Climate disasters leave lasting impact on health care infrastructure and access

Immediate recovery efforts receive the most attention after severe natural disasters, yet new data from researchers at Drexel University and the University of Maryland suggests these climate events often also leave a critical long-term - and often unaddressed - problem in declines in access to health care.

The team found a statistically significant link between severe natural disasters, such as heatwaves, droughts, floods and wildfires, and loss of health care infrastructure - including hospitals and outpatient care facilities.

Data was drawn from 3,108 United States counties nationwide from 2000-2014. It included whether a county never had, lost, gained, or always had a health care facility, and a record of 6,263 climate disasters those counties experienced during that period. After adjusting for other factors that could impact closures, such as total population and poverty, the team found an even stronger association between severe climate events and closures of outpatient care practices. The findings were recently published in the International Journal of Environmental Research and Public Health.

County-level disaster data came from the Spatial Hazards and Events Losses database. Using data on losses, the researchers classified each disaster's impact as "minor" (causing a death or less than $10 in property damage per capita), "moderate" (causing two deaths or $10-50 in damage per capita), or "major" (causing three or more deaths or more than $50 in property damage per capita). Health care infrastructure data came from the National Establishment Time Series database.

Unlike previous studies that typically focused on a single disaster in a single location, such as Hurricane Katrina and Hurricane Sandy, the currently study captured all climate-related disaster events nationwide during the time period.

Communities experiencing severe disasters often face declines in health care resources, with the effects lasting for years. This underscores the potential long-term effects of disasters on human health, beyond their immediate, acute impacts."

Yvonne Michael, ScD, senior author, professor of epidemiology, Dornsife School of Public Health

By 2050, the effects of climate change across the globe are predicted to cause 14.5 million deaths, as well as $12.5 trillion in economic costs (including $1.1 trillion faced by health care systems), according to a 2024 World Economic Forum report.

"Our study offers another key data point to support investment in public health infrastructure, as well as disaster planning and recovery efforts," said lead author Kevin Chang, MD, who contributed to the research as a medical student in Drexel's College of Medicine. "Without these investments, more patients will experience an interruption in care and worse health post-disaster."

The team found no link between closures of pharmacies and climate disasters, and suspect that this is due to the wide prevalence of "pharmacy deserts," communities that lack access to a pharmacy - created by the expanded role of pharmacy benefit managers and use of online pharmacies across the United States. The study did not examine other types of medical facilities, such as community health centers, urgent care, and long-term care practices.

The team's study also showed that counties that lost health care facilities were more likely to experience high poverty and greater racial segregation. Similarly, counties that maintained or gained health care facilities following a natural disaster had lower levels of poverty.

"More affluent communities often have better connections, such as political influence, that help them maintain these important health institutions following a period of crisis," said Michael. "These collaborations after a natural disaster are especially critical in low-income communities that often otherwise lack the resources to rebuild shuttered health institutions."

The authors suggest that these findings may be conservative, considering the increasing number of climate-induced natural disasters and costs associated with these events. Future studies, the authors suggest, should seek out what influences this link between climate disasters and loss of health care infrastructure, including policy, funding and measures of community resilience.