Postcrisis redevelopment of sustainable healthcare systems


  • Koren V. Kanadanian, MS
  • Constance K. Haan, MD, MS, MA



redevelopment, healthcare systems, postcrisis, postdisaster


Objective: Research and field experience have identified a global gap in postdisaster rebuilding of healthcare systems due to the current primary focus on returning devastated community infrastructures to predisaster conditions. Disasters, natural or man-made, present an opportunity for communities to rebuild, restructure, and redefine their predisaster states, creating more resilient and sustainable healthcare systems.

Design: A model for sustainable postdisaster healthcare rebuilding was developed by bridging identified gaps in the literature on the processes of developing healthcare systems postdisaster and utilizing evidence from the literature on postdisaster community reconstruction.

Results: The proposed model—the Sustainable Healthcare Redevelopment Model—is designed to guide communities through the process of recovery, and identifies four stages for rebuilding healthcare systems: (1) response, (2) recovery, (3) redevelopment, and (4) sustainable development. Implementing sustainable healthcare redevelopment involves a bottom-up approach, where community stakeholders have the ability to influence policy decisions. Relationships within internal government agencies and with public-private partnerships are necessary for successful recovery.

Conclusion: The Sustainable Healthcare Redevelopment Model can serve as a guideline for delivery of healthcare services following disaster or conflict and use of crisis as a window of opportunity to improve the healthcare delivery system and incorporate resilience into the healthcare infrastructure.

Author Biographies

Koren V. Kanadanian, MS

Emergency Response Coordinator, United States Department of Health and Human Services, Boston, Massachusetts; Assistant Secretary of Emergency Preparedness and Response, Office of Emergency Management, Franklin, Massachusetts.

Constance K. Haan, MD, MS, MA

President & CEO, Global Health Systems, LLC, Jacksonville, Florida.


Berlin R, Schatz B: The inevitable evolution of healthcare infrastructure. Medscape General Medicine (MedGenMed), 2005.

PAHO: Natural Disasters: Protecting the Public's Health. Washington, DC: Pan American Health Organization, 2000.

Rubin C: Long-term recovery from disasters: The neglected component of emergency management. J Homeland Secur Emerg Manage. 2009; 6: 1-14.

Rodriguez H: Handbook of Disaster Research. New York, NY: Springer, 2007.

Kates RW, Pijawka D: From rubble to monument: The pace of reconstruction. In Haas JE, Kates RW, Bowden MJ (eds.): Disaster and Reconstruction. Cambridge, MA: MIT Press, 1977: 1-23.

Beatley T: Promoting Sustainable Land Use: Mitigating Natural Hazards Though Land Use Planning. College Station, TX: Hazard Reduction and Recovery Center, 1995.

Haas JE, Kates RW, Bowden MJ: Reconstruction Following Disaster. Cambridge, MA: MIT Press, 1997.

Berke P: Recovery after disaster: Achieving sustainable development, mitigation, and equity. Disasters. 1993; 17: 93-109.

Rubin C: The community recovery process in the United States after a major natural disaster. J Mass Emergencies Disasters. 1985; 3: 9-28.

Natural Hazards Center: Holistic disaster recovery: Ideas for building local sustainability after a natural disaster. Boulder, CO: University of Colorado, 2005. Available at Accessed July 13, 2014.

Mileti D: Disasters by Design: A Reassessment of Natural Hazards in the United States. Washington, DC: Joseph Henry Press, 1999.

Cassels A: A Guide to Sector-Wide Approaches for Health Development. Geneva: World Health Organization, 1997.

Sphere Project: Humanitarian charter and minimum standards in disaster response, 2000. Sphere Project. Available at Accessed April 1, 2010.

Committee on the Quality of Health Care in America, IOM (Institute of Medicine): To Err is Human: Building a Safer Health System. Washington, DC: The National Academies Press, 2000.

Beatley T: The vision of sustainable communities. In Burby R (ed.): Cooperating with Nature: Confronting Natural Hazards with Land Use Planning for Sustainable Communities. Washington, DC: Joseph Henry Press, 1998: 229-262.

Smith G: Holistic disaster recovery: Creating a more sustainable future. FEMA, Emergency Management Institute Higher Education Project. Available at Accessed April 15, 2010.

Pfeiffer J: International NGOs and primary healthcare in Mozambique: The need for a new model of collaboration. Soc Sci Med. 2003; 56: 725-738.

Tun K: Potential for government-NGO partnership in health care. Available at Accessed July 20, 2014.

Soberon G, Frank J, Sepulveda J: Heath care reform in Mexico: Before and after the 1985 earthquakes. Am J Public Health. 1986; 76: 673-680.

Springgate B, Allen C, Jones C, et al.: Rapid community participatory assessment of health care in post-storm New Orleans. Am J Prev Med. 2009; 37: 237-245.

Alvaro A, Ruairi B: Rehabilitating the health system after conflict in East Timor: A shift from NGO to governmental leadership. Health Policy Planning. 2006; 21: 206-216.



How to Cite

Kanadanian, MS, K. V., and C. K. Haan, MD, MS, MA. “Postcrisis Redevelopment of Sustainable Healthcare Systems”. American Journal of Disaster Medicine, vol. 9, no. 4, Oct. 2014, pp. 247-58, doi:10.5055/ajdm.2014.0177.