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Preparing Vulnerable Populations for Catastrophic Public Health Emergencies

(Michael Greenberger) -- It goes without saying that preparing for catastrophic emergencies requires careful planning, coordination and implementation.  However, when developing emergency plans, it is especially important that policymakers keep the special needs of vulnerable populations in mind.

Vulnerable populations include inner-city and low-income communities, as well as, the physically/mentally disabled, limited English or non-English speakers, the elderly/frail, children, and the homeless.  These groups frequently do not have access to general resources that government and private care providers assume are available in the event of a natural disaster or a terrorist threat.  For example, vulnerable populations often do not have access to private and/or adequate transportation for evacuation, surplus food and water, medical supplies, medical care, or appropriate and safe shelter during an emergency.

The Hurricane Katrina experience offers a grim example of the deadly consequences a catastrophe can wreak on vulnerable populations, who are poorly prepared for emergencies.  The hurricane flooded approximately 80% of New Orleans, killed an estimated 1,527 residents in the New Orleans metropolitan area, and displaced 770,000 others.  Nearly 100,000 inner-city New Orleans residents could not evacuate, because they lacked the means to do so.   Many residents who could not afford to shoulder the costs of lodging, food, and transportation took shelter at the Superdome, a designated “special-needs shelter,” where the electricity and plumbing failed for roughly 20,000-30,000 individuals leading to lawlessness and desperation.  As many as 30,000 people filled the New Orleans convention center, which was never meant to be a shelter and had no food or water provisions.  

Patients living in New Orleans nursing homes were especially devastated as many of those facilities lacked adequate evacuation plans and emergency resources. Indeed, seventy one percent of the victims in Louisiana were older than sixty, and forty-seven percent of those were over seventy-five.  The hurricane also caused nearly 2,000 foster children in Louisiana to be displaced, disrupting their access to health care, education and social services. 

In sum, one of the key lessons of Hurricane Katrina is that it is critical that emergency planning include strategies for vulnerable populations; however, the federal post- mortems on Hurricane Katrina illustrate a distanced and vague approach towards this issue.

For example, the Bush Administration’s report about Katrina, The Federal Response to Hurricane Katrina: Lessons Learned, offered only the most highly generalized support and guidance for emergency preparedness efforts addressed to vulnerable populations.  Of the 125 recommendations in the report, only about 8 are arguably applicable to improving vulnerable population emergency preparedness efforts, and these 8 recommendations deal with community preparedness in a general way.  Moreover, the federal government must focus on the other 117 recommendations that bear no relationship to vulnerable populations’ preparedness in order to strengthen the federal response.  Without further funding or specific direction from the federal government, state and local governments alone, with their severe budget and resource constraints, cannot be expected to support these kinds of preparedness initiatives. 

For this reason, it is critical that stakeholders at all levels, both public and private, work in unison to ensure that vulnerable populations are prepared for the next disaster. Among the appropriate stakeholders are: government agencies and officials at the federal, state, and local level; community organizations; academic leaders and scholars; physicians; nurses; social workers; lawyers; emergency responders; religious leaders; and charitable institutions.  These groups must take the lead and work together to establish cost-effective pilot programs that incorporate all the necessary components to ensure that vulnerable populations are prepared for a catastrophe, such as notification procedures, access to emergency supplies and information on evacuation and shelters.  These programs should help families prepare a “go” kit that contains vital records and supplies in the event that evacuation is necessary.  Once a pilot program has been created, implemented and tested in a particular community, it can then be used as a template for the development of similar models for other communities throughout the nation.

The University of Maryland Center for Health and Homeland Security is helping initiate stakeholder interactions and cooperation by hosting a conference, Vulnerable Populations:  Emergency Planning, to discuss the challenges associated with preparing vulnerable populations for emergency situations.  The conference is funded by the McCormick Tribune Foundation and will take place on November 5-7, 2007.  The key goals and follow-up activities of the conference include: (1) establishing partnerships among the key stakeholders, including representative community leaders, federal, state and local government officials, emergency preparedness planners, private charities, and public health practitioners; (2) organization and stimulation of literature, curricula, and plans relating to this subject; (3) developing a national action plan to address the problem of vulnerable populations in catastrophic emergencies; and (4) stimulating interest and private funding in establishing pilot projects using the recommendations from the conference that would undertake emergency planning efforts in carefully selected local constituencies with the idea of developing templates of response to be developed nationally.

For more information on the conference and regarding emergency planning for vulnerable populations, visit the conference Web site at http://www.umaryland.edu/healthsecurity/mtf_conference/index.html#background.