Date of Conferral

2023

Degree

Ph.D.

School

Public Health

Advisor

W. Sumner Davis

Abstract

AbstractWhether from natural or human causes, every global community is at risk for overwhelming, destabilizing incidents. Hurricanes Irma and Maria devastated the U.S. Virgin Islands in late August and early September 2017, necessitating the urgent evacuation of hemodialysis patients over 1000 miles to the U.S. mainland. Because the damage and response to the U.S. territory were unprecedented, the public health implications of the government’s strategies on the evacuated population subset were unexplored. However, available information suggested that some evacuees sustained avoidable harm while in the protracted care and custody of the government. This qualitative case study, conceptually framed by Bronfenbrenner’s socioecological systems, examined the federal disaster management program’s sufficiency to abate or preclude foreseeable risks to the evacuees. Structured interviews and documented evacuee and responder experiences, compared with programmatic specifications, informed equity and efficacy determinations. Decades of research described enhanced vulnerability among individuals impacted by social determinants of health. Despite these known risks, this study revealed operational activities that negatively impacted some evacuees’ health, safety, wellbeing, and community reentry capability. Redirecting policy level disaster management priorities to those at the highest risk for worse outcomes can expose person level procedural gaps. As such, programmatic enhancements can spur transformative holistic positive social change, promoting equity in disaster response.

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