On May 12, a 7.9-magnitude earthquake hit Sichuan Province in western China. More than 70,000 people died in the quake, including many schoolchildren who were killed when their schools collapsed. Of the more than 15 million people living in the area; more than 300,000 were injured during the quake and at least one third of the population was left homeless.

The earthquake hit close to home for Wilson Center staff. Our colleague Rob Litwak, director of International Security Studies, and his wife Liz were visiting the Panda Reserve Center in Wolong when the quake hit, about six miles from its epicenter. Thankfully, they and many other foreign tourists were airlifted to safety.

In the aftermath of any disaster, basic human needs must be met to avoid protracted catastrophe: shelter, potable water, food, medical care, and sanitation. The international community bands together to provide these services but often the casualties continue long after the disaster itself. The damage to a nation's public health infrastructure can be more dangerous than injuries sustained during an earthquake, flood, or cyclone, concluded panelists at one recent Wilson Center meeting.

In China, shoddy construction likely contributed to building collapses after the earthquake. As panelists at another recent seminar attested, the structural problems are only compounded by the many health and environmental impacts of the country's increasing need for cement to house its growing population.

Natural Disasters
Three main factors contributing to the severity of natural disasters are human vulnerability due to poverty and inequity; environmental degradation, and rapid population growth, especially among the poor, said Dr. Eric Noji, a renowned physician who recently retired after a 20-year career in public health at the Centers for Disease Control and Prevention (CDC). Addressing these factors require public policy action, he said at a June 17 seminar co-sponsored by the Global Health Initiative and the Environmental Change and Security Program.

"Developing nations suffer more from huge natural disasters," said Dr. Frederick "Skip" Burkle, senior fellow at the Harvard Humanitarian Initiative and Wilson Center public policy scholar, in advance of his presentation at this meeting. "In Asian megacities, the population is increasing exponentially, sometimes by a million people in six months, many of them moving to disaster-prone areas."

When interviewed for this story, Burkle, also a clinical professor of surgery at the University of Hawaii and former deputy assistant administrator for the Bureau of Global Health at the U.S. Agency for International Development, recalled speaking at a disaster conference in Beijing in the 1980s when the editor of the Chinese Daily News pointed at a high-rise being built and asked if the building was quake-proof. It was not. "China has long sacrificed for speedy building of the economy," Burkle said. Many buildings, both old and new, are constructed top-heavy with a weak foundation and no internal strength around windows and doors, so in an earthquake, they flatten.

Large-scale disasters are beyond the scope of local communities because they impact the existing public health infrastructure. "Disasters define public health and expose its vulnerabilities," Burkle said, noting that many indirect deaths and injuries happen long after the initial disaster due to the deterioration of public health services. One year after Hurricane Katrina, the public health system remained in shambles and patient medical data, all stored on paper and not electronically, was destroyed in the flooding. Also, social problems had set in, such as crime, suicide, alcohol abuse, domestic abuse, and student delinquency. Burkle noted there was a 47 percent increase in deaths a year after the hurricane.

One vital factor of disaster management is proper classification of displaced persons, such as evacuees and refugees so they can receive proper targeted assistance, said Dr. Lynn Lawry of the International Health Division in the office of the Assistant Secretary of Defense for Health Affairs in Washington. "Without adequate resources, IDPs [internally displaced persons] don't have a chance for self-realized improvements," she said, "and must rely on stretched local and federal funding."

Noji underscored the need to collect accurate data to target resources effectively. He also emphasized that epidemics are not inevitable after a disaster. Resuming basic health services is critical to ensuring public safety, he said, and diverting resources can lead to unnecessary deaths.

In Asia, globalization is spurring the economies but, said Burkle, as these nations start to build a private health infrastructure, little money is invested in public health. As a result, new socio-economic disparities are emerging and health indicators are diminishing. Natural disasters can strike anywhere, which reinforces the importance of a functioning health sector for immediate and long-term recovery as well as resources to meet basic human needs. In the absence of such an infrastructure, Burkle said, "All countries are prone to natural disasters becoming catastrophes."

Building Blocks
Following China's massive earthquake, many buildings remained intact while many others, particularly schools, crumbled. The Chinese government estimated some 7,000 classrooms were destroyed in the quake. News accounts reported that some rescuers and angry parents noticed the steel support rods found in the broken concrete seemed quite thin, and many are questioning the shoddy construction that killed untold numbers of children.

For 32 years, since the Tangshan earthquake killed a quarter-million people, China has required that new structures be built able to withstand major quakes. But the collapse of schools, hospitals, and factories in Sichuan Province raises questions about China's enforcement of building codes, adding to existing concerns over environmental standards, energy consumption, and overall public investments.

China is the world's largest producer of cement. Its production has grown about 10 percent per year over the past two decades and is now growing even faster to keep up with massive urbanization. Today, China produces roughly half of total global output, whereas the next three largest producers—India, Japan, and the United States—combined produce less than 20 percent of the world's cement.

Cement production is a highly energy-intensive process. Estimates reveal that China's cement—much of which is produced in energy inefficient, highly polluting kilns—consumes six percent of the nation's energy, with 80 percent of that coming directly from coal and other fossil fuels, and the remaining 20 percent from electricity. Cement manufacturing is thus a major contributor to greenhouse gas emissions (GHG) in China.

At a May 16 China Environment Forum meeting, Wang Lan from China's Building Materials Academy discussed the environmental impacts of China's cement sector. China's growing population and economy have produced inordinate amounts of pollution, threatening the environment and threatening human health. The cement clinker burning in kilns, for example, produces toxic chemicals and byproducts.

The Chinese government has developed policies to improve energy efficiency and pollution control in the cement sector. The government passed the Energy Conservation Law and Environmental Protection Law, which include such measures as eliminating outdated production capacity and installing more advanced technologies and production lines. New energy-efficient kilns are becoming more widely used. Meanwhile, an international initiative called the Asia-Pacific Partnership (APP) on Clean Development and Climate is helping China adopt advanced cement production technologies and efficient management skills.

Pankaj Bahtia of the GHG Protocol Initiative at the World Resources Institute discussed some of the collaborative projects and activities with key Chinese organizations including the National Development Reform Commission, Tsinghua University, and China Business Council for Sustainable Development. Such collaborations are assisting China in its plans to manage and reduce energy use and GHG emissions in the cement and other industries in China.

Bhatia commended the dedication of the private sector, both domestic and international, and the Chinese government for working together to combat dangerous pollutants in many cement plants while trying to maintain high production levels.

As China recovers and rebuilds from the earthquake, it remains to be seen whether China will incorporate lessons learned and build sturdy, disaster-proof structures. Effective regulation and modernization of the cement industry could make it not only safer and more environmentally friendly, but could also help the country avoid catastrophic collapses in future natural disasters.