Road To Health
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Road To Health: HURRICANE HARVEY, WHICH dumped trillions of gallons of water on the southern U.S., killed at least 89 people and displaced thousands more in a matter of days, held only a 0.2 percent chance of bringing its type of torrential flooding to Houston last year.

But Harvey – referred to by many as a 500-year flood event because the odds of it happening in a given year are at least 1 in 500 – was the third such major natural disaster to hit the city in as many years. And months later, Houston, the fourth-largest city in the U.S., is still grappling with the storm’s aftermath.

Harvey also wasn’t America’s only major storm last year. According to the National Oceanic and Atmospheric Administration, there were 16 severe weather events that each cost the U.S. $1 billion or more in 2017, ranging from wildfires in California to a tornado outbreak in the Midwest. Carrying a total price tag of $309.4 billion along with 362 deaths, 2017 was the costliest year on record for weather and climate events.

Though natural disasters last for a relatively short period of time, their damage often remains long after floodwaters recede or wildfires burn out. And health-related problems – which can include damaged hospitals and housing, communicable diseasemental health conditions such as post-traumatic stress disorder and depression, and simple neglect of one’s own well-being – reverberate throughout communities as they attempt to recover and rebuild.

“When people are busy with their jobs and getting their lives back together, they’re not always thinking about their own health, so they’re not always taking their medication or getting their refills,” says Dr. Umair Shah, president of the National Association of County and City Health Officials.

As major natural disasters become more frequent, public health experts say leaders should treat these severe events as a “new public health normal” and prioritize disaster resilience in community planning and rebuilding. Every pre-emptive dollar spent on mitigation can save about $6 in future disaster costs, according to a report from the National Institute of Building Sciences.

“Every community needs to recognize they’re at risk for something, and it’s important for them to identify what those risks are and begin planning now,” says Dr. Georges Benjamin, executive director of the American Public Health Association. Those threats could be floods or hurricanes, but they also include earthquakes, wildfires and water shortages that are already affecting some states, Benjamin adds.

“We’ve had water problems in the U.S. already – nothing like in Cape Town, but we have had them,” he says. “So we need to pay a lot more attention to that kind of stuff, because I think that’s going to be an emerging problem. If you think we had too much water with the floods, what happens when we have too little water?”

In the wake of Harvey, Houston has become a prominent test case for resilient rebuilding. Last month, the Houston City Council approved regulations requiring new buildings in the 100- and 500-year floodplains be built 2 feet above ground level or above the projected water level of a 500-year flood. The city previously mandated a 1-foot height for homeowners in the 100-year floodplain, and a report earlier this year found that 84 percent of Harvey-damaged homes in the area’s floodplains could have been spared with the higher height standard.

Houston Mayor Sylvester Turner, who originally proposed the new height rule, also is seeking funding to build a third reservoir for the city, though such a project would take years to complete.This year’s hurricane season, which begins June 1, is forecast to be “slightly above average.”

“We are in what Mayor Turner calls a post-Harvey era, where doing things the same way going forward would be a total folly,” says Alan Bernstein, a spokesman for Turner.

Still, the effects of Harvey would’ve been significantly worse if officials hadn’t had experience dealing with previous storms such as Tropical Storm Allison in 2001, says Shah, who also leads the public health department for Harris County, which includes Houston.

He says other communities recovering from their own natural disasters should draw on lessons from areas hit by major catastrophes in the past, such as New Orleans – which was struck by Hurricane Katrina in 2005 – and the East Coast, which was plagued by Superstorm Sandy in 2012.

“We were very aggressive about things (leading up to and during the hurricane). … If you’ve gone through emergencies before, you recognize patterns faster and you recognize what needs to be done faster,” Shah says. “But there are many communities across the country that have not gone through those emergencies, and so it’s really a shared responsibility … so we can really learn from each other.”

New Orleans is perhaps the most poignant example of what happens when a community is unprepared for the health challenges that natural disasters pose. When Katrina struck, the region was already unhealthy – New Orleans had a large uninsured population to go with high rates of heart disease, stroke and diabetes, and Louisiana’s Medicare population experienced a low quality of care at high financial expense, according to a paper published recently in the American Journal of Public Health.

Katrina compounded the city’s woes to the extreme: The storm cut hospital capacity by 80 percent and forced 3 in 4 safety net clinics to shutter, leaving hundreds of thousands of people without access to care, the paper said.

But during storm recovery, the report authors noted, the Louisiana Health Care Redesign Collaborative addressed four major areas to improve health in the region: primary care and prevention, quality of care, health information technology and insurance coverage. Meanwhile, flooded areas were converted into family parks, walking trails and meeting centers, and empty lots in food deserts became community orchards.

Within five years of Katrina, more than 300,000 patients visited new primary care facilities and emergency department usage declined, according to the AJPH paper. About three-quarters of New Orleans patients reported satisfaction with the quality of their care, compared with about 40 percent of U.S. patients overall, the report said.

Communities that have not been hit hard by natural disasters also should be intentional about building for resilience, Benjamin says, because while “it will cost money, we’re always renovating something.” And as public health becomes a greater consideration among those who design communities, Benjamin says preparing public spaces for natural disasters should be just as paramount as planning for safety and mobility.

“If you’re going to start thinking about bicycle lanes and redoing your streets as a way to improve mobility and make it more walkable, you do have to remember you have to have egress routes and emergency preparedness routes,” Benjamin says. “And you have to make sure you don’t impede your snow removal equipment from getting in or your fire equipment from getting in.”

“You’ve got these beautiful communities [and] you put in a new plaza that’s wonderful and green and people can sit out there and smell the fresh air and the flowers, but is it designed for if something bad happens?” he says. “It really needs to be thought through about resilience.”

Benjamin and Shah say a major challenge to these efforts is getting the necessary buy-in at the state and national levels.

Despite a federal effort underway to create a strategy aimed at mitigating the risks of natural hazards, core federal funding that helps states and localities prepare for things such as health emergencies and natural disasters fell by more than half between fiscal 2002 and 2017, according to a report from the nonprofit Trust for America’s Health. President Donald Trump’s fiscal 2019 budget request would keep funding relatively stable for the Public Health Emergency Preparedness cooperative agreement program.

That funding is usually allotted to emergency management services or health care systems, Shah says, with little or none granted to public health agencies that are “also boots on the ground responders, and are equally responsible for the health and wellbeing of a community.”

In Texas, Republican Gov. Greg Abbott asked for $61 billion in additional federal funding for hurricane recovery efforts in October, but Congress appropriated nearly $90 billion as part of the spending deal in February for the state to share with CaliforniaFlorida, Puerto Rico and others recovering from disasters of their own.

“Obviously, Texas ain’t gonna get its $61 billion,” Bernstein says. “Will Houston get enough money to make a serious dent in those projects that nobody felt the urgency to build before? Yes. Is it going to be 100 percent of what we’re looking for yet? No.”

Benjamin and Shah say that while they would like to see the process of integrating natural disaster planning into wider public health efforts move more quickly, they have seen increased awareness of the issue and coordination among governments, public health agencies and others charged with protecting communities from natural disasters.

“We have made progress, but we also recognize this journey is a long one and it’s going to be months or years before our community is completely recovered,” Shah says. “And our job is to build a community that is healthier and more resilient than it was.”

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