Strengthening public health and disaster resilience in American Samoa: the use of the precede-proceed model

By: Emma J. I. Apatu Dr.PH(c)1, Chris E. Gregg2, PhD, Dan Aga3, PhD,  Kasie Richards, DrPH1

American Samoa is a U.S. island territory located in the South Pacific Ocean. The group of islands is rich with breathtaking coastlines and culture filled with great tradition; however, local officials are actively working to combat one of the world’s worst obesity-related syndemics. Like many islands in the Samoa Archipelago, the livelihood of many American Samoans is being threatened by high rates of obesity (World Health Organization, 2007). High prevalence of diabetes, sedentary behavior, movement away from traditional food practices and heavy reliance on imported goods, are just a few factors that exacerbate health outcomes in this resource poor island (Davison, Fanolua, Roaine, & Vargo, 2007; World Health Organization, 2007). Obesity related health problems can have negative consequences on individual and community health; it can also hinder peoples’ ability to respond to natural hazards.

The group of American Samoa islands is geographically located in a very seismically active region—the Tonga trench, which has the potential to produce large earthquakes.  This U.S. territory’s vulnerability to earthquakes and tsunamis was realized on September 29, 2009, when a M8.1 earthquake created a destructive tsunami, which damaged local infrastructure and locally claimed 34 human lives (United States Geological Survey, 2009). Given American Samoa’s geographical positioning, in an area where earthquakes and tsunamis are a real threat, ensuring that individuals can physically reach safety areas (i.e. high ground) by foot is imperative given that road networks can become unusable due to earthquake damage and traffic congestion (Wood & Schmidtlein, 2012).

The intersection of natural disaster resilience and public health is an important interface for health program planning. With the building of the new American Samoa Community College (ASCC) Nutrition, Exercise, Health & Wellness Community Research Center and the existence of the local Territorial Emergency Management Coordinating Office (TEMCO), public health practitioners, medical personnel, nutritionists, and emergency managers are in an exciting position to develop system approaches to improving health outcomes and disaster resilience in American Samoa. Interdisciplinary teamwork aimed to improve population health and safety is of paramount importance in order to maximize resources and to save lives.

In July 2011, East Tennessee State University’s Tsunami Preparedness Program conducted a study with TEMCO and the Office of Samoan Affairs to understand associations between individual determinants (i.e. demographic, health related and household characteristics) with protective response (i.e. evacuation) to the 2009 earthquake and tsunami. The main goal of the project was to test the Protective Action Decision Model (PADM) created by Lindell and Perry for tsunamis and in a non-US-based culture. Ten local interviewers conducted 300 interviews of adult householders in twelve American Samoa villages.

Findings from the PADM study were analyzed (and will be reported in forthcoming reports). In general it was found that among study participants individual and household response to the 2009 earthquake and tsunami was good where a minority of the population reported health related barriers to evacuation during the event. Respondents expressed the need for village safety zones and better evacuation routes to help facilitate household evacuation response to future earthquakes and tsunamis. Obesity related issues did indeed hamper a minority (13.8%) of the respondents’ ability to evacuate.  Of the 13.8 % that reported health problems that hindered evacuation obesity related health problems such as diabetes, high blood pressure and foot problems were mentioned.  The abovementioned tsunami evacuation and obesity related data was plugged into an adapted health promotion planning framework called the Precede- Proceed Model, to inform the visualization of an integrative plan for obesity prevention and tsunami preparedness.

Application of this data from the study interviews into an adapted Precede-Proceed Model showed that integrated approaches to tsunami preparedness and obesity prevention can be undertaken by developing foot paths that are surrounded by community gardens.  Additionally, these footpaths could serve as fitness trails that support healthy lifestyles and function as paths that lead to high ground safety zones that function as emergency centers that could aid displaced survivors during a disaster.

1 Department of Community & Behavioral Health, College of Public Health, East Tennessee State University, Box 70674, Johnson City, USA

2 Department of Geosciences, College of Arts & Sciences, East Tennessee State University, East Tennessee State University, Box 70357, Johnson City, TN, USA

3 Community & Natural Resources, American Samoa Community College, P.O. Box 5319, AS 96799


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