Coping and recovering from natural disasters

[00:00:05]

RICK WEISS: Hi, everybody. Thanks from me as well for joining us for today’s media briefing. I want to take just two minutes upfront to introduce those of you who are not familiar with SciLine to what SciLine is and what we do. We are, as many of you know already, a free service for reporters based at the American Association for the Advancement of Science in Washington. We are completely philanthropically funded, and everything we do is free with the overall goal, in every instance, of helping to get more research-based, scientific evidence into the news stream to help the public make more better informed decisions in their lives. We offer a variety of free services, including a on-deadline matching service through which you can get in touch with us when you’re working on a story, tell us what kind of an expert you need and what your deadline is, and we will provide you a connection with one or more of scientists who can help you with that story. We sponsor all-expenses-paid boot camps for journalists to get you up to speed on different areas that are science related. We provide, on our website, an array of fact sheets that are specially designed for you, hair-on-fire, on-deadline reporter who just wants the facts in a hurry. They’re written in-house. They’re vetted by outside experts. They’re footnoted. You can trust them. You can put those facts into your stories and have a more substantive story. And we provide these media briefings.

So today’s briefing, as Josh mentioned, will go for an hour. We’re going to have short presentations from three experts from universities around the country. And then we’ll open it up for a Q&A. The bios are available on the landing page for this media briefing, so I’m not going to spend time actually doing full introductions of everyone. But I’ll just tell you briefly that we will start by hearing from Dr. Lori Peek who is a professor of sociology and the director of the Natural Hazards Center at the University of Colorado, Boulder – that’s Peek – P-E-E-K – who will help us understand some of the basic concepts that you’ll want to get right as you create journalism on this topic, like vulnerability, risk and resilience, and who can talk about some research involving vulnerable populations in the aftermath of disasters. We’ll hear, second, from Dr. Sarah Lowe, assistant professor of public health at Yale School of Medicine – that’s L-O-W-E – who will focus on short-term and long-term mental health sequelae for people who have survived natural disasters. Sequelae is one of those great words I love to use, but you shouldn’t use it in your stories. Everyone knows that. But now that I’m not a reporter anywhere – anymore, I can use these words occasionally. And she’ll talk a little bit about how and why people react differently to some of these traumas.

And last, Dr. Shannon Van Zandt, professor and interim head of the Department of Landscape and Architecture – Landscape Architecture and Urban Planning at Texas A&M University, who’s going to focus on housing and other community-level impacts of natural disasters and some of the disparities in those domains that can affect outcomes for people who have survived disasters. So looking forward to these presentations and then a Q&A. We’ll start with Dr. Lori Peek.

[00:03:19]

LORI PEEK: Thank you, Rick. OK. OK. And you can see my screen, Rick?

RICK WEISS: Yes.

LORI PEEK: OK. All right. Hi, everyone. Thank you so much to the SciLine team for organizing this briefing and to the journalists who are participating. I’m really honored to be here with Shannon and Sarah to talk to you about this important topic. As Rick said, my name is Lori Peek. And part of my job today is to set the broader context for the conversation through a focus on socially vulnerable populations. Over the past 20 years, I have studied a range of marginalized groups in various disasters, including Muslim Americans after 9/11, children in low-income families after Hurricane Katrina and the BP oil spill and persons with disabilities living at risk in some of our nation’s largest and most hazard-prone cities. To begin, I want to start with a basic definition of risk that is often used in our hazards and disaster research field. When we talk about risk, we are referring to the interaction between hazard exposure and physical and social vulnerability divided by the capacity of a person, household or community to be prepared.

[00:04:46]

To take this definition and make it more concrete, let’s start with the hazard exposure. Although all states – all 50 states in the U.S. experience some natural hazards exposure, this exposure varies by geographic location and by hazard type. Take earthquakes, for example. This U.S. Geological Survey map that you can see on the left side of your screen shows that almost every state in the U.S. has some earthquake hazard exposure, while California, Washington, Puerto Rico, Alaska and Hawaii may be especially likely to experience damaging shaking in an earthquake. But that does not mean that the risk is equally distributed. To understand the risk – again, returning to our – returning to the definition above – we also have to understand the vulnerability of the physical environments where people live, work, play and go to school and the social and economic vulnerability of people and communities.

The map on the right is drawn from the Centers for Disease Control’s Social Vulnerability Index, which uses census data to determine human vulnerability at the census tract level. The SVI, or Social Vulnerability Index, then ranks each tract on 15 social factors, including things like poverty, lack of vehicle access and crowded housing, and then it groups them into an overall ranking of social vulnerability. What this map on the right shows is the overall ranking with the darker blue tracts being the most socially vulnerable in our nation according to these 15 measures. But you can then go into the CDC’s free online map and drill deeper into the various factors that are influencing that overall score. The USGS, the CDC and many other government agencies, as well as researchers, produce tools and resources like these to help community leaders and building officials and others to help understand and mitigate risk. But the many resources that are out there can also be especially helpful to journalists so that you can identify where there may be high levels of hazard exposure and/or a physical and social vulnerability.

[00:07:11]

Now, before I move off this slide, just one more comment about capacity as part of the risk equation. If we live in Southern California, we can’t change our geologic exposure to earthquake hazard, but we can build stronger homes, schools and businesses. We can support the preparedness actions of low-income persons. And we can engage marginalized populations in our disaster preparedness efforts to help lower that risk. While countless stories are told about communities and people after disaster strikes, I think there are many inspiring stories to also be told about local capacity building and hazard mitigation efforts that are happening across our nation and around our world to reduce risk. In my remaining few minutes today, the SciLine team asked me to share just a snippet of a few findings from my own qualitative, as well as quantitative, research on children as a vulnerable population. But in order to understand any question about vulnerable groups, I think it is crucial that we pause to then question which persons are most vulnerable within that population segment of interest. In response to this need for more nuanced information on children’s risk of death in extreme events, my colleagues and I used CDC WONDER data to study youth mortality by forces of nature.

Our analysis revealed several important things, including that children’s risk of death resulting from natural disasters is relatively low in our nation compared to other groups and compared to other nations around the world. However, differential risk exists depending on the type of hazard agent involved and between youth populations based on age, gender and race. Specifically, our analyses of those CDC WONDER data showed a number of things, including that when we looked at youth cohorts age 0 to 24, the risk of death in extreme events was highest for infants, our most vulnerable population perhaps of all. The death rate for male children is higher than the death rate for female children across all age cohorts in the U.S. – or all youth age cohorts. Data on race indicate that African American male children between the ages of 0 to 4 are most at risk for death by disaster while white male children between the ages of 5 to 24 are most at risk. In terms of risk by hazard type, and here’s – listen up, there is some diversity here – infants and very young children age 0 to 4 are most likely to die of exposure to extreme heat. We found that 5 to 14-year-olds are most likely to die in cataclysmic storms and flood events and that youth aged 15 to 24 are most likely to die of excessive cold.

[00:10:17]

And so this is all a way of sort of unpacking that question of if we say children are vulnerable, which children are most vulnerable? How does that vary by age, stage of development, race? And how does that vary by hazard type? OK. I want to close with a few words on capacity and in reference to a book that I co-wrote with fellow sociologist Alice Fothergill. We interviewed and observed hundreds of children over a seven-year period following Hurricane Katrina. Our work revealed that the children followed three recovery patterns, which we refer to as the declining, finding equilibrium and fluctuating trajectories. Our research was focused on the social factors that either hindered or facilitated children’s recovery. And one of our core findings related to the role of advocates or non-familial outsiders in children’s lives after Katrina. In particular, we learned that even children who would have been considered very vulnerable by nearly any indicator imaginable before Katrina, they were able to find equilibrium and to recover after the storm if they and their families were able to land in stable housing, the children were able to get into a stable schooling environment and if these families had contact with advocates who could then connect the disaster-affected families to vital resources and strong institutions that provided social structural support after the storm.

So this work showed that recovery is possible even among our most vulnerable when we dedicate the proper attention, time, care, resources and connect people to strong institutional supports. So with that, I wanted to end by sharing weblinks to the Natural Hazards Center and to our NSF-supported CONVERGE facility where you can find numerous, free online resources that we hope can support your vital evidence informed reporting efforts. Thank you for listening.

RICK WEISS: Thank you very much, Dr. Peek, really interesting. And by the way, reporters, these slides and links that you’re seeing will be available on our website after the briefing. So super interesting, thanks. And we’ll move now to Dr. Sarah Lowe.

[00:12:39]

SARAH LOWE: Hey, so I’m going to share my slides. Here they are. OK, so I’m going to be talking about the mental health effects of disasters. And in doing so I’m going to be drawing on some of my work in the aftermath of Hurricanes Katrina, Ike and Sandy, as well as the disaster mental health literature more broadly. And I’m going to be covering essentially four different topics, the first topic being mental health conditions after disasters. So what types of conditions are we as researchers looking at? And I pasted here the DSM-5. For those of you who are unfamiliar, this is the manual that mental health practitioners use to diagnose. And it has a slew of diagnoses and symptom criteria. And I’ve listed here two main classes of disorders that we look at. The first are trauma-related disorders. So these are disorders for which trauma is a prerequisite, so exposure to a traumatic event, life-threatening event like a disaster. And these are the ones that we think of when we think of disasters and trauma exposure.

So the two most relevant here are acute stress disorder and post-traumatic stress disorder, or PTSD. They share many of the same symptoms, including flashbacks and nightmares, avoidance of persons, places, things, emotions related to the trauma, negative emotional experiences and thoughts, like anger, irritability, guilt and shame, as well as alterations in arousal and reactivity, like an exaggerated startle response or difficulty falling asleep. The key difference between these two is that acute stress disorder is always diagnosed within the first month of trauma exposure, whereas after a month has passed, the diagnosis would move over to PTSD. What I think is really interesting, though, and that epidemiologic research has investigated – and there’s a great review out there by Goldmann and Galea published in the 2014 Annual Review of Public Health – are these other mental health conditions that do not have exposure as a prerequisite and which have been shown to be elevated among disaster-affected populations, things like depression, anxiety disorders, like panic disorder and generalized anxiety disorder, and substance use disorder.

[00:14:58]

Another point I want to make is that mental health is very much interrelated with impacts in other domains of functioning. So disasters, of course, don’t just affect mental health, but they also affect physical health, economic standing, social relationships. And these are all interrelated. So you sort of can’t look at one without the others. OK, moving on to my second topic, I’m going to discuss differences in the population. And I think this very much aligns with what Lori said about vulnerability. So, of course, disasters do not affect everyone equally. And there are certain populations who are going to be at increased risk of mental health adversity. And in epidemiologic studies, as summarized in the review, there are some pretty robust characteristics that increase risk. The top three are having a pre-existing mental health condition, being female and also being of low socioeconomic status.

A point I would want to make here, though, is that it’s not that these characteristics in and of themselves directly increase risk for mental health problems. It’s that a lot of the risk is through exposure, so exposure to immediate exposures and secondary stressors. So immediate exposures are stressors and traumatic events that occur during a disaster or traumatic event – things like property loss, lack of resources like food, water and shelter, injuries, bereavement and so on – where secondary stressors are certainly disaster related but emerge over a longer period of time – things like prolonged displacement and separation from family members, financial losses and dealing with repairs and, in doing so, navigating insurance companies, FEMA and other bureaucracies. OK. The third topic I have is children in disasters. And Lori has done a lot of great work on this topic and I’m sure can speak more to this issue. So people often ask, are children as affected by disasters as adults?

[00:17:12]

And my answer is just generally yes and no, so there are similarities and differences. The similarities lie in the nature of the mental health conditions and patterns of symptoms over time. The children definitely can exhibit depression, anxiety. Children can be diagnosed with PTSD, although the diagnostic criteria for kids under 7 is slightly different, although mostly overlapping with the criteria for those age 8 and older. And certainly, adolescents have been shown to have heightened substance use after disasters. What differs is the presentation of symptoms, and this is true not just in disasters but really in any context. So, for example, a depressed preschooler is going to look very different from a depressed adolescent and a depressed adult. And younger children are more likely to present as irritable or lethargic and to have somatic or bodily complaints, things like headaches and stomachaches.

The next bullet I have here is that there are age-sensitive periods of trauma impacts. And this means that the mental health impact of a disaster or trauma is going to be greater or lesser depending on when in the life course it’s experienced. When I think about this area of research, I actually think more broadly of the trauma literature and work by Erin Dunn and her colleagues at Harvard published in 2017, 2018 looking at childhood maltreatment and interpersonal violence, showing that the effects of these types of trauma are worse when experienced in early childhood, as opposed to first experienced in adolescence or later on, perhaps because of the impact of trauma on the developing brain. In the specific context of disasters, there’s not that much research on this topic that I’m aware of, but I do know of a study by Emily Harville and her colleagues that show that – they looked at a sample of women in the Gulf Coast and found that those who were first exposed to a natural disaster in early adolescence were protected against mental health adversity as opposed to those who were first exposed in later adolescence or adulthood. And then, of course, there are age differences in emotional experiences and stressors.

So here I have peritraumatic reactions. And that’s kind of a technical term, but what it basically means is an emotional response during a trauma, so feeling extremely terrified, confused, having a panic attack or even dissociating during a trauma. And qualitative research that my team has done, and I believe that Lori’s team has also done, has shown that younger children tend to be more confused about what’s going on during disasters, which certainly can heighten risk. But on the other hand, mothers, in a study that I’m a part of after Hurricane Katrina, said that their younger children were more likely to see Hurricane Katrina as an adventure or a vacation, whereas the older children understood the gravity and seriousness of the situation, and that could increase risk. And then when thinking about secondary stressors, the biggest one for kids is schools. So disasters damage schools, lead to school closings. One of the studies I was a part of found that the number of school changes within the first year after Hurricane Katrina was associated with the worst symptoms. But of course, the impact of a school change is going to vary by age, as children differ in the centrality of peer relationships to their identity, the nature of their education and its relation to college admissions and the importance of their relationships to adults in the school contexts.

[00:21:02]

And then my last slide is just a little tidbit on short- versus longer-term outcomes. This figure is from George Bonanno, who’s a clinical psychologist. He’s done a lot of great work on grief, trauma and disasters. It’s actually from 2014. And what it shows is on the x-axis, we have time. On the y-axis, we have health and dysfunction, or I like to think of it as symptoms, from no symptoms to very severe symptoms. And the shaded area in the middle is a PTE, or potentially traumatic event. And what it shows are these varying trajectories. And what has been theorized and now empirically shown is that most people after disaster and trauma are going to fall into what’s called the resilience trajectory. And that’s a trajectory of consistently low symptoms over time. However, these other trajectories are apparent in substantial minorities of the population. Most notably, 5 to 10% of disaster survivors have been shown to have a chronic trajectory, so a trajectory of consistently high symptoms. Although I love this figure in align (ph) with this point, there’s something that I think it misses, which is that it sort of assumes that people come into disasters all with good health and high levels of functioning, whereas we know that there’s substantial variability in how people are doing in terms of their mental health and otherwise.

And a study that I’ve been a part of that has access to pre-disaster data has shown that participants who are in this chronic trajectory tend to be those who were suffering from mental health problems before. So how you were doing before really does matter. What I think this figure also misses is the possibility of improvement. So that same study found that there was a small percentage of participants whose mental health actually got better from predisposed disaster. And when we looked qualitatively at those participants, they tended to talk about the disaster pushing them to new opportunities, whether new neighborhoods, educational opportunities for their kids, better employment or the disaster serving as sort of a touchpoint for mental health services and social services to deal with some of the symptoms and other difficulties that they were having prior to the disaster and maybe they weren’t aware of those services before. So that’s it. Thank you very much.

RICK WEISS: Fantastic. Thank you. And on to Shannon Van Zandt.

[00:23:37]

SHANNON VAN ZANDT: Hi, everybody. Can you hear me? It says you’re on – OK, there we go (laughter), unmuted by host. That’s a good thing. I’m Shannon Van Zandt at Texas A&M University. You might have noticed that I come from a different background than Dr. Peek or Dr. Lowe. They’re both sociologists, but I am trained as an urban planner. And so the way that I look at social vulnerability is spatial and really is focused on the built environment.

So I’m going to talk a little bit about how the built environment contributes to vulnerability, as well as recovery during a disaster. One of the most common misconceptions that I hear repeated about disasters is that they are equal opportunity events, that they don’t discriminate. And while it’s true that hazards themselves are indiscriminate, when hazards interact with the built and social environment, they become disasters and they’re anything but indiscriminate. The ways that our communities are structured and the ways that households are distributed among our communities cause disaster impacts and consequences to affect different subpopulations in very different ways, as you’ve heard from our previous speakers. People and households are not randomly distributed across cities. They’re concentrated in fairly predictable patterns, which are based largely on race, ethnicity and income. Neighborhoods tend to be fairly homogeneous.

And so we have neighborhoods that sometimes are characterized as black neighborhoods or as poor neighborhoods or very often poor black neighborhoods, although neighborhoods themselves can’t actually hold those characteristics. The people in them do. So we have areas of suburban sprawl, which until fairly recently have been mostly affluent and white, as well as areas of concentrated poverty, which are typically black and brown. We also see wide differences in housing types and quality where socially vulnerable populations are more often living in multifamily homes, apartments and duplexes or they’re more often renters. In Houston, for example, where Hurricane Harvey did enormous damage, more than 50% of households are renters. Just being a renter automatically makes people more vulnerable because they don’t have control over hardening or retrofitting their units to make them safer. And they often aren’t fully aware of the risk. Unlike homeowners, renters are not required to be notified that they’re living in a flood plain or even in a floodway, as many are in Houston.

[00:26:09]

Further, their leases can be terminated based on acts of God in their lease and they have little recourse about whether they get to return to their unit. And they also have no control over whether their units are rebuilt at all. And if not more important than their housing type is their housing location. Due to development patterns and market forces, low-income housing is almost always placed in the least desirable areas. This often includes the flood plain, particularly in cities along the coasts or in other flat areas where low-quality homes may be concentrated, which increases their risk. I like to say that low-income households live in low-quality homes in low-lying areas. But it may also include locations that are adjacent to undesirable facilities, such as oil refineries, plants or other heavy polluting industries like we have a lot of along the Gulf Coast. We call these environmental justice neighborhoods, and they can actually interact with natural disasters to result in what we call natech disasters, natural disasters that turn into technological disasters.

The Sendai or Tohoku tsunami and subsequent nuclear emergency in Japan is perhaps the most major recent example, but smaller events were very prevalent during Hurricane Harvey, where many of the petroleum and chemical facilities experienced leaks or fires during the flooding event. And very little media attention was paid to those events, and the damage to public health through air, water and soil contamination is really fairly unknown at the moment. The academic literature on neighborhood impacts of social vulnerability is very consistent in finding that low-income and minority populations receive a disproportionate share of damage with disasters because of the greater exposure of their location, as well as the lower quality of their structures.

Most of my own work, along with some of my colleagues Walt Peacock and Sara Hamideh, has focused on hurricanes and flooding, but these findings have been replicated for other types of disasters. We also see that these populations take much longer to recover. With my colleagues, we’ve tracked housing recovery over many years following major disasters. And we found that lower value homes can take two to three times as long as higher value homes to regain their pre-disaster value. We also see that multifamily housing types experience a much more volatile recovery, presumably as owners decide whether or not to rebuild and try to find the funding to do so. And we see that housing types that are associated with renting are also slower to recover.

[00:28:49]

After Hurricane Ike, which struck Galveston off the – south of Houston in 2008, we found that most higher income areas recovered after about two years, but the lower income areas had not entirely recovered even after four years. Of course, this was also the same time that the recession began, and so it’s difficult to attribute all of the effect to the hurricane. But still, we saw that the higher income areas bounced back relatively quickly. We’ve also been able to compare that data to data from Hurricane Andrew in 1992 that my colleague Walt Peacock studied. And we found identical patterns in housing recovery. A big part of the reason for the delays for lower income households and neighborhoods is the difference in resources that higher income homeowners have relative to lower income households. Higher income homeowners are more likely to have flood insurance, homeowner’s insurance and probably most importantly their own personal savings.

Typically, wealthier homeowners can get started on rebuilding right away out of their own pocket, but lower income families just don’t have these kinds of resources. Even if they have insurance, it may be inadequate and very often they may be denied based on deferred maintenance – which means that if the insurance company couldn’t determine that the observed damage was attributable to the disaster, then they would deny the claim. Perhaps most distressing to me is the loss of affordable housing. Because lower value properties sustain disproportionate amounts of damage and take much longer to recover, the opportunity for redeveloping those areas is very high. What I mean is that the delay in the recovery gives developers and owners an opportunity to either swoop in and buy up damaged properties and then redevelop them at a higher price point because almost anything new will be more expensive than what was there before. We have seen a lot of speculative buying in Houston after Hurricane Harvey. The other option is that an existing owner will take the opportunity to rebuild, but they’ll upgrade their property so they can get a higher rent.

[00:31:00]

Most affordable housing results from housing filtering down as the housing stock ages, and so when it’s rebuilt, it automatically becomes more expensive. And so what we see is that the results of – the resulting stock of affordable housing is dramatically reduced, and this could compound the impact of the disaster itself. As you all know, the affordable housing shortage is a major crisis in the country. Most cities, and particularly those in higher priced coastal markets, are experiencing a shortage of affordable units. And so when a disaster hits, not only are there fewer units available, but there are more people looking. For those households that are surviving on a thin margin, they’re barely making it, the disaster can often be the trigger that causes them to slide back down the ladder of social mobility. Stable housing is the basis for family stability as Dr. Lowe and Dr. Peek referred to. Without stable and secure housing, it’s very difficult, if not impossible, to make the other things in your life work – things like jobs and school and personal health, which have been referred to.

There was some very good reporting by the Houston Chronicle and the Victoria Advocate after Hurricane Harvey that documented some of these stories that take a little bit longer to unfold. I really appreciated their efforts to follow those families for a year or so after the disaster so that we really can understand better how those struggles compound over time. There are some promising efforts happening in states that are particularly disaster prone. I can speak mostly just about Texas. But we have advocacy groups here, most notably Texas Housers on whose board I sit. But they’ve been very active for the past decade in trying to ensure that our most vulnerable populations get the federal assistance that they both need and are entitled to.

They serve as kind of a watchdog for state – and mostly – state and federal but mostly state government to ensure that the funds that come into communities – which are called CDBGDR funds and what that stands for is Community Development Block Grants Disaster Recovery – and that the CDBG funding is funding that normally flows into a community. But after each disaster, Congress will allocate – do a special allocation of disaster recovery funds for the state or for a local area. And those funds are required by law to go to 70% low and moderate-income households, but it’s not unusual for state officials to ask for that requirement to be waived. And so the advocacy groups play an important role in making sure that it stays in place.

[00:33:49]

But even when the money does come into the community, we see that there – they may not always be prepared to spend it appropriately even though it’s desperately needed. It takes a long time for that money to come into a community – a minimum of a year and usually longer, up to two years – but cities have not really identified the projects that are appropriate to help the vulnerable populations rebuild and recovery – recover. So one of the things that I often promote is the need for communities to plan ahead of time for disasters. I am a – I’m a planner, so that’s kind of a natural place for me to go, but I always like to note at the time of Hurricane Harvey, the city of Houston had three other disaster programs that were active, including 2008’s Hurricane Ike as well the Memorial Day and Tax Day floods of 2015 and 2016. And so for Houston and for the Texas coast, at least, if not the Gulf and Atlantic coast as well, disasters are regular events. They happen.

Texas has sometimes 80 declared disasters in a given year – not all hurricanes, of course, but tornadoes, fires, all of that sort of stuff. We have a lot. So it’s not – we can’t treat them as though they’re events that can’t be anticipated. They should and really must be anticipated. And so we – I would suggest that cities incorporate disaster planning into their normal planning activities. And there are a number of useful tools that both federal agencies like USGS and NFF have developed, as well as some that researchers have developed that can really help communities do this and particularly those communities that we would consider low-capacity communities that don’t have the expertise or the resources, including time, to do a good job of that. I hope we can change that in a number of ways, and I would be happy to talk about some of those during the Q&A session if anyone’s interested.

[00:35:52]

RICK WEISS: Thank you, Dr. Van Zandt. Thank you, all three. I’ll remind reporters here that if you’d like to ask questions, you can find the Q&A box at the bottom of your screen a little bit to the left. And if you want to direct that question to anyone in particular, go ahead, or else just to the panel generally is fine. And I just want to say for starters, I didn’t mention at the beginning, but I think it’s such an inspiring topic because, you know, we all cover disasters all the time. But so often, the news teams are gone soon after and have moved on to the next news item. And one thing I find inspiring about these presentations is – it’s not inspiring that the ill effects continue for a long time, but it is inspiring that there are – that we actually know enough from the research at this point that there are ways to mitigate and hopefully prevent this kind of thing the next time around. So this is an area where journalism can actually make a difference if we just stick to the story and cover what is being done in the aftermath of a disaster to mitigate the kind of – these kinds of impacts the next time a disaster comes around – so a great area for journalism to do its job of helping people (inaudible) forward.

So we have a couple of questions coming in. Let me start with this one from Charlie Brennan at the Boulder Daily Camera. He says, as the impacts of climate change are compounded, is it believed that natural disasters as you would define them are likely to become more commonplace? And do you anticipate more taxing on communities in this regard? And in particular, he’s asking what to make of the possible expected change in the nature of these disasters. Are disasters always short and well-defined, or do you see them gradually unfolding over the long term like drought, famine, sea level rise – sort of slower-moving but equally problematic disasters as a result of climate change? Anyone want to start with that?

SHANNON VAN ZANDT: I can, if you – if that’s all right (laughter).

RICK WEISS: Go for it.

[00:38:08]

SHANNON VAN ZANDT: So yeah. The short answer is yes. I think we definitely expect disasters to increase in frequency and severity. And I think even in Texas, where we’re a little – you know, typically a little bit more skeptical of climate change – not me, but the state as a whole – that we’ve seen those effects. I mean, I think Hurricane Harvey – a lot of people spotlighted it as, like, the new normal. Like, we’re going to have more of these severe rain events; they’re going to last longer. Harvey really caught us by surprise in many regards because, you know, with hurricanes, we know they’re coming, and we usually have a few days to prepare for them. But it didn’t stop when it came onshore. It did this – you know, this different thing where it came and sat over Houston and just rained, and rained and rained for days and with an unprecedented volume of rain, really. And so whether that’s the new – you know, the new normal, I kind of think it is.

And I think you bring up a good point about chronic versus acute disasters. It’s a lot of what we’ve been talking about – is fairly acute kinds of disasters, but things like drought and sea level rise, as Rick mentioned, but even things like increasing heat – I mean, I think – I started seeing some stories recently about the impacts of a lack of shade and things like that that are related to heat-related illnesses and even deaths in some cases. And so these are, you know, perhaps disasters that we don’t yet really know how to prepare for. I think we have ideas about how things might change. Certainly, we talk about retreat from the coast, and even cities like Miami are already planning for that. Whether it goes efficiently or not is – remains to be seen, but it’s happening already. There are communities not just across the world, but in the United States – in Louisiana, in Alaska, in Florida – that are finding themselves displaced. They can’t live there anymore, or they can’t produce the kinds of crops that they’ve been able to produce before.

I visited the coast of Virginia, and they’re suffering from, you know, incursion from saltwater, and so they’re unable to grow some of the things that they used to grow. Generally, these kind of more chronic or long-term disasters gives us more time to adapt, but to adapt a built environment is a very slow and expensive process. And it may not be something that is available to every community. And so it really is important to start considering those consequences, well, yesterday, really, but now, as soon as possible and to use the normal streams of funding and the normal planning processes to address these kinds of issues that are really part of our new reality.

RICK WEISS: We have some other questions, but if Dr. Lowe or Dr. Peek want to address that particular point, I’ll give you a moment there.

[00:41:18]

SARAH LOWE: Yeah. I thought that was very-well said, Shannon. And yeah, I would say for the – like, yes, there is evidence from the Intergovernmental Panel on Climate Change that disasters are going to become more frequent and more intense, and I think you bring up the issue of disaster-related migration and those effects on populations and individuals. In terms of these more chronic climate change-related indicators like extreme heat, drought, air pollution, I think they’re – at least in terms of mental health, the effects are – can be difficult to parse out. But I know of some scholars who are trying to do that.

LORI PEEK: And Charlie, I just wanted to echo and say, I think the three things I always say about that question is, we already are in this situation, and disasters already are more complex, more commonplace and more catastrophic. And just, I mean, I feel like journalists are running out of adjectives to describe the number of record-breaking events that we are already experiencing. And so I just – I really appreciate your question and thank you for bringing that into this dialogue.

[00:42:33]

RICK WEISS: Great. We have a question from Markian Hawryluk at Kaiser Health News. Are there things that government or agencies can do before an impending disaster to mitigate specifically the mental health impact of the disaster, or would mitigating mental health impact really just rely primarily on preventing the overall impact of the disaster overall? Is there something we can do specifically? I guess that means to protect people from the mental health follow-ons from these things. I think Dr. Peek or Dr. Lowe might want to address that.

SARAH LOWE: I mean, I think, basically, bolstering the mental health of communities prior to disasters since we know that pre-disaster mental health problems are among the strongest predictors of post-disaster mental health problems. I think also, making sure that vulnerable populations are prepared and can escape from danger to the extent that they can – so especially people struggling from chronic mental health conditions, making sure that they have a disaster plan in place in addition to their ongoing mental health services.

LORI PEEK: Yeah, absolutely. I agree. And I really appreciate this question, given that we are living in a time of a mental health service provision crisis in the nation, as well. And so building on what Sarah just shared about pre-disaster mental health being a predictor of post-disaster outcomes, also, we know exposure in the actual event, as she suggested during her wonderful presentation, is really important as well. And so I think one of the most important things that our government agencies are doing and can do is figuring out, if we know where vulnerable populations are located, where we know there are transportation-dependent populations that may not be able to move out of harm’s way, how can we engage in planning and preparedness efforts to at least reduce the exposure to the disaster? And if we can reduce that exposure to the catastrophic event, then we might be able to lower down some of those most severe mental health consequences.

So I think all of those preparedness and mitigation actions that our government agencies and other groups engage in, they are so vital on so many fronts. But we know that only a fraction of pennies on the dollar go to those pre-disaster mitigation and preparedness sorts of programs for the built environment, as well as for individuals and for our social environment because most of that – 90 cents on the dollar, about – goes to the response and the recovery after the disaster has happened. So I think, again, this is a real place where reporters can make such a difference in focusing on that. Before the catastrophe occurs, what is happening in the communities?

[00:45:20]

RICK WEISS: So we have a question here that really focuses on that 10 cents, I think, that’s left for that. This is from Ciara McCarthy at the Victoria Advocate, who says she’s really interested to read about the programs that Florida has launched after Hurricane Michael specifically to address the mental health needs of residents. She’s unaware of comparable efforts after Harvey in Texas. She wants to know, are statewide disaster dollars specifically for mental health common? Sounds like not. And are there best practices for how agencies and providers should provide mental health aid in the wake of a disaster?

SARAH LOWE: I think we’re learning about what the best practices are. And I think something that the research has shown that – is that it’s not a one-size-fits-all deal and that different people are going to have different mental health needs, and it’s a matter of identifying who needs what. So most people are going to be fine with a low-level intervention. Like, there’s one called skills for prevention and recovery (ph) that came out of California that’s empirically supported in disasters and other mass-trauma contexts. But there are going to be some people who have a higher level of need, and it’s a matter of finding out who those people are. And it’s not just going to be the people who were suffering before. There are going to be some new-onset cases as well – and making sure that they have empirically supported treatments for the particular condition they have, whether it’s cognitive behavioral therapy or prolonged exposure therapy – something like that.

LORI PEEK: And I think since you have three long-term-recovery researchers on the phone, too, building on what Sarah just shared, something that Shannon and Sarah and my work shares in common is sort of how long recovery takes. And so even when there are these mental health – wonderful mental health programs that are oftentimes implemented after a disaster – that sometimes due to how our federal disaster recovery funding works, which is – Shannon can say more about this – is that oftentimes it’s time-delimited. It may – we may only have these resources for 18 months.

But one of the things we saw is sometimes, children who were not expressing mental health issues in the first year or even two years after Katrina, then year three hit, year four hit, year five hit, and they still weren’t stable housing and stable schooling. And that’s when they needed those mental health supports, but the funding had dissipated. So I think, again, sometimes there’s this mismatch between when the response and recovery dollars and supports come in and then how the disaster actually unfolds in people’s lives and in communities. And when those needs emerge, these things may not always be aligned.

SARAH LOWE: Yeah, I think building in, like, a sunset period for funding – so I know the folks in Sandy Hook who manage all the donations there have plans for the funding to go through when the kindergartners at the school graduate from high school, with the acknowledgment – with the knowledge that, you know, these are going to be long-term effects for them. And I think it’s the same for disasters, as well.

[00:48:36]

RICK WEISS: Dr. Van Zandt, we have a question for you from Neela Banerjee at InsideClimate News. You spoke of post-Harvey real estate speculation in Houston. Did the impact of Harvey fail to have an effect on zoning and building decisions in Houston?

SHANNON VAN ZANDT: Yes and no. I mean, I think that the overall – well, most disasters open up a window of opportunity in which people are generally more interested in making decisions that might improve their resilience over time. And I think that occurred after Harvey in Houston. But the powers that be and – they have a really strong real estate lobby in the state of Texas that really resists any effort to notify people of their risk or using the word climate change and things like that because they don’t want to do anything that’s going to lower the value of the properties. I mean, to me, this is like a – excuse me for – a bastardization of capitalism in the sense that capitalism is based on the idea that people – consumers – have good information about their risks so that they can make smart decisions and that market value should actually reflect that, much in the same way that they might – mortgage interest rates, for example – your risk should be captured in the amount that you’re paying. And I think the value of a home should be affected by its risk, as well. But the real estate industry doesn’t want that to happen.

And so I think the – you know, the overall effect is that Houston has not made the necessary changes that it needs to. I can’t say that it has not made any changes. They have tried to restrict development in the flood plain, but it came with a lot of requirements that developers pushed back on, and so they – you know, they tried to make it more and more conservative. So they could get some changes passed but not enough – really, not nearly enough. And so, you know, I think they recognize that this is likely to happen again. But there is – has been a lot of interest at the state level, and there were a number of bills that were passed in this last legislative session that should at least provide more knowledge about risk and exposure and even, to consumers, more information about their risk that hopefully will help people make better decisions about where they locate. But, of course, their choices are fairly limited, especially for low-income households who really don’t have much choice about where to live. And, of course, those homes are more likely to be located in flood-prone areas.

[00:51:20]

RICK WEISS: And related to that, Dr. Van Zandt, there’s a question from Todd Melby at American Public Media in Minneapolis asking about the importance of the role of water and sewer infrastructure in minimizing natural disaster. Has Houston been dealing with bigger storm sewer pipes, at least, or…

SHANNON VAN ZANDT: They have. Yeah. They actually have, and I love that question because one of my current – my really current interest in research is inequities in infrastructure provision because some of my research suggests – although I don’t have the data to really prove it, but there is data to suggest that low-income neighborhoods and particularly minority communities may not have had the same kind of maintenance and upgrading in their stormwater management infrastructure that they should have had and that that actually contributes to the damage that they occurred. But I will say Houston – Houston knew before Hurricane Harvey that it needed a third reservoir. So, you know, it has two that actually had to do releases after Hurricane Harvey, which flooded neighborhoods that have never been flooded before. But they are now working towards a third reservoir that – which should increase their capacity to hold the water. And there is – you know, there is investment in – you know, there’s been a lot of, like, creative ideas about how to increase the capacity of the stormwater management system. It will be extraordinarily expensive.

But one thing that I do expect to see from Houston – and I think we’re seeing it – is Houston is a very engineering-oriented city. I think it has the highest concentration of engineers in the country. Most of them are petroleum engineers. But my feeling about that is that they’re going to come up with an engineering solution, which typically is a much more expensive solution. Planners like me typically advocate nonstructural solutions or really a combination of both. In other words, we move out of harm’s way or we elevate above the flood level. And those are – particularly moving land-use planning as a mitigation tool is probably the most cost-effective way of doing mitigation but is very difficult to do in areas that are growing rapidly and have limited land on which to develop. And so it can be difficult but cheaper. And – but I think they’re going to choose the easier, more expensive solution.

RICK WEISS: Sounds like we might need more engineers in elected offices. But that’s a separate topic.

SHANNON VAN ZANDT: Maybe. I’m not sure I would agree with that but maybe so (laughter).

[00:54:01]

RICK WEISS: I think we have time for one last question here, and this comes from Dean Russell at Columbia Journalism Investigations in New York who notes that there’s a range of data sources used in studies such as mental health-related emergency department visits or suicide rates, but these sources are limited in what they show, and they often differ by state. So as journalists look into this, how can we begin to quantify the mental health effects of natural disasters across the board?

SARAH LOWE: Across the board across different disasters. I mean, I think in addition to those sort of archival data sources like ER visits (unintelligible) mortality, there are a number of epidemiologic studies, many of them led by my mentor, Sandro Galea, across a variety of different disasters that have used common measures. So that permits sort of investigation across different events at the mental health impacts. And in those studies, they use validated questionnaires that have cut-off scores for probable diagnoses. So you can say, you know, this percentage of the population or this representative sample is likely to have PTSD, is likely to have depression. What is beneficial about those studies as it compared to archival data is that they don’t require someone to go to the emergency room. They’re just administered to households randomly. So it’s probably more representative of the population, although that, again, doesn’t capture people who are homeless or incarcerated or who don’t respond to surveys…

RICK WEISS: Yeah.

SARAH LOWE: Which is happening more and more unfortunately.

[00:55:56]

RICK WEISS: Right. Great. OK. Great. We’re at 3 o’clock Eastern time, and I want to end timely. I want to thank our three speakers today for a really informative, and I hope for the journalists, story-inspiring presentations. I want to remind folks before we close that SciLine is here at your service for free. If you ever need an expert for a story you’re working on, get in touch with us. It’s – check us out at sciline.org. We encourage you to follow us at @RealSciLine. A last point is that for the journalists participating today, as you shut down from this, you will get a small prompt asking you to answer a three-question survey. It’s really short. It really helps us do a better job on these things. I hope if you appreciated this opportunity or didn’t that you will take the half a minute or so it takes to answer three questions and help us do as good a job as we can to keep you informed on issues like this.

Thanks to everyone for attending. Thanks Dr. Peek, Dr. Lowe and Dr. Van Zandt. And we’ll see you at the next SciLine event. So long.