Extreme Weather Preparedness, Healthcare, and Equity in Vulnerable Populations: "Lead" No One Behind

Session Submission Type: Panel Discussion

Short Description

Join this multinational panel of public health practitioners, physicians, and researchers. During this spirited discussion, the audience will be challenged to consider direct and indirect consequences of extreme weather conditions on the most vulnerable within their respective fields of practice. Through a public heath lens, learn, debate, and apply the “diagonal approach.” Consider how authentic team leadership can think “glocally,” maximize institutional outcomes, and minimize unintended effects, while applying equitable solutions that benefit all when preparing for extreme weather events.

Detailed Abstract

Extreme Weather

The world is hotter, and extreme weather patterns are becoming the norm. Coastal cities are particularly vulnerable to the effect of climate change. One such affected region is South Florida. In 2016, “super moon” tides resulted in severe flooding. The following year brought severe drought warnings, followed by unseasonably high rainfall that threatened water quality and wildlife. This phenomenon is widely observed elsewhere. In winter 2017/2018, five winter storms impacted the US East Coast, resulting in death, displacement, and billions of dollars of losses. The detrimental effects were widespread, and certain sub-populations were particularly affected by disruptions to public transportation, small businesses, and health care systems. Extreme weather conditions (EWC) have indirect consequences; research has demonstrated a relationship between increased temperatures and local violent crime (Hsiang, 2017). Additionally, hurricanes, rainstorms, snowstorms can negatively impact healthcare utilization due to delays in public transportation or cancellation of outpatient clinic visits. This results in difficulty accessing healthcare services and in receiving opportune public health or emergency accurate information.

Disaster Preparedness

EWC preparedness requires cohesive efforts, training, and effective communication; multifaceted challenges that require authentic leadership. For cities at sea-level, small increases in water level can greatly impact residents, forcing architectural adaptions and other systematic changes. Public health officials recognize the increased transmission of vector-borne infections in EWC (e.g., Zika); however, the indirect consequences of extreme weather and displacement of vulnerable populations on chronic viral infections and other medical conditions has not been sufficiently addressed. Unequal access to resources that occurs during and after disasters especially affect certain population subgroups. These inequalities negatively affect people’s attitudes, behaviors, and confidence in government responses (Savoia, 2017). In addition, arbitrary decisions and limited budgets often focus on temporary patches rather than sustainable solutions, in contrast to integrated approaches recommended by public health researchers, such as the “diagonal approach” (Frenk, 2014).

Vulnerable/Special Populations

Certain subpopulations are distinctly at risk for the negative effects of EWC. For vulnerable, indigent, uninsured, or undocumented populations in urban areas, public safety-net hospitals, are often the only source of healthcare (Lukas,2015). These individuals struggle already with economic insecurity, unstable housing, poor social support, and limited transportation options—all of which impact their ability to access or prioritize healthcare, compared to those in their communities with more access to resources.
Vulnerable and special populations, such as people living with disabilities, are a wide-ranging community with needs that vary depending on individual circumstances, such as age and ability to live independently within their communities, demonstrating the need for individualized, cohesive, and collaborative solutions. Chronic medical conditions, such as HIV, require the use of antiretroviral medications to maintain a healthy immune system, and reduce the risk of transmitting HIV to their unborn children and intimate partners. Persons living with a physical disability, such as spinal cord injuries, experience higher rates of social risk factors that contribute to poor health, such as unemployment and lack of transportation. Persons with a spinal cord injury also experience difficulty regulating body temperature, and a limited income may inhibit their ability to afford constant cooling to avoid a risk of heat stroke (Price, 2006).
Besides apparent medical and physical barriers, other factors may affect access to care during and after EWC for vulnerable populations. Individuals with mobility issues relying on public or special transportation services may encounter unsurmountable challenges after EWC, making it difficult to obtain needed health services. Immigrants, low-income, and uninsured individuals may be hesitant to seek health services due to expected financial burden or fear of deportation. These indirect barriers restrict prevention efforts and negatively affect public health. Furthermore, cancellations and re-scheduling occurring after EWC impacts not only important prenatal clinic visits, laboratory testing, and ultrasounds, but also the long-term effects that inadequately-managed medical conditions may have on obstetric outcomes, maternal health, and neonatal development (Martin, 2013). Finally, these logistical barriers disrupt scheduled clinical care at outpatient clinics served by public hospital networks.

Authentic Team Leadership

Tackling these important health consequences requires strong, integrated, and authentic leadership. Typically, leadership is associated with one person, administration, or team; however, a group can only be as strong as its weakest link. Leaders work to mitigate the effects of loss; but an authentic leader not only reaches for the highest rung on the administrative ladder, but also contributes by "being the people we really are, and to help others do the same” (Gunderman, 2014). Authentic team leadership is similar to a mosaic—each individual piece will be a small contribution to a bigger image, and any missing piece detracts from the overarching picture.  This focus allows developing the skill set of each individual to achieve the common goal of the group, thus integrating and "helping others see who they are meant to be and bring forth their best.” (Gunderman, 2014).

Public Health: The Diagonal Approach

The public health discipline involves making hard choices about improving population health and distributing it fairly. Unfortunately, maximizing overall population health necessitates that vulnerable populations may be left behind. Our diagonal approach implementation aims to utilize innovative strategies and merge them into current practices to include those affected by unintended consequences of EWC.
Although clinical medicine and public health disciplines are often at the forefront of EWC efforts, the inclusion of other disciplines professionals (e.g., law, communication, academia, etc.) is necessary to improve care and promote community-based prevention efforts. Thereafter comprehensive solutions to upcoming "glocal" challenges, where local actions are reflected as global practices, will be addressed.

Conclusion

The development of a collaborative leadership workforce will enhance authentic team leadership skills and prioritize decisions for an all-inclusive approach to addressing EWC preparedness for the most vulnerable populations. A need exists to identify and support authentic leaders committed to developing multidisciplinary solutions to the “glocal" consequences of EWC, with cohesive efforts dedicated to addressing its distinct effects on vulnerable populations. In this way, viable targeted solutions can be directed to achieve health equity and improve population health overall.

Sub Unit

• Public Leadership

Chair

• Daniel Samano, University of Miami

Presenters

• Daniel Samano, University of Miami

• Lunthita M. Duthely, University of Phoenix, School of Advanced Studies

• Mandeville Anne Wakefield, University of Miami

• Marco Andres Morochz, NA