Editorials |
Long-term health effects of flooding
Selena Gray, Joint Editor
Journal of Public Health
A recent visit to the city of New Orleans is enough to bring home the long-term effects of flooding and natural disasters on individuals and communities. Three years after Hurricane Katrina broke the canal levees in New Orleans, leaving 80% of the city flooded, warnings about Hurricane Gustav again led to a mass evacuation of the city in August 2008. This time the levees held, and there was no widespread flooding.
New Orleans is still trying hard to rebuild itself after Hurricane Katrina. An estimated 1836 deaths occurred, with evacuation of 90% of residents and £81 billion worth of damage. Although the Unified New Orleans Plan Citywide Strategic Recovery and Rebuilding Plan seeks to rebuild the damaged city, and deal with some of the chronic problems affecting the city before the hurricane, public services have struggled to cope few of the state primary schools are yet open, and public health services such as psychiatric beds are in short supply, many having failed to re-open after the Hurricane. Some estimate that the population has fallen by 60–70%. Many houses are left uninhabitable and derelict.
The disaster has taken its toll on health; one study has shown that death rates in New Orleans in 2006 were almost half as much again as their 2002–03 rates1. There is evidence that damage to the infrastructure has reduced access to mental health services, both for existing patients with mental health disorders and for those with new conditions2. And yet there has been a significant and continued rise in the prevalence of mental health disorders 2 years post-Katrina, with an increase in the prevalence of post-traumatic stress disorder, serious mental illness and suicide ideation3. Evidence also shows that a fifth of those with chronic medical conditions cut back their treatment in the 12-month period after the hurricane, with disruptions in treatment more common in the non-elderly, uninsured, socially isolated and those with relatively asymptomatic conditions4. Reasons included problems accessing physicians, insurance and financial difficulties and transportation.
In the UK, in summer of 2007, floods affected communities, particularly in Hull, Worcestershire and Gloucestershire. In Hull, it was estimated £140 million of flood damage occurred, with the City Council needing to spend £25 million on a flood recovery package. A total of 8657 homes, 1986 owned by the council were flooded. A year later, Hull City Council reported that 1476 residents were still ‘displaced’ and unable to return to their homes5.
The Pitt Review Learning Lessons from the 2007 floods6 subsequently commissioned in the UK was published earlier this year. This comprehensive review examined all aspects of flood planning and management. With respect to health, it concluded that although there was little evidence of the long-term health effects and impact of flooding, the limited evidence available suggested that there are significant short- and long-term impacts on psychosocial health. Data from Hull found that 70% of those who had been flooded and moved out of their homes reported health problems, both physical and mental. Of those affected by floods overall, 64% said that their health had been adversely affected, most commonly with stress, anxiety and depression, but also with a range of conditions, including dermatitis, worsening asthma, arthritis and chest infections. Children moving out of their home were more likely to suffer emotional health problems. Debt related problems were common, leading to a large increase in calls to Citizens Advice Bureau. Preliminary findings from a research study funded by the ESRC and the Environment Agency and being undertaken by Lancaster University, following up in depth 45 residents of Hull affected by flooding have demonstrated many are suffering depression, with hardship in temporary accommodation, negotiating with insurance companies and mortgage companies while their houses are rebuilt, loss of social contact and strain on personal relationships. However, even those returning to their homes can experience ongoing anxiety, a lack of security, anxiety and loss of a sense of home. These impacts extend beyond individual families to the community, both in terms of damage and usability of existing community facilities and changes in traditional support networks because of displaced families.
The Review has recommended that monitoring of the impact of flooding on the health and well being of the people and actions to mitigate and manage the effects should form a systematic part of the work of local Recovery Co-ordinating Groups, and that local responses need to ensure that health and well-being support is readily available to those affected by flooding. Additionally, it recommends that community networks, effective tools in reducing the psychosocial impact, need to be actively supported at local level. The Review specifically highlighted the need for consistent guidance about living or moving back into a damp home, given the psychological and physical ill health effects of having to stay out of ones home.
Most cogently, the review recommends that ‘Given the predicted increase in the range of future extremes of weather, the Government should give priority to both adaptation and mitigation in its programmes to help society cope with climate change.’ The Intergovernmental Panel on Climate Change has concluded that increased precipitation intensity and variability are projected to increase the risks of flooding and drought in many areas. Flooding has created significant health problems in both the USA and the UK, two of the wealthiest countries in the world. How much more challenging will it be to deal with the long-term effects of flooding on health on those in developing countries, such as Bihar, India, where an estimated 3 million people have been displaced by flooding in August 2008? Dealing with, and mitigating the short- and long-term health impacts of flooding is likely to be a key public health challenge for the 21st Century.
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References |
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 TOP References |
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- Stephens KU Sr, Grew D, Chin K, et al. Excess mortality in the aftermath of Hurricane Katrina: a preliminary report. Disaster Med Public Health Prep (2007) 1(1):15–20.
[Abstract/Free Full Text] - Wang PS, Gruber MJ, Powers RE, et al. Disruption of existing mental health treatments and failure to initiate new treatment after Hurricane Katrina. Am J Psychiatry (2008) 165(1):34–41.
[Abstract/Free Full Text] - Kessler RC, Galea S, Gruber MJ, et al. Trends in mental illness and suicidality after Hurricane Katrina. Mol Psychiatry (2008) 13(4):374–84.[CrossRef][Web of Science][Medline]
- Kessler RC, Hurricane Katrina Community Advisory Group. Hurricane Katrina's impact on the care of survivors with chronic medical conditions. J Gen Intern Med (2007) 22(9):1225–30.[CrossRef][Web of Science][Medline]
- One Year One. http://www.hullcc.gov.uk/portal/page?_pageid=221,589788&_dad=portal&_schema=PORTAL (31 August 2008, date last accessed).
- The Pitt Review: Learning Lessons from the 2007 floods. London: HMSO.
- 2008 Intergovernmental panel on climate change. IPPC Technical Paper VI. http://www.ipcc.ch/ipccreports/tp-climate-change-water.htm (31 August 2008, date last accessed).
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