U.S. Healthcare Infrastructure: Unprepared for Worsening Hurricanes?

Authored By: Merrick Word-Brown

Art By: Mia Hsu

Around the world, extreme weather events are increasing in severity and frequency due to global climate change, presenting a significant threat to public health and healthcare infrastructure. The negative health impacts of weather disasters not only increases the burden on hospitals and healthcare centers, but also damages and limits function at these facilities. The recent devastating effects of Hurricanes Helene and Milton in the southeast United States brought national attention to this issue, exposing the vulnerabilities of critical health infrastructure to extreme weather events.

Of all extreme weather events, hurricanes are some of the most damaging to the health of affected communities. The acute health impacts of hurricanes include drowning, injury, carbon monoxide poisoning, and disease outbreaks stemming from crowded shelters or contamination. Additionally, these impacts extend well beyond a storm event. Research shows an increase in the prevalence of chronic and mental illness as well as mortality, with prevalence often elevated for months or years after. [1] Given the burden of injury and disease during and after a hurricane, the role of a community’s healthcare infrastructure becomes even more important. Patient volume increases significantly at most hospitals and emergency departments post-hurricane, with this increase especially pronounced among at-risk populations like children and the elderly. [2, 3]

During hurricanes, hospitals and other medical centers often experience significant damage and operational interruptions during a time when they are needed more than ever. High winds, storm surges, and debris can weaken or destroy buildings, essential power grids, and transportation necessary for healthcare delivery. One study found that during Hurricane Maria, a majority of hospitals and medical centers assessed in Puerto Rico sustained structural damage impacting operations, and flooding from Hurricane Katrina led to the permanent closure of the only Level I trauma center in the Gulf Coast region. [4, 5]  Additionally, hurricane power and frequency, as well as the subsequent vulnerability of healthcare infrastructure is rising due to climate change. The geographic range of hurricanes is also expanding, putting communities further north and inland at risk of damage, as seen in the destructive flooding in western North Carolina from Hurricane Helene. A recent Harvard study found over 50% of hospitals are vulnerable to hurricane flooding in 25 Atlantic and Gulf Coast metropolitan statistical areas, with the risk rising nearly 25% by 2100 due to projected sea level rise. [6] Moreover, a report from the Center for American Progress found that over a third of community health centers are at heightened risk for damage from climate-related disruptions, particularly in underserved areas. [7]

Despite the rising toll of hurricanes and other extreme weather events, hospitals and other healthcare infrastructure remain unprepared. A recent literature review found that among U.S. hospitals, mitigation efforts have not sufficiently addressed the most commonly identified vulnerabilities of water, communication, staff, and power loss. [8] In fact, a standard assessment procedure to evaluate and report damage to healthcare facilities after disasters does not exist. [4] Retrospective research on the impacts of specific hurricanes such as Katrina and Harvey on healthcare infrastructure describes it as severely unprepared. [9, 10] However, larger scale research is still needed to evaluate hurricane healthcare emergency response and preparedness, especially in rural and underserved communities. [11]

In addition to insufficient research, healthcare emergency preparedness in the United States is chronically underfunded. Programs within the Centers for Disease Control and Prevention and the Health and Human Services Department have had their budgets either cut outright or effectively decrease due to inflation. [12] Some initiatives to promote disaster preparedness have received funding increases, though. For example, in 2021, the Biden administration allocated $65 million to the U.S. Department of Health and Human Services for primary care hurricane preparedness and response in several states at greatest risk. [13] However, such efforts remain insufficient, especially as climate change threatens even more devastating storms. The recent re-election of President Donald Trump casts further doubt on the future of emergency preparedness efforts given significant cuts to public health and emergency preparedness budgets during his first term.

Overall, a combination of extensive research and funding for hurricane preparedness and resilient healthcare infrastructure is essential for ensuring a healthy present and future in the United States. Given that climate change is expanding areas impacted by hurricanes, many individuals and communities not traditionally at risk face the possibility of new or worsened weather events and their subsequent healthcare facility damage. Increased focus on strengthening healthcare infrastructure also benefits its resilience and ability to respond to other extreme weather events like heat waves, wildfires, and floods. Prevention and preparedness measures are often overlooked in public opinion and government funding. Raising awareness and calling on elected officials to take action are important steps Cornell students and community members can take to help ensure that healthcare infrastructure is prepared to offer quality care when hurricanes and other natural disasters strike.

References:

1. Waddell, S. L., Jayaweera, D. T., Mirsaeidi, M., Beier, J. C., & Kumar, N. (2021). Perspectives on the Health Effects of Hurricanes: A Review and Challenges. International Journal of Environmental Research and Public Health, 18(5), Article 5. https://doi.org/10.3390/ijerph18052756

2. Chambers, K. A., Husain, I., Chathampally, Y., Vierling, A., Cardenas-Turanzas, M., Cardenas, F., Sharma, K., Prater, S., & Rogg, J. (2020). Impact of Hurricane Harvey on Healthcare Utilization and Emergency Department Operations. Western Journal of Emergency Medicine, 21(3), 586. https://doi.org/10.5811/westjem.2020.1.41055

3. Heslin, K. C., Barrett, M. L., Hensche, M., Pickens, G., Ringel, J. S., Karaca, Z., & Owens, P. L. (2020). Effects of Hurricanes on Emergency Department Utilization: An Analysis Across Seven U.S. Storms. Disaster Medicine and Public Health Preparedness, 15(6), 762. https://doi.org/10.1017/dmp.2020.281

4. Irvin-Barnwell EA, Cruz M, Maniglier-Poulet C, et al. (2020). Evaluating Disaster Damages and Operational Status of Health-Care Facilities During the Emergency Response Phase of Hurricane Maria in Puerto Rico. Disaster Medicine and Public Health Preparedness. 14(1):80-88. doi:10.1017/dmp.2019.85 

5. Kaiser Family Foundation. (2013). Addressing the Health Care Impact of Hurricane Katrina. Kaiser Commission on Medicaid and the Uninsured. https://www.kff.org/wp-content/uploads/2013/01/7387-2.pdf

6. Tarabochia-Gast, A. T.,  Michanowicz, D. R., &  Bernstein, A. S. (2022).  Flood risk to hospitals on the United States Atlantic and Gulf Coasts from hurricanes and sea level rise. GeoHealth,  6, e2022GH000651. https://doi.org/10.1029/2022GH000651 

7. Johns, M & Rosenthal, J. (2024) Climate-Resilient Health Care Promotes Public Health, Equity, and Climate Justice. Center for American Progress. https://www.americanprogress.org/article/climate-resilient-health-care-promotes-public-health-equity-and-climate-justice/

8. Melnychuk, E., Sallade, T. D., & Kraus, C. K. (2022). Hospitals as disaster victims: Lessons not learned? Journal of the American College of Emergency Physicians Open, 3(1), e12632. https://doi.org/10.1002/emp2.12632

9. Gray, B. H., & Hebert, K. (2007). Hospitals in Hurricane Katrina: Challenges Facing Custodial Institutions in a Disaster. Journal of Health Care for the Poor and Underserved, 18(2), 283–298. https://dx.doi.org/10.1353/hpu.2007.0031 

10. Newman, B., & Gallion, C. (2019). Hurricane Harvey: Firsthand Perspectives for Disaster Preparedness in Graduate Medical Education. Academic Medicine, 94(9), 1267. https://doi.org/10.1097/ACM.0000000000002696

11. Manley, W. G., Furbee, P. M., Coben, J. H., Smyth, S. K., Summers, D. E., Althouse, R. C., Kimble, R. L., Kocsis, A. T., & Helmkamp, J. C. (2006). Realities of Disaster Preparedness in Rural Hospitals. Disaster Management & Response, 4(3), 80–87. https://doi.org/10.1016/j.dmr.2006.05.001

12. McKillop, M & Lieberman, LM. (2024). The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations. Trust for America’s Health. https://www.tfah.org/wp-content/uploads/2024/08/2024-PublicHealthFunding-FINAL.pdf

13. U.S. Department of Health and Human Servces. (2021) Biden-Harris Administration Announces $65 Million to Strengthen Hurricane Response and Emergency Preparedness at Health Centers. https://www.hhs.gov/about/news/2023/06/01/biden-harris-administration-announces-65-million-strengthen-hurricane-response-emergency-preparedness-health-centers.html