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The Need for a National Strategy to Assess and Reduce Disaster-Related Mortality in the United States
Abstract
Disasters are becoming more frequent. The US is experiencing a dramatic increase in the number of natural disasters, many involving a catastrophic number of related deaths.
Despite billions of dollars being spent on the development of national, state and local interventions, there has been no significant change in the rate of disaster-related mortality among US populations over the past 50 years.
As such, we evaluate strategies for reducing disaster-related mortality in the US in comparison to that associated with motor vehicle crashes. In doing so, a multi-faceted strategy is proposed for reduction of disaster-related mortality, based upon a sustained record of effectiveness involving transportation-related incidents.
... 8 In fact, there is no evidence of significant change in US disaster-related mortality rates over the past 50 years despite billions of dollars in public outlays. 10 Health inequity has persisted for decades among US minorities affected by disasters. 11 Recent events have raised public concern regarding systemic inequality during public health emergencies, such as Hurricane Maria (2017) and the COVID19 pandemic. ...
Objective
The efficacy is measured for a public health intervention related to community-based planning for population protection measures (PPMs; ie, shelter-in-place and evacuation).
Design
This is a mixed (qualitative and quantitative) prospective study of intervention efficacy, measured in terms of usability related to effectiveness, efficiency, satisfaction, and degree of community engagement.
Setting
Two municipalities in the Commonwealth of Puerto Rico are included.
Participants
Community members consisting of individuals; traditional leaders; federal, territorial, and municipal emergency managers; municipal mayors; National Guard; territorial departments of education, health, housing, public works, and transportation; health care; police; Emergency Medical Services; faith-based organizations; nongovernmental organizations (NGOs); and the private sector.
Intervention
The intervention included four community convenings: one for risk communication; two for plan-writing; and one tabletop exercise (TTX). This study analyzed data collected from the project work plan; participant rosters; participant surveys; workshop outputs; and focus group interviews.
Main Outcome Measures
Efficacy was measured in terms of ISO 9241-11, an international standard for usability that includes effectiveness, efficiency, user satisfaction, and “freedom from risk” among users. Degree of engagement was considered an indicator of “freedom from risk,” measurable through workshop attendance.
Results
Two separate communities drafted and exercised ~60-page-long population protection plans, each within 14.5 hours. Plan-writing workshops completed 100% of plan objectives and activities. Efficiency rates were nearly the same in both communities. Interviews and surveys indicated high degrees of community satisfaction. Engagement was consistent among community members and variable among governmental officials.
Conclusions
Frontline communities have successfully demonstrated the ability to understand the environmental health hazards in their own community; rapidly write consensus-based plans for PPMs; participate in an objective-based TTX; and perform these activities in a bi-lingual setting. This intervention appears to be efficacious for public use in the rapid development of community-based PPMs.
... Local public health departments form the backbone of the US health system, and the hazards associated with a changing climate create health and preparedness challenges that are often unfamiliar to the workforce in many of these hardworking agencies (1)(2)(3). This is occurring in a context in which America's local public health and preparedness efforts have been underfunded for more than a decade (4,5) and in which priorities among health and preparedness have sometimes been at odds (6). The COVID-19 pandemic has brought these issues sharply into focus. ...
Local public health departments form the backbone of the US health system, and the hazards associated with a changing climate create health and preparedness challenges that are often unfamiliar to the workforce in many of these hardworking agencies. This is occurring in a context in which America’s local public health and preparedness efforts have been underfunded for more than a decade and in which priorities among health and preparedness have sometimes been at odds. The COVID-19 pandemic has brought these issues sharply into focus. At the same time, it is now well recognized that upstream health determinants and complex sectoral interconnections play an important role in climate-relevant health outcomes. Such connectedness requires public health agencies to partner with others in ways many may not have previously done. Tracking and monitoring public health adaptation effort can serve as institutional incentive to build formal and informal governance mechanisms needed to develop these collaboration arrangements. It can also help build local public health capacity to adapt, ensure adequate resources are allocated and local workforce is appropriately trained. This makes tracking and monitoring indicators a powerful tool for local health departments.
... 8 In fact, there is no evidence of significant change in US disaster-related mortality rates over the past 50 years despite billions of dollars in public outlays. 10 Health inequity has persisted for decades among US minorities affected by disasters. 11 Recent events have raised public concern regarding systemic inequality during public health emergencies, such as Hurricane Maria (2017) and the COVID19 pandemic. ...
Guest Lecturer for day-long workshop
Johns Hopkins University Bloomberg School of Public Health
Health Emergency for Large Populations (HELP) Course
Title: Planning for Community-based Disaster Risk Reduction
Baltimore, MD January 16, 2014
... 8 In fact, there is no evidence of significant change in US disaster-related mortality rates over the past 50 years despite billions of dollars in public outlays. 10 Health inequity has persisted for decades among US minorities affected by disasters. 11 Recent events have raised public concern regarding systemic inequality during public health emergencies, such as Hurricane Maria (2017) and the COVID19 pandemic. ...
Disaster management is most effective when developed at the community level. Community based planning, prevention, mitigation, and emergency response all engage the population to make choices that are commensurate with local needs and resources. Community based disaster management also offers a force multiplying effect by increasing the number of potential participants and leaders. This discussion of key community based developmental activities is meant to provide a primer for the public health practitioner beginning the study of emergency preparedness and response.
The health of the public is rarely in more jeopardy than during natural or human-caused disasters. Reliable data are scarce, but a United Nations report confirms that people with disabilities are disproportionately affected by disasters. Public health professionals’ mission, whether in the public and private sectors, is to be responsible for helping all citizens prepare, react, and recover from disasters. Often the stated mission and the practical realities, however, do not mesh. Individuals with activity limitations, mental health conditions, or other problems with access or functional limitations are not identified or included in public health preparations for disaster leading to unacceptable consequences for this population. This chapter provides an outline of the characteristics of individuals in need of additional services during disasters. In addition, the sobering reality of inadequate preparedness, response, and recovery efforts is described. Guiding principles for preparation and response for people with disabilities are provided, along with specific recommendations for preparedness and response. Finally, directions are recommended to improve public health perceptions, training, and data. The most important steps always begin with the inclusion of people with disabilities in every aspect of preparation, response, and recovery.
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