May 18, 2024

For Dr. Vian Nguyen, one of the more harrowing moments of Hurricane Harvey in 2017 came when she fielded an emergency call about a woman in labor who was stuck in her home, trapped by flooding that made it impossible for an ambulance to reach her.

“The family had moved upstairs because water was already filling the downstairs,” says Nguyen, chief medical officer for Legacy Community Health, a federally qualified health center in southeast Texas.

The pregnant woman’s home was located in Gulfton, a predominantly Latino and Black neighborhood on the southwest side of Houston. Unable to reach her, Nguyen says she was forced to talk through the delivery with the woman’s husband, who was able to carry it out successfully and without complications.

Despite the positive outcome, Nguyen says the moment still serves as a reminder of the gaps in access that continue to exist for many communities where people are most in need of both emergency and routine health care. At the same time, Nguyen says a number of Legacy’s patients were displaced from their homes due to Harvey, forced to move to other neighborhoods, out of Houston or even out of the state, hampering efforts to curb health disparities that existed prior to the storm.

“That’s when we started to see some of our efforts to try to overcome these disparities start to not work,” Nguyen says.

Questions about the impact of natural disasters like Harvey on the life and health of communities have taken on greater urgency as such events have become more common. The number of recorded disasters related to weather, climate or water hazards increased by roughly 400% in recent decades, from 711 between 1970 and 1979 to more than 3,500 between 2000 and 2009, according to a 2021 report from the World Meteorological Organization, an agency of the United Nations. There were more than 3,100 disasters from 2010 to 2019.

But in many ways, there’s nothing natural about the level of vulnerability a community may or may not have to a disaster.

From racist practices of the past to present-day failures in preparedness, response and recovery, experts say poor policies and procedures have disproportionately put certain communities – particularly those predominantly occupied by racial and ethnic minorities – at higher risk of harm. And the growing threat of climate change only further heightens that risk.

“When we talk about natural disasters as though it is a force of nature, that sort of leaves humans off the hook,” says Anna Weber, a senior policy analyst for the Natural Resources Defense Council. “A lot of these human decisions have put people in harm’s way.”

Unequal Risks

A U.S. News & World Report analysis of figures from the Federal Emergency Management Agency’s National Risk Index – data from which was incorporated at the county level into the newly released 2022 Healthiest Communities rankings – highlights the increased level of risk racial and ethnic minority populations face from a host of extreme weather events, including events linked to climate change.

The FEMA index itself reflects the risk of a community for negative impacts from natural hazards relative to other communities, and is based on an equation involving three components: expected annual loss, social vulnerability and community resilience. The U.S. News analysis examined the risks of specific demographic groups by pairing the FEMA data at the census tract level with race and ethnicity data from the U.S. Census Bureau to create average risk scores for those demographic groups, weighted by population.

Overall, the U.S. News analysis found Indigenous people, encompassing American Indian and Alaska Native individuals, were the most at risk from natural hazards in the U.S. Among the various racial and ethnic groups examined, Alaska Natives were the group most at risk from hazards like volcanic activity, avalanches and cold waves, while American Indians were the group most at risk from drought, riverine flooding, wildfires and ice storms.

The analysis also highlights the dangerous threats natural hazards pose for Black individuals. While Black or African American people in the U.S. have the lowest overall risk from natural hazards, according to the analysis, this group also is at highest risk for negative impacts from hurricanes and tornadoes, as well as heat waves and flooding that occurs in coastal areas. Though evidence linking tornadoes to climate change is more difficult to pin down, scientists have connected the crisis to hazards including hurricanes, heat waves and flooding.

“This data adds to the growing evidence that certain racial and ethnic communities are currently bearing the brunt of illness and death from climate change,” says Dr. Renee Salas, an emergency medicine physician at Massachusetts General Hospital and a Yerby Fellow at the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health.

Salas says systemic racism has played a large role in the societal, economic and health inequities that have limited the ability of communities of color who are vulnerable to natural disasters to adequately respond to them.

Discriminatory policies like redlining in relation to home loans, for example, led to the segregation of many racial and ethnic minority populations to less desirable areas – including to where industrial sites and highways have led to higher exposure to air pollutants, or to areas vulnerable to flooding.

These areas also tend to have less green space, contributing to hotter temperatures. A 2020 study examining land surface temperatures in 108 urban areas across the country found that on average, redlined neighborhoods were warmer by 4.7 degrees Fahrenheit than nonredlined locations. Another study published last October in the Proceedings of the National Academy of Sciences found that exposure to extreme heat among urban dwellers globally nearly tripled from 1983 to 2016.

Higher surface temperatures found in minority communities appear to help explain why people of color are disproportionately threatened by extreme heat – a dangerous and potentially deadly disparity, as the Centers for Disease Control and Prevention reports more than 67,500 heat-related emergency department visits and approximately 700 deaths occur in the U.S. each year, on average.

In California, according to an analysis published in 2019, the rate of emergency department visits for heat-related illness increased on average by 67% for African Americans, 63% for Hispanics and 53% for Asian Americans from 2005 to 2015, compared with 27% among whites. Under a scenario with global warming of 3.6 degrees Fahrenheit, a recent analysis of 49 cities by the U.S. Environmental Protection Agency found that Black and African American individuals were 40% more likely than others to live in areas where mortality tied to extreme temperatures was projected to be the highest.

“So far, we are seeing that climate change is exacerbating a lot of disparities we are already seeing among these groups,” says Nambi Ndugga, a policy analyst with the Kaiser Family Foundation’s Racial Equity and Health Policy Program.

Ndugga is the co-author of a research brief published in May on the intersection of climate change and health equity. The brief notes that the same socioeconomic factors that have contributed to poorer health outcomes among racial and ethnic minorities – including poverty, exposure to environmental hazards and less access to health care – also affect their vulnerability to negative impacts related to climate change.

“People of color are more likely to experience homelessness and displacement during extreme weather events due to living in more fragile housing and in areas with less climate-resilient infrastructure” to begin with, Ndugga says.

But a community’s preexisting vulnerability is only one factor that determines its level of risk from climate change and related disasters. Katherine Catalano, deputy director of the Center for Climate, Health and Equity at the American Public Health Association, says a community’s resilience and ability to bounce back from such events depend largely on the investments in infrastructure and social supports made before those events occur. Yet low-income communities and communities of color often have received less funding toward capital improvements compared with more affluent, more white neighborhoods.

“You see communities with more parks and other permeable surfaces and updated storm water systems that can help mitigate flood risk,” Catalano says. “It’s not just to mitigate property damage, but the mold and diseases that can follow a flood with all of that standing water.”

Physical infrastructure investments aside, Catalano says many communities of color also tend to have weaker local food and health care systems, both of which she says are crucial in recovery.

“You just see that communities of color in the United States see less of this type of investment overall,” Catalano says.

Unequal Response

Maria Lopez-Nunez, deputy director of organizing and advocacy for the Ironbound Community Corp. – a community advocacy organization in the Ironbound neighborhood of Newark, New Jersey – says many of the working-class area’s 50,000 diverse residents have felt the effects of living in an area surrounded by heavy industry. The community is in proximity to power plants, a sewage treatment facility and a garbage incinerator, and has a reputation as one of the most toxic neighborhoods in the country.

“We’ve always been dealing with toxic waste facilities and toxic polluters,” Lopez-Nunez says. “With climate change, when our neighborhood floods, it’s toxic waters that are coming into our neighborhood.”

While the problems of pollution and contaminated sites can bring additional challenges when a natural disaster strikes, Lopez-Nunez says the most difficult aspect of dealing with climate change threats is the lack of timely federal support to help people quickly recover. She says community residents can wait more than a year until they receive any aid after a disaster.

“There are a lot of inequalities built into the way we recover from disasters in this country,” Lopez-Nunez says.

Events like the death of George Floyd in 2020 and the disproportionate impact the COVID-19 pandemic has had on communities of color have brought a heightened sense of urgency to issues of equity. Access and allocation issues tied to FEMA recovery assistance are no exception.

In a November 2020 report, FEMA’s National Advisory Council acknowledged that many of the administration’s programs “do not consider the principle of equity in financial assistance relief.”

“By perpetually assisting larger communities that already have considerable resources, the smaller, less resource-rich, less-affluent communities cannot access funding to appropriately prepare for a disaster, leading to inadequate response and recovery, and little opportunity for mitigation,” the report states. “Through the entire disaster cycle, communities that have been underserved stay underserved, and thereby suffer needlessly and unjustly.”

Along with people of color, data also indicates those who are less educated or renters have benefited less from federal disaster aid compared with those who are more educated or homeowners, with wealth disparities worsened in the wake of disasters.

There have been recent positive steps, however. In September, FEMA announced changes allowing residents to show more forms of documentation to prove occupancy or homeownership in a bid for disaster assistance, and allowing some residents to self-certify their ownership. Those actions are included in a broader Equity Action Plan released by FEMA earlier this year, with similar efforts taking root elsewhere among federal agencies as part of the Biden administration’s focus on advancing equity.

The issue also has received congressional attention. In early May, Democratic lawmakers Sen. Elizabeth Warren of Massachusetts and Rep. Bennie Thompson of Mississippi introduced a bill seeking to improve FEMA’s data collection to “better identify inequities within its programs” and directing the agency to ensure equity is integrated within its disaster assistance programs.

“For too long, frontline communities have been disproportionately impacted by the devastating effects of natural disasters, and this injustice is exacerbated by the distribution of relief,” Warren said in a statement when the bill was announced.

Still, Le says such reforms are only a first step toward achieving greater racial equity in the way the country approaches managing emergency response and recovery efforts. FEMA, she says, also will need to take a more active role in ensuring recovery initiatives like housing and infrastructure development, as well as remediation, are implemented and completed.

“Hurricane Harvey was five years ago, and we still have communities in Houston that have not been rebuilt,” she says.

FEMA spokesman Jeremy Edwards says the agency remains “laser focused” on ensuring equity is at “the center of its work to better serve survivors.” He notes FEMA recently launched a new Emergency Manager Exchange program to bring local and state emergency managers and government officials to Washington, D.C., to work with the agency on developing and changing policies.

“Ultimately, we know that disaster response is best executed and managed at the state and local level with additional support provided by the federal government,” Edwards says.

U.S. News’ Christopher Wolf performed the data analysis examining hazard risks by race and ethnicity.

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