POV: After Harvey, What Next?

Hurricane Harvey has left an estimated 30,000 Texans temporarily homeless. Volunteers help stranded neighbors in Friendswood, Tex. Photo by Steve Gonzales/Houston Chronicle via AP

Harvey is no longer classified as a hurricane, but the destruction it’s caused continues to unfold. In the past few days, parts of Houston, Tex., have been hit with more than 30 inches of rain and could receive as much as 50 inches before the storm ends. Nearby cities and towns have been overwhelmed by floodwaters, as swollen lakes and rivers have spilled into surrounding communities. At least 14 people have died because of Harvey—a figure expected to rise—and officials say that over 30,000 people are being housed in temporary shelters. The National Weather Service has emphasized the unprecedented nature of the storm, tweeting that it is “beyond anything experienced.”

While it is certainly true that we are not used to seeing devastation on this scale, Harvey is just the latest in a long line of big hurricanes that have struck the United States in late August. From Andrew to Katrina, we are sadly familiar with the timing of such events. Past experience teaches us that there will be a period of intense media focus on the disaster, an outpouring of donations as Americans mobilize their generosity to help those affected, then, after about a week, a gradual fading of attention, leaving survivors to ask: now what?

There is a wide body of research that answers this question. The mental and physical health effects of disasters take the form of a range of short- and long-term health consequences. Indeed, the initial loss of life, property damage, interruption of services, and monetary loss caused by large-scale traumatic events like hurricanes tend to be only the tip of the iceberg when it comes to their true cost. While death and physical injury are the most immediate markers of a storm’s human toll, often occurring within minutes of the event’s onset, the mental health effects of disasters, though less obviously apparent, often leave the more lasting wound.

Epidemiological studies have found that up to half of those who are directly in a storm’s path, who lose possessions, or who are injured may develop post-traumatic stress disorder (PTSD); one in 10 of everyone in the general affected area may also develop PTSD. Depression and substance use may also be more common after disasters than they were before; in particular, alcohol and substance use disorders, which tend to be more prevalent among men, represent a frequently used coping mechanism after disasters. After September 11, 2001, for example, use of alcohol, cigarettes, and drugs increased in New York City. Risk factors that can exacerbate poor post-hurricane health include ongoing stressors, low social support, and financial strain.

How can we best protect public health when disaster strikes? We tend to read much about individual resilience and the role that has in disaster recovery. While stories of individual courage and resilience indeed have a place, it is becoming ever clearer that our social, economic, and environmental contexts play an even more central role in determining our capacity to bounce back following destructive events. The strength of a society’s fabric—whether it is healthy to begin with, before disasters occur—can help predict how well that society will be able to absorb the effects of a large-scale traumatic event.

Community social capital can contribute to individual resilience. A flexible, well-funded health system is essential to help us cope with disaster and its aftermath, and to quickly restore individuals to functional lives.

As past disasters have made tragically clear, poverty and marginalization create the conditions for lingering trauma long after a storm has dissipated and our national focus has turned elsewhere. It is often the poor who suffer most when these events take place. Factors like immigrant and minority status, English language proficiency, and living in high-density housing can all amplify the pain of events like storms, floods, and fires. These vulnerable groups deserve extra attention as we work to shore up the social capital and public infrastructure necessary to protect our communities before the next disaster strikes.

The agencies specifically tasked with protecting us from extreme-weather events play an enormous role in helping communities to cope with disasters. The Trump administration’s proposed budget cuts to the Federal Emergency Management Agency and the National Oceanic and Atmospheric Administration are disheartening in this regard. Hopefully, the experience of Harvey will cause the president and his team to reconsider their position, as well as their denial of the global climate change that has done so much to cause unprecedented storms like this one. While the government cannot, of course, prevent storms from occurring, it can provide the resources and the leadership necessary to foster resilience in populations and spotlight the vulnerable groups most at risk when disasters like Harvey strike.

Sandro Galea, dean of the BU School of Public Health and Robert A. Knox Professor, can be reached at sgalea@bu.edu. An expert in social epidemiology, trauma, and the health of urban populations, he is the author of Healthier: Fifty Thoughts on the Foundations of Population Health (Oxford University Press, 2017).

This commentary originally appeared in “Cognoscenti,” WBUR’s online opinion page.

“POV” is an opinion page that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international. Anyone interested in submitting a piece, which should be about 700 words long, should contact Rich Barlow at barlowr@bu.edu. BU Today reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Boston University.