Mission Possible: Preparing and Responding to Disasters through a Health Equity LensPosted on by
It was September 2017, and like many others, I was watching as Hurricane Maria moved across the Atlantic Ocean heading towards the US Virgin Islands and Puerto Rico. Having been part of the recent responses to Hurricanes Harvey and Irma, I was all too aware of the potential for devastation, especially for the most vulnerable among us. Previous disasters have shown that certain groups of people face greater risk during and after disasters. This includes those who may have difficulty accessing or receiving standard resources before, during, or after an emergency.
People are not equally able to access resources and opportunities, nor are they equally exposed to hazards. For example, low-income and predominantly minority communities have fewer resources, higher vulnerabilities to disease, and less access to healthcare. Many of these communities are in areas prone to natural disasters and other threats, such as the Gulf Coast. These communities are less able to cope with natural hazards due to continuous stressors and gaps in community resilience.[i] During a disaster, these gaps are exacerbated, necessitating preparedness policies and practices that account for social, economic, and health disparities.
To understand how public health agencies are addressing the needs of vulnerable populations in emergencies while working to reduce social, economic, and health disparities, I moderated a panel at the annual workshop of the Natural Hazards Center titled Root Causes: Social Inequality and Vulnerability in Disasters.
During the panel, we discussed the following barriers to addressing disparities and vulnerability in disasters:
- Government mistrust. Mistrust of government and institutions is a deep-seated barrier that has historic roots and can be difficult to change. Diverse communities often do not feel respected and may not have the political power to garner necessary resource.
- Layered disasters. Hazards tend to harm segments of the population that were already disadvantaged before a disaster. There is differential vulnerability for people by where they live, work, and play.
- Organizational resilience. The organizations that address the day-to-day needs of vulnerable populations are themselves vulnerable during a disaster due to resource constraints. These organizations may exhaust their yearly budget on a disaster response and may not be able to continue to provide day-to-day needs of the populations they serve.
- Misconceptions. In the past, people with disabilities and other impairments may have been perceived as unable to care for themselves, unable to function in daily activities, and unable to make decisions about their health and welfare. Because of these and other misconceptions, segments of the populations are marginalized, causing systematic exclusion from the social environment.
The panel also offered examples of ways to address these barriers, such as the following:
- Collaboration. One panelist described how her city uses emergency managers as a conduit to other social services. During a disaster response, they have social services and emergency management in the same room, increasing collaboration and providing both immediate assistance and the potential for long-term improvement to individual’s day-to-day life.
- Engagement. One panelist discussed how they purposefully ensure Community Emergency Response Teams (CERT) mirror their community. To ensure broader engagement by the community, the CERT training courses are inclusive and accessible. For example, trainings are in a building that is centrally located and accessible to persons with disabilities, sign language interpreters and translators are available, and training times are varied to accommodate those who work or have young children.
- Inclusion. One panelist detailed how they are sure to include appropriate representatives from vulnerable populations in their planning meetings. Inclusion of vulnerable populations in emergency planning allows the other planners to recognize their strengths and hear directly from them about their needs.
- Representation. Research has shown that racial and ethnic minorities often experience disproportionate negative impacts from disasters. Thus, inclusion of minorities in disaster mitigation is important. Panelists discussed participation in programs such as the Bill Anderson Fund, which supports individuals from underrepresented groups as they complete graduate programs related to hazards, disaster, and emergency management.[ii]
Although addressing the specific needs of vulnerable populations in disasters has received more emphasis in recent years, many of the social, economic and health disparities at the root of vulnerability during disasters persist. Addressing the needs of vulnerable populations in emergencies includes improving day-to-day life and harnessing the strengths of these groups. Many public health practitioners have recognized that a health equity lens and consideration of social determinants of health (e.g., healthcare access, education, built environment) is required when addressing disease management.[iii] A health equity lens should also be applied to emergency preparedness, response, and recovery activities to address disparities to ensure that disparities are not inadvertently created or exacerbated during disasters.
How are you working in your community to apply a health equity lens to emergency preparedness, response, and recovery activities?
Special thanks to Dr. Wolkin for contributing this blog in recognition of National Preparedness Month and as part of the celebration of the 30th anniversary commemoration of CDC’s Office of Minority Health and Health Equity. Our theme for the 30th anniversary commemoration is Mission: Possible. We believe “healthy lives for everyone” is possible and a goal that resonates in public health.
10 comments on “Mission Possible: Preparing and Responding to Disasters through a Health Equity Lens”
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It is an important list and I recall that the list we discussed in college among political science and psychology students was very much the same. I think it means that those issues must be addressed every time there is a disaster that must be handled by public health officials, the public itself, and support agencies and volunteers. It is so helpful to have a publication that addresses such. It seems to be a growing field of awareness and preparedness and our nation improves its resilience by it!
Is this Sheila that goes to AU?
It seems like a lot of the disaster programs are for those that can run,see and hear. What about those that can’t run, see, hear or have other disabilities as well and hidden disabilities. Are they going to be left behind?
I see a problem and am starting to put together a disaster awareness and preparedness program for the low vision and blind in helping them become aware and prepared.
I work in a Urban Public Health department as a social worker. I work with the vulnerable population who are already dealing with lack of resources. During a disaster there is no rebounding from the disaster without outside assistance. FEMA and Red Cross do not often reach out to this population with same resources or as quickly as others in need who have some resources as their own housing, jobs and bank account with savings. I believe that state , county, and local agencies need more resources to assist the vulnerable in urban and rural communities.
I loved reading this blog post and seeing the synthesis of such an important panel. Thank you to Dr. Amy Wolkin for your leadership in this area. What an important panel and post, and so glad to see so much progress in this area.
It’s worth looking at why these same populations are facing health disparities on a daily basis – not just in disproportionate impacts resulting from disasters. The answer is the institutional and structural racism and bias that permeate every one of the systems in this country.
I loved reading this blog post and seeing the synthesis of such an important panel. Thank you to Dr. Amy Wolkin for your leadership in this area.
Thanks for sharing with us.
I loved reading this blog post and seeing the synthesis of such an important panel
It’s worth looking at why these same populations are facing health disparities on a daily basis – not just in disproportionate impacts resulting from disasters. I loved reading this blog post and seeing the synthesis of such an important panel. Thank you to Dr. Amy Wolkin for your leadership in this area. What an important panel and post, and so glad to see so much progress in this area.
This may have been discussed before and if it has, I do apologize. One of the items I’ve noted is “planning from the response mindset” (or planning to respond) vs. “planning to build individual and community capacities”. I think they are both necessary and complementary. I came into public health / healthcare preparedness as a paramedic and maintained the stance of government having the duty to respond to crises. With that mindset was the notion of triage and utilitarianism – most good for most of the people. Over the past 15 years however, I’ve transitioned some of my thinking towards “if we can close the health equity gap, then perhaps our response will benefit even more people” – that is to say, individuals / communities with better baseline health would be more resilient to the hazard and perhaps, require less response actions or benefit more from the response actions (or both?).
While I’ve made this transition to a “both-and”, I can’t speak to the public health preparedness world as a whole. I’m also wondering if there are action items that can be built into PHEP / ASPR grants that are not so much “thou shall do incorporate health equity” but more “here’s how you can bridge between programs”.
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