November 13, 2018

Building a Health-Focused Recovery and Reconstruction After Disasters

Health focused recovery and rebuilding

The 2018 hurricane season brought another year of intense and devastating storms to the southeastern United States. As the climate continues to change and ocean temperatures warm, the intensity and amount of rainfall associated with hurricanes are likely to increase.1 The damage inflicted by Hurricane Florence on communities across the Carolinas provides a vivid and troubling illustration.

Climate change, and the dynamic impact it has on our most vulnerable neighbors, poses substantial risks to health, including significant but often unmentioned mental health challenges.2 These health and environmental impacts are particularly devastating to low- and moderate-income populations, which tend to take the longest time to recover.

At Enterprise, we know that these challenges – while significant – are solvable. Our work toward long-term recovery and rebuilding means helping disaster-struck communities rebuild better and stronger, and equipping neighborhoods nationwide to stay prepared ahead of any natural disaster or extreme weather-related event. And we do this work together, recognizing that no community can rebuild without thinking critically about its health.

Watch: One family's story of hope after Hurricane Harvey – see how we're working to rebuild a better future in our Annual Report

How Health Is Affected by Hurricanes

Hurricane Florence created a health emergency for communities across the Carolinas, including vulnerable communities that were still recovering from 2016’s Hurricane Matthew. Florence dropped close to 40 inches of rain in just a few days. That amount of rain and the storm’s winds resulted in devastating flooding and damage.

Flooding creates the most immediate health impact after a storm because of the physical damage to homes, buildings and neighborhoods. In the case of Hurricane Florence, the flooding affected swaths of North Carolina's agricultural industry, killing an estimated 4.1 million chickens and turkeys and 5,500 hogs.3 Piles of manure stored at those farms were swept into swollen rivers. Along with animal waste, wastewaters and coal ash contaminated the flood waters that entered buildings and homes, leaving behind a toxic residue. Flooding also causes mold, which creates health hazards for the most vulnerable residents and worsens asthma, allergies and breathing conditions.

Beyond the immediate health concerns, a major storm like Florence leads to long-term mental and physical health issues. Research following Hurricane Katrina found that after a disaster the prevalence of mental health problems increased, most likely as a result of trauma, increased stress and disrupted social support. Housing instability and food and medication access delays, often for long periods, also take a toll on the management of chronic diseases after a disaster. Considering that 42 percent of Americans have at least one chronic disease and one in three have multiple chronic diseases,that delay can be a significant issue in the aftermath of a hurricane. Already vulnerable populations, including low-income residents, children and those who have a minimal or nonexistent support network, are the most affected.5

How Can We Build Health-Focused Recovery?

As we think about our future as a nation, we must consider how to incorporate health-focused support in our disaster planning and recovery efforts. This includes planning for and creating resilient buildings, planning and zoning requirements, agricultural practices and communities in practice. After a storm hits, the appropriate mental and physical healthcare providers and social services should be brought in to address the health challenges the community will be facing. It is also important to provide outlets to reduce stress for both children and their families after the disaster. Fundamentally, the best way to support the health of communities is to rebuild housing and communities in a way that is resilient and able to withstand future events.

Five Lessons Learned

  1. Keep in mind that zoning and planning industrial areas and communities requires an adherence to best-practice land use. Don’t concentrate industries in areas prone to flooding and try to keep them removed from residential communities as much as possible.
  2. Ensure that vulnerabilities caused by natural hazards are incorporated into land-use decisions and development and accounted for in future development.
  3. Plan ahead to ensure the safe storage of hazardous material, including making sure that agricultural waste is not vulnerable to release during natural disasters.
  4. Communicate to residents the health risks they should be aware of even after the storm has passed and give them the tools and information they need to act fast. This includes information about mold growth, contaminated water and surfaces, tap water advisories and the possibility that many home safety mechanisms (e.g. refrigerator, smoke alarm, etc.) may be damaged during the storm. Mold remediation tools and cleaning guidance should be readily available to communities before and after an event to ensure health and safety. (Refer to the Enterprise mold guide.)
  5. Maintain a commitment to mental health and chronic disease management during and after a natural disaster.

Additional Resources


2 Bolin, B., & Kurtz, L. C. (2018). Race, class, ethnicity, and disaster vulnerability. In Handbook of disaster research (pp. 181-203). Springer, Cham.
5 Buttorff, C., Ruder, T., & Bauman, M. (2017). Multiple chronic conditions in the United States. Santa Monica (CA): RAND Corporation.
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