Transcript of Get Ready Report podcast, episode 51

This is APHA's Get Ready Report, coming to you from Washington, D.C.

Hello everyone! Welcome to our latest edition of the Get Ready Report. Today we’re joined by Dr. Nicolette Louissaint, the executive director of Healthcare Ready and an APHA member, and she’s going to talk a little bit about disaster preparedness and how it relates to health equity. Nicolette, thanks so much for joining us.
Thank you so much for having me.

So we’re gonna go ahead and get started, and our first question for you is why are some people hit harder by disasters and what kinds of communities face greater risks?
So I think we have to dissect that question, the scientist in me feels the need to start with a definition. When we think about disasters, we are really thinking about a wide range of hazards. Every single one of us — depending on where we live, the experiences we’ve had, the disasters that we have survived — probably thinks about one or two disasters in particular, but when you think about disasters we’re really talking about a wide range of events that also includes disease outbreaks. So it’s not just hurricanes and tornadoes, it could be a disease outbreak like Ebola or something that happens every year like the flu.

There are truly dozens and dozens of different types of hazards that classify as disasters. And when we think about it that way, and we think about the likely events that are caused by whatever the disaster is, there are going to be certain populations that will be impacted by the disasters. We like to think in terms in our organization as cascading health effects. And so if you’re thinking about an event where there is a loss of that power, you’re going to, you know, automatically shift to, “Which populations are going to be dependent on power in order for their health care to be delivered?”

For example, people that are using oxygen concentrators. And if you really just go through those long lists of different events, you will find that there are certain populations that are inherently more vulnerable because of their dependence on certain systems, or their ability to be independently resilient. We are a tremendously interconnected society, whether we like to believe it or not.

Right! And so because of that, it’s critical for us to think about the populations that depend on certain systems. And so in the absence of things like power, whether that be electricity or generator power or communications, or road access, or water, there are going to be people that are going to be much more vulnerable and probably far more dependent on folks like us to assist them during disasters.

Yeah, absolutely. And just kind of going off of that, in those populations of people that might be a little bit more dependent, you know, why are maybe some communities of color more likely to suffer long-term damage from disasters?
So one of the hardest things about being in the disaster preparedness and response space is that you cannot divorce the conversation about disaster preparedness and response or really the entire emergency management life cycle with systems.

With any other systems.

And so, you really can’t talk about mitigation without talking about planning. You can’t really talk about planning without talking about economics. You can’t really talk about economics without talking about racism.

And so we find ourselves in a place where we are forced to really think through which systems are in place, especially in the United States, which systems are sufficient to mitigate against certain events, how we prepare for those events and who’s gonna be left out. The reality is that the systems that we have created are going to leave many communities of color out. And that is no different during a disaster. So the way I like to think about it is in terms of blue sky, gray sky and black sky. If you are in a serious event that may be a gray sky event or a catastrophic event that’s gonna be a black sky event, the systems you’re relying on are going to be no better than they were during blue sky, right?

So you’re not going to see that somehow magically during a disaster somehow all the things that were major problems in a, you know, regular day just go away.

They’re gonna be exacerbated. Whatever we see as it relates to challenges with communities having access to care or ability to have physical access to health care or dependence on transportation in order to get refills of medicine, all of those things are going to be worse during a disaster, they’re never going to be improved.

And so what we see in many communities is that the communities of color are already, on a blue sky day, facing the most challenged access issues. And so if we’re thinking about dependence on health care systems we already know that communities of color are going to have higher chronic care needs. Those don’t go away during a disaster. If we’re thinking about the vulnerability of systems we also know that communities of color tend to live in places that are gonna be more prone to disasters and more vulnerable in terms of their infrastructure and there, the infrastructure’s ability to respond or be resilient during the disaster, that’s not gonna change.

And so those things are going to actually converge in a very catastrophic way during those events so we’re going to see a surge of not just acute care needs; not just the broken legs and the things that are associated with the event, but the chronic care needs that now cannot be managed by the system that these communities depend on.

Absolutely, yeah. And so on that blue sky day that you’re mentioning, that preparedness is already not there for a lot of these communities, so if a population is struggling before a disaster, be it an outbreak or a natural disaster, what is the role of the community leader and public health advocates — what is their responsibility? How do they increase equity for that group on those blue sky days to prepare for the gray sky days as you say?

Absolutely, that’s a great question and I wish I had the perfect answer, and I will give it my best shot as what I think some of the solutions are.

But I think this is just a conversation we need to have in the field because there — for one, there really aren’t a lot of public health folks that are engaged in the emergency preparedness response discussion. And we need more of that.

And we need that cross-pollination of priorities. One of the hardest parts of us thinking about how we equip communities to be resilient and make sure that individuals are prepared is that that is a luxury that many communities and individuals simply don’t have. There are many members of our society that just are focused so much on their day-to-day survival that the idea of preparing for something that might happen is just out of, you know, their immediate priority. So for us, part of our challenge is thinking through what exactly it looks like to have resilience happen at the community level and allowing communities to work together. Local jurisdictions are a big part of this. So public health departments, emergency management agencies are part of this, the communities in many ways have to drive it.

One of the realities we see in a lot of the work we do at the community level is that while people are not using the language that we might use in emergency management, they are very much aware of their risks and vulnerabilities in a way that can really improve an emergency response. Communities know what they can handle and what they can’t. And just being able to get that information out so that we have a realistic sense of what can be done or how we should prepare and how we should plan on coordinating with those communities is really important. And I think community leaders have the ability to serve as aggregators of that type of information, but they can also serve as disseminators. So some of this is how we think about preparedness as not being a luxury but being a vital part of how our community functions.

It’s thinking through being able to prepare as a community as opposed to being responsible for just the individual or your household. There is a sense of shared responsibility and we always see that during events, neighbors show up in incredible, incredible ways and can really support one another. But how much more could we do if there was a concerted effort to do that planning in advance, and those community leaders were able to step in and facilitate some of that? But at the same time those leaders also need to be resourced. And organizations like ours are really focused on making sure we can get those resources to those leaders and make it as easy for them to do this as possible because, again, they have other priorities every day as well.

If we as public health experts know how many different things are going on at any different day —

Oh yeah, for sure.
— it’s really difficult to add any new priorities so we have to make it as easy as possible for them to do so.

So you’ve talked a little bit about this but can you give us a general sense of what a prepared community looks like and sort of how that’s different in general in maybe a community that’s a little bit more marginalized?
Sure, so I paused because I’m thinking about some examples.

Oh, perfect!
I’ll say this and I think most of my colleagues would agree with me — there is no community that is fully
prepared. What we find is that certain communities are more prepared for certain events —

— than others. So if you’re thinking about Florida for example, Florida geographically just juts out into the Atlantic Ocean; they are prepared for hurricanes —

— because they see them often. But another type of event — whether it be extreme cold, or a disease outbreak like Zika — you’re not gonna see the same type of readiness because that’s not what they’re used to dealing with.

And I think generally a state like Florida is actually a lot more prepared than other states. But again preparedness is not just a checklist of things, and it’s so dependent on events that there is really a wide range of things you need to do and capabilities you need to have. But I think what community preparedness looks like in general and I think the most important part of it is the fact that we need communities to be prepared as a unit. And so in that community it’s not enough for individuals or single households to be prepared, it’s that the community understands how they support each other during an event. And that may be having a plan for how they take shelter or evacuate together, making sure they understand the individuals that in their community that might need assistance during an evacuation — so are there wheelchair-dependent folks? Are there individuals who may be fragile? Are there individuals that are living in a complex where they need to get downstairs and they have difficulty doing that? For us, as public health preparedness folks, thinking about medical needs, understanding who your community needs refills.

A lot of the public health challenges that we see during events are related to chronic care needs, and so if the community has a better assessment of how to support one another, that is something that can actually improve preparedness. One thing that we’re starting to see in some communities are community organizations taking the role of being kind of support hubs during disasters for the people that are in their community — being able to provide emergency power, being able to store medicine in a refrigerator, or even just giving people a safe place to stay and get warm, or serving as a cooling center.

But in communities that have been marginalized I think there’s an interesting paradox where you will find that those communities are more interconnected, so people know what people’s needs are but they’re not sure how to help.

Like a support system?
Yeah, yeah exactly. So you’ll see that there is a sense of awareness to what certain members of the community might need. But there isn’t really a plan to get those things to them, and there aren’t resources available to get those to them. And so while there may be a church or another institution or rec center or things like that that might be able to serve as aggregators or support, they aren’t resourced to do that. So they don’t understand what the emergency plans are for their jurisdiction. They don’t have resources as it relates to emergency, you know, preparedness packs or go-kits or anything like that that could be useful. And a lot of times I think that that is actually what causes some of the pain and the strain between communities and their leaders during disasters because they will have such a clear sense of what is needed and will feel let down because they didn’t have access to the help that they knew they needed during that event.

Alright, so kind of along the vein of recovery now after a disaster, again any natural disaster or outbreak or anything like that, what does it take to bring a community back to where it was before?
So a lot of folks say that communities never fully recover, that that is a commonly held belief that most communities will never be 100 percent who they were before. Our belief is that if we do recovery right communities can be better.

That’s a great belief!
Yeah, well I think part of it is that in the emergency management cycle, recovery should feed back into mitigation. So however we are allowing that community to recover and supporting the recovery efforts that allow for a rebuild should be measures that improve the resilience of that community and improve their mitigation strategy. So it can take as long as three decades for a community to fully recover after an event. It’s commonly known in our field, but the community that was impacted by Hurricane Sandy is not 100 percent recovered.

So it takes a long time and it takes a lot of investment. And part of what we see is that if that investment is not sustained and intentional and not connected to a wide range of different plans and of infrastructure rebuilding, that it’s going to fail because disaster recovery is not in a silo. It’s about rebuilding the parts of the systems and the society that people depended on in a way that allows for it to be more resilient than it was before the event. And the further out you go from the event, the easier it is for that to be de-prioritized, especially in budgets. So while I’m aware that Hurricane Sandy recovery is still ongoing and that’s a really important investment, it becomes harder year after year —

— to justify expenditure on an event that happened so long ago.

Alright, and then this is our final question for the day, is there anything else you think we should know about disaster preparedness and how it relates to health equity and how we can help as people interested in public health?
Absolutely, so I think the most important thing we should be mindful of is that every disaster or disease outbreak has a range of cascading public health effects. It is not always commonly thought of and we tend not to think about the risks associated with a tornado on public health, but they’re there and they’re important. And so it is our responsibility, I think, to really think about how we as a field contribute to emergency management of those cascading public health impacts.

Alright, that is really awesome to hear and thank you so much for joining us today, we really appreciate it!
Absolutely, thank you so much for having me. This was fun!

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