Open-source data pipeline for street-view images: A case study on community mobility during COVID-19 pandemic.

Street View Images (SVI) are a common source of valuable data for researchers. Researchers have used SVI data for estimating pedestrian volumes, demographic surveillance, and to better understand built and natural environments in cityscapes. However, the most common source of publicly available SVI data is Google Street View. Google Street View images are collected infrequently, making temporal analysis challenging, especially in low population density areas. Our main contribution is the development of an open-source data pipeline for processing 360-degree video recorded from a car-mounted camera. The video data is used to generate SVIs, which then can be used as an input for longitudinal analysis. We demonstrate the use of the pipeline by collecting an SVI dataset over a 38-month longitudinal survey of Seattle, WA, USA during the COVID-19 pandemic. The output of our pipeline is validated through statistical analyses of pedestrian traffic in the images. We confirm known results in the literature and provide new insights into outdoor pedestrian traffic patterns. This study demonstrates the feasibility and value of collecting and using SVI for research purposes beyond what is possible with currently available SVI data. Our methods and dataset represent a first of its kind longitudinal collection and application of SVI data for research purposes. Limitations and future improvements to the data pipeline and case study are also discussed.

Assessing community-level impacts of and responses to stay at home orders: The King County COVID-19 community study.

BACKGROUND: At the beginning of the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) of unprecedented scope and duration were implemented to limit community spread of COVID-19. There remains limited evidence about how these measures impacted the lived experience of affected communities. This study captured the early impacts and coping strategies implemented in King County, Washington, one of the first U.S. communities impacted by COVID-19. METHODS: We conducted a cross-sectional web-based survey of 793 English- and Spanish-speaking adult King County residents from March 18, 2020 -May 30, 2020, using voluntary response sampling. The survey included close- and open-ended questions on participant demographics, wellbeing, protective actions, and COVID-19-related concerns, including a freeform narrative response to describe the pandemic's individual-, family- and community-level impacts and associated coping strategies. Descriptive statistics were used to analyze close-ended questions, and qualitative content analysis methods were used to analyze free-form narrative responses. RESULTS: The median age of participants was 45 years old, and 74% were female, 82% were White, and 6% were Hispanic/Latinx; 474 (60%) provided a qualitative narrative. Quantitative findings demonstrated that higher percentages of participants engaged in most types of COVID-19 protective behaviors after the stay-at-home order was implemented and schools and community spaces were closed, relative to before, and that participants tended to report greater concern about the pandemic's physical health or healthcare access impacts than the financial or social impacts. Qualitative data analysis described employment or financial impacts (56%) and vitality coping strategies (65%), intended to support health or positive functioning. CONCLUSIONS: This study documented early impacts of the COVID-19 pandemic and the NPIs implemented in response, as well as strategies employed to cope with those impacts, which can inform early-stage policy formation and intervention strategies to mitigate the negative impacts. Future research should explore the endurance and evolution of the early impacts and coping strategies throughout the multiyear pandemic.

Preferences of healthcare workers using tongue swabs for tuberculosis diagnosis during COVID-19.

Healthcare workers (HCWs) who come into contact with tuberculosis (TB) patients are at elevated risk of TB infection and disease. The collection and handling of sputum samples for TB diagnosis poses exposure risks to HCWs, particularly in settings where aerosol containment is limited. An alternative sample collection method, tongue swabbing, was designed to help mitigate this risk, and is under evaluation in multiple settings. This study assessed risk perceptions among South African HCWs who used tongue swabbing in TB diagnostic research during the COVID-19 pandemic. We characterized their context-specific preferences as well as the facilitators and barriers of tongue swab use in clinical and community settings. Participants (n = 18) were HCWs with experience using experimental tongue swabbing methods at the South African Tuberculosis Vaccine Initiative (SATVI). We used key informant semi-structured interviews to assess attitudes toward two tongue swab strategies: Provider-collected swabbing (PS) and supervised self-swabbing (SSS). Responses from these interviews were analyzed by rapid qualitative analysis and thematic analysis methods. Facilitators included aversion to sputum (PS and SSS), perceived safety of the method (SSS), and educational resources to train patients (SSS). Barriers included cultural stigmas, as well as personal security and control of their work environment when collecting swabs in community settings. COVID-19 risk perception was a significant barrier to the PS method. Motivators for HCW use of tongue swabbing differed substantially by use case, and whether the HCW has the authority and agency to implement safety precautions in specific settings. These findings point to a need for contextually specific educational resources to enhance safety of and adherence to the SSS collection method.

A novel climate and health decision support platform: Approach, outputs, and policy considerations.

BACKGROUND: The adverse health impacts of climate change are increasingly apparent and the need for adaptation activities is pressing. Risks, drivers, and decision contexts vary significantly by location, and high-resolution, place-based information is needed to support decision analysis and risk reduction efforts at scale. METHODS: Using the Intergovernmental Panel on Climate Change (IPCC) risk framework, we developed a causal pathway linking heat with a composite outcome of heat-related morbidity and mortality. We used an existing systematic literature review to identify variables for inclusion and the authors' expert judgment to determine variable combinations in a hierarchical model. We parameterized the model for Washington state using observational (1991-2020 and June 2021 extreme heat event) and scenario-driven temperature projections (2036-2065), compared outputs against relevant existing indices, and analyzed sensitivity to model structure and variable parameterization. We used descriptive statistics, maps, visualizations and correlation analyses to present results. RESULTS: The Climate and Health Risk Tool (CHaRT) heat risk model contains 25 primary hazard, exposure, and vulnerability variables and multiple levels of variable combinations. The model estimates population-weighted and unweighted heat health risk for selected periods and displays estimates on an online visualization platform. Population-weighted risk is historically moderate and primarily limited by hazard, increasing significantly during extreme heat events. Unweighted risk is helpful in identifying lower population areas that have high vulnerability and hazard. Model vulnerability correlate well with existing vulnerability and environmental justice indices. DISCUSSION: The tool provides location-specific insights into risk drivers and prioritization of risk reduction interventions including population-specific behavioral interventions and built environment modifications. Insights from causal pathways linking climate-sensitive hazards and adverse health impacts can be used to generate hazard-specific models to support adaptation planning.

Health Research in the Wake of Disasters: Challenges and Opportunities for Sensor Science.

BACKGROUND: Disaster events adversely affect the health of millions of individuals each year. They create exposure to physical, chemical, biological, and psychosocial hazards while simultaneously exploiting community and individual-level vulnerabilities that allow such exposures to exert harm. Since 2013, the National Institute of Environmental Health Sciences (NIEHS) has led the development of the Disaster Research Response (DR2) program and infrastructure; however, research exploring the nature and effects of disasters on human health is lacking. One reason for this research gap is the challenge of developing and deploying cost-effective sensors for exposure assessment during disaster events. OBJECTIVES: The objective of this commentary is to synergize the consensus findings and recommendations from a panel of experts on sensor science in support of DR2. METHODS: The NIEHS convened the workshop, "Getting Smart about Sensors for Disaster Response Research" on 28 and 29 July 2021 to discuss current gaps and recommendations for moving the field forward. The workshop invited full discussion from multiple viewpoints, with the goal of identifying recommendations and opportunities for further development of this area of research. The panel of experts included leaders in engineering, epidemiology, social and physical sciences, and community engagement, many of whom had firsthand experience with DR2. DISCUSSION: The primary finding of this workshop is that exposure science in support of DR2 is severely lacking. We highlight unique barriers to DR2, such as the need for time-sensitive exposure data, the chaos and logistical challenges that ensue from a disaster event, and the lack of a robust market for sensor technologies in support of environmental health science. We highlight a need for sensor technologies that are more scalable, reliable, and versatile than those currently available to the research community. We also recommend that the environmental health community renew efforts in support of DR2 facilitation, collaboration, and preparedness. https://doi.org/10.1289/EHP12270.

Survey of extreme heat public health preparedness plans and response activities in the most populous jurisdictions in the United States.

BACKGROUND: Increasingly frequent and intense extreme heat events (EHEs) are indicative of climate change impacts, and urban areas' social and built environments increase their risk for health consequences. Heat action plans (HAPs) are a strategy to bolster municipal EHE preparedness. The objective of this research is to characterize municipal interventions to EHEs and compare U.S. jurisdictions with and without formal heat action plans. METHODS: An online survey was sent to 99 U.S. jurisdictions with populations > 200,000 between September 2021 and January 2022. Summary statistics were calculated to describe the proportion of total jurisdictions, as well as jurisdictions with and without HAPs and in different geographies that reported engagement in extreme heat preparedness and response activities. RESULTS: Thirty-eight (38.4%) jurisdictions responded to the survey. Of those respondents, twenty-three (60.5%) reported the development of a HAP, of which 22 (95.7%) reported plans for opening cooling centers. All respondents reported conducting heat-related risk communications; however, communication approaches focused on passive, technology-dependent mechanisms. While 75.7% of jurisdictions reported having developed a definition for an EHE, less than two-thirds of responding jurisdictions reported any of the following activities: conducting heat-related surveillance (61.1%), implementing provisions for power outages (53.1%), increasing access to fans or air conditioners (48.4%), developing heat vulnerability maps (43.2%), or evaluating activities (34.2%). There were only two statistically significant (p ≥ .05) differences in the prevalence of heat-related activities between jurisdictions with and without a written HAP, possibly attributable to a relatively small sample size: surveillance and having a definition of extreme heat. CONCLUSIONS: Jurisdictions can strengthen their extreme heat preparedness by expanding their consideration of at-risk populations to include communities of color, conducting formal evaluations of their responses, and by bridging the gap between the populations determined to be most at-risk and the channels of communication designed to reach them.

Planning to Reduce the Health Impacts of Extreme Heat: A Content Analysis of Heat Action Plans in Local United States Jurisdictions.

Objectives. To examine commonalities and gaps in the content of local US heat action plans (HAPs) designed to decrease the adverse health effects of extreme heat. Methods. We used content analysis to identify common strategies and gaps in extreme heat preparedness among written HAPs in the United States from jurisdictions that serve municipalities with more than 200 000 residents. We reviewed, coded, and analyzed plans to assess the prevalence of key components and strategies. Results. All 21 plans evaluated incorporated data on activation triggers, heat health messaging and risk communication, cooling centers, surveillance activities, and agency coordination, and 95% incorporated information on outreach to at-risk populations. Gaps existed in the specific applications of these broad strategies. Conclusions. Practice-based recommendations as well as future areas of research should focus on increasing targeted strategies for at-risk individuals and expanding the use of surveillance data outside of situational awareness. (Am J Public Health. 2023;113(5):559-567. https://doi.org/10.2105/AJPH.2022.307217).

Examining the Optimal Placement of Cooling Centers to Serve Populations at High Risk of Extreme Heat Exposure in 81 US Cities.

OBJECTIVE: Although extreme heat can impact the health of anyone, certain groups are disproportionately affected. In urban settings, cooling centers are intended to reduce heat exposure by providing air-conditioned spaces to the public. We examined the characteristics of populations living near cooling centers and how well they serve areas with high social vulnerability. METHODS: We identified 1402 cooling centers in 81 US cities from publicly available sources and analyzed markers of urban heat and social vulnerability in relation to their locations. Within each city, we developed cooling center access areas, defined as the geographic area within a 0.5-mile walk from a center, and compared sociodemographic characteristics of populations living within versus outside the access areas. We analyzed results by city and geographic region to evaluate climate-relevant regional differences. RESULTS: Access to cooling centers differed among cities, ranging from 0.01% (Atlanta, Georgia) to 63.2% (Washington, DC) of the population living within an access area. On average, cooling centers were in areas that had higher levels of social vulnerability, as measured by the number of people living in urban heat islands, annual household income below poverty, racial and ethnic minority status, low educational attainment, and high unemployment rate. However, access areas were less inclusive of adult populations aged ≥65 years than among populations aged <65 years. CONCLUSION: Given the large percentage of individuals without access to cooling centers and the anticipated increase in frequency and severity of extreme heat events, the current distribution of centers in the urban areas that we examined may be insufficient to protect individuals from the adverse health effects of extreme heat, particularly in the absence of additional measures to reduce risk.

Climate Change Adaptation Activities and Needs in US State and Territorial Health Agencies.

OBJECTIVE: To characterize US State and Territorial Health Agencies' (S/THA) climate change adaptation activities and priorities to facilitate appropriate investments, skills development, and support that will strengthen health sector capacity in response to a changing climate. DESIGN: In 2021, we conducted an online survey of S/THA staff requesting information on current activities related to climate change and health, the state of climate and health programming, and anticipated needs and priorities for assistance. We analyzed survey results using descriptive statistics. SETTING: US State and Territorial Health Agencies. PARTICIPANTS: We received responses from 41 of 59 S/THAs (69.5%). MAIN OUTCOME MEASURES: Implementation of S/THA climate and health programs (CHPs); engagement in climate and health activities; maintenance of hazard early warning systems and action plans; employment of climate and health communications strategies; capability to assess risks and adaptation needs related to various climate-sensitive conditions; priorities and plans for climate change adaptation in relation to climate-sensitive health risks; climate change adaptation-related partnerships and collaborations; requests of the Association of State and Territorial Health Officials (ASTHO) for advancing climate change adaptation activities; and the impacts of the COVID-19 pandemic on climate change work. RESULTS: Nineteen S/THAs reported having CHPs, the majority of which are federally funded. On average, S/THAs without CHPs reported engagement in fewer climate and health activities and more early warning activities. The S/THAs reported the highest levels of concerns regarding non-vector-borne infectious disease (66%), vector-borne infectious diseases (61%), and extreme heat (61%) hazards. CONCLUSIONS: As S/THAs with CHPs report substantially greater climate and health capacity than those without, additional federal and state investments (eg, Building Resilience Against Climate Effects [BRACE]) are urgently needed to catalyze climate and health capacity.

Barriers and facilitators to state public health agency climate and health action: a qualitative assessment.

BACKGROUND: As the health implications of climate change become more apparent, agencies and institutions across the United States are developing recommendations for state and territorial health agencies (S/THAs) to implement evidence-informed climate and health adaptation strategies. The CDC established the Building Resilience Against Climate Effects (BRACE) framework in 2010 to encourage local and state public health engagement in climate change adaptation. However, even after a decade of the BRACE initiative, the elements that affect the adoption and implementation of climate and health programming by S/THAs are not well understood. METHODS: Using an implementation science framework, this study sought to further understand and define the barriers and facilitators that determine the breadth and success of climate change and health activities undertaken by state health agencies (SHAs). We conducted focus groups with representatives from SHAs with and without climate and health programs, and analyzed data using the framework method for qualitative research. RESULTS: This study identified funding, state and agency-level prioritization, staff capability and capacity, and political will and polarization as factors that influence the readiness for implementation and implementation climate for climate and health activities. CONCLUSIONS: As the impacts of climate change intensify, S/THAs will need to expand resources and capacity, and seek advocacy and assistance from external organizations in order to support the level of engagement required to strengthen climate resilience. Findings from this study have implications for public health policy and highlight potential pathways to expand support for climate and health activities in S/THAs in the U.S.

Public Health Preparedness for Extreme Heat Events.

Heat is a dangerous hazard that causes acute heat illness, chronic disease exacerbations, adverse pregnancy outcomes, and a range of injuries. Risks are highest during extreme heat events (EHEs), which challenge the capacity of health systems and other critical infrastructure. EHEs are becoming more frequent and severe, and climate change is driving an increasing proportion of heat-related mortality, necessitating more investment in health protection. Climate-resilient health systems are better positioned for EHEs, and EHE preparedness is a form of disaster risk reduction. Preparedness activities commonly take the form of heat action plans (HAPs), with many examples at various administrative scales. HAP activities can be divided into primary prevention, most important in the pre-event phase; secondary prevention, key to risk reduction early in an EHE;and tertiary prevention, important later in the event phase. After-action reports and other postevent evaluation activities are central to adaptive management of this climate-sensitive hazard.

Association Between the 2021 Heat Wave in Portland, Oregon, and Seattle, Washington, and Emergency Department Visits.

This study used a health care claims data set of enrollees in commercial and Medicare Advantage insurance plans to assess the association between the June 2021 heat wave and the rates of emergency department visits in Portland, Oregon, and Seattle, Washington.

"When people see me, they know me; they trust what I say": characterizing the role of trusted sources for smoke risk communication in the Okanogan River Airshed Emphasis Area.

INTRODUCTION: As wildfire smoke events increase in intensity and frequency in the Pacific Northwest, there is a growing need for effective communication on the health risks of smoke exposure. Delivery through a trusted source or intermediary has been shown to improve reception of risk communication messages. This is especially salient in rural and tribal communities who may be hesitant to trust information from state and federal agency sources. This study aims to identify and characterize trusted sources for smoke risk information in the Okanogan River Airshed Emphasis Area (ORAEA), a rural region of North Central Washington state that is heavily impacted by smoke from wildfires and prescribed fire. METHODS: The research team conducted a qualitative study using data collected through key informant interviews and focus groups to assess the role of various sources and intermediaries in disseminating smoke risk information. We used a consensual coding approach in NVivo Qualitative Analysis Software to sort data into preliminary categories, which were grouped into themes using a thematic analysis approach. We used member checking and iterative feedback processes with local project partners throughout the project to ensure credibility of results. RESULTS: Through the analysis, we identified three themes characterizing trusted sources for smoke risk communication in the ORAEA. These themes were: (1) local and tribal sources of information are perceived as more trustworthy than state and federal government sources, (2) trustworthiness is determined by an evaluation of multiple factors, in particular, perceived credibility, quality of information, and relationship with the source, and (3) conservative political ideology and perceived parallels with COVID-19 communication influence perception of trust. Within each theme, we identified several sub-themes, which contributed additional nuance to our analysis. CONCLUSION: This study provides insights into which sources of information are trusted by rural and tribal community members in the ORAEA and why. Results from our study emphasize the importance of relationships and collaboration with local and tribal partners in smoke risk communication. In this paper, we discuss implications for state and federal agency practitioners and present recommendations for how to work with local and tribal partners on smoke risk communication.

Preferences of health care workers using tongue swabs for tuberculosis diagnosis during COVID-19.

Healthcare workers (HCW) who come into contact with tuberculosis (TB) patients are at elevated risk of TB infection and disease. The collection and handling of sputum samples for TB diagnosis poses exposure risks to HCW, particularly in settings where aerosol containment is limited. An alternative sample collection method, tongue swabbing, was designed to help mitigate this risk, and is under evaluation in multiple settings. This study assessed risk perceptions among South African HCW who used tongue swabbing in TB diagnostic research during the COVID-19 pandemic. We characterized their context-specific preferences as well as the facilitators and barriers of tongue swab use in clinical and community settings. Participants (n=18) were HCW with experience using experimental tongue swabbing methods at the South African Tuberculosis Vaccine Initiative (SATVI). We used key informant semi-structured interviews to assess attitudes toward two tongue swab strategies: Provider-collected swabbing (PS) and supervised self-swabbing (SSS). Responses from these interviews were analyzed by rapid qualitative analysis and thematic analysis methods. Facilitators included aversion to sputum (PS and SSS), perceived safety of the method (SSS), and educational resources to train patients (SSS). Barriers included cultural stigmas, as well as personal security and control of their work environment when collecting swabs in community settings. COVID-19 risk perception was a significant barrier to the PS method. Motivators for HCW use of tongue swabbing differed substantially by use case, and whether the HCW has the authority and agency to implement safety precautions in specific settings. These findings point to a need for contextually specific educational resources to enhance safety of and adherence to the SSS collection method.

Addressing Capacity Constraints of Rural Local Health Departments to Support Climate Change Adaptation: Action Is Needed Now.

Looming climate change health impacts among rural communities will require a robust health system response. To reduce health inequities and promote climate justice, rural local health departments (LHDs) must be adequately resourced and supported to engage in climate change mitigation and adaptation policy and program development and implementation. In the United States, small local tax bases, overreliance on revenue from fee-based services, and limited federal funding to support climate change and health programming, have left rural LHDs with limited and inflexible human, financial, and political capital to support engagement in local climate change activities. Because of the urgent demands stemming from climate change, additional investments and supports are needed to rapidly build the capacity and capability of rural LHDs. Federal and state approaches to public health funding should consider the unique climate change and health risks of rural communities. Further, cross-jurisdictional shared service arrangements and state-level support to build rural LHDs' technical capacity, and research on local impacts and culturally appropriate solutions, must be prioritized.

A Review of Public Health Emergency Preparedness and Response (PHEPR) Curricula in US CEPH-Accredited Schools and Programs of Public Health.

OBJECTIVE: To assess the current state of graduate-level disaster-related curricula (i.e., Masters and Doctoral programs, degree concentrations, and graduate certificates) offered by the Council on Education for Public Health (CEPH)-accredited public health schools and programs in the US. METHODS: This research reviewed, evaluated, and summarized the content of websites of all US-based CEPH-accredited schools and programs to identify disaster-related degree programs, degree concentrations and graduate certificates from April - June 2021. RESULTS: Of 191 schools and programs reviewed, 29 (15%) offered disaster-related curricula, totaling 44 degrees and programs. Programs included Masters-level degrees and Masters/ Doctoral degree concentrations, with the majority taking the form of graduate certificates (64%). Schools that offered disaster-related curricula were clustered in eastern and Gulf states. CONCLUSION: Most US CEPH-accredited schools and programs do not offer graduate-level disaster-focused curricula. Of the programs offered, far fewer opportunities exist for in-depth graduate-degree level training compared to certificate-level training. Additionally, programs are constrained to certain areas of the country. Our findings suggest a need for disaster and public health emergency-related curricula development within schools and programs of public health to meet the growing needs of communities affected by disasters and emergencies.

Challenges to evidence-informed decision-making in the context of pandemics: qualitative study of COVID-19 policy advisor perspectives.

INTRODUCTION: The exceptional production of research evidence during the COVID-19 pandemic required deployment of scientists to act in advisory roles to aid policy-makers in making evidence-informed decisions. The unprecedented breadth, scale and duration of the pandemic provides an opportunity to understand how science advisors experience and mitigate challenges associated with insufficient, evolving and/or conflicting evidence to inform public health decision-making. OBJECTIVES: To explore critically the challenges for advising evidence-informed decision-making (EIDM) in pandemic contexts, particularly around non-pharmaceutical control measures, from the perspective of experts advising policy-makers during COVID-19 globally. METHODS: We conducted in-depth qualitative interviews with 27 scientific experts and advisors who are/were engaged in COVID-19 EIDM representing four WHO regions and 11 countries (Australia, Canada, Colombia, Denmark, Ghana, Hong Kong, Nigeria, Sweden, Uganda, UK, USA) from December 2020 to May 2021. Participants informed decision-making at various and multiple levels of governance, including local/city (n=3), state/provincial (n=8), federal or national (n=20), regional or international (n=3) and university-level advising (n=3). Following each interview, we conducted member checks with participants and thematically analysed interview data using NVivo for Mac software. RESULTS: Findings from this study indicate multiple overarching challenges to pandemic EIDM specific to interpretation and translation of evidence, including the speed and influx of new, evolving, and conflicting evidence; concerns about scientific integrity and misinterpretation of evidence; the limited capacity to assess and produce evidence, and adapting evidence from other contexts; multiple forms of evidence and perspectives needed for EIDM; the need to make decisions quickly and under conditions of uncertainty; and a lack of transparency in how decisions are made and applied. CONCLUSIONS: Findings suggest the urgent need for global EIDM guidance that countries can adapt for in-country decisions as well as coordinated global response to future pandemics.

Characterizing observable COVID-19 controls in Pacific Northwest grocery stores.

Utilizing a longitudinal, observational study, grocery store health and safety controls implemented during the COVID-19 pandemic across stores in two cities were characterized. Sixteen stores between Seattle, WA (n = 9) and Portland, OR (n = 7) were visited monthly by the study team from May 2020 to January 2021, and observations of controls were recorded using a standardized checklist in REDCap. The checklist included questions on the presence or absence of controls such as physical barriers, social distancing markers, required masking of customers, cleaning of check-out stands, and closures of store areas. Descriptive analyses were conducted to determine the proportion of stores with a certain control each month. Mixed-effects logistic regression was used to explore how controls changed over time, and whether differences were observed between cities or by income of the area the store serves. Source control (e.g., mask requirements) and engineering controls (e.g., physical barriers at checkout) were the most common and consistent controls observed across stores and over the study period. Controls such as having special hours for vulnerable populations, demarcations on aisles for directionality, and cleaning check-out stands between customers varied significantly over time (p < 0.05 in the mixed-effects model). Having an employee present to clean baskets and carts, as well as physical barriers between self-checkouts, were significantly more common in stores in areas above the median income (p < 0.05 in the mixed-effects model). To best protect workers and shoppers from infectious agents, controls should be evidence-based, consistently implemented across grocery stores, and coupled with administrative practices and policies to promote worker wellbeing.

Working with Disaster-Affected Communities to Envision Healthier Futures: A Trauma-Informed Approach to Post-Disaster Recovery Planning.

Disasters are becoming increasingly common and devastating, requiring extensive reconstruction and recovery efforts. At the same time, the level of available resources and the need to rebuild can present opportunities for more resilient land use and infrastructure, and to build healthier, more equitable and sustainable communities. However, disaster-affected individuals may experience trauma and mental health impacts that impede their ability to engage in long-range recovery planning. It is essential to consider and address community trauma when engaging with disaster-affected communities and in developing plans for recovery. Planners and engineers from outside the community (including public, private and non-profit practitioners) are often brought in to support long-term recovery. Most of these practitioners (particularly those focused on longer-range recovery) have no training in how disasters can affect mental health or what this could mean for their interactions with individuals or communities. In order to acknowledge and address disaster trauma in community recovery and redevelopment, we propose a trauma-informed approach which aims to provide practitioners supporting post-disaster community recovery planning guidance, in order to: avoid the causation of harm by re-traumatizing communities; better understand community needs; make sense of observed behaviors and avoid potential roadblocks; avoid becoming traumatized themselves; and facilitate community healing.