Studying the relationship between natural disasters and the well-being and recovery of communities has been my passion since I coordinated medical relief efforts across Asia as a member of the Navy in Japan.
While doing this work I learned a saying: natural disasters are national events but local crises.
Disasters are local because their impacts are unique to each community. Some communities may struggle to rebuild their infrastructure, while others may struggle with their health or employment sectors; each local crisis requires specific responses to guide recovery. For example, if a tornado strikes, a poor county may need immediate and long-term housing assistance due to a lack of insurance and savings, whereas a prosperous county may only require temporary support. Research has shown that health needs vary by location, income, and even gender.
But all too often, recovery efforts are inefficient and lack focus, resulting in futile or failed relief responses. The hardest-hit county in Texas after Hurricane Harvey, Harris County, had an estimated $20 billion in property damage , while the least affected counties had less than $50 million in damage. Disaster experiences are compounded by economic inequality, poverty, and oppression. The increased frequency and severity of natural disasters such as floods, hurricanes, and wildfires in recent years, combined with the devastating effects of poverty, is not only a social moral failing but also a devastating obstacle to community preparedness for disasters.
In the United States, there is a renewed focus on community infrastructure. But while the 2021 infrastructure bill reflects a growing interest in complex infrastructure, these policies often promote general strategies for community improvement, ignoring the need to measure and meet specific community needs. For example, the Appalachian region is experiencing record job losses due to the decline in coal mining jobs. They are also grappling with the health burden left by coal mining. Thus, infrastructure reform in this region requires both health and financial investment in its recovery strategy.
This monitoring is crucial because, following natural disasters, women and children are the most affected populations. Due to their vulnerability, children are the best indicator of community health and recovery after a disaster. A community’s health is undeniably intertwined with poverty and children’s health, so when preparing communities to cope with natural disasters, we must first address the root cause of poverty and examine the health and well-being of our children, which is a vital measure for communities.
Poverty and natural disasters
Poverty is expensive. Disasters exacerbate existing poverty and exponentially hinder the recovery of the poorest communities. Understanding how these effects accumulate is crucial for reducing disparities. To understand “exacerbated poverty,” let’s consider the three pillars of the community: social and economic infrastructure, the built and natural environment, and health infrastructure (Figure 1).
Approximately 40 million Americans live in low-income, low-access areas, which are areas with limited access to a supermarket or grocery store. Low-income Americans are also less likely to have reliable transportation and more likely to rely on public transit. Therefore, grocery shopping becomes a much more laborious and time-consuming process, which is why many people in low-income areas turn to local convenience stores and purchase less healthy foods. Poor access to quality nutrition makes them more susceptible to poor health, which in turn affects employment and insurance rates. Rising insurance costs and limited access to healthcare result in more time off work, which costs money, exacerbates existing costs, and adds new financial hardship. People living in low-income areas are pressured from all sides.
Poverty not only adds burdens, it multiplies them. And just as poor access to a grocery store is part of a chain of problems rather than a single issue, natural disasters create ripple effects for low-income communities that must be addressed. Poor communities experience more deaths from disasters, greater property damage, and, in their wake, disasters often exacerbate poverty.
The poorest communities often do not truly recover from disasters, but rather improve after a period of crisis, yet they have a new normal, a poorer status.
Focus on children’s health and well-being
Over the years, I have worked with local and state health departments to assess specific community needs. Currently, I am researching the impact of disasters on children’s mental health using the Children and Adolescents Needs Survey (CANS), a national survey that collects data on the physical and mental health of more than 80% of American children. It focuses on their well-being needs and is collected over the course of a year following a disaster, when children are being cared for by health and human services workers, such as counselors and social workers.
Because CANS can identify children’s needs at the individual, family, and community levels, I can define and measure variables such as parental mental health or individual school resources—factors that are often overlooked because they are difficult to measure. Health outcome data are plagued by a single limiting factor: diagnoses, which can be a barrier, especially for disadvantaged communities. CANS data are more accessible to these communities than professional care and diagnoses, and they offer an opportunity to examine factors we know are crucial to health outcomes. By identifying and incorporating these “difficult” variables, our solutions can be broader and better tailored to the needs of the community.
By focusing on children’s well-being and taking into account poverty and income, we can ensure that the future growth of communities is not hampered by the destruction left in the wake of a disaster. Evidence shows that the lasting mental trauma inflicted on children by disasters can exacerbate previous traumas, impacting a child’s long-term development. Currently, community improvement efforts are driven by remote leaders, but the aim of my work is to equip community leaders and policymakers close to the communities in question with the necessary tools.
When health is viewed as a product of both community systems and individual experiences, it becomes clear that the most effective strategies cut across disciplines. For example, drug addiction is often the result of a poor economy, drug availability, and poor mental health. Unfortunately, urban planners and population health scientists are often working on this problem in separate rooms.
My work focuses on developing strategies to unite disciplines, especially in the aftermath of disasters, and on creating strategies to improve our communities.
