Compounding Disasters, Disaster Vulnerability and Disaster Management: A Case Study of Breast Cancer Patients in Puerto Rico

Abstract

BACKGROUND: Puerto Rico (P.R.) faces particular and exacerbated vulnerabilities from climate change-induced disasters. These types of disasters are increasing, becoming stronger and more destructive due to unnatural human activities. The increase in exposures, vulnerabilities, and health risks, leads to increased stress on health systems worldwide but disproportionately affects countries where health inequities exist. Most recently, Hurricane Maria, the earthquake sequence, and the COVID-19 pandemic have led to the collapse of the healthcare system and the exacerbation of health inequities in P.R. Research shows that disaster management (DM) can help communities, families, and individuals prepare for disasters. However, current DM strategies are mainly focused on short-term health risks (such as immediate injuries and trauma, and acute infections), whereas the long-term impacts (e.g., risk of complications of specialized care and interruption of cancer treatment) remain overlooked. Disasters can significantly interrupt health services and lead to increased psychological distress, particularly in medically fragile populations. Women have been identified as more vulnerable to disasters; therefore, breast cancer patients face a “double jeopardy” to disaster risk due to their gender and illness. Therefore, this research will investigate DM from the Social Determinants of Health (SDH) perspective, two concepts often studied separately, giving a more comprehensive picture of the needs of vulnerable populations after disasters.

METHODS: A qualitative approach through media analysis, stakeholder interviews, and a case study focus group discussion was conducted to understand the relationship between health inequities and DM. It explored how current DM strategies in P.R. can create, and reinforce existing inequities, specifically for breast care patients after disasters.

RESULTS: The myopic and traditional perspective of DM is insufficient when health inequities exist, and therefore, there is an urgent need to broaden DM to incorporate the SDH perspective to mitigate health inequities. The results show that key barriers to DM implementation are (1) lack of preparedness, (2) top-down implementation, and (3) lack of data and transparency. Specifically for vulnerable populations, such as breast cancer patients, this results in inadequate access to healthcare, loss of electricity, and heightened psychological stress. Ultimately leading to lower survival rates and long-term adverse health outcomes.

CONCLUSION: The disasters exposed how current DM strategies are inadequate for mitigating long-term health outcomes. Therefore, a broader (bottom-up, inclusive, and community-level) perspective of DM prioritizing vulnerable populations and existing health inequities is imperative. Further research should be conducted to determine specific actions and recommendations for P.R. to facilitate this integration.