This article is one of a three-part series. Please note that the following contains discussions about suicide and other difficult health topics.

Welcome to National Hurricane Preparedness Week. Each May, the National Weather Service urges residents of hurricane-prone areas to prepare for the possibility of damage and disruption. But many households do not have the means or the capacity to stay safe and healthy, and even the best prepared among us can be harmed in a particularly serious event. This is why it is also important to ensure that our critical 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 has set or tied several records including the number of named storms, the latest Category 5 storm, and the number of rapidly escalating storms. Seven of the hurricanes were placed on the US 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 exceptionally active season. In fact, the past 30 years have been so busy that NOAA last month improved the definition of a “normal” hurricane season and will begin issuing tropical weather forecasts for that season two weeks earlier than usual. To what extent is this due to the climate crisis? Scientists are carefully analyzing last year’s storms, so stay tuned to their findings. But in the meantime, hurricane experts generally agree that warming caused primarily by fossil fuel pollution is leading to an increase in the intensity and precipitation of tropical storms and hurricanes, as well as an increase in the proportion of storms. of category 4 and 5.

Hurricanes are associated with a dizzying array of costly health damage. Each storm brings a different combination of risks from rain, wind, flood and tornadoes to different areas, all of which challenge the public health and hospital systems on which we depend for damage prevention and medical care. In each article in this three-part series, I’ll summarize some of the latest research on hurricane health threats and discuss some of the solutions needed to keep us safe and healthy.

First of all: death and injury, exposure to toxic chemicals, effects on pregnancy outcome and consequences on mental health.

Deaths

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

Deaths directly associated with wind, water, or other physical force from storms tend to gain the most attention immediately after hurricanes. However, the indirect deaths that occur hours to years after a hurricane’s displacement is an important part of public health history, often revealing deep social and economic vulnerabilities. I will discuss these intersections in more detail in my next two articles.

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

Injuries

Even when storms aren’t deadly, they create endless opportunities for people to be injured: from accidents with power tools to colliding with jagged pieces of metal in floodwater. After Hurricane Irma, the South Miami hospital emergency room ran out of braces because many people fell in their dark homes and backyards during power outages.

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

Exposure to toxic air and water

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

Communities of color are disproportionately exposed to toxic fumes and flood waters during hurricanes, just as they are to daily air pollution due to their proximity to these industrial facilities and major roads. For example, 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 establishments that reported releases were in Latin American and low-income neighborhoods.

Birth results

Hurricane stress on pregnant women is associated with an increased risk of preterm birth and other negative birth outcomes. Severe storms can also adversely affect maternal health, increasing the risk of emergency room visits or admission to intensive care units for conditions such as pulmonary edema (fluid in the lungs).

For example, emergency room visits in New York City for pregnancy complications such as preterm labor increased by nearly 17% during prolonged power outages caused by Hurricane Sandy (2012). The highest increases were seen among black, latinox, uninsured, and under 20 people. This fits with the larger national pattern of disparities in maternal and child health, which is driven by factors such as lack of access to safe, culturally appropriate and abuse-free care from providers.

Mental Health

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

For example, emergency room visits in New York City for pregnancy complications such as early delivery increased by almost 17% during prolonged power outages caused by Hurricane Sandy (2012). The largest increases were for people who were black, Latin, uninsured, or under the age of 20. This fits with the larger national pattern of disparities in pregnancy and child health, which is driven by factors such as lack of access to safe, culturally appropriate and abuse-free care from providers.

Sadly, this year’s hurricane season will overlap with the ongoing fallout from the COVID-19 pandemic, especially for communities of color and low-wage workers hardest hit by the pandemic. Numerous studies have shown that the vulnerability of mental health to hurricanes is highly dependent on inequalities related to gender, race and ethnicity, socioeconomic status, and other factors.

What needs to be changed?

The health outcomes of a hurricane depend not only on the severity of the storm, but also on the ability of local health care providers and government agencies to prepare for, cope with, and recover from flooding. But U.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 improve the readiness of the U.S. health care system said that the system “lacked will, mechanisms for coordination, habits of cooperation, agreements of cooperation. governance and investments in shared resources essential for preparedness.

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

• Better surveillance and tracking of hurricane-related deaths, injuries, illnesses and mental health issues. Data is the cornerstone of public health decision making. Without sufficiently granular data, vulnerable populations are inherently invisible to policymakers, and solutions can worsen health disparities rather than improve them. Our current, regional and national methods of tracking public health data fail to capture the full toll of hurricanes, let alone the most burdensome one. We need a more modern, integrated and climate-smart system.
• More equitable financing and access to basic public health services and medical care. The COVID-19 pandemic has raised 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 opportunity and fair to be as healthy as possible. . Health justice – the correlation between health and social attributes – has actually declined across the country over the past 25 years. The THRIVE Agenda, presented to Congress in February, recognizes the need to address this issue by investing directly in systematically marginalized communities.
• Stronger and more urgent adaptation planning and implementation in health departments at all levels of government. A recent national survey of state health departments found that most were not adequately prepared for the effects of climate change on health, including more severe hurricanes. And this investigation took place before the COVID-19 pandemic began to seriously stress our healthcare system. President Biden’s FY22 funding request contains two important first steps to close the climate preparedness gap: $ 8.7 billion to the Centers for Disease Control and Prevention (CDC) to restore the capacity of essential human functions. public health, and $ 110 million for the CDC’s Climate and Health program, the only direct federal support for climate adaptation in public health services.

In my next article, I will cover the essential role of climate smart physical infrastructure in protecting our health from hurricanes and tropical storms.