A Framework for Assessing Mortality and Morbidity After Large-Scale Disasters (2020) / Chapter Skim
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Appendix D: Integrating Community Vulnerabilities into the Assessment of Disaster-Related Morbidity and Mortality: Two Illustrative Case Studies
Appendix D: Integrating Community Vulnerabilities into the Assessment of Disaster-Related Morbidity and Mortality: Two Illustrative Case Studies
Pages 227-246
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From page 227... ...
Early in the committee's deliberation the committee acknowledged that the social determinants of health (SDOH) contribute in known and less well-defined ways to disasterrelated mortality and morbidity; however, they were bound by the limitations of the report's scope from conducting an in-depth review of these critical socio-environmental dimensions and how those relate to community vulnerabilities and mortality and morbidity assessment.
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From page 228... ...
The integration of these data represent real opportunities to identify the underlying causal pathways and sub-population inequities existing at the intersection of the SDOH, disaster exposure, and disaster-related mortality and morbidity, which could in turn allow for the improved design and targeting of resources and programs to the sub-populations in greatest need. The contextualization of morbidity and mortality using SDOH data adds additional value and evidence to foster a stronger and more responsive disaster management enterprise that prioritizes community resilience (see Figure D-1)
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From page 229... ...
. SOCIAL DETERMINANTS OF HEALTH AND DISASTER RELATED MORTALITY AND MORBIDITY Post-Hurricane Maria Puerto Rico: A Case Study 1.
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From page 230... ...
(2018) write that damages from Hurricane Maria reached approximately $90 billion, ranking it as the third costliest hurricane in the United States since 1900 and resulted in the displacement of thousands of individuals and families from their homes (Kishore et al., 2018)
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SOURCE: NASEM, 2019. Hurricane Maria struck, 50 percent of Puerto Rico still lacked electricity, and even those who did not lack access to electricity experienced ongoing power outages (ACS, 2018)
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Even today, the exact number individuals who died as a result of Hurricane Maria remains unknown, illustrating a persistent shortcoming in disaster management and part of the impetus for the committee's authoring of this report. The official death toll of Hurricane Maria remains 64.
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Puerto Rico faced public health challenges both before and after the arrival of Hurricane Maria. The financial status of many hospitals, after suffering severe structural damage, remained an issue at least through 2018, when Chowdhury et al.
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From page 234... ...
the impact of social determinants of Puerto Ricans' health (e.g., housing, health care services, access to clear water and sanitation." The SDOH, such as financial capital, have clear implications for the ability of a locality to recover from adversity and also for its most financially vulnerable populations.
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From page 235... ...
Puerto Rico provides appropriations to the Federal Emergency Management Agency annually in order to utilize their disaster relief management efforts; however, the arrival and subsequent damage that Hurricane Maria caused exposed colonial laws that limit Puerto Rico's abilities to recover from natural disasters (Rodriguez-Diaz, 2018)
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From page 236... ...
. Vincent Lafronza and Natalie Burke write that social conditions are major determinants of health" with "social forces acting at a collective level shaping individual biology, individual risk be haviors, environmental exposures, and access to resources that promote health … and while public health programs alone cannot ameliorate the social forces that are associated with poor health outcomes, developing a better understanding of the social determinants of health is critical to reducing health disparities.
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From page 237... ...
According to research by the Tulane University School of Public Health & Tropical Medicine, minority groups are at highest risk for COVID-19 due to their higher rates of co-morbidities such as heart disease and obesity, they have higher rates of multigenerational household units, and compared to their White counterparts they face a greater difficulty in access to the necessary testing. These minority communities also experience barriers to health and economic opportunity and, often due to their employment, are unable to comply with social distancing guidelines meant to protect them from COVID-19 itself (Patel et al., 2020; Raifman and Raifman, 2020)
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From page 238... ...
Beyond employee paid sick leave, other built or infrastructural elements also impact morbidity and mortality. According to Tulane University, minority groups face greater difficulty in accessing COVID-19 testing when compared to their White counterparts (Lieberman-Cribbin et al., 2020)
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From page 239... ...
As the wealthy flee the viral hot spot, they are able to reduce their likelihood of infection and transmission -- their financial status serving protections that are not afforded to others. This ultimately creates a situation where those with less financial security are simultaneously forced to face the brunt of COVID-19 morbidity and mortality -- "the lower a person's socioeconomic status, the more limited their resources and ability to access essential goods and services, and the greater their chance of suffering from chronic disease, including conditions like heart disease, lung disease, and diabetes that may increase the mortality risk of COVID-19" (Benfer and Wiley, 2020)
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The same study showed that 47 percent of individuals sheltering in place reported negative mental health effects compared to 37 percent of those not sheltering in place (Panchal et al., 2020)
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. A joint statement released by the International Federation of Red Cross and Red Crescent Societies, the United Nations Children's Fund, and WHO warns that stigmatization can actually enhance the spread of the virus, not hamper it, and it can lead to infected individuals hiding their illness, prevent people from seeking care right away, and can even discourage the exhibition and practice of healthy behaviors (IFRC et al., 2020)
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From page 242... ...
While mortality and morbidity data hold immense potential value, the lack of incorporation of the SDOH into the collection and assessment of these data limits the degree to which these data can inform changes in policy, practice, and behavior. The incorporation of SDOH data into morbidity and mortality assessment for the purpose of informing the disaster management enterprise will require improvements in data collection, recording, reporting, and use if these data are to be used in collaboration to identify groups most at risk and can help target public health efforts more successfully.
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From page 243... ...
24) writes, "measuring only mortality during an emergency says nothing about sequelae of complex emergency that may have profound effects on the population." Therefore, SDOH data hold intrinsic value, which can be tapped to more accurately interpret mortality and morbidity data following disasters and target the root causes of community vulnerabilities to disasters -- a value that will likely expand as certain disasters grow in frequency and severity.
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From page 244... ...
2020. Out-migration and return migration to Puerto Rico after Hurricane Maria: Evidence from the consumer credit panel.
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From page 245... ...
Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/ the-implications-of-covid-19-for-mental-health-and-substance-use (accessed September 1, 2020)
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From page 246... ...
2019. The mental health impact of Hurricane Maria on Puerto Ricans in Puerto Rico and Florida.
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