This is the Year of Climate Change and Health, a 12-month APHA-led initiative with monthly themes meant to raise awareness of and mobilize action on the health impacts of climate change. Our September focus has been Extreme Weather, and we cap off the month with a Q&A Public Health Newswire conducted earlier this month with Linda Young Landesman, DrPH, MSW. A pioneer in the field of public health preparedness, her landmark Landesman’s Public Health Management of Disasters: The Practice Guide, is now in its fourth edition.

linda-landesmanQ: Dr. Landesman, how do extreme weather events like Superstorm Sandy, Hurricane Katrina and now Hurricanes Harvey and Irma [This interview took place before the devastation of Hurricane Maria] affect the way you think about public health disaster preparedness and response in this country?

Since 2001, the United States has experienced an annual average of 120 disasters that are significant enough to require the deployment of federal resources. Public health preparedness and response is critical to the nation’s health as communities deal with environmental (e.g., air, mold, sanitation and water), occupational and a surge of medical and behavioral health issues following disasters.

In most of these incidents, properly trained public health professionals are able to respond because the tasks needed are part of the extensive preparedness repertoire that has been built up since 9-11. The maintenance of these essential skills is critical to the welfare and security of every community and to a region’s recovery.

However, if federal funding is cut back, there will be fewer public health personnel to provide the education, surveillance and service delivery needed when communities have been torn apart by powerful storms. This will be especially noticed if the storms are catastrophic in nature.

With warming global temperatures, we are likely to see more catastrophic hurricanes because higher temperatures lead to more water vapor over the oceans, which effects the amount of rain brought to shore by these storms. The impact of larger storms, such as what we experienced from Hurricanes Harvey and Irma this month, will devastate larger areas of land with denser populations. Without a strong public health system to provide necessary services, communities will be sicker and it will take longer to recover.

Q: What do you foresee including in a fifth edition of Landesman’s Public Health Management of Disasters: The Practice Guide as climate change causes more frequent and extreme weather events around the world?Landesman's Public Health Management of Disasters

If the summer of 2017 is any indication of what is to come, the world must be prepared for future catastrophic events. I write this as Texas is in the early stages of recovery from Hurricane Harvey and Florida, Puerto Rico and others saw Hurricane Irma devastate whole communities.

Clearly, lessons learned from Hurricane Katrina and Superstorm Sandy have translated into a more robust federal and local response, which resulted in dramatically fewer deaths and injuries from the most recent storms. Given the proximity of Harvey and Irma, we even saw that current planning was sufficient to handle more than one major event at a time.

While the response was robust in Texas, an innumerable number of people were exposed to toxic chemicals released into the floodwater from the hundreds of petrochemical plants, superfund sites and oil refineries located in the state. Further, people cleaning their homes are being exposed to high levels of e-coli from the seepage of sewage systems into the floodwaters. While it is impossible to know the exact levels of toxins that people were exposed to, surveillance is needed to track possible negative health outcomes. These studies should be long term, such as those tracking people exposed to toxins following 9-11.

By the time writing of the fifth edition begins, the After Action Report will be completed and we will have a better idea of what went well and what needs improvement. In addition, the US will have experienced other major disasters from which we will identify areas that will need further advances. At a minimum, the fifth edition of the Practice Guide will need to include new information on planning and response for catastrophic events, toxic exposures in floodwaters and surveillance for environmental exposures. Experience has shown that, when it is time to start researching and writing, I will be amazed at how may changes have occurred that need to be reflected in an updated edition. The fourth edition is almost three times longer than the first.

Q: What lessons in public health preparedness did we learn from recent extreme weather events, and do you see those lessons reflected in the preparation for and response to Hurricanes Harvey and Irma? What other lessons can we learn?

It is clear that the federal and local response to Hurricanes Harvey and Irma reflected better preparedness. Part of this is attributable to strengthened federal standards and increased efforts to shore up state and local planning. Another part of the “success” of this effective response may be attributable to the emphasis on the “whole community,” an approach advocated by the Federal Emergency Management Agency.

Without evaluation, we won’t know if the neighborly help offered in Texas and Florida was a reflection of the moral fabric of these communities or encouraged because of FEMA’s push for everyone in the community to be part of preparedness and response. Finally, in advance of Harvey making landfall, the Department of Health and Human Services deployed a significant number of healthcare professionals, hospital beds and other resources. This advance deployment is crucial in being able to meet the expected surge of people losing their healthcare providers, medication and medical supplies in the storm.

Q: How do we better help vulnerable populations (children, seniors, the disabled and infirmed, low-income and minority communities) increase physical and mental resiliency to extreme weather events?

When ordered, evacuation is the best way to ensure that people will survive an extreme weather event. However, in addition to having the financial resources to leave, people have to be physically able and have a place to go. Vulnerable populations are most at risk of not being able to do that. Of the people who remained in New Orleans during Hurricane Katrina, 14 percent had a physical disability. Fifty-five percent didn’t have access to a car or other transportation.

Resilience is the ability of people to rapidly and effectively rebound from challenging events. While more research is needed about the level of resilience of vulnerable populations in disasters, people who have been more resilient in the past made more preparations, had involved family and neighbors in their preparedness activities and had worked with non-governmental organizations that provide services to them. Further preparedness could be accomplished by stronger outreach to ensure that vulnerable individuals are prepared by a community or region’s healthcare coalition.

APHA Press offers Landesman’s Public Health Management of Disasters: The Practice Guide, 4th edition, co-authored by Rita V. Burke, PhD, PMH. ISBN: 978-0-87553-279-0, softcover, 745 pages, list price: $85.00 (APHA member price: $59.50). To order, call toll-free 888-320-APHA; email APHA Press or visit the APHA Bookstore. And for more information on how you can prepare for hurricanes and other disasters, hazards and emergencies, visit APHA’s Get Ready campaign blog and listen to the Get Ready Report Podcast, episode 49: “Preparing for the next public health emergency,” featuring Dr. Landesman.