Reclaiming Leadership in Public Health and Healthcare Resilience

In August of 1992, Hurricane Andrew decimated Homestead, Florida (south of Miami). More than half of Homestead Hospital’s staff left the region and it was a week before the hospital reopened. Disrupting the continuity of patient healthcare increased the chances that patient may die prematurely. In response, the Florida Agency for Healthcare Administration developed nation leading policies to improve hospital resilience. Forward thinking policies prevented building new hospitals in high hurricane risk zones, strengthened infrastructure, and required healthcare systems to develop emergency plans. Federal funding helped pay for valuable hospital renovations. In 2004, when the next hurricane struck, the region’s hospital systems were better prepared. For example, medically dependent children from neighboring areas sought shelter in the newly retrofitted Miami Children’s Hospital.

In 2017, Hurricane Irma further exposed healthcare system problems. Hurricane Irma crippled the region’s power grid and provision of vital services to senior living communities. Without air conditioning, twelve nursing home residents died from extreme temperature exposures. For at-risk older adults, infants, and people with chronic diseases, air conditioning is a life saver instead of a luxury. Consequently, Governor Scott and the Florida Legislature (Rule: 59A-4.1265) required assisted living facilities to have a backup power and sufficient fuel to run air conditioning for 48-72 hours. This policy is an important step to help Florida reclaim leadership in healthcare resilience.

Judicious air conditioning usage is our most effective tool to prevent heat related sickness and death. Florida does not require landlords to provide tenants with air conditioning or repair/replace it when it breaks. In contrast, other hot states like Arizona, consider air conditioning essential for health and safety and requires landlords this appliance. Relatedly, older adults living on a fixed income and poor households have difficulty paying electric bills. A 2010 AARP study found low income households receiving federal assistance spend ~16% of their income on electricity (Snyder and Baker 2010). This is comparable to the amount spent on transportation or food. Low income households may have to make impossible choices to cut back on food, healthcare, or transportation to pay for electricity.

One of the most important parts of Florida’s new assisted living facility and air conditioning legislation received scant attention. Florida established one of the nation’s first indoor heat exposure limits which pinpoints a temperature (81 °F) that is potential harmful to older and sicker adults. Florida could once again become a healthcare leader by 1) requiring landlords to provide air conditioning and 2) creating policies to keep indoor summer temperatures below (81 °F) for at-risk households. Expanding indoor heat policies makes sense since the vast majority of at-risk older adults live outside of assisted living facilities. Energy assistance can be provided to at-risk households through public/private energy programs, state assistance, or private philanthropy.

The Florida Building Resilience Against Climate Effects Program (BRACE), hosted at FSU, works with health departments to adapt to extreme weather. Public health departments are on the front lines of responding to climate threats like extreme heat, hurricanes, and Zika virus. Currently, BRACE and local partners are evaluating the effectiveness of health improvement programs. For example, Volusia County is measuring the benefits of extreme heat public service announcements. Similarly, Sarasota County held community meeting with at-risk communities to update their emergency management and evacuation plans. You can find out more information by visiting http://flbrace.org/.


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Christopher Uejio is an assistant professor in the Department of Geography. He gave a Policy Pub on a similar topic. You can listen to his short talk and questions from the audience here.

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