Disaster, Human Mobility, & Networks of Care: How the U.S. government can mitigate the challenge of managing chronic disease and mental health in populations displaced by natural disaster

Increasingly frequent and intense climate crisis-induced natural disasters trigger a host of impacts, including human migration, that bring underprepared communities great environmental harm and exacerbate existing inequities. For people with chronic disease, disaster disrupts continuity of care. Displacement after disaster adds another layer of complexity in disaster recovery, as it often jeopardizes social determinants of health and creates a mental health burden. Hurricane Maria struck Puerto Rico as a Category 4 hurricane in September 2017. After more than 13,000 Puerto Ricans were subsequently displaced to Connecticut, community health workers saw an influx in patients with acute, chronic, and acute-on chronic medical needs that required adept pivoting toward a team-based model of care and a community-wide approach in resettling families into the New Haven area. Drawing on these themes, the paper focuses on two key questions: How do the unique challenges faced by community healthcare providers affect their abilities to care for a disaster-displaced patient population? And how can the U.S. government institutionalize local, state, and federal responses that protect the physical and mental health of disaster-displaced populations? This community-based participatory action research project involved a partnership with Fair Haven Community Health Care, a federally qualified health center in New Haven, Connecticut that worked alongside a network of local partners to triage an influx of behavioral, medical, and social needs exacerbated by Hurricane Maria and the experience of displacement. Utilizing qualitative methodologies of semi-structured interviews with healthcare providers and government employees as well as document analysis, I summarize FHCHC’s post-Maria response and make policy recommendations in advance of the next disaster. I ultimately call on state government to plan for disaster-induced displacement, invest in prevention resources, and advocate for expanded medical and behavioral healthcare coverage that meets the escalating and diverse needs of displaced persons with chronic disease.