Intersectionality and the health impacts of disasters: Why we must meet the SDGs

This month, we celebrated the 75^th anniversary of the World Health Organization opens in new tab/window. WHO defines health as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Goal 3 of the UN’s Sustainable Development Goals (SDGs) opens in new tab/window delineates specific indicators for measuring progress toward making health a reality for all. However, increasingly frequent and severe disasters and emergencies limit our ability to fully realize this definition of health both in the United States and around the globe.

The first two and a half years of the 2020s have highlighted the severe and lasting impacts of not only the COVID-19 pandemic but also co-occurring climate, weather and environmental disasters. A person born in 2020 will experience three times more climate and weather disasters — including heatwaves, droughts, crop failures, floods, and wildfires — than a person born in 1960 (Thiery et al opens in new tab/window, 2021). The impacts of these disasters will be most severe for the billions of people globally who experience discrimination, higher levels social or physical vulnerability, and constrained access to and inclusion in disaster risk reduction tools and planning.

Despite increased global recognition of the severity of infectious diseases, progress toward controlling or eliminating infectious diseases stalled during the pandemic. For example, nearly 23 million children globally missed an indicated vaccine in 2020 alone, creating large cohorts of un-vaccinated and under-vaccinated children (UN, 2022 opens in new tab/window). Vaccination levels below herd immunity thresholds — whether due to lack of access or vaccine hesitancy — can contribute to significant morbidity and mortality in disasters and emergencies, particularly among displaced populations. Lapses in coverage have significant knock-on effects, such as the re-emergence of infectious diseases, more frequent disease outbreaks, increased difficulty in outbreak response at the population level, and exacerbated clinical severity and risk of long-term sequelae at the individual level. Cumulatively, such lapses jeopardize progress toward reducing the global under-5 mortality rate (SDG 3.2.1 opens in new tab/window).

Mental health and chronic and non-communicable diseases have also experienced appreciable setbacks throughout the early part of the decade. Disaster exposure has long been associated in epidemiologic studies with an increased prevalence of a range of mental health consequences, including posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder — covered in SDG Target 3.4 opens in new tab/window. According to the Kaufman Family Foundation, the average share of US adults reporting symptoms of anxiety disorder and/or depressive disorder in 2021 was four times the share reporting these symptoms in 2019. Interruptions in treatment for chronic diseases like diabetes, kidney diseases, and opioid use disorders (SDG Target 3.5 opens in new tab/window) after disasters can double the number of emergency room admissions and increase mortality. Throughout the pandemic, delays in access to screening and preventive care for cancers — including breast, colorectal, esophageal and lung — by patients in the UK’s National Health Service are predicted to increase mortality from these cancers by between 4% and 16%. Critical progress toward reducing premature mortality “attributed to cardiovascular disease, cancers, diabetes and chronic respiratory diseases” by 2030 — also covered in SDG Target 3.4 — has been severely hampered over the last three years.

Disasters caused by negligence

Disasters caused by natural hazards are not the only emergencies that have complicated progress toward the SDG 3 Targets and Indicators. Environmental disasters caused by a lack of regulation and negligence — like the February 2023 train derailment and subsequent contamination of East Palestine, Ohio; insufficiently protected Super Fund sites in flood-prone areas; and the dumping of toxic chemicals into municipal water sources throughout Appalachia by large corporations — have directly and indirectly exposed millions of Americans to endocrine disruptors, carcinogens, and countless other harmful chemicals. The US, as a whole, has failed to ensure its people have safe water, as evidenced by the water crisis in Flint, Michigan, and the ongoing water crisis in Jackson, Mississippi. While the indicators for SDG Target 3.9 opens in new tab/window are measured in terms of directly attributable mortality, there is significant work in both prevention and post-event risk reduction needed to truly make substantial improvements in morbidity and mortality related to hazardous chemicals and air, water and soil pollution and contamination.

A critical juncture for public health

Given the global experiences of the early 2020s, the landscape for providing Health for All has become even more challenging. As the Public Health Emergency declaration for the COVID-19 pandemic ends in the US in May 2023, public health finds itself at an inflection point. Building back to the level of the pre-pandemic public health system will not be enough to both address the gaps opened during the early part of the 2020s and make progress towards reaching goals for better physical, mental and social wellbeing by 2030 and beyond. At this critical juncture, concerted efforts are needed to ensure that the trajectory of public health is in a positive direction. Despite the immense amount of work to be done, we — as disaster epidemiologists — also see the vast opportunities for capitalizing on efforts that have and are being made by communities and global governing bodies alike to reduce the negative human health impacts of inextricably linked riskscapes.

There have been great successes in international health in the first 75 years of WHO. In 1980, just 32 years after the founding of WHO, smallpox was eradicated. In 2020, polio was declared eliminated from all but one of the six WHO regions. Expanded Programmes on Immunization and Supplementary Immunization Activities — often in post-disaster or humanitarian contexts — have prevented and stopped outbreaks in their tracks. Through collaboration with global partners and governments, WHO has supported the development and deployment of critical medications and vaccinations for neglected tropical diseases, infectious diseases and chronic conditions.

Opportunities for cross-sector collaboration

Building off this legacy, there are ample opportunities to capitalize on cross-sector collaboration to maximize efforts. For example, Target 7 of the Sendai Framework for Disaster Risk Reduction opens in new tab/window calls for the “substantial increase [in] the availability of and access to multi-hazard early warning systems (EWS) and disaster risk information and assessments to people by 2030.” In March 2023, UN Secretary General Antonio Guterres’s March 2022 expedited call for EWS for all by 2027 was given increased urgency, with new, critical findings from the Climate Change 2023: Synthesis Report opens in new tab/window. Globally, breaking from sectoral silos to capitalize on the strengths and improve upon the weaknesses of existing EWS for climate, weather and biological hazards can synergistically advance the effectiveness of early warning mechanisms at both local and global levels. Timely and accurate warnings support evidence-informed disaster risk reduction practices and, consequently, can mitigate negative health outcomes in disaster contexts. Building upon the legacy of the first 75 years of work undertaken by WHO and leaning into intersectional spaces are critical for achieving Health for All by 2030 and beyond.

Health and the SDGs

The SDGs provide a foundation for people — from individuals and practitioners to governments and institutions — to build their work toward creating a more equitable, inclusive, safe, healthy and sustainable world. From improving working conditions; increasing access to safe and reliable sources of food and water; addressing climate change and sustainability; building safer communities with reliable infrastructure; and integrating best-practices in at local, national, regional and global levels, health is inherent to all 17 SDGs. As WHO celebrates 75 years of groundbreaking work across the globe, the theme of Health for All is perhaps more important than ever.