Risks, Health Consequences, and Response Challenges for Small-Island-Based Populations: Observations From the 2017 Atlantic Hurricane Season

Evacuation Decision-Making Post-COVID-19 Vaccine Availability: Implications of Compound Hazards in Puerto Rico and the US Virgin Islands

OBJECTIVE

The threat of novel pathogens and natural hazards is increasing as global temperatures warm, leading to more frequent and severe occurrences of infectious disease outbreaks and major hurricanes. The COVID-19 pandemic amplified the need to examine how risk perceptions related to hurricane evacuations shift when vaccines become available. This study explores individuals' expected evacuation plans during the early stages of COVID-19 vaccine availability.

METHODS

In March 2021, an online survey was disseminated in Puerto Rico and the US Virgin Islands.

RESULTS

An overwhelming majority (72.6%) of respondents said that their vaccination status would not affect their hurricane evacuation intentions. The unvaccinated were significantly more likely to consider evacuating during a hurricane than the vaccinated. Even with vaccines available, respondents suggested they were less likely to evacuate to a shelter during the 2021 season than prior to the COVID-19 pandemic. Respondents generally believed that the risk of contracting COVID-19 at a shelter was greater than the risk of sheltering-in-place during a hurricane.

CONCLUSIONS

Government officials need to develop and communicate clear information regarding evacuation orders for municipalities that may be more impacted than others based on the trajectory of the storm, social determinants of health, and other factors like living in a flood zone.

"Many old people taking care of old people": Experiences of older adults after Hurricane María in Puerto Rico

The Puerto Rican population has presented demographic changes resulting in a greater proportion of older adults than almost any other country in the world, with an estimated 28% of the total population being over 60 years of age. A key public health issue in Puerto Rico (PR) is older adults' mental health and wellbeing. Located in the Caribbean, PR is prone to natural hazards such as hurricanes, which are a known threat to older adults' overall health and wellbeing. However, the needs of older adults in PR and their mental health have been largely neglected, especially in less visible and marginalized rural areas. Therefore, the main objective of this study is to examine the challenges and needs of older adults following Hurricane María in the rural towns of Adjuntas and Castañer, PR. We implemented an exploratory qualitative research design informed by the principles of Liming methodology. We used semi-structured interviews to gather data and analyzed it using thematic analysis. A total of 25 participants engaged in our interview process including older adults (n = 15) and community caregivers and leaders that provide services to older adults (n = 10). We present three main themes regarding older adults' experiences after Hurricane María: 1) Challenges to wellbeing (i.e, loneliness, lack of resources), 2) Relational solidarity (i.e., communal support, equitable resource sharing) and 3) La brega (i.e., adaption and autogestión). Older adults in Adjuntas and Castañer addressed the emergent challenges after Hurricane María such as loneliness and lack of resources by relying on their communities. These findings highlight the role of community support as a key component to understand and foster older adults' wellbeing following a natural hazard.

Protecting Caribbean patients diagnosed with cancer from compounding disasters

Caribbean small island developing states are becoming increasingly vulnerable to compounding disasters, prominently featuring climate-related hazards and pandemic diseases, which exacerbate existing barriers to cancer control in the region. We describe the complexities of cancer prevention and control efforts throughout the Caribbean small island developing states, including the unique challenges of people diagnosed with cancer in the region. We highlight potential solutions and strategies that concurrently address disaster adaptation and cancer control. Because Caribbean small island developing states are affected first and worst by the hazards of compounding disasters, the innovative solutions developed in the region are relevant for climate mitigation, disaster adaptation, and cancer control efforts globally. In the age of complex and cascading disaster scenarios, developing strategies to mitigate their effect on the cancer control continuum, and protecting the health and safety of people diagnosed with cancer from extreme events become increasingly urgent. The equitable development of such strategies relies on collaborative efforts among professionals whose diverse expertise from complementary fields infuses the local community perspective while focusing on implementing solutions.

The Impact of Climate Change on Global Oncology

Climate change is the greatest threat to human health of our time, with significant implications for global cancer control efforts. The changing frequency and behavior of climate-driven extreme weather events results in more frequent and increasingly unanticipated disruptions in access to cancer care. Given the significant threat that climate change poses to cancer control efforts, oncology professionals should champion initiatives that help protect the health and safety of patients with cancer, such as enhancing emergency preparedness and response efforts and reducing emissions from our own professional activities, which has health cobenefits for the entire population.

Hurricane risk assessment in a multi-hazard context for Dominica in the Caribbean

Hurricanes can trigger widespread landslides and flooding creating compound hazards and multiple risks for vulnerable populations. An example is the island of Dominica in the Caribbean, where the population lives predominantly along the coast close to sea level and is subject to storm surge, with steep topography rising behind, with a propensity for landslides and flash river flooding. The simultaneous occurrence of the multiple hazards amplifies their impacts and couples with physical and social vulnerabilities to threaten lives, livelihoods, and the environment. Neglecting compound hazards underestimates overall risk. Using a whole island macroscale, (level-I) analysis, susceptibility scenarios for hurricanes, triggered landslides, and floods were developed by incorporating physical process parameters. The susceptibilities were combined with vulnerability indicators to map spatial patterns of hurricane multi-risks in Dominica. The analysis adopted a coupled approach involving the frequency ratio (FR), analytic hierarchy process (AHP), and geographic information system (GIS). Detailed hazard modelling was done at selected sites (level-II), incorporating storm surge estimates, landslide runout simulations, and steady flow analysis for floods. High-resolution terrain data and simulation models, the Rapid Mass Movement Simulation (RAMMS) and the hydrologic engineering center's river analysis system (HEC-RAS), were employed. Ground validation confirmed reasonable agreement between projected and observed scenarios across different spatial scales. Following the United Nations Office for disaster risk reduction (UNDRR) call for the inclusion of local, traditional, and indigenous knowledge, feedback, and expert opinion to improve understanding of disaster risk, 17 interviews with local experts and 4 participatory workshops with residents were conducted, and findings were incorporated into the analysis, so as to gain insights into risk perceptions. The study's outcomes encompass projections and quantification of hurricane compound hazards, vulnerabilities, accumulated risks, and an understanding of local priorities. These findings will inform decision-making processes for risk mitigation choices and community actions by providing a new framework for multi-hazard risk assessment that is easy to implement in combining different data forms.

Environmental violence: a tool for planetary health research

From climate change to toxic pollution and the interactive effects of multiple pollution streams, human health is under siege. Human-produced environmental risks to health and wellbeing are high and contributing to patterns of global morbidity, mortality, economic inequality, displacement, and insecurity. The implications of human-produced environmental harms to global health are complex just as are their causes. The concept of environmental violence offers a potentially robust frame for engaging this issue. We argue that a more specified and structured framework and definition of environmental violence-focusing on human-produced harms by way of pollution emissions-is both timely and beneficial for engaging the complexities of global public health. To clarify why and how this is the case, we review the literature for publications that use the term environmental violence and we subsequently propose a specific definition focused on human-produced pollution along with a framework for tracking and analysing environmental violence and its constituent components. Finally, we discuss the potential value of our framework for research and policy making regarding human health.

Microbial Characterization, Factors Contributing to Contamination, and Household Use of Cistern Water, U.S. Virgin Islands

Households in the United States Virgin Islands (USVI) heavily rely on roof-harvested rainwater stored in cisterns for their daily activities. However, there are insufficient data on cistern water microbiological and physicochemical characteristics to inform appropriate cistern water management. Cistern and kitchen tap water samples were collected from 399 geographically representative households across St. Croix, St. Thomas, and St. John and an administered survey captured household site and cistern characteristics and water use behaviors. Water samples were analyzed for Escherichia coli by culture, and a subset of cistern water samples (N = 47) were analyzed for Salmonella, Naegleria fowleri, pathogenic Leptospira, Cryptosporidium, Giardia, and human-specific fecal contamination using real-time polymerase chain reaction (PCR). Associations between E. coli cistern contamination and cistern and site characteristics were evaluated to better understand possible mechanisms of contamination. E. coli was detected in 80% of cistern water samples and in 58% of kitchen tap samples. For the subset of samples tested by PCR, at least one of the pathogens was detected in 66% of cisterns. Our results suggest that covering overflow pipes with screens, decreasing animal presence at the household, and preventing animals or insects from entering the cisterns can decrease the likelihood of E. coli contamination in USVI cistern water.

Children's environmental health and disaster resilience in Puerto Rico and the U.S. Virgin Islands

The environment plays a significant role in the global burden of disease for children. Climate-related disasters such as the 2017 Atlantic hurricane season are increasingly contributing to this burden. United Nations designated Small Island Developing States (SIDS) like Puerto Rico and the U.S. Virgin Islands are particularly at risk due to environmental health hazards caused by natural disasters, and health care structure vulnerabilities. United Nations' Sustainable Development Goals (UN SDG), specifically UN SDG 3, 13 and 17, focus on climate impacts via promotion of health preparedness and building partnerships between different sectors of society, respectively. The Pediatric Environmental Health Specialty Unit's (PEHSU) work is consistent with these most notably via the delivery of environmental health services along with training nurses, doctors, and other health professionals, formation of partnerships and linking resources. Therefore, training a diverse array of health professionals and linking these groups to relevant community resources is of utmost importance and has the potential to enhance the effective management and early prevention of top environmental health (EH) risks. Nursing is identified as a key health sector to engage for this initiative. This article describes the work of the Federal Region 2 PEHSU in Puerto Rico and the U.S. Virgin Islands that supports health professionals' knowledge building, development of environmental health services, and promotion of wide scale access to such services for children and families. The PEHSU's work is consistent with these most notably with regards to the delivery of environmental health services in pediatrics.

"Burnt by the scorching sun": climate-induced livelihood transformations, reproductive health, and fertility trajectories in drought-affected communities of Zambia

Background

Climate-induced disruptions like drought can destabilize household and community livelihoods, particularly in low- and middle-income countries. This qualitative study explores the impact of severe and prolonged droughts on gendered livelihood transitions, women’s social and financial wellbeing, and sexual and reproductive health (SRH) outcomes in two Zambian provinces.

Methods

In September 2020, in-depth interviews (n = 20) and focus group discussions (n = 16) with 165 adult women and men in five drought-affected districts, as well as key informant interviews (n = 16) with civic leaders and healthcare providers, were conducted. A team-based thematic analysis approach, guided by the Framework Method, was used to code transcript text segments, facilitating identification and interpretation of salient thematic patterns.

Results

Across districts, participants emphasized the toll drought had taken on their livelihoods and communities, leaving farming households with reduced income and food, with many turning to alternative income sources. Female-headed households were perceived as particularly vulnerable to drought, as women’s breadwinning and caregiving responsibilities increased, especially in households where women’s partners out-migrated in search of employment prospects. As household incomes declined, women and girls’ vulnerabilities increased: young children increasingly entered the workforce, and young girls were married when families could not afford school fees and struggled to support them financially. With less income due to drought, many participants could not afford travel to health facilities or would resort to purchasing health commodities, including family planning, from private retail pharmacies when unavailable from government facilities. Most participants described changes in fertility intentions motivated by drought: women, in particular, expressed desires for smaller families, fearing drought would constrain their capacity to support larger families. While participants cited some ongoing activities in their communities to support climate change adaptation, most acknowledged current interventions were insufficient.

Conclusions

Drought highlighted persistent and unaddressed vulnerabilities in women, increasing demand for health services while shrinking household resources to access those services. Policy solutions are proposed to mitigate drought-induced challenges meaningfully and sustainably, and foster climate resilience.

Climate Change Adaptation on Small Island States: An Assessment of Limits and Constraints

Small Island States (SIDS) are among the nations most exposed to climate change (CC) and are characterised by a high degree of vulnerability. Their unique nature means there is a need for more studies focused on the limits to CC adaptation on such fragile nations, particularly regarding their problems and constraints. This paper addressed a perceived need for research into the limitations of adaptation on SIDS, focusing on the many unique restrictions. To this end, the study identified and described the adaptation limits they have by using a review of the literature and an analysis of case studies from a sample of five SIDS in the Caribbean and Pacific regions (Barbados, Trinidad and Tobago, Cook Islands, Fiji, Solomon Islands and Tonga). This research’s findings showed that an adaptable SIDS is characterised by awareness of various values, appreciation and understanding of a diversity of impacts and vulnerabilities, and acceptance of certain losses through change. The implications of this paper are two-fold. It explains why island nations continue to suffer from the impacts of CC and suggest some of the means via which adequate policies may support SIDS in their efforts to cope with the threats associated with a changing climate. This study concluded that, despite the technological and ecological limits (hard limits) affecting natural systems, adaptation to CC is limited by such complex forces and societal factors (soft limits) that more adequate adaptation strategies could overcome.

Climate Change, Migration, and Civil Strife

Purpose of Review

In this article, we examine the intersection of human migration and climate change. Growing evidence that changing environmental and climate conditions are triggers for displacement, whether voluntary or forced, adds a powerful argument for profound anticipatory engagement.

Recent Findings

Climate change is expected to displace vast populations from rural to urban areas, and when life in the urban centers becomes untenable, many will continue their onward migration elsewhere (Wennersten and Robbins 2017; Rigaud et al. 2018). It is now accepted that the changing climate will be a threat multiplier, will exacerbate the need or decision to migrate, and will disproportionately affect large already vulnerable sections of humanity. Worst-case scenario models that assume business-as-usual approaches to climate change predict that nearly one-third of the global population will live in extremely hot (uninhabitable) climates, currently found in less than 1% of the earth’s surface mainly in the Sahara.

Summary

We find that the post–World War II regime designed to receive European migrants has failed to address population movement in the latter half of the twentieth century fueled by economic want, globalization, opening (and then closing) borders, civil strife, and war. Key stakeholders are in favor of using existing instruments to support a series of local, regional, and international arrangements to protect environmental migrants, most of whom will not cross international borders. The proposal for a dedicated UN agency and a new Convention has largely come from academia and NGOs. Migration is now recognized not only as a consequence of instability but as an adaptation strategy to the changing climate. Migration must be anticipated as a certainty, and thereby planned for and supported.

Mitigating the Twin Threats of Climate-Driven Atlantic Hurricanes and COVID-19 Transmission

The co-occurrence of the 2020 Atlantic hurricane season and the ongoing coronavirus disease 2019 (COVID-19) pandemic creates complex dilemmas for protecting populations from these intersecting threats. Climate change is likely contributing to stronger, wetter, slower-moving, and more dangerous hurricanes. Climate-driven hazards underscore the imperative for timely warning, evacuation, and sheltering of storm-threatened populations – proven life-saving protective measures that gather evacuees together inside durable, enclosed spaces when a hurricane approaches. Meanwhile, the rapid acquisition of scientific knowledge regarding how COVID-19 spreads has guided mass anti-contagion strategies, including lockdowns, sheltering at home, physical distancing, donning personal protective equipment, conscientious handwashing, and hygiene practices. These life-saving strategies, credited with preventing millions of COVID-19 cases, separate and move people apart. Enforcement coupled with fear of contracting COVID-19 have motivated high levels of adherence to these stringent regulations. How will populations react when warned to shelter from an oncoming Atlantic hurricane while COVID-19 is actively circulating in the community? Emergency managers, health care providers, and public health preparedness professionals must create viable solutions to confront these potential scenarios: elevated rates of hurricane-related injury and mortality among persons who refuse to evacuate due to fear of COVID-19, and the resurgence of COVID-19 cases among hurricane evacuees who shelter together.

Provider-Guided Emergency Support for Persons Living With Type 1 Diabetes During Hurricanes Harvey, Irma, and Maria

The 2017 Atlantic hurricane season was especially memorable for 3 major hurricanes-Harvey, Irma, and Maria-that devastated population centers across Texas, Florida, and Puerto Rico, respectively. Each storm had unique hazard properties that posed distinctive challenges for persons living with type 1 diabetes (T1D). Diabetes care specialists and educators took on leadership roles for coordinating care and establishing insulin supply lifelines for people with T1D living in the hardest-hit neighborhoods affected by these extreme storms. Strategies and resources were customized for each population. Diabetes specialists strategized to provide mutual support and shared insulins and supplies across sites.

Climate Change Should Be on Every Nursing Research Agenda

Human-caused climate change is a global emergency, and its harms are predicted to increase exponentially in the coming years, particularly if unsustainable practices continue unmitigated. Adverse effects of climate change on communities affected by or at risk for cancer, such as frail older adults, are already measurable and deadly. If nurse scientists continue to ignore these realities, more people are likely to suffer and die as a result. The purpose of this critical reflection is to discuss the vital necessity of including climate change in the research agenda of the Oncology Nursing Society and all nursing science. Using an approach grounded in critical theory and design justice, the authors provide specific suggestions for the incorporation of scientific considerations and nursing measures related to climate change into oncology nursing science.

Health Impact of Hurricanes Irma and Maria on St Thomas and St John, US Virgin Islands, 2017-2018

Objectives. To assess the health impact of Hurricane Irma and Hurricane Maria on St Thomas, US Virgin Islands.Methods. We collected data from interviews conducted 6 and 9 months after the hurricanes, a review of 597 randomly selected emergency department (ED) encounters, and administrative records from 10 716 ED visits 3 months before, between, and 3 months after the hurricanes.Results. Informants described damaged hospital infrastructure, including flooding, structural damage, and lost staff. The greatest public health impact was on the elderly and persons with chronic diseases. In the setting of loss of the electronic medical record system, ED chart reviews were limited by problems with missing data. ED administrative data demonstrated that posthurricane patients, compared with prehurricane patients, were older and had less severe complaints. There was a significant increase in patients being seen for diabetes-related and respiratory complaints, especially asthma. Suboptimal recordkeeping for medical evacuees limited the ability to assess outcomes for patients with severe illnesses.Conclusions. Hurricanes Irma and Maria caused major disruptions to health care on St Thomas. Emphasis should be given to building a resilient health care system that will optimally respond to future hurricanes.

The human imperative of stabilizing global climate change at 1.5°C

Increased concentrations of atmospheric greenhouse gases have led to a global mean surface temperature 1.0°C higher than during the pre-industrial period. We expand on the recent IPCC Special Report on global warming of 1.5°C and review the additional risks associated with higher levels of warming, each having major implications for multiple geographies, climates, and ecosystems. Limiting warming to 1.5°C rather than 2.0°C would be required to maintain substantial proportions of ecosystems and would have clear benefits for human health and economies. These conclusions are relevant for people everywhere, particularly in low- and middle-income countries, where the escalation of climate-related risks may prevent the achievement of the United Nations Sustainable Development Goals.

The Medical, Public Health, and Emergency Response to the Impact of 2017 Hurricane Irma in Cuba

In 2017, Cuba was pummeled by Hurricane Irma, one of the strongest and most devastating Atlantic basin hurricanes in history. Twelve of Cuba’s 15 provinces and 90 percent of the population were affected, and there was island-wide loss of electrical power. Despite the significant damage, ongoing economic hardships, and the political realities that required Cuba to handle the situation without response support from other nations, Cuba’s recovery was swift and effective. Cuba’s disaster self-sufficiency and timely response to Hurricane Irma was grounded on 5 decades of disaster planning coupled with ongoing evolution of disaster risk reduction and management strategies. While the central command center, with local dispatch response teams, and mandated citizen engagement are features unique to Cuba’s political structure, in this study, we highlight 5 defining attributes of Cuba’s hurricane response that can constructively inform the actions of other island and coastal nations vulnerable to Atlantic tropical cyclones. These attributes are: (1) actively learning and incorporating lessons from past disaster events, (2) integrating healthcare and public health professionals on the frontlines of disaster response, (3) proactively engaging the public in disaster preparedness, (4) incorporating technology into disaster risk reduction, and (5) infusing science into risk planning. In terms of hurricane response, as a geopolitically isolated nation, Cuba has experienced particular urgency when it comes to protecting the population and creating resilient infrastructure that can be rapidly reactivated after the onslaught of storms of ever-increasing intensity. This includes planning for worsening future disaster scenarios based on a clear-eyed appreciation of the realities of climate change.

Cultural Sensitivity and Global Pharmacy Engagement in the Caribbean: Dominica, Jamaica, Puerto Rico, and St. Kitts

Sustainable and reciprocal partnerships in pharmacy education and practice exist between schools and colleges of pharmacy in the United States and Caribbean countries and territories. This paper discusses the cultural considerations for such partnerships to flourish. First, general information on Caribbean countries and territories is covered. Next, the paper transitions into how to ensure culturally sensitive engagements when traveling to or hosting visitors from the Caribbean. This paper is intended to assist practitioners with integrating culturally sensitive considerations into the development of partnerships in this region.