Hurricane Preparedness Week: Protecting Public Health

This post is part one of a three-part series. Please be aware that the following contains discussions of suicide and other difficult health topics.

Welcome to National Hurricane Preparedness Week. Every May, the National Weather Service urges residents of hurricane-prone areas to prepare for the possibility of damage and disruption. But many households don’t have the means or ability to keep themselves safe and healthy, and even the best-prepared among us can be harmed in a particularly severe event. That’s why it’s also important to ensure our essential infrastructure and health services are ready for this hurricane season and the increasingly dangerous hurricane seasons to come under climate change.

The 2020 Atlantic hurricane season set or tied multiple records, including for the number of named storms, the latest Category 5 storm, and the number of rapidly-intensifying storms. Seven of the hurricanes made it onto the U.S. National Oceanic and Atmospheric Administration’s (NOAA) billion-dollar disaster list, with particularly catastrophic consequences for Louisiana.

2020 was the fifth year in a row with an unusually active season. In fact, the last 30 years have been so busy that NOAA last month upgraded the definition of a “normal” hurricane season and will start issuing Tropical Weather Outlooks for this season two weeks earlier than usual. How much of this is due to the climate crisis? Scientists are carefully analyzing last year’s storms, so stay tuned for their findings. But in the meantime, hurricane experts generally agree that warming caused mostly by fossil fuel pollution is driving an increase in tropical storm and hurricane intensity and rainfall, as well as an increase in the proportion of Category 4 and 5 storms.

Hurricanes are associated with a dizzying array of costly health harms. Each storm brings a different combination of rain, wind, flooding, and tornado hazards to different areas, all of which stress the very public health and hospital systems we depend on for harm prevention and medical care. In each post of this three-part series, I’ll summarize some of the latest research on the health threats of hurricanes and examine some of the solutions needed to keep us safe and healthy.

First up: deaths and injuries, exposures to toxic chemicals, effects on pregnancy outcomes, and mental health consequences.

Deaths

There have been 52 hurricanes and tropical storms on NOAA’s billion-dollar disaster list since 1980. Nearly 6,600 people perished during and after those storms, more than 45 percent of them in Hurricane Maria (2017) alone.

Deaths directly associated with wind, water, or some other physical force of the storms tend to get the most attention in the immediate aftermath of hurricanes. However, the indirect deaths that happen hours to years after a hurricane has moved away are an important part of the public health story, often revealing deep social and economic vulnerabilities. I’ll be discussing these intersections further in my next two posts.

These delayed losses of life caused by things like carbon monoxide poisoning or insufficient medical care can be substantial. Recent shares of indirect deaths ranged from a third of total mortality during Hurricane Harvey (2017) to 90 percent during Hurricane Irma (2017).

Injuries

Even when storms aren’t deadly, they create endless opportunities for people to hurt themselves: from power tool accidents to running into jagged pieces of metal in floodwaters. After Hurricane Irma, South Miami Hospital’s emergency room ran out of splints because so many people were falling in their dark houses and yards during power outages.

From 2005 to 2016, injury-related emergency room visits across 11 states increased across all age groups—including children—during the week of hurricane strikes. However, the largest increase (53 percent) occurred in adults 65 years or older.

An alligator in flood waters after Hurricane Laura.

Will Schnyer, Creative Commons/CC BY 2.0.

Exposure to toxic air and water

Wind and water damage, power outages, and even hasty shutdown procedures during hurricanes and tropical storms can unleash toxic chemicals from waste facilities, manufacturing plants, oil and gas facilities, and other industrial sites. Up to five months after Hurricane Katrina (2005), for example, concentrations of diesel and arsenic in New Orleans soil samples were hundreds of times higher than the “safe” levels set by the Louisiana Department of Quality.

Communities of color are disproportionately exposed to toxic fumes and floodwaters during hurricanes, just as they are to everyday air pollution because of their proximity to these industrial facilities and major roads. For instance, 42 industrial facilities in southeast Texas released about 5.5 million pounds of pollution during Hurricane Harvey, including chemicals that can harm child development and cause cancer. The highest density of facilities that reported releases were in Latino and lower income neighborhoods.

U.S. Coast Guard officers walking through foam blowing off the surface of an oil spill after Hurricane Harvey. The foam is used to prevent the oil from igniting.

U.S. Coast Guard / Petty Officer 2nd Class Paul Krug, CC BY-NC-ND 2.0

Birth outcomes

Hurricane stresses on pregnant people are associated with an increased risk of preterm birth and other negative birth outcomes. Severe storms also can harm maternal health, increasing the risk of emergency room visits or admission into ICUs for conditions such as pulmonary edema (fluid in the lungs).

For example, emergency room visits in New York for pregnancy complications such as early delivery increased nearly 17 percent during extended power outages caused by Hurricane Sandy (2012). The highest increases were among people who were Black, Latinx, uninsured, or younger than 20 years old. This aligns with the larger national pattern of maternal and infant health disparities, which is driven by factors such as lack of access to safe, culturally appropriate care that is free of mistreatment by providers.

Mental health

Hurricane stresses are associated with a higher risk of preterm birth and other negative birth outcomes. Severe storms also can increase emergency room visits and ICUs admissions among pregnant people for conditions such as pulmonary edema (fluid in the lungs).

For example, emergency room visits in New York for pregnancy complications such as early delivery increased nearly 17 percent during extended power outages caused by Hurricane Sandy (2012). The highest increases were among people who were Black, Latina, uninsured, or younger than 20 years old. This aligns with the larger national pattern of pregnancy and infant health disparities, which is driven by factors such as lack of access to safe, culturally appropriate care that is free of mistreatment by providers.

Unfortunately, this year’s hurricane season will overlap with the ongoing fallout of the COVID-19 pandemic—especially for the communities of color and low-wage workers hit hardest by the pandemic. Multiple studies have found that mental health vulnerability to hurricanes depends heavily on inequities associated with gender, race and ethnicity, socioeconomic status, and other factors.

Pamela Drew, Creative Commons / CC BY-NC 2.0

What needs to change?

The health outcomes of a hurricane depend not just on the storm’s severity, but also the ability of local health care providers and government agencies to prepare for, cope with, and recover from flooding. But America’s public health agencies have long been underfunded and understaffed, hampering their ability to help people survive and thrive after hurricanes.   

And the challenges go beyond funding. A recent opinion piece by the co-chairs of a National Academies initiative to enhance preparedness in the U.S. healthcare system said the system “lacks the will, coordinative mechanisms, habits of cooperation, governance agreements, and shared resource investments essential to preparedness.”

Here are just three of the major changes we need now.

  • Better surveillance and monitoring of hurricane-related deaths, injuries, illnesses, and mental health outcomes. Data is the lifeblood of public health decision making. Without sufficiently granular data, vulnerable populations are basically invisible to decision makers and solutions can make health disparities worse instead of better. Our current state, regional, and national ways of tracking public health data fail to capture the full toll of hurricanes, let alone who bears the greatest burden. We need a more modern, integrated, climate-smart system, stat.
  • More equitable funding for, and access to, basic public health services and medical care. The COVID-19 pandemic has elevated the profile of a long-standing problem in the United States: people of color, low income people, LGBTQ people, and other underserved groups do not have a “fair and just opportunity to be as healthy as possible.” Health justice—the correlation of health with social attributes—has in fact declined across the country over the last 25 years. The THRIVE Agenda, introduced in Congress in February, recognizes the need to right this wrong by investing directly in systematically marginalized communities.   
  • More robust and urgent adaptation planning and implementation in health departments at all levels of government. A recent nationwide survey of state health departments found that most were insufficiently prepared for the health impacts of climate change, including more severe hurricanes. And that survey happened before the COVID-19 pandemic started severely stressing our health system. President Biden’s FY22 funding request contains two important first steps to address the climate preparedness gap: $8.7 billion to the Centers for Disease Control and Prevention (CDC) to restore capacity in core public health functions, and $110 million for CDC’s Climate and Health program, the only direct federal support for climate adaptation in public health departments.

In my next post, I’ll cover the critical role of climate-smart physical infrastructure in protecting our health from hurricanes and tropical storms.