Magazine article Nursing Economics

Climate Change-Related Hurricane Impact on Puerto Rico and the U.S. Virgin Islands, Environment Risk Reduction, and the Social Determinants of Health

Magazine article Nursing Economics

Climate Change-Related Hurricane Impact on Puerto Rico and the U.S. Virgin Islands, Environment Risk Reduction, and the Social Determinants of Health

Article excerpt

Climate change-related disasters, including hurricanes, floods, and typhoons, directly impact community economies, force millions of people into poverty, and cost billions of dollars annually (Hallegatte, VogtSchilb, Bangalore, & Rozenberg, 2017; Mal, Singh, Huggel, & Grover, 2018). All such events disproportionately affect the poor and most vulnerable, including children, the elderly, and people with disabilities (Centers for Disease Control and Prevention, 2017). Disaster shocks disrupt essential services, schools, and businesses and lead to higher poverty rates, reduced economic development, and poorer health outcomes (Aitsi-Selmi, Egawa, Sasaki, Wannous, & Murray, 2015). Because disaster-related health data tend to focus on short-term impacts, researchers and policymakers must develop an improved evidence base of disasters' mid- and long-term effects on social determinants of health (SDOH) (Nomura et al., 2016). Such efforts should strive to identify strategies for sustainable development, adapting and expanding income, health care, education, childcare, social protection, and basic services such as nutrition, water, and sanitation in response to climate changerelated disasters. In this article, the impact of the 2017 hurricanes and resultant flooding on Puerto Rico (PR) and the United States Virgin Islands (USVI) are characterized, and operationally relevant evidence, frameworks, and recommendations regarding disaster shocks' impact on SDOH and community and infrastructure resilience are identified. The role of nurses in climate change-related water disaster planning, mitigation, response, and recovery is explored.

National and Global Frameworks for Disaster Response

Climate change-related water disasters cause environmental disruption, resulting in exposure to toxins and changes in population susceptibility while also fracturing health systems' infrastructure (Veenema et al., 2017). Climate change-related hurricanes (in particular, storms whose impact is influenced by warmer ocean temperatures, ocean systems acidification, and sea level rise) create rapid-onset shocks that affect a large proportion of the population simultaneously (Center for Climate and Energy Solutions, 2018; Intergovernmental Panel on Climate Change, 2018). In the case of such populationwide shocks, the event itself often does not determine the disaster; instead, the defining factors are "the vulnerability, exposure, and ability of the population to anticipate, respond to, and recover from its effects" (Aitsi-Selmi et al., 2015, p. 165). Climate-sensitive hazards create both direct and indirect health impacts (Banwell, Rutherford, Mackey, Street, & Chu, 2018) that are characterized by four major categories: weather-related morbidity and mortality, waterborne diseases/waterrelated illness, vector-borne and zoonotic diseases, and psychiatric/mental health effects (Veenema et al., 2017). Disasters often weaken public health infrastructure, particularly in resource-poor settings (Veenema et al., 2017; Watson, Gayer, & Connolly, 2007), and high-risk, high-vulnerability populations must be accounted for in all response and recovery plans (Davis, Hansen, Peek, Phillips, & Tuneberg, 2018; Wingate, Perry, Campbell, David, & Weist, 2007).

Disaster Risk Reduction

Disaster policies drive the design, delivery, and implementation of disaster preparedness and response efforts. Existing frameworks seek to reduce risk, mitigate the consequences of an event, and advance community resilience. The U.S. National Security Strategy acknowledges the importance of integrating national security with the healthsecurity concepts of resilience, community-based prevention, intergovernmental coordination, and global public health cooperation (The White House, 2017; U.S. Department of Homeland Security [DHS], 2015). The National Preparedness Goal aims for "[a] secure and resilient nation with the capabilities required across the whole community to prevent, protect against, mitigate, respond to, and recover from the threats and hazards that pose the greatest risk" (DHS, 2015, p. …

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