In the NYTimes this morning, op-ed columnist David Brooks makes an interesting point: In 1989, a 7.0 magnitude earthquake struck just outside San Francisco leading the loss of 63 lives. Earlier this week, an earthquake of the same magnitude struck just outside Port-au-Prince, the capital of Haiti, and although final estimates of the death toll have not been made, without hubris I can safely say that about a thousand times more lives will be lost this time around.

Wikipedia, lists the official population of the Port-au-Price metropolitan area at 1.7 million people. The International Red Cross has estimated that the death toll could exceed – perhaps by a great deal – 50,000 people. Conservatively, this means that approximately 3% of the city perished in a few minutes, a shockingly high mortality rate.

Last fall, my husband and I moved from our suburban house just outside of Boston to an apartment in Greenwich Village, in the heart of Manhattan. Public health wonk that I am, I had wondered how living in NYC might affect my probability of dying from injury and other health conditions one morning as I walked my 10 blocks from my apartment to my office. I suspected it would have declined: I had traded my daily 18 mile round-trip daily commute on the Mass Pike with a cardiovascular enhancing walk (probably calorie neutral, given the excellent choice of coffee shops I had to contend with on my walk through the Village). But, surely we would be safer from injury in NYC than in Boston.

In early December, in the wee hours of the morning, my husband hopped in a cab to go to work, Blackberry ablaze on a conference call with London. Minutes later his cab crashed into the side of a delivery truck. My husband was sent flying face first into the bullet proof glass that separated him and his driver. His front lip was split in two my his front teeth. He has been left with a permanent scar, but luckily nothing more serious happened.

The following morning on my way to work, I also came within inches of serious injury when a bicycle narrowly missed hitting me head on at top speed flying the wrong way down a one way street – although giving my outstretched arm a good clip. I fear what would have happened to me – and worse my unborn child – had I been one second further along the crosswalk (I am 5 months pregnant).

So as it turns out, my estimated risk of injury had perhaps not declined as much as I had hoped, I had simply exchanged one risk exposure for others. But the Haitian earthquake made me reflect on how where you live, can greatly affect your probability of death from injury. Haiti lies near a fault line, and has been affected by major earthquakes in the past, although none nearly this large in a few centuries. Like most impoverished nations, construction standards are no where near as high as they are in rich countries.

It would have been easy to predict that had an earthquake hit the region many buildings would have crumbled – they did in Sichuan Province in 2008, Kashmir Province in 2005, and Acheh Province in 2004. When major earthquakes strike, your chances of surviving do seem to depend on whether you live in a rich or a poor country – one more great health inequality that exists in the world.

So if these risks are so predictable, why is there not more done about it? Well, first it is expensive. Reducing the risk of injury from earthquakes would likely require rebuilding cities, which is unlikely to be cost-effective in countries where so many more cost-effective interventions are not even implemented. As well, the risks are still after all just probabilities that something will happen, and with so many other more pressing development concerns, it is no wonder that these types of concerns would take back seats other initiatives.

But does it mean nothing can be done? New building standards can be improved and existing standards can be enforced on new projects. Risk assessments can be done, disaster management plans developed, and educations campaigns could be launched against major natural disaster risks. Tsunami warning signs have sprung up all around the world in response to the Indian Ocean tsunami of 2004.

It is encouraging to see the outpouring of donations that have ensued this past week, as they did in 2004 following the Indian Ocean tsunami, but it is discouraging that these risks get so little attention before disaster strikes. Global public health should be all about the latter, and it is therefore surprising that it receives so little attention in global health dialogues. Perhaps it is time to try harder.

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