Preparing and Rebuilding After Natural Disasters: A New Public Health Normal!

This January 2018 issue of AJPH comprises an initial set of reactions and questions about Hurricanes Harvey, Irma, and Maria, which ravaged the United States in 2017. The common message from our invited authors: natural disasters should no longer be viewed as extraordinary events that require exceptional responses. These storms not only have demonstrated the capacity for destruction of property and their aggravation of injustice but also have shown their lasting consequences to human health. The frequency and severity of recent disasters, coupled with science-based predictions that both characteristics will persist or worsen, have set the management of natural disaster as a new normal for public health.

Zolnikov (p. 27), who sheltered in place in her home in Florida during Hurricane Irma, describes what such calamity means for each individual and family in exposed zones, in terms of traumatizing experiences and need for planning. We have passed the disaster supply kits phase.¹ As Zolnikov writes, “The frequency of these disasters and the size of the populations affected have moved this public health issue from that of manageable emergencies into the realm of humanitarian crises [our emphasis]. The response to disaster outcomes needs to change as well as the preparatory work before beforehand and the funding, support, and rebuilding that occur afterward” (p. 28).

Lichtveld (p. 28) stresses that communities are not on an equal footing before the disaster occurs. The burden of health disparities, persistent environmental health threats, and societal challenges prevents already vulnerable communities from effectively preparing and then recovering from natural and technological disasters. Lichtveld concludes that “one potentially daring but promising strategy is to elevate community resilience [our emphasis] as an essential public health service,” (p. 30) followed by performance benchmarks for federal, state, and local health agencies.

Rodríguez-Díaz (p. 30) draws a harrowing portrait of post-Maria Puerto Rico. He reports that this unincorporated territory of the United States, already juggling a postcolonial status, economic crisis, and huge public health problems, finds itself in profound disarray in the aftermath of Hurricane Maria. Rodríguez-Díaz argues that both immediate relief and future reconstruction of a healthy and sustainable Puerto Rico require grassroots initiatives of culturally relevant interventions.

All of these contributions resonate with the definition by Dzau et al. (p. 32) of the goal that should unite everyone who is dedicated to public health, independent of partisan affiliation: rebuild our communities as we want them! Rebuilding takes decades and may have to be started over and over in the eventuality of new disasters. The Louisiana Health Care Redesign Collaborative during the post-Katrina (August 2005) recovery focused on four key areas: prevention, care, health information technology, and insurance coverage. Flooded areas became family parks and meeting centers. Engineered berms now serve as walking trails. Devastated lots—formerly food deserts—became community orchards.

And climate change? As explained by Woodward and Samet (p. 33), there are practical reasons to see the imprint of climate change in these cataclysmic events as a whole. Moreover, even if the exact responsibility cannot be established for each disaster separately, the potential repercussions of climate change on the risk profile of hurricanes and floods and their potential impacts cannot be ignored, and need to be factored in when reconstructing resilient communities.

Hurricanes in the South, wildfires in the West. The balance would be worse without the past 15 years of preparedness orchestrated by the United States after the attacks of the World Trade Center on September 11, 2001, and of the letters containing anthrax that followed a month later. As shown in the recent AJPH supplement “The Evolution of Public Health Emergency Management: From Preparedness to Response and Recovery,” before 9/11 most Public Health Emergency Preparedness awardees reported limited preparedness capabilities. By 2014, the number of jurisdictions reporting established capability functions within the countermeasures and mitigation domain had increased from less than three percent in 2001 to more than 97% in 2016.² Between 2007 and 2014, the minimum overall scores for the Centers for Disease Control and Prevention’s Technical Assistance Review among the 50 states increased from 51 to 89, and the mean from 86.6 to 98, on a scale of zero to 100.³ These efforts, unfortunately jeopardized by funding reductions and capacity loss of many public health agencies noticeable since 2004,³ are essential, and must be sustained and strengthened. In addition, we need to move our efforts beyond just preparedness and response. It is time to build strong communities to contain the preventable consequences of these natural disasters.

Our experience with Hurricanes Maria, Irma, and Harvey resulted in major tragedies. There is an opportunity to learn from them how to rebuild equitable and resilient communities able to dodge predictable devastation. Preparing to mitigate disasters and rebuilding by design is now a new public health normal.