disasters, such as changes in the structure of production, infrastructure, communications or access to basic services. The decisions made in immediate response to the disaster will greatly determine the direction of recovery efforts. For this reason, policies must reflect long-term strategies.

Serious difficulties have been encountered while attempting to obtain concrete data beyond counts of the dead or missing in the aftermath of Mitch. The lack of baseline information complicates the compilation of detailed and reliable estimates concerning the direct or indirect, short or long-term effects. In spite of such difficulties, a simple model of possible relations and effects of Hurricane Mitch on demographic variables and on population dynamics in general provides interesting results. The exercise in this case is focused on Honduras.

Effects on demographic variables

Mortality

Diagram 1 shows the theoretical effects of Hurricane Mitch on total mortality rates in Honduras. The only concrete data available refer to direct effects. It is estimated that the hurricane resulted in a total of 13,567 deaths, two thirds of which concern persons who were declared missing and who have been added to the official figures of those confirmed dead.

These figures imply a 42% excess in the number of deaths for the year, using as a baseline the total number of deaths expected in the country under normal circumstances in 1998 (32,000). A similar impact on total deaths (42%) may be applied to the crude death rate. The mortality effect, however, was greater in some of the larger provinces such as Gracias a Dios and the Islas de la Bahia, where deaths caused by Mitch exceeded the yearly number of expected deaths by close to 400%.

Only fragmentary data are available in relation to short term indirect effects, that is to say, those resulting from the deterioration of the health conditions of the population as a result of the hurricane. According to health authorities, an increase in infectious and respiratory diseases was confirmed. This would suggest an increase in deaths as a result, particularly if, as can be expected, the lethality levels of these diseases were to increase. These factors could have a particular effect on children and the elderly population. Even though vital statistics do not reveal the magnitude of these effects, figures provided by the Ministry of Health show an increase of 20% in the incidence of diarrhea in the under 15 population, as well as epidemic outbreaks of leptospirosis and conjunctivitis, skin diseases and acute respiratory infections (Ayes Cerna, 1999). There are no reliable quantitative data, however, on the extent of the latter increases.

Residual after-effects of a more permanent nature can be expected, due to lack of access to drinking water, sanitation and to the deterioration of conditions in health centers. Although, in the main, services have been rapidly restored, the situation is still not completely normalized.

Indirect medium-term effects are more complex to identify. Nevertheless, one could suppose that the magnitude and direction of these effects will depend on whether or not the damages caused by Mitch serve as motivation for the reactivation of economic activity and for the reduction of social and economic levels of vulnerability in important segments of the population. Levels of international help and the post-Mitch expansion of sectors such as the construction industry, as well as the intensification of anti-poverty actions in the sequel of Mitch, would be critical in this concern. That is to say, indirect medium-term effects would depend on the extent to which difficulties are transformed into opportunities and this, in turn, would depend largely on what political and economic actions are implemented by the Government. In the second meeting of the Consultative Group for the Reconstruction and Transformation of Central America (Stockholm, May 25-28, 1999), the international community of donors committed $US 9 billion to the reconstruction process ^[4]. Plans for reconstruction are directed primarily to the reactivation of the economy, the alleviation of poverty, the rational utilization of natural resources and protection of the environment, and the promotion of local initiatives that can help mitigate vulnerability to natural disasters ^[5].

It is likely that Hurricane Mitch has, in the short term, temporarily caused stagnation in the epidemiological transition previously on-going in the country, perpetuating the important role of preventable diseases in morbidity and mortality structures. However, the promotion of the reconstruction process in general, and in the health sector in particular, as well as the recovery of economic activities, suggest that Mitch's effects on the epidemiological transition would be less severe in the medium and long term. Moreover, health programs for emergencies are generally more effective nowadays and can help prevent epidemics.

No reliable or detailed information which would allow us to relate the mortality caused by Mitch to the socio-economic levels of the population is available; nevertheless, two pieces of evidence would indicate that, in fact, the greatest mortality levels were experienced by the poor. Firstly, observations carried out on the effects of the hurricane show that, in both San Pedro Sula and Tegucigalpa, the areas with the greatest number of missing and dead are also environmentally unsafe areas (due to landslides, floods, etc.), whose inhabitants are the poorest. (Not shown) Secondly, the composition of those housed in shelters can be taken as a valid indicator of vulnerability. Data from shelter censuses in San Pedro Sula and other surveys carried out by city authorities are broken down by education level. As can be observed from Figure 1, among the population with no education, the relative risk of being affected by Mitch is 80 times greater than in the population from the highest educational levels.

Impacts on reproductive health

Natural disasters heighten pre-existing situations of precariousness and vulnerability. In the case of reproductive health, they can accentuate and broaden reproductive health needs, due to the inability of many couples and individuals to exercise their reproductive rights. Disasters have an immediate effect on health conditions, on access to health services in general, and to reproductive health in particular, due to:

• Deterioration of health services, infrastructure, equipment, medical drugs and medical materials, as a consequence of the natural phenomenon itself.

• Difficulty in access to services, as a direct consequence of natural phenomena and due to its impact on communications and transportation.

• Changes in priority: the priority accorded to certain medical services due to the emergency situation may be in detriment of reproductive health services.

• Conditions in shelters, including the lack of privacy and promiscuity, may provoke an increase in sexual abuse, in sexually transmitted diseases (STDs), and in unwanted pregnancies.

Among the factors which prolong such negative effects are: the extent of the disaster itself in each country or region; the level of impact on health service infrastructure; the financial limitations of the countries; the level of dependency of the population on public services, and; the types of contraceptive methods employed. Changes in the assignment of priorities in the Ministries of Health (specific attention to certain infectious and respiratory diseases in detriment of others) are also important, as are investments in infrastructure versus preventive actions, given the imperative need for reconstruction efforts as a result of the total or partial destruction of health centers.

As a result of the above, a significant part of the population may be exposed, to an important degree, to shortages in contraceptive methods and information. Since it is the poorest segment of the population who relies most heavily on the public services hardest hit by the emergency, it is a real possibility that reproductive health services have suffered an important deterioration in precisely those sectors which need them the most. In the case of family planning, this results in limited access to contraceptive methods, leading to their non-use, or to the temporary use of ineffective methods. This could result in an increase in exposure to unwanted pregnancies or to induced abortions. In addition, there are delays in the implementation of new programs, both in education and in services.

Hence, some of the adverse factors in reproductive health may lead to an increase in fertility and/or abortions. Unprotected sexual relations could also lead to an increase in STDs. This relates to the increase in unprotected sexual relations derived from abuse, a problem that tends to increase under the promiscuous conditions prevailing in times of disaster.

Mitch's actual effects on fertility have to be viewed in different time frames. Insofar as short term effects are concerned, crisis and disaster analyses show that the immediate impact is usually a decrease in the rate of pregnancies and fertility - despite the above-mentioned breakdown in access to contraception and information. This can be explained by the postponement or cancellation of marriages and pregnancies resulting in the decrease in frequency of sexual relations and by an increase in temporary or definite separations resulting from the stress caused by the crisis. There could also be an increase in amenorrea caused by stress or prolonged malnutrition (see Curson, 1989), although there is no evidence for this in the present case.

The magnitude of these changes is not only related to the size of the affected population but also to the duration of the crisis. In Mitch's case, the impact should be minor, given its short duration and the rapid recovery of economic activities for the majority of the affected population^[6]. Effects should only be noticed, if at all, in a reduction in births during the months of July and August 1999.

There are also medium term effects. In the same way that period fertility tends to decrease in times of crisis, it also tends to increase with recovery. This is clearly demonstrated by experiences of war and famine and other disasters. This increase is explained by the recovery of postponed pregnancies, by the tendency of couples to replace lost children and by the increase in marriages previously delayed or occurring as a result of the optimism which is often displayed some time after the crisis. However, in this case, the country faces severe constraints in its reconstruction efforts. This leads to a prolongation of the social crisis, which could mean a reduction of desired fertility, since the postponement of births will be extended.

To: Population, poverty and vulnerability: Mitigating the effects of natural disasters, Part 2

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Notes

1. For more information on FAO's role in emergencies, one can consult "FAO's role in emergencies - Mission statement" (1997) and the forthcoming publication "Technical Handbook Series on FAO's Emergency Activities" on the following site: http://www.fao.org/tc/tco/Publicat/default.htm.

2. In reality initial impact may, in some cases, similarly affect all classes in determined circumstances, but even here the capacity to recover is different due to unequal resources amongst socioeconomic groups.

3. Comparable patterns also prevail in the other countries of the region. (Cf. UNFPA 1998:22-23 and INEC 1998:108)

4. La Declaración de Estocolmo. C-G Meeting in Stockholm, 25-28 May 1999. http://www.ud.se/english/gcmeeting/Spanish/decl.htm)

5. See: Boletin Informativo. Reunion del Grupo Consultivo de Estocolmo. Numero 3, 1999. http://www.ud.se/english/gcmeeting/Spanish/nyhet3.htm)

6. In the case of Honduras, the most affected country by Hurricane Mitch, the population housed in shelters reached some 600 thousand during the days immediately following Mitch; three weeks later this figure decreased to 285 thousand and at present (April 1999), it is estimated at 20 thousand.