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ABSTRACT Climate change exacerbates the severity of natural disasters, which disproportionately affect vulnerable populations. Mitigating disasters' health consequences is critical to promoting health equity, but few studies have isolated the short- and long-term effects of disasters on vulnerable groups. We filled this gap by conducting a fifteen-year (20032018) prospective study of low-income, predominantly Black parents who experienced Hurricane Katrina: the Resilience in Survivors of Katrina (RISK) Project. Here we describe this project and synthesize lessons from work that has resulted from it. Our findings can guide policy makers, service providers, and health officials in disaster planning and response. We synthesize them into an organizational schema of five priorities: Primary efforts should be aimed at preventing exposure to trauma through investments in climate resilience and by eliminating impediments to evacuation, health care policies should promote uninterrupted and expanded access to care, social services should integrate and strive to reduce the administrative burden on survivors, programs should aid survivors in forging or strengthening connections to their communities, and policy makers should fund targeted long-term services for highly affected survivors.
Natural disasters harm human health and well-being, and the size of the population exposed to disasters is increasing as climate change intensifies extreme weather events, damages protective ecosystems, and causes sea level rise that leads to coastal flooding.1 The risks associated with natural disasters exacerbate existing social and racial/ethnic inequities in health, with low-income people and members of racial/ethnic minority groups more likely to live in disaster-prone areas and in lower-quality housing that is less safe when disasters occur.2 Although climate change affects health through a variety of pathways, disaster mitigation and response planning are increasingly important targets for health equity interventions.
However, most studies either lack the predisaster data required to estimate the effects of disasters on health or follow local survivors only briefly after the traumatic event, obscuring long-term health needs. Moreover, few disaster studies are adequately powered to explore outcomes for socially vulnerable groups, even though low-income people and members of racial/ethnic minority groups are most at risk for disaster exposure and have fewer resources to buffer against their effects.3 These limitations hamper the creation of evidence-based policy, programming, and service delivery designed to protect health and promote health equity.
We address these limitations...