To “Build Back Better,” We Must Build Back Healthier

Nicole A. Errett, PhD, MSPH, is a lecturer in the department of environmental and occupational health sciences at the University of Washington School of Public Health.  Dr. Errett is a New Connections grantee.

Over the past several weeks, our attention has been directed to Hurricanes Harvey and Irma in the Southeast and the wildfires in the West. These tragic events have resulted in injury, illness, death, and displacement. As the response to address immediate threats to health, safety, environment, and property draws to a close, affected communities must embark on the long and challenging road to recovery.

The emergency management community has coined the term “build back better” to reflect the emerging consensus that building back a community to its pre-disaster state is often not sufficient to protect against future events. The recovery period provides an opportunity to address vulnerabilities that have exacerbated disaster-related impacts in a community, potentially lessening the blow from the next event.

To date, the primary application of “build back better” has been to invest in more sustainable and resilient infrastructure. However, we repeatedly have seen that healthier, more equitable, and more interconnected communities fare better in a disaster. To truly build back better, we must also invest in stronger, healthier, and more resilient people. In short, we can build back better by building a culture of health.

The disaster recovery process requires interdisciplinary community redevelopment and reinvestment, including identifying and prioritizing what and where to rebuild, in a compressed timeframe. In the wake of tragedy, we can enhance a community’s culture of health by responding to impacts on population health and the healthcare system, and by strategically reconstructing and reinvesting in social and community infrastructure to promote social justice, health, and wellbeing.

However, according to the 2015 Institute of Medicine (now National Academy of Medicine) report, Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery, the opportunity to use the disaster recovery process to build health resilience is often missed. Non-health sectors (e.g., transportation) may not consider the potential health impacts of their actions that ultimately influence health outcomes.  For example, a transportation agency may not think to include a grocery store or behavioral health clinic on a public transportation route that has been modified to accommodate displaced populations or inaccessible areas. As such, an opportunity to increase access to healthy foods or to healthcare may be missed. Yet, as healthy people contribute to the economic and social fabric of a society, it is in everyone’s best interest to ensure that we maximize population health during the recovery period.

By using a “health in all policies” approach in disaster recovery, we can ensure that activities implemented during the disaster recovery period improve population health and equity. Health in all policies is “an approach to public policy that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity.” For example, community planners employing a health in all policies approach might consider increasing access to parks or sidewalks to promote physical activity when redesigning a neighborhood devastated by disaster.

The public health community has developed tools to help non-health sectors think about the health impacts of their actions and inform their decisions. Health impact assessments, for example, use a variety of methods to systematically consider potential effects of proposed policies or solutions on population health. More simply, in resource or time constrained environments, decision makers can consider health impacts by ensuring public health representation in interdisciplinary planning or decision making committees. They can also seek and meaningfully consider public health data to inform programmatic and policy decisions.

The aforementioned National Academy of Science report suggests that there are opportunities for incorporating health considerations into the recovery period at all phases of the strategic planning process. First, there must be a shared vision to use the recovery process to enhance health, resilience, and sustainability. Health data must be considered in community assessments that identify gaps between the community’s current and desired state to inform goals, priorities, and decisions. The health sector must be represented in interdisciplinary planning activities to ensure health considerations are incorporated into multi-sector decision-making processes. Recovery strategy implementation must be innovative and strive to enhance health outcomes. And, interventions must be evaluated so that we can maximize our impacts, improve in real time, and generate evidence to do it better next time.

As a former public health practitioner and current disaster researcher, I am confident that we can enhance community resilience in disaster-affected communities by prioritizing public health. By thoughtfully building social and physical environments that promote healthy lifestyles, we can help build communities that will thrive on an everyday basis, and withstand future disaster. We must work rapidly and across disciplinary boundaries. Academics and practitioners must come together to ensure data and evidence drive decisions. When the media attention fades, our collective persistence and commitment to building a culture of health will make Houston, Florida, and other affected communities and regions stronger than ever before.