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This review of the 2017 hurricane season and the ongoing response and recovery efforts 1 year following the disasters in Puerto Rico and the U.S. Virgin Islands reveal the cascading effects of these events on the social determinants of health. Nurses are well positioned to participate as full partners with the medical, public health, and emergency management community in all aspects of disaster planning, mitigation, response, and recovery.
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...