Oriana Carswell

How do we make decisions when faced with uncertainty and risk?

25 May 2022

flooded street with people wading through the water

Using early warning information can help to reduce the health consequences of disasters.

Every year, millions of people around the world are affected by disasters. Disasters can have both short-term and long-term effects on people’s physical and mental health. They may also result in serious disruptions to health systems through infrastructure damage, loss of personnel, disruption of health programmes and overburdening of services.

Climate change, population growth, displacement, migration and conflict are contributing to the increased frequency, severity and impacts of hazards that can lead to disasters. This ultimately adds to the uncertainty that disasters bring.

Decision-makers must act under uncertain conditions to reduce the risks and consequences of disasters, and ensure health security.

Moving towards proactive decision-making

Early warning information can play an important role in reducing the impact of disasters, but information of an increased risk of a disaster rarely results in early action. Instead, there is often overemphasis on reacting to a disaster after it has occurred, and a lack of coordination within health systems and between health and other sectors. To reduce the threat to life, livelihoods and community, this approach needs to change. Better utilisation of early warning information would have the added benefit of helping countries to reach optimal development outcomes, including in public health.

Early action can be diverse and adaptable; in a drought, this could include distributing water pumps, seeds and tools in advance.

Some organisations have started to focus on early actions, with an emphasis on preparedness. This is done through the use of forecasts that are linked to agreed triggers for action, with the aim of mitigating or preventing the impact of a hazard.

Early action can be diverse and adaptable; in a drought, this could include distributing water pumps, seeds and tools in advance, or distributing livestock treatments and animal feed to herders as the drought intensifies. In Yemen, since conflict escalated in 2015, food shortages, widespread displacement and other factors have increased the risk of cholera, leading to one of the worst cholera epidemics in modern times. Cholera risk information and rainfall forecasts were used to assess which districts were at high risk. Interventions to mitigate this risk resulted in a significant drop in cases. The early action approach to cholera control is in its infancy, but the example of Yemen highlights that decision-making based on early warning information can be life-saving.

Decisions during uncertainty need to be flexible, robust and ‘low-regrets’

The nature of risk is such that a forecast event might not occur. Decisions should therefore be ‘low-regrets’ – they should address the risk, but also produce co-benefits to help address other (e.g. developmental) goals. Uncertainty means that there are a wide range of potential future scenarios. As such, decisions should be robust rather than ‘optimal’ to ensure actions offer benefits across all potential future scenarios, rather than being the ‘best’ option at that time. Decisions should also be flexible enough to adapt to changing conditions.

The nature of risk is such that a forecast event might not occur. Decisions should therefore be ‘low-regrets’ – they should address the risk, but also produce co-benefits.

For example, a programme of desilting traditional water tanks in India (rather than creating a dam) was a flexible, robust and ‘low-regrets’ decision to address the risk of water scarcity. Comparatively, desilting the water tanks is cheaper, and if the shock does not materialise there will be a benefit to local livelihoods as desilting increases access to surface and groundwater, which can improve agricultural production and increase incomes.

Flexible, robust and low-regrets decisions are particularly important in low-income countries with limited resources. Not all actions can be flexible, robust and low-regrets, but each help to address the uncertainty in forecasts. Forecasts can trigger early action, which is much more effective than acting after a disaster has occurred.

Careful planning is required to adapt to the increasing risk of disasters

The COVID-19 pandemic has highlighted that a prepared and timely response to disasters is essential. Their impact on health and health systems can be devastating, and with factors such as climate change, conflict and displacement, the risk and uncertainty of disasters is growing. Although risk and uncertainty are complex, decision-makers in all sectors need to work with communities on the ground and enable cross-society preparedness to help reduce the impact of disasters.

How do we make decisions when faced with uncertainty and risk?

Using early warning information can help to reduce the health consequences of disasters.

Moving towards proactive decision-making

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Decisions during uncertainty need to be flexible, robust and ‘low-regrets’

Careful planning is required to adapt to the increasing risk of disasters

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.