CONCLUSIONS
The precise mechanisms through which a community with preexisting health and health care disparities may become more susceptible to the deleterious effects of a disaster are unknown. The focus on the context of health and health care disparities before and after a disaster is important because the current literature does not capture the subsequent strain on medical esources imposed by the secondary surge of incident chronic disease in medically underserved communities. Given that chronic disease accounts for the greatest cause of morbidity in the United States, especially in rural areas, it is imperative to address chronic disease management in disaster response and identify ways to mitigate the health and health care disparities associated with populations vulnerable to disaster.
To better facilitate disaster recovery, it is vital that study designs account for effect modification by health and health care disparities for more accurate risk assessment models. Future studies should account for differences in health status and access before and after the disaster to better address the interaction between disparities in health and health care and adverse health outcomes in disaster populations. Disaster preparedness is not often a leading priority for most communities in the United States. Furthermore, lessons learned from Hurricane Katrina regarding existent health and health care disparities and increased morbidity and mortality among poor populations should be more extensively documented so that they can be used to plan for future disaster events.
The Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act)153 governs the federal response to disasters within the United States, including provisions for medical care and treatment of injured victims. However, the act does not address health and health care disparities or the specific needs of communities that are medically underserved. Therefore, further research is needed to better understand the most appropriate approaches to addressing health and health care disparities in the context of the Stafford Act. Factors contributing to health and health care disparities must be accounted for in disaster planning and response to ensure that rural and vulnerable populations are equipped to be resilient during the initial and secondary surges and other disaster-related events. We believe that the secondary surge of incident chronic disease after a disaster is an underappreciated phenomenon and needs further study.