As Hurricane Harvey bore down on the United States, President Trump pledged to unleash “the full force of government” to assist the victims of the storm. The White House later released a statement outlining the administration’s plan to make federal funds available to affected individuals, state and local governments, and some nonprofit organizations to meet the demands of the emergency. In the ensuing days, as rain and floodwaters have inundated Texas, Americans have responded generously, adding to the resources available to Harvey’s victims. Celebrities and businesses have contributed millions to relief efforts, airlines have offered miles in exchange for Disaster relief donations, and everyday citizens continue to give their time and money to help those whose lives were shaken by the hurricane.
These actions represent a familiar cycle. When large-scale tragedies occur, we Americans are accustomed to reaching out in the weeks and months that follow, raising vast sums to support communities in their hour of need. This is commendable and speaks well of our capacity for empathy and simple neighborliness. But how much good does this investment really do? Certainly, having millions of dollars on hand to help flood-ravaged cities and towns is better than not having it. Yet many of these communities needed assistance well before the hurricane hit. This unmet need set the stage for the acute challenges they now face.
A large body of epidemiological research has shown that certain groups are more likely than others to suffer when disasters occur. These populations include immigrants, non-English speakers, minorities, the poor, and people who live in high-density housing. Economic vulnerability in particular can significantly compound the effects of disasters.
The poor frequently lack insurance, mobility, and places to flee to when disasters strike — all of which undermine their ability to survive events like Harvey and “bounce back” in the years that follow. This is especially challenging given that the period after a disaster is often more painful than the initial catastrophe. It is then that the long-term mental and physical Health consequences of the event take hold. These can include depression, post-traumatic stress disorder, a higher risk of alcohol and substance use, and the challenge of coping with injuries. Once again, it is the marginalized and the vulnerable who bear the brunt of these effects, shouldering a disproportionate share of the physical and financial burden imposed by disasters.
While Americans are clearly willing to invest in the health of suffering communities, our tendency to do so only in the immediate aftermath of tragedies like Harvey means that the benefits of those donations will likely be minimal. By effectively ignoring marginalized communities until after they have been devastated by a natural disaster, we all but ensure that the human toll will be higher and the damage costlier when the storm finally arrives. A far better strategy would be to spend money to improve the conditions of vulnerable communities well before the worst happens, mitigating in advance the costs of tragedy and helping to build a healthier world. While there is no large-scale data available on the effectiveness of such an approach, consider the following examples:
- In a city of 1 million people, an increase in the proportion of households located in developments with access to public transportation from 10% to 40% was estimated to have an annual health benefit of more than $216 million.
- On-the-job obesity-prevention programs that result in 5% weight loss among overweight and obese employees have been estimated to produce $90-per-person savings for employers, due to a reduction in medical and absenteeism costs.
- Investment in early childhood education has a benefit/cost ratio of 5:1, owing to reductions in child maltreatment, teen pregnancy, and the crime rate.
- Every time the U.S. Earned Income Tax Credit is raised by 10%, infant mortality declines by 23.2 per 100,000 children.
These examples illustrate the maxim “an ounce of prevention is worth a pound of cure.” This worth amounts to significant financial savings and suggests a model that we could apply to other, more ambitious projects, building on isolated successes to improve the health of whole populations. We can start with the groups we know to be at risk not just of natural disasters but of the daily hazards of being marginalized in America. It remains a fact that if you live in the United States and are poor, sick, old, not white, a sexual minority, or a refugee, there are regular, systematic threats to your health even without a “one-in-1,000-year flood.” The everyday disasters of poverty and discrimination play out in cities and towns across the United States, while our focus is frequently elsewhere.
Harvey teaches us that Americans are willing to invest enormous resources, at practically a moment’s notice, in protecting the health of their fellow citizens. If we choose, we can parlay this generosity into improving the social, economic, and environmental conditions that shape health, with a particular focus on the health of marginalized groups, rather than waiting until after a disaster to do so. This would allow us to help populations be more resilient in the face of the next Harvey.