BARCELONA (Thomson Reuters Foundation) - As economic losses from disasters rise around the world, more effort is needed to reduce the risks from extreme weather and earthquakes in every area, from infrastructure to health, the United Nations disaster prevention chief said.

Margareta Wahlström, head of the U.N. Office for Disaster Risk Reduction (UNISDR), said in an interview that a new global plan to protect people and assets from disasters, due to be approved in March, aims to ensure "a much stronger link than we have had in the past between development and disaster risk".

"There is progress, but it is not wide and speedy enough to really tackle the increasing disaster losses in many parts of the world," she told the Thomson Reuters Foundation from Geneva, where negotiations on the agreement are taking place this week.

Governments are mulling ways to measure improvements, including global targets for lowering deaths and economic losses from disasters, and how well key infrastructure like schools and hospitals is protected.

The world's existing 10-year disaster risk reduction plan, launched after the 2004 Indian Ocean tsunami, did not include numerical indicators of progress.

But Wahlström said it had played a major role in pushing governments to set up institutions, laws and policies for dealing with disasters, and strengthening early warning systems.

"There is such an awareness now about how quickly risk is increasing," she said. But many countries still feel "they are moving very slowly" to manage it, she added.

PROTECTING INVESTMENT

One problem has been a shortage of funding to plan and implement disaster risk reduction efforts, whether during post-crisis reconstruction or in long-term development projects.

Most of what has been achieved has come from national budgets, Wahlström noted.

According to a 2013 report from the London-based Overseas Development Institute, the international community spent $13.5 billion on reducing the risk of damage from disasters in the past two decades - just 40 cents for every $100 of aid.

Wahlström said the new plan - due to be agreed at a conference in Sendai, Japan, in two months' time - was unlikely to contain a goal for the percentage of aid that should be spent on disaster risk reduction. Nor did she expect "huge new funding streams globally".

But she hoped the Sendai framework, which will not be legally binding, would lead to greater commitment among donor governments to manage and reduce the risk of disasters to all their development investments.

As climate change impacts worsen, efforts are ramping up to manage floods and prevent landslides, for example.

But poorer nations should also prioritize disaster risk in plans for areas such as health and education, Wahlström added.

In addition, big disasters that have hit rich nations in recent years, including Superstorm Sandy in the United States and the 2011 tsunami and nuclear crisis in Japan, have highlighted inadequate sharing of expertise across sectors, she said.

Risks are rising fastest for infrastructure like power plants, subways, airports and communications networks, she noted.

"We become very dependent on systems that can also be touched by cyclones, flooding etc," she said.

Protecting those systems effectively "requires a lot of imagination, and a willingness to step out of your specialist environment and look wider", she added.

Along with flood waters, Hurricane Sandy raised death rates among dialysis patients in New York and New Jersey.

An analysis of Medicare claims data found that 30-day mortality rates rose to 1.83% during Sandy, compared with 1.47% among those living in states unaffected by Sandy, and 1.6% among those living in New York and New Jersey a year before the hurricane hit.

Nicole Lurie, MD, MSPH, assistant secretary for preparedness and response at the Department of Health and Human Services, and colleagues reported their findings in the January issue of the American Journal of Kidney Disease.

End-stage renal disease (ESRD) patients also visited the emergency department more frequently during Sandy than they did in the other two comparison groups (4.1% versus 2.6% and 1.7%, P<0.001 for both).

And hospitalization rates were higher for these patients during the storm (4.5% versus 3.2% and 3.8%, respectively, P<0.001 and P<0.003).

"The research showed clearly that delaying dialysis can have devastating health effects for patients with end-stage renal disease," Lurie said in a statement.

But preparedness procedures may have prevented those numbers from going any higher, she noted.

Just before Hurricane Sandy hit, state health officials encouraged dialysis centers to treat patients ahead of their scheduled visits -- a practice called "early dialysis."

Among 13,264 patients, almost 60% were given early dialysis ahead of the storm, either on that Saturday, Sunday, or Monday (Sandy's worst impact came the evening of Monday, Oct. 29), indicating that the "preparedness practice of providing early dialysis ... was widely implemented," the researchers wrote.

"The good news is that we saw a lot of patients receiving dialysis before the storm hit," Lurie said. "That type of advance planning by patients and their facilities should become routine nationwide."

"Everyone involved should know what to do when their facilities might close," she continued. "Patients should know where to go, and facilities should be able to provide a surge in early dialysis care so treatment is not delayed. At the end of the day, that helps people and their communities be more resilient."

The study did note, however, that there was significant regional variation in delivery of early dialysis, suggesting some room for improvement.

"About 40% of patients did not receive early dialysis, which means there is still plenty of room for dialysis patient and facility improvement," Lurie said. "I hope these findings serve as a rallying cry, not just for the dialysis community, but for all for people with any type of chronic health condition and their care providers to plan for emergencies."