Paul Perrin

Abstract
Introduction: The 2010 Haiti earthquake and Pakistan floods were similar in their massive human impact. Although the specific events were very different, the humanitarian response to disasters is supposed to achieve the same ends. This paper contrasts the disaster effects and aims to contrast the medium-term response. Methods: In January 2011, similarly structured population-based surveys were carried out in the most affected areas using stratified cluster designs (80320 in Pakistan and 60320 in Haiti) with probability proportional to size sampling. Results: Displacement persisted in Haiti and Pakistan at 53% and 39% of households, respectively. In Pakistan, 95% of households reported damage to their homes and loss of income or livelihoods, and in Haiti, the rates were 93% and 85%, respectively. Frequency of displacement, and income or livelihood loss, were significantly higher in Pakistan, whereas disaster-related deaths or injuries were significantly more prevalent in Haiti. Conclusion: Given the rise in disaster frequency and costs, and the volatility of humanitarian funding streams as a result of the recent global financial crisis, it is increasingly important to measure the impact of humanitarian response against the goal of a return to normalcy.

Conflict in the post-Soviet Republic of Georgia in both the early 1990s and again in 2008 has left sizeable populations of both “protracted” and shorter-term internally displaced persons (IDPs) living in both urban and non-urban environments. In contrast to many other displaced persons situations in the world, nearly one-third of Georgian IDPs are older adults, persons over the age of 60. The ultimate goal of this study was to foster a better understanding of dignity among the displaced population and thereby provide policy makers and program practitioners with measurement tools and evidence to inform improved response to older adults, especially in protracted situations of displacement in urban areas.
The research proceeded in an incremental process that included the phases of instrument development, instrument validation, and instrument implementation in a prevalence study of physical and mental health indicators, including dignity in the population. Instrument development entailed an eight-step sequential approach that began with a set of qualitative data generated during an earlier phase of the larger study. The steps were domain identification, existing instrument selection, extraction of qualitative language, matching of qualitative language, creation of additional scales, addition of explanatory variable sections, creation of visual aids, and questionnaire refinement.
The questionnaire then underwent a validation study through a convenience sample of 100 older adults. The instrument showed acceptable psychometric properties and was
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only minimally adapted for the prevalence phase of the study, involving 900 older adults in the regions of Samegrelo, Shida Kartli, Mtskheta-Mtianeti, and Tbilisi. The data suggest that among older adult displaced persons in Georgia, the strongest predictor of dignity scores was depressive symptom scores, followed by function, anxiety, health status, and cognitive ability. What might be considered more traditional humanitarian indicators, such as accommodation type, current socioeconomic status, and lack of household items were weaker predictors, after being controlled for the other predictors in the model. The implications for such findings are discussed, including the need for increased attention to mental and physical health in the overall assistance package to older adult IDPs, as well as a discussion on the implications of using dignity as an outcome measure.

Diarrhea is the second highest cause of global mortality of children under five, responsible for nearly one in five childhood deaths. Outcomes are estimated to be worse for children with HIV. CRS, with WHO, USAID, and local partners, developed a pilot project in a rural high-prevalence region of Malawi to improve WSH practices at community-based childcare centres (CBCCs). The pilot collected pre and post-test data on WSH knowledge, attitudes and practices (KAP) of community caregivers at twelve purposively sampled CBCCs, each with four caregivers serving an average of 70 children, ages 2-5. WSH interventions were implemented within the communities, with an assessment conducted after one year to examine changes in KAP within CBCCs. There were significant improvements in WSH practices at the CBCCs over the one-year period including: 1.) 100{\%} increase in caregivers who reported treating the water at the facility; 2.) 100{\%} increase in caregivers who reported drawing water in a safe manner; 3.) Observed hand washing facilities increased by 60{\%}; 4.) The number of facilities with latrines increased by 17{\%}; 5.) The number of latrines with visible fecal matter declined by 34{\%}; and 6.) In the communities surrounding the CBCCs, household members with reported diarrhea during the previous two weeks declined from 26.3{\%} to 15{\%}. Small, do-able actions, combined with complementary interventions to improve access to basic services resulted in substantial WSH improvements in HIV-affected communities' childcare centres. Replication of these actions may be an option to decrease diarrhea and morbidity in children from high HIV prevalence communities.

Pornography is a public health issue. However, since the US Surgeon General's workshop on pornography and public health reached a consensus statement about the impacts of pornography in 1986, few policy actions have been taken to deal with this public health problem, and intense discussion surrounding the regulation of pornography has continued. This debate spans a continuum between individual rights on one extreme and complete restriction of such material for society's good on the other extreme. However, during this same period much research has been done on the impacts of pornography on children and adults. This paper focuses on reviewing the effects of pornography on society including women, children, and consumers, and includes discussion on the current and failed policies aimed at regulating pornography. The growing phenomenon of Internet pornography use is discussed in depth, and specific policy ideas pertaining to Internet pornography are presented from a public health perspective.

During responses to disasters, the credibility of humanitarian agencies can be threatened by perceptions of poor quality of the responses. Many initiatives have been introduced over the last two decades to help address these issues and enhance the overall quality of humanitarian response, often with limited success. There remain important gaps and deficiencies in quality assurance efforts, including potential conflicts of interest. While many definitions for quality exist, a common component is that meeting the needs of the "beneficiary" or "client" is the ultimate determinant of quality. This paper examines the current status of assessment and accountability practices in the humanitarian response community, identifies gaps, and recommends timely, concise, and population-based assessments to elicit the perspective of quality performance and accountability to the affected populations. Direct and independent surveys of the disaster-affected population will help to redirect ongoing aid efforts, and generate more effective and comparable methods for assessing the quality of humanitarian practices and assistance activities.Kirsch TD, Perrin P, Burkle FM Jr, Canny W, Purdin S, Lin W, Sauer L. Requirements for independent community-based quality assessment and accountability practices in humanitarian assistance and disaster relief activities. Prehosp Disaster Med. 2012;27(3):1-6.

ObjectiveAscertain recipients' level of satisfaction with humanitarian response efforts.DesignA multi-stage, 80×20 cluster sample randomized survey (1800 households) with probability proportional to size of households affected by the 2010 Indus river floods in Pakistan. The floods affected over 18 million households and led to more than 8 billion USD in response dollars.ResultsLess than 20{\%} of respondents reported being satisfied with response, though a small increase in satisfaction levels was observed over the three time periods of interest. Within the first month, receipt of hygiene items, food and household items was most strongly predictive of overall satisfaction. At 6 months, positive receipt of medicines was also highly predictive of satisfaction. The proportion of households reporting unmet needs remained elevated throughout the 6-month period following the floods and varied from 50{\%} to 80{\%}. Needs were best met between 1 and 3 months postflood, when response was at its peak. Unmet needs were the greatest at 6 months, when response was being phased down.ConclusionsAccess-limiting issues were rarely captured during routine monitoring and evaluation efforts and seem to be a significant predictor in dissatisfaction with relief efforts, at least in the case of Pakistan, another argument in favor of independent, population-based surveys of this kind. There is also need to better identify and serve those not residing in camps. Direct surveys of the affected population can be used operationally to assess ongoing needs, more appropriately redirect humanitarian resources, and ultimately, judge the overall quality of a humanitarian response.