Natural Disasters Are Widening the Health Equity Gap, Now’s the Time to Address It

The 2020 Atlantic hurricane season has come to an end. On top of the record-setting 30 named storms that brought intense wind, rain and storm surges along the coast, this year also included wildfires that forced hundreds of thousands to evacuate, simultaneous major disaster declarations in all 50 states due to Covid-19 and an intense wind storm that destroyed homes and devastated residents.  

This year becomes only the latest data point in an established trend towards more frequent and more damaging disasters, and this new reality will have alarming impacts on our health. But what is downright petrifying is the impact of more frequent disasters on the widening health equity gap.

Frontline communities, which include low-income neighborhoods and neighborhoods that are majority Black, Indigenous and people of color, bear the brunt of disaster impacts. These communities often face compounded vulnerabilities that are layered on top of one another. Each layer of vulnerability represents an increased risk of exposure to disaster, a greater impact when disaster strikes and longer recovery time after a disaster. These vulnerabilities aren’t naturally occurring, they are the result of systemic bias and discrimination that has been allowed to fester into gaping, harmful wounds. 

In this recipe for disaster, we start with the first layer of baseline vulnerability that takes the form of low salaries, food insecurity, poor housing conditions, underlying medical conditions and lack of transportation. Most of these vulnerabilities are the result of systemic, discriminatory practices such as redlining and gender and race-based wage gaps. As a result of unjust policies, frontline communities are more likely to face socioenvironmental conditions that negatively impact their health. Put simply, these communities are incredibly vulnerable before disaster strikes.

Next, frontline communities face disaster-specific vulnerabilities. For example, low-income people are less likely to have flood insurance and Native Americans are six times more likely than other groups to live in wildfire-prone areas. Additionally, underlying medical conditions are also a threat because certain disaster conditions can aggravate existing health problems. For example, people with asthma and other lung conditions are especially vulnerable to wildfire smoke or toxic air pollution caused by storm damage and the prevalence of asthma is highest among Blacks and American Indian/Alaska Natives.

Altogether, these vulnerabilities create an inequitable starting position for frontline communities, with grave consequences to their health. For example, when Hurricane Sally affected the Gulf Coast states of Alabama, Florida, Louisiana and Mississippi, many low-income communities located in a floodplain were affected. Most of these communities also were facing rising Covid-19 cases at the time, so community members experienced the worst effects of one disaster on top of an existing disaster and underlying socioeconomic vulnerabilities.

Frontline communities also take much longer to recover from a disaster. Research shows that Black and Hispanic households lose an average of $27,000 and $29,000 in wealth, respectively, after disasters while white households gain $126,000. Since health is connected to wealth, these communities are also likely to be sicker than their white counterparts following a disaster. Forced to allocate money towards home repairs or relocation instead of health insurance or medications, frontline communities are left further and further behind.

This exploding health equity gap will widen as disasters become more common and increasingly unmanageable. The current concept of disaster management is flawed and needs to be reimagined to be more focused on human services with a high priority on equity. Specifically, social determinants of health must be incorporated as a starting point for disaster planning and fully embraced by emergency managers.  

The current pandemic offers a unique opportunity to make our public health system more equitable and to better prepare frontline communities for inevitable future disasters.

First, we can dramatically increase investment in public health infrastructure at the local, state and federal levels, which has been far too low for far too long. Spending on local and state health departments has dropped by more than 15% over the last decade,. At the federal level, the Centers for Disease Control and Prevention funding for public health preparedness and response has suffered over the last several years. The Covid-19 pandemic shed light on this challenge and while stimulus bills seek to fill the immediate gap, deeper solutions are needed. Doubling down on funding for the country’s public health infrastructure will mitigate the grave, inequitable health impacts of disasters.

Second, we can focus on fixing the inequities in the disaster preparedness system to ensure frontline communities are resilient well in advance of a disaster. These interventions include addressing systemic racism in federal programs for housing, urban planning, workforce development, health care and infrastructure projects. For example, the U.S. Army Corps of Engineers should revisit its metrics for prioritizing flood mitigation infrastructure projects, since their metrics currently value the protection of wealthy communities, with higher property values, over poorer communities.

While we can’t predict which specific disaster will occur next, we know that stronger wildfires, stronger storms and other climate events will become the new normal, and gaps in health equity will stretch even further. We know that the enemy of equity is the failure to acknowledge existing inequities in our planning; now is our moment to change course toward a better, more equitable and healthier reality.