Addressing Health Inequalities through the United Nations’ Sendai Framework for Disaster Risk Reduction 2015-2030

This article focuses on the Sendai Framework for Disaster Risk Reduction 2015-2030 and how it addresses health and vulnerability. It is hoped that this short report will assist communities of research, policy in understanding the aim of the Sendai Framework and identifying synergies and foster collaboration, particularly through research and evidence-translation for policy makers

Amina Aitsi Selmi

by Amina Aitsi-Selmi

 MBBChir MA(cantab) MRCP MPH MFPH PhD  

Consultant in International Public Health, Global Disaster Risk Reduction/International Public Health, Public Health England

Addressing Health Inequalities through the United Nations’ Sendai Framework for Disaster Risk Reduction 2015-2030



The year 2015 is a crucial year in global policy with the publication of three landmark UN agreements: 1) the Sendai Framework for Disaster Risk Reduction 2015-2030 (agreed by 187 Member States after negotiations at the World Conference on Disaster Risk Reduction in March 2015);[1] 2) the Sustainable Development Goals (SDGs)[2] which are the successors of the Millennium Development Goals (agreed in September); and the climate change agreements (to be agreed in December). The success of these global agreements is partly dependent on ensuring coherence and building on synergies to avoid duplication and encourage joint initiatives. For example SDG targets 1.5, 2.4, 11.b, 11.5 and 13.1 all pertain to disaster risk reduction (DRR) and are, therefore, areas of synergy with the Sendai Framework.[3]

A comprehensive approach to future economic development – in low-, middle- and high-income countries – must ensure that future economic activity has people’s wellbeing and the environment’s preservation at its heart. It is encouraging that, so far, the agreements acknowledge the role of unmanaged development processes in increasing the risk of disasters and disease and the need to address vulnerability by influencing wider socioeconomic factors. This article focuses on the Sendai Framework and how it addresses health and vulnerability. It is hoped that this short report will assist communities of research, policy in understanding the aim of the Sendai Framework and identifying synergies and foster collaboration, particularly through research and evidence-translation for policy makers.

Health in the Sendai Framework

The Sendai framework for disaster risk reduction 2015–2030 has a substantial emphasis on health – much more so than its predecessor, the Hyogo framework for action 2005–2015.[4] There are more than 30 explicit references to health (compared to three in its predecessor), referring to the implementation of an all-hazards approach to managing disaster risk including links to epidemics and pandemics, the International Health Regulations and to rehabilitation as part of disaster recovery and health system resilience.[5] These are welcome links as disasters often exacerbate the causes of ill-health, whether through direct physical injury, mental health sequelae, infectious disease outbreaks through damage to water and sanitation infrastructure or disruption to health service access which impact those with chronic disease.[6]

Over the next 15 years, the framework’s main objective is to achieve the “substantial reduction of disaster risk and losses in lives, livelihoods and health and in the economic, physical, social, cultural and environmental assets of persons, businesses, communities and countries.” Voluntary commitments with a specific public health focus that have been agreed include: enhancing the resilience of national health systems through training and capacity development; improving the resilience of new and existing critical infrastructure, including hospitals, to ensure that they remain safe, effective and operational during and after disasters, to provide live-saving and essential services; establishing a mechanism of case registry and a database of mortality caused by disaster to improve the prevention of morbidity and mortality and enhancing recovery schemes to provide psychosocial support and mental health services for all people in need; enhancing cooperation between health authorities and other relevant stakeholders to strengthen country capacity for disaster risk management for health; and the implementation of the International health regulations (2005).

Disaster impacts are strongly influenced by physical, social, economic and environmental factors apparent as underlying vulnerability from poverty, inequity and poor urban planning and land use.[7] The Sendai Framework acknowledges that reducing disaster risk requires concerted action across a wide range of sectors, institutions and disciplines. In alignment with the Social Determinants of Health approach,[8] which calls for intervention on the wider determinants that impact individual lives and health, reducing disaster risk is, therefore, relevant within and beyond the health sector.

Vulnerability in the Sendai Framework

The United Nations Office for Disaster Risk Reduction (UNISDR) defines vulnerability as “The conditions determined by physical, social, economic and environmental factors or processes, which increase the susceptibility of a community to the impact of hazards”.[9] Vulnerability may vary within a population by subgroup (e.g. income level or type of livelihood) and may change over time, adding complexity to vulnerability measurement.[10]

An important area of progress is reflected in Priority 1 of the Sendai Framework: understanding risk. Risk assessment and modelling that incorporate all dimensions of risk including vulnerability can help to communicate usable risk information to users and assist decision-makers in understanding the potential impact of disasters and highlighting effective policies to reduce risk, increase preparedness, and improve response and recovery.

Traditionally, the focus of risk assessments has been on (natural) hazards or physical infrastructure alone. However, the Sendai Framework gives prominence to the vulnerability of populations, communities and groups and calls on the scientific community and its partners to: discuss and identify main gaps and challenges in the development of vulnerability data and models, considering physical, socio-economic, institutional and environmental factors; identify needs for improved understanding and models for community resilience; and promote enhanced collection, availability and dissemination of datasets fundamental to assessing exposure and vulnerability, such as up-to-date disaggregated census data, building typologies, poverty and household surveys, sectoral data (e.g., school locations and attributes) and systematic post-disaster analysis of building and infrastructure failure and socio-economic impacts on communities; but also: strengthening the design and implementation of inclusive policies and social safety-net mechanisms, including access to basic health care services towards the eradication of poverty; finding durable solutions in the post-disaster phase to empower and assist people disproportionately affected by disasters, including those with life threatening and chronic disease. The latter recommendation will be particularly important in the coming years as non-communicable diseases continue to rise in low- and middle-income countries.

Four distinct and largely independent research and policy communities – disaster risk reduction, climate change adaptation, environmental management and poverty reduction have been working to reduce vulnerability to hazards but face challenges in terms of facilitating learning and exchanging information.[11]  In addressing these challenges to produce useful, usable and used risk information that incorporates vulnerability as a critical dimension of risk, different communities of producers and users of information across sectors and disciplines will need to work together at all levels, local, national, regional and global to ensure the aspirations of the Sendai Framework (and its closely related policy agreements of 2015) are achieved.

Next steps: convening the scientific community to leverage science for life-saving policy

The Sendai Framework strongly endorses the role of science and the importance of the scientific community in supporting the implementation of the framework over the next 15 years. Multidisciplinary research is highlighted as critical to producing science that is used, usable and used through improved databases, the use of baselines and disaggregated data, more effective dissemination of evidence and knowledge and capacity building to name but a few areas of recommendation. The framework is a call to all scientists to collaborate in making a positive difference to ‘lives, livelihoods and health’. One of the Sendai Framework’s priorities for action is: to promote investments in innovation and technology development in long-term, multihazard and solution-driven research in disaster risk management to address gaps, obstacles, interdependencies and social, economic, educational and environmental challenges and disaster risks.

In order to offer an opportunity to explore the implications for the scientific community of the Sendai Framework, the United Nations Office for Disaster Risk Reduction (UNISDR) is organising an international conference to launch a science and technology global partnership and develop a 15 year road map for the global science and technology community to support the implementation of the Sendai Framework until 2030.  The conference will take place in Geneva, 27-29th of January 2016 (For further information and call to abstracts, see


  1. UNISDR. 2015b. Sendai framework for disaster risk reduction 2015–2030. In: UN world conference on disaster risk reduction, 2015 March 14–18, Sendai, Japan. Geneva: United Nations Office for Disaster Risk Reduction; 2015. Available at
  2. The Sustainable Development Goals. Available at [Accessed 18 October 2015].
  3. Aitsi-Selmi A, Murray M. Ensure healthy lives and promote well-being for all at all ages. ICSU, ISSC (2015): Review of the Sustainable Development Goals: The Science Perspective. Paris: International Council for Science (ICSU). Available at [Accessed 18 October 2015].
  4. UNISDR. The Hyogo Framework for Action (HFA). Available from  [Accessed 18 January 2015]. 2005.
  5. Aitsi-Selmi A MV. The Sendai framework: disaster risk reduction through a health lens. Bulletin of the World Health Organization 2015;93:362.
  6. Aitsi-Selmi A, Egawa S, Sasaki H, Wannous C, Murray V. The Sendai Framework for Disaster Risk Reduction: Renewing the Global Commitment to People’s Resilience, Health, and Well-being. International Journal of Disaster Risk Science. 2015;6:164-76. doi: 10.1007/s13753-015-0050-9.
  7. UNISDR. Proposed Elements for Consideration in the Post‐2015 Framework for Disaster Risk Reduction: By the UN Special Representative of the Secretary‐General for Disaster Risk Reduction. Geneva: United Nations Office for Disaster Risk Reduction; 2013. Available from: [cited 18 October 2015]. 2013.
  8. CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.
  9. UNISDR. 2009. Terminology on Disaster Risk Reduction. Available at [Accessed 19 June 2015].
  10. Birkmann Jr, Pelling M. Measuring vulnerability to natural hazards : towards disaster resilient societies Tokyo: United Nations University; 2006.
  11. Thomalla F, Downing T, Spanger-Siegfried E, Han G, Rockstrom J. Reducing hazard vulnerability: towards a common approach between disaster risk reduction and climate adaptation. Disasters. 2006;30(1):39-48. doi: 10.1111/j.1467-9523.2006.00305.x. PubMed PMID: 16512860.