Factors that support public health infrastructure recovery in Puerto Rico and US Virgin Islands after Hurricanes Irma and Maria
DOI:
https://doi.org/10.5055/jem.0841Keywords:
public health infrastructure, recovery, United States territories, linkages, basic infrastructureAbstract
This paper describes the factors that support recovery of public health infrastructure (PHI), including conditions that facilitated or hindered recovery in United States (US) territories impacted by hurricanes Irma and Maria. A deductive approach was used to categorize data from five organizations that received crisis hurricane recovery (CHR) funds from the Centers for Disease Control and Prevention.* Spending was grouped into five infrastructure gaps: (1) human resources, (2) informatic upgrades, (3) equipment, (4) minor repairs, and (5) preventive maintenance. Unanticipated PHI costs, facilitators, and hinderances to PHI recovery were identified. Most (72 percent) of the $53,529,823 CHR funding was used to address infrastructure gaps in (1) human resources (56 percent), (2) informatics (16 percent), (3) equipment (13 percent), (4) minor repairs (10 percent), and (5) preventive maintenance (5 percent). Most of the
requests (56 percent) to redirect funds were associated with unanticipated costs in initial work plans and budgets. The use of administrative partners, planning tools, dedicated staff, streamlined procedures, eg, contracts, and cost sharing facilitated PHI recovery. The most common hindrance to PHI recovery were delays in procurement and shipping. In summary, investments in dedicated funding to upgrade, repair, or replace critical structures and systems for infectious disease surveillance, laboratory capacity, vector control, environmental health inspections, and vaccine storage and administration in Puerto Rico and the US Virgin Islands after Hurricanes Irma and Maria contributed to their recovery capacity. These findings may inform funding and resource allocation considerations for PHI recovery in the US territories.
References
Benah J, Rivera Diaz M, Muñoz NJ, et al.: What the Puerto Rican hurricanes make visible: Chronicle of a public health disaster foretold. Soc Sci Med. 2019; 238: 112367. DOI: 10.1016/j.socscimed.2019.112367. DOI: https://doi.org/10.1016/j.socscimed.2019.112367
Lerman S: ¿Qué sistema de salud? Broken health care in Puerto Rico. Med Anthropol. 2019; 38(3): 210-223. DOI: 10.1080/01459740.2018.1506451. DOI: https://doi.org/10.1080/01459740.2018.1506451
Michaud J, Kates J: Public health in Puerto Rico after hurricane Maria. 2017. Available at http://files.kff.org/attachments/issue-Brief-Public-Health-in-Puerto-Rico-after-Hurricane-Maria. Accessed February 27, 2024.
Puerto Rico Government: Transformation and innovation in the wake of devastation: An economic and disaster plan for Puerto Rico. 2018. Available at https://www.preventionweb.net/publication/transformation-and-innovation-wake-devastation-economic-anddisaster-recovery-plan. Accessed February 27, 2024.
Roman J: The Puerto Rico healthcare crisis. Ann Am Thorac Soc. 2015; 12(12): 1760-1763. DOI: 10.1514/AnnalsATS.201508-531PS. DOI: https://doi.org/10.1513/AnnalsATS.201508-531PS
USVI Government: USVI hurricane recovery and resilience task force report. 2018. Available at https://tile.loc.gov/storage-services/master/gdc/gdcebookspublic/20/20/37/68/69/v1/2020376869v1/2020376869v1.pdf. Accessed February 27, 2024.
Hallengatte S, Przyluski V: The economics of natural disasters: Concepts and methods (December 1, 2010). World Bank Policy Research Working Paper No. 5507. Available at https://ssrn.com/abstract=1732386. Accessed March 1, 2024.
Concepcion-Acevedo J, Patel A, Luna-Pinto C, et al.: Initial public health laboratory response after Hurricane Maria—Puerto Rico, 2017. MMWR Morb Mortal Wkly Rep. 2018; 67(11): 333-336. DOI: https://doi.org/10.15585/mmwr.mm6711a5
Gordon JM, Orriola D, Unangst M, et al.: Lessons learned from a medical response team 45 days post hurricane Maria in Puerto Rico. Disaster Med Public Health Prep. 2020; 14(1): 28-33. DOI: 10.1017/dmp.2019.65. DOI: https://doi.org/10.1017/dmp.2019.65
Irvin-Barnwell EA, Cruz M, Maniglier-Poulet C, et al.: Evaluating disaster damages and operational status of health-care facilities during the emergency response phase of hurricane Maria in Puerto Rico. Disaster Med Public Health Prep. 2020; 14(1): 80-88. DOI: 10.1017/dmp.2019.85. DOI: https://doi.org/10.1017/dmp.2019.85
Luna-Pinto SC, Rivera A, Cardona I, et al.: Restoring immunization services provided by the vaccines for children program in Puerto Rico after hurricanes Irma and Maria, 2017-2019. J Public Health Manag Practice. 2020. DOI: 10.1097/PHH.0000000000001193. DOI: https://doi.org/10.1097/PHH.0000000000001193
Chowdhury MAB, Fiore A, Cohen S, et al.: Health impact of hurricanes Irma and Maria on St Thomas and St John, US Virgin Islands, 2017–2018. Am J Public Health. 2019; 109: 1725-1732. DOI: 10.2105/AJPH.2019.305310. DOI: https://doi.org/10.2105/AJPH.2019.305310
Cruz MA, Rivera-Gonzalez LO, Irvin-Barnwell E, et al.: Public health branch incident management and support as part of the federal government response during emergency phase of hurricanes Irma and Maria in Puerto Rico and US virgin islands. J Emerg Manag. 2022; 19(8): 63-77. DOI: 10.5055/jem.0631. DOI: https://doi.org/10.5055/jem.0631
Acosta J, Burgette L, Chandra A, et al.: How community and public health partnerships contribute to disaster recovery and resilience. Disaster Med Public Health Prep. 2018; 12: 635-643. DOI: 10.1017/dmp.2017.130. DOI: https://doi.org/10.1017/dmp.2017.130
Americares: Responding to hurricane Irma and Maria. 2017. Available at https://www.americares.org/news/2017-0907-irma/; https://www.americares.org/news/2017-pr-0919-maria/. Accessed February 27, 2024.
Schnall AH, Roth JJ, Ekpo LL, et al.: Disaster-related surveillance among US virgin islands (USVI) shelters during the hurricanes Irma and Maria response. Disaster Med Public Health Prep. 2019; 13(1): 38-43. DOI: 10.1017/dmp.2018.146. DOI: https://doi.org/10.1017/dmp.2018.146
Colon-Flores LG, Rosario Cruz V, Gonzalez-Soto M, et al.: Challenges and lessons learned after hurricane Maria: Learning points for the medical student community. Yale J Biol Med. 2020; 93(3): 429-432.
Jimenez-Mangual BC, Cuevas-Acevedo DM, Quiles-Alves N, et al.: Description of patients medications needs and the community pharmacist’s role in Puerto Rico following a natural disaster. J Prim Care Community Health. 2019; 10: 215013271984270. DOI: 10.1177/2150132719842701. DOI: https://doi.org/10.1177/2150132719842701
Dwyer C, Horney J: Validating indicators of disaster recovery with qualitative research. PLoS Curr. 2014. DOI: 10.1371/currents.dis.ec60859ff436919e096d51ef7d50736f. DOI: https://doi.org/10.1371/currents.dis.ec60859ff436919e096d51ef7d50736f
Mainzer HM, Kruger J, Mahany M: Essential public health services framework: Use for rebuilding communities. Am J Public Health. 2019; 109(S4): S271-S273. DOI: 10.2105/AJPH.2019.305261. DOI: https://doi.org/10.2105/AJPH.2019.305261
Murthy BP, Molinari NA, LeBlanc TT, et al.: Progress in public health emergency preparedness-United States, 2001-2016. Am J Public Health. 2017; 107: S180-S185. DOI: 10.2105/AJPH.2017.304038. DOI: https://doi.org/10.2105/AJPH.2017.304038
CDC: 10 essential public health services (revised, 2020). 2020. Available at https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html.
US Government Accountability Office: Budgeting for disasters: Approaches to budgeting for disasters in selected states. 2015. Available at https://www.gao.gov/products/gao-15-424. Accessed February 27, 2024.
US Government Accountability Office: Disaster response: HHS should address deficiencies highlighted by recent hurricanes in the US Virgin Islands and Puerto Rico. 2019. Available at https://www.gao.gov/products/gao-19-592. Accessed February 27, 2024.
US Government Accountability Office: FEMA’s disaster recovery efforts in Puerto Rico and the US Virgin Islands. 2019. Available at https://www.gao.gov/assets/gao-19-662t.pdf. Accessed February 27, 2024.
Healy A, Malhotra N: Myopic voters and natural disaster policy. Am Polit Sci Rev. 2009; 103(3): 387-406. DOI: 10.1017/S0003055409990104. DOI: https://doi.org/10.1017/S0003055409990104
Renken K, Jackman AM, Beruvides MG: Comparing predisaster mitigation grant spending with post-disaster assistance spending: Are mitigation investments saving federal dollars? J Emerg Manag. 2020; 18(4): 349-354. DOI: 10.5055/jem.2020.0479. DOI: https://doi.org/10.5055/jem.2020.0479
Renken K, Jackman AM, Beruvides MG: Quantifying the relationship between predisaster mitigation spending and major disaster declarations for US states and territories. J Emerg Manag. 2020; 18(4): 341-347. DOI: 10.5055/jem.2020.0478. DOI: https://doi.org/10.5055/jem.2020.0478
National Centers for Environmental Information: Billion-dollar weather and climate disasters. 2022. Available at https://www.climate.gov/news-features/blogs/beyond-data/2022-us-billion-dollarweather-and-climate-disasters-historical. Accessed February 27, 2024.
CDC: CDC public health crisis cooperative agreement and 2017 hurricane supplemental funding FAQs. 2018. Available at https://www.cdc.gov/orr/readiness/funding/funding-hurricane.htm. Accessed February 27, 2024.
Jurevicius O: McKinsey 7s model. 2013. Available at https://strategicmanagementinsight.com/tools/mckinsey-7s-model-framework/. Accessed February 27, 2024.
Granovetter M: The strength of weak ties. Am J Sociol. 1973; 78(6): 1360-1380. DOI: 10.1016/B978-0-12-442450-0.50025-0. DOI: https://doi.org/10.1086/225469
Valente TW, Lawrence A, Palinkas SC, et al.: Social network analysis for program implementation. PLoS One. 2015; 10(6): e0131712. DOI: https://doi.org/10.1371/journal.pone.0131712
NACCHO: Public health infrastructure and systems. Every tool and resource it takes to keep your local health department running. 2021. Available at https://www.naccho.org/programs/public-healthinfrastructure. Accessed February 27, 2024.
Office of Disease Prevention and Health Promotion: Public health infrastructure. Overview and objectives. 2021. Available at https://health.gov/healthypeople/objectives-and-data/browse-objectives/public-health-infrastructure. Accessed February 27, 2024.
US Census Bureau: 2019 American community survey 1-year estimates. 2019. Available at https://www.census.gov/search-results.html?q=poverty+in+puerto+rico&page=1&stateGeo=none&searchtype=web&cssp=SERP&_charset_=UTF-8. Accessed February 27, 2024.
Kaiser Family Foundation: US Virgin Islands fast facts. 2017. Available at https://files.kff.org/attachment/Fact-Sheet-US-Virgin-Islands-Fast-Facts. Accessed February 27, 2024.
CDC Foundation: Hurricane response and recovery midaward review in Puerto Rico and USVI. 2019. Available at https://www.cdcfoundation.org/programs/hurricane-responseand-recovery-mid-award-review-puerto-rico-and-usvi. Accessed February 27, 2024.
ASTHO: Association of state and territorial health officials. 2009. Available at https://astho.org/Research/Major-Publications/ASTHO-Fiscal-Intermedaries-Report/. Accessed October 20, 2023.
NNPHI: Partnering for the Public’s Health: The Role of Public Health Institutes as Fiscal Agents and Intermediaries. New Orleans, LA: National Network or Public Health Institutes, 2009. Available at https://nnphi.org/resource/partnering-for-the-publics-health-therole-of-public-health-institutes-as-fiscal-agents-and-intermediaries/. Accessed February 27, 2024.
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