Epidemiology and the Policy Arena
You have been invited to the World Health Organization to present a lecture on the public health issues created by the 2017 Hurricane Maria in Puerto Rico. In this activity, you will address the following: (a) a description of Puerto Rico prior to the 2017 hurricane including the major health problems and infrastructure; (b) the initial impact of the hurricane on human life, public health, and infrastructure; (c) immediate and long-term health issues and any health policy recommendations that will need to be addressed when rebuilding the healthcare infrastructure. Provide a rationale for any policy recommendations. Use at least 5 scholarly references in your paper.
Your paper should include the following:
Introduction
The elements listed above in (a), (b), and (c)
Referencesappmiology
Activity 8: Epidemiology and the Policy Arena.
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Introduction
Puerto Rico is an island located in the Caribbean with a population of approximately a 3.5million people. The island became a territory of the U.S. in 1898 after Spain ceded it and since then, the region has retained its colonial status. This status has significantly contributed to a history of exclusion and discrimination in the United States. Puerto Ricans are U.S. citizens although they do not enjoy similar rights to those living in the continental U.S. As a result, the island’s residents experience many issues including high poverty rates and poor healthcare access. In 2017, Hurricane Maria hit the island and resulted in further deterioration of the country’s infrastructure including the healthcare system (Rodriguez-Madera et al., 2021). The purpose of this essay is to describe Puerto Rico before the hurricane, the initial and immediate impact of the hurricane, and long-term health issues. The essay will also include health policy recommendations that may help rebuild the island’s healthcare infrastructure.
Puerto Rico before Hurricane Maria
Before the hurricane, the island’s healthcare system faced many challenges. Although Puerto Ricans make significant contributions to the national health programs provided by the U.S., they have limited access to programs such as Medicare and social security after the U.S. implemented mandated restrictions for the island’s residents (Joseph et al., 2020). Additionally, the U.S. eliminated tax protections and critical infrastructure, including healthcare, became privatized. Issues such as the mismanagement of the local infrastructure and a high external debt had a negative impact on the island’s economy and healthcare system (Rodriguez-Madera et al., 2021).
The main issues affecting the Puerto Rican healthcare system before Hurricane Maria included the high burden of chronic illnesses and mental health issues. The people on the island experienced high rates of diabetes, hypertension, and heart disease. Psychiatric disorders such as alcohol abuse were also prevalent. Mental and physical health issues were mainly linked to high poverty rates. Outmigration from the island, in addition to natural aging, has led to an increasingly aging population. Other issues include environmental hazards such as air and water pollution, shortage in the healthcare workforce, and limited access to welfare services including Medicaid, Medicare, and Temporary Assistance for Needy Families (TANF). Healthcare provider shortages are linked to outmigration that left many municipalities in the area medically underserved (Chandra et al., 2021).
The Initial Impact of the Hurricane on Human Life, Public Health, and Infrastructure
The hurricane resulted in an exacerbation of the initial public health and infrastructure challenges. Many healthcare institutions, especially those in the Southern, Eastern, and northern parts of the Island were damaged. The hurricane also resulted in significant damage to other infrastructure including water, electricity, and communications. As a result, even medical facilities that did not suffer significant damage could not operate efficiently due to the inability to access medical records, lack of water and power, and limited staff. Activities at social service agencies also stalled due to the inability to access existing data. Most residents resorted to using unsafe water sources which led to a leptospirosis outbreak. The incidence of influenza and conjunctivitis also increased significantly. The official death toll was initially 64 although other reports estimated that more than 2500 people died in the hurricane (Chandra et al., 2021).
Immediate and Long-Term Health Issues and Health Policy Recommendations for Rebuilding the Healthcare Infrastructure.
Immediate and long-term health issues included increased prevalence of chronic illnesses such as hypertension, heart problems, and mental illnesses due to increased stress and poor access to healthcare services. Furthermore, many residents developed mental illnesses such as post-traumatic stress disorder (PTSD), depression, and anxiety (Alcorn, 2017). Approximately 90 percent of patients who reported to emergency clinics required mental health screening. Suicide rates also increased by 29 percent after the hurricane, and most of the victims were men. Emerging issues associated with healthcare included an increase in primary care utilization following physical injuries and the disruptions in infrastructure. Puerto Rico also experienced an increase in infectious diseases from contaminated water and poor hygiene and sanitation (Chandra et al., 2021).
Health policy recommendations for Puerto Rico should focus on the restoration of the healthcare system by building a sufficient and qualified healthcare workforce and addressing physical damage to the healthcare institutions. Policy changes include the allocation of funds to facilitate the rebuilding of healthcare institutions, especially primary care facilities. Better financing mechanisms for Medicare and Medicaid should be implemented to improve access to healthcare. Moreover, the U.S. should implement policies that allow healthcare professionals such as nurse practitioners to provide healthcare in Puerto Rico to increase the provider workforce (Chandra et al., 2021). The Puerto Rican local government should also implement policies that improve the capability of the public health workforce through public health surveillance and digitalization of vital healthcare and social services records. All healthcare institutions should also have access to energy backup options in case of electricity outages in the future (CDC, 2021).
Conclusion
Hurricane Maria had significant negative impacts on the infrastructure of Puerto Rico including healthcare, electricity, communication, and water supply. These impacts led to increased incidence of waterborne diseases, mental health issues, and exacerbation of chronic illnesses. Policy recommendations include focusing on re-establishing and retaining the healthcare workforce and rebuilding healthcare institutions to improve healthcare access.
References
Alcorn, T. (2017). Puerto Rico’s health system after Hurricane Maria. The Lancet, 390(10103), e24. https://doi.org/10.1016/s0140-6736(17)32591-6
CDC. (2021). Puerto Rico Department of Health Responds to Health Emergencies through Strategic Program Management. https://www.cdc.gov/publichealthgateway/field-notes/2021/Puerto-Rico-Department-of-Health-Responds-to-Health-Emergencies.html.
Chandra, A., Marsh, T., Madrigano, J., Simmons, M. M., Abir, M., Chan, E. W., Ryan, J., Nanda, N., Ziegler, M. D., & Nelson, C. (2021). Health and Social Services in Puerto Rico before and After Hurricane Maria: Predisaster Conditions, Hurricane Damage, and Themes for Recovery. Rand health quarterly, 9(2), 10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383835/
Joseph, S., Voyles, C., Williams, K., Smith, E., & Chilton, M. (2020). Colonial Neglect and the Right to Health in Puerto Rico after Hurricane Maria. American Journal of Public Health, 110(10), 1512-1518. https://doi.org/10.2105/ajph.2020.305814
Rodriguez-Madera, S., Varas-Diaz, N., Padilla, M., Grove, K., Rivera-Bustelo, K., & Ramos, J. (2021). The impact of Hurricane Maria on Puerto Rico’s health system: post-disaster perceptions and experiences of health care providers and administrators. Global Health Research and Policy, 6(1). https://doi.org/10.1186/s41256-021-00228-w