Natural hazard disasters often have large area-wide impacts, which can cause adverse stress-related mental health outcomes in exposed populations. As a result, increased treatment-seeking may be observed, which puts a strain on the limited public health care resources particularly in the aftermath of a disaster. It is therefore important for public health care planners to know whom to target, but also where and when to initiate intervention programs that promote emotional wellbeing and prevent the development of mental disorders after catastrophic events. A large body of literature assesses factors that predict and mitigate disaster-related mental disorders at various time periods, but the spatial component has rarely been investigated in disaster mental health research. This thesis uses spatial and spatio-temporal analysis techniques to examine when and where higher and lower than expected mood and anxiety symptom treatments occurred in the severely affected Christchurch urban area (New Zealand) after the 2010/11 Canterbury earthquakes. High-risk groups are identified and a possible relationship between exposure to the earthquakes and their physical impacts and mood and anxiety symptom treatments is assessed. The main research aim is to test the hypothesis that more severely affected Christchurch residents were more likely to show mood and anxiety symptoms when seeking treatment than less affected ones, in essence, testing for a dose-response relationship. The data consisted of mood and anxiety symptom treatment information from the New Zealand Ministry of Health’s administrative databases and demographic information from the National Health Index (NHI) register, when combined built a unique and rich source for identifying publically funded stress-related treatments for mood and anxiety symptoms in almost the whole population of the study area. The Christchurch urban area within the Christchurch City Council (CCC) boundary was the area of interest in which spatial variations in these treatments were assessed. Spatial and spatio-temporal analyses were done by applying retrospective space-time and spatial variation in temporal trends analysis using SaTScan™ software, and Bayesian hierarchical modelling techniques for disease mapping using WinBUGS software. The thesis identified an overall earthquake-exposure effect on mood and anxiety symptom treatments among Christchurch residents in the context of the earthquakes as they experienced stronger increases in the risk of being treated especially shortly after the catastrophic 2011 Christchurch earthquake compared to the rest of New Zealand. High-risk groups included females, elderly, children and those with a pre-existing mental illness with elderly and children especially at-risk in the context of the earthquakes. Looking at the spatio-temporal distribution of mood and anxiety symptom treatments in the Christchurch urban area, a high rates cluster ranging from the severely affected central city to the southeast was found post-disaster. Analysing residential exposure to various earthquake impacts found that living in closer proximity to more affected areas was identified as a risk factor for mood and anxiety symptom treatments, which largely confirms a dose-response relationship between level of affectedness and mood and anxiety symptom treatments. However, little changes in the spatial distribution of mood and anxiety symptom treatments occurred in the Christchurch urban area over time indicating that these results may have been biased by pre-existing spatial disparities. Additionally, the post-disaster mobility activity from severely affected eastern to the generally less affected western and northern parts of the city seemed to have played an important role as the strongest increases in treatment rates occurred in less affected northern areas of the city, whereas the severely affected eastern areas tended to show the lowest increases. An investigation into the different effects of mobility confirmed that within-city movers and temporary relocatees were generally more likely to receive care or treatment for mood or anxiety symptoms, but moving within the city was identified as a protective factor over time. In contrast, moving out of the city from minor, moderately or severely damaged plain areas of the city, which are generally less affluent than Port Hills areas, was identified as a risk factor in the second year post-disaster. Moreover, residents from less damaged plain areas of the city showed a decrease in the likelihood of receiving care or treatment for mood or anxiety symptoms compared to those from undamaged plain areas over time, which also contradicts a possible dose-response relationship. Finally, the effects of the social and physical environment, as well as community resilience on mood and anxiety symptom treatments among long-term stayers from Christchurch communities indicate an exacerbation of pre-existing mood and anxiety symptom treatment disparities in the city, whereas exposure to ‘felt’ earthquake intensities did not show a statistically significant effect. The findings of this thesis highlight the complex relationship between different levels of exposure to a severe natural disaster and adverse mental health outcomes in a severely affected region. It is one of the few studies that have access to area-wide health and impact information, are able to do a pre-disaster / post-disaster comparison and track their sample population to apply spatial and spatio-temporal analysis techniques for exposure assessment. Thus, this thesis enhances knowledge about the spatio-temporal distribution of adverse mental health outcomes in the context of a severe natural disaster and informs public health care planners, not only about high-risk groups, but also where and when to target health interventions. The results indicate that such programs should broadly target residents living in more affected areas as they are likely to face daily hardship by living in a disrupted environment and may have already been the most vulnerable ones before the disaster. Special attention should be focussed on women, elderly, children and people with pre-existing mental illnesses as they are most likely to receive care or treatment for stress-related mental health symptoms. Moreover, permanent relocatees from affected areas and temporarily relocatees shortly after the disaster may need special attention as they face additional stressors due to the relocation that may lead to the development of adverse mental health outcomes needing treatment.
The magnitude 6.2 Christchurch earthquake struck the city of Christchurch at 12:51pm on February 22, 2011. The earthquake caused 186 fatalities, a large number of injuries, and resulted in widespread damage to the built environment, including significant disruption to lifeline networks and health care facilities. Critical facilities, such as public and private hospitals, government, non-government and private emergency services, physicians’ offices, clinics and others were severely impacted by this seismic event. Despite these challenges many systems were able to adapt and cope. This thesis presents the physical and functional impact of the Christchurch earthquake on the regional public healthcare system by analysing how it adapted to respond to the emergency and continued to provide health services. Firstly, it assesses the seismic performance of the facilities, mechanical and medical equipment, building contents, internal services and back-up resources. Secondly, it investigates the reduction of functionality for clinical and non-clinical services, induced by the structural and non-structural damage. Thirdly it assesses the impact on single facilities and the redundancy of the health system as a whole following damage to the road, power, water, and wastewater networks. Finally, it assesses the healthcare network's ability to operate under reduced and surged conditions. The effectiveness of a variety of seismic vulnerability preparedness and reduction methods are critically reviewed by comparing the observed performances with the predicted outcomes of the seismic vulnerability and disaster preparedness models. Original methodology is proposed in the thesis which was generated by adapting and building on existing methods. The methodology can be used to predict the geographical distribution of functional loss, the residual capacity and the patient transfer travel time for hospital networks following earthquakes. The methodology is used to define the factors which contributed to the overall resilence of the Canterbury hospital network and the areas which decreased the resilence. The results show that the factors which contributed to the resilence, as well as the factors which caused damage and functionality loss were difficult to foresee and plan for. The non-structural damage to utilities and suspended ceilings was far more disruptive to the provision of healthcare than the minor structural damage to buildings. The physical damage to the healthcare network reduced the capacity, which has further strained a health care system already under pressure. Providing the already high rate of occupancy prior to the Christchurch earthquake the Canterbury healthcare network has still provided adequate healthcare to the community.
Social and natural capital are fundamental to people’s wellbeing, often within the context of local community. Developing communities and linking people together provide benefits in terms of mental well-being, physical activity and other associated health outcomes. The research presented here was carried out in Christchurch - Ōtautahi, New Zealand, a city currently re-building, after a series of devastating earthquakes in 2010 and 2011. Poor mental health has been shown to be a significant post-earthquake problem, and social connection has been postulated as part of a solution. By curating a disparate set of community services, activities and facilities, organised into a Geographic Information Systems (GIS) database, we created i) an accessibility analysis of 11 health and well-being services, ii) a mobility scenario analysis focusing on 4 general well-being services and iii) a location-allocation model focusing on 3 primary health care and welfare location optimisation. Our results demonstrate that overall, the majority of neighbourhoods in Christchurch benefit from a high level of accessibility to almost all the services; but with an urban-rural gradient (the further away from the centre, the less services are available, as is expected). The noticeable exception to this trend, is that the more deprived eastern suburbs have poorer accessibility, suggesting social inequity in accessibility. The findings presented here show the potential of optimisation modelling and database curation for urban and community facility planning purposes.
Fine grained sediment deposition in urban environments during natural hazard events can impact critical infrastructure and properties (urban terrain) leading to reduced social and economic function and potentially adverse public health effects. Therefore, clean-up of the sediments is required to minimise impacts and restore social and economic functionality as soon as possible. The strategies employed to manage and coordinate the clean-up significantly influence the speed, cost and quality of the clean-up operation. Additionally, the physical properties of the fine grained sediment affects the clean-up, transport, storage and future usage of the sediment. The goals of the research are to assess the resources, time and cost required for fine grained sediment clean-up in an urban environment following a disaster and to determine how the geotechnical properties of sediment will affect urban clean-up strategies. The thesis focuses on the impact of fine grained sediment (<1 mm) deposition from three liquefaction events during the Canterbury earthquake sequence (2010-2011) on residential suburbs and transport networks in Christchurch. It also presents how geotechnical properties of the material may affect clean-up strategies and methods by presenting geotechnical analysis of tephra material from the North Island of New Zealand. Finally, lessons for disaster response planning and decision making for clean-up of sediment in urban environments are presented. A series of semi-structured interviews of key stakeholders supported by relevant academic literature and media reports were used to record the clean-up operation coordination and management and to make a preliminary qualification of the Christchurch liquefaction ejecta clean-up (costs breakdown, time, volume, resources, coordination, planning and priorities). Further analysis of the costs and resources involved for better accuracy was required and so the analysis of Christchurch City Council road management database (RAMM) was done. In order to make a transition from general fine sediment clean-up to specific types of fine disaster sediment clean-up, adequate information about the material properties is required as they will define how the material will be handled, transported and stored. Laboratory analysis of young volcanic tephra from the New Zealand’s North Island was performed to identify their geotechnical properties (density, granulometry, plasticity, composition and angle of repose). The major findings of this research were that emergency planning and the use of the coordinated incident management system (CIMS) system during the emergency were important to facilitate rapid clean-up tasking, management of resources and ultimately recovery from widespread and voluminous liquefaction ejecta deposition in eastern Christchurch. A total estimated cost of approximately $NZ 40 million was calculated for the Christchurch City clean-up following the 2010-2011 Canterbury earthquake sequence with a partial cost of $NZ 12 million for the Southern part of the city, where up to 33% (418 km) of the road network was impacted by liquefaction ejecta and required clearing of the material following the 22 February 2011 earthquake. Over 500,000 tonnes of ejecta has been stockpiled at Burwood landfill for all three liquefaction inducing earthquake events. The average cost per kilometre for the event clean-up was $NZ 5,500/km (4 September 2010), $NZ 11,650/km (22 February 2011) and $NZ 11,185/km (13 June 2011). The duration of clean-up time of residential properties and the road network was approximately two to three months for each of the three liquefaction ejecta events; despite events volumes and spatial distribution of ejecta. Interviews and quantitative analysis of RAMM data revealed that the experience and knowledge gained from the Darfield earthquake (4 September 2010) clean-up increased the efficiency of the following Christchurch earthquake induced liquefaction ejecta clean-up events. Density, particle size, particle shape, clay content and moisture content, are the important geotechnical properties that need to be considered when planning for a clean-up method that incorporates collection, transport and disposal or storage. The geotechnical properties for the tephra samples were analysed to increase preparedness and reaction response of potentially affected North Island cities from possible product from the active volcanoes in their region. The geotechnical results from this study show that volcanic tephra could be used in road or construction material but the properties would have to be further investigated for a New Zealand context. Using fresh volcanic material in road, building or flood control construction requires good understanding of the material properties and precaution during design and construction to extra care, but if well planned, it can be economically beneficial.
