Health Care Utilization Among Texas Veterans Health Administration Enrollees Before and After Hurricane Harvey, 2016-2018.

Importance: Hurricanes and flooding can interrupt health care utilization. Understanding the magnitude and duration of interruptions, as well as how they vary according to hazard exposure, race, and income, are important for identifying populations in need of greater retention in care. Objective: To determine how the differential exposure to Hurricane Harvey in August 2017 is associated with changes in utilization of Veterans Health Administration health care. Design, Setting, and Participants: This is a retrospective cohort analysis of primary care practitioner (PCP) visits, emergency department visits, and inpatient admissions in the Veterans Health Administration among Texas veterans residing in counties impacted by Hurricane Harvey from 2016 to 2018. Data analysis was performed from September 2020 to May 2021. Exposures: Residential flooding after Hurricane Harvey. Main Outcomes and Measures: Interrupted time series analysis measured changes in health care utilization over time, stratified by residential flood exposure, race, and income. Results: Of the 99 858 patients in the cohort, 89 931 (90.06%) were male, and their median (range) age was 58 (21 to 102) years. Compared with veterans in nonflooded areas, veterans living in flooded areas were more likely to be Black (24 715 veterans [33.80%] vs 4237 veterans [15.85%]) and low-income (14 895 veterans [20.37%] vs 4853 veterans [18.15%]). Rates of PCP visits decreased by 49.78% (95% CI, -64.52% to -35.15%) for veterans in flooded areas and by 45.89% (95% CI, -61.93% to -29.91%) for veterans in nonflooded areas and did not rebound until more than 8 weeks after the hurricane. Rates of PCP visits in flooded areas remained lower than expected for 11 weeks among White veterans (-6.99%; 95% CI, -14.36% to 0.81%) and for 13 weeks among racial minority veterans (-7.22%; 95% CI, -14.11% to 0.30%). Low-income veterans, regardless of flood status, experienced greater suppression of PCP visits in the 8 weeks following the hurricane (-13.72%; 95% CI, -20.51% to -6.68%) compared with their wealthier counterparts (-9.63%; 95% CI, -16.74% to -2.26%). Conclusions and Relevance: These findings suggest that flood disasters such as Hurricane Harvey may be associated with declines in health care utilization that differ according to flood status, race, and income strata. Patients most exposed to the disaster also had the greatest delay or nonreceipt of care.

Evaluating Collaborative Readiness for Interdisciplinary Flood Research.

Increasing trends in global flood risk are driven by a complex web of interactions among natural, built environment, and social systems. As a result, flood resilience research is an ideal topic for an interdisciplinary approach. Core characteristics of interdisciplinary research are team collaboration and the systematic integration of disciplinary knowledge, in both problem formulation and analytical methods. Indicators of interdisciplinarity tend to focus on scholarly outcomes, but collaborative processes may be even more important for knowledge integration. In this Perspective piece, we outline and advocate a two-pronged approach to enhance potential for integrating knowledge: using collaborative proximity to assess team readiness to conduct interdisciplinary research and employing program evaluation to assess change in proximity components over time. To do so, we draw on scholarship in economic geography, team science, and program evaluation. We then connect the findings to a case study of collaboration within our interdisciplinary team of flood researchers, program evaluators, and local stakeholders, as we navigate a multi-institutional project on flood resilience.

Pigs in Space: Determining the Environmental Justice Landscape of Swine Concentrated Animal Feeding Operations (CAFOs) in Iowa.

Given the primacy of Iowa in pork production for the U.S. and global markets, we sought to understand if the same relationship with traditional environmental justice (EJ) variables such as low income and minority populations observed in other concentrated animal feeding operation (CAFO) studies exists in the relationship with swine CAFO densities in Iowa. We examined the potential for spatial clustering of swine CAFOs in certain parts of the state and used spatial regression techniques to determine the relationships of high swine concentrations to these EJ variables. We found that while swine CAFOs do cluster in certain regions and watersheds of Iowa, these high densities of swine are not associated with traditional EJ populations of low income and minority race/ethnicity. Instead, the potential for environmental injustice in the negative impacts of intensive swine production require a more complex appraisal. The clustering of swine production in watersheds, the presence of antibiotics used in swine production in public waterways, the clustering of manure spills, and other findings suggest that a more literal and figurative "downstream" approach is necessary. We document the presence and location of antibiotics used in animal production in the public waterways of the state. At the same time, we suggest a more "upstream" understanding of the structural, political and economic factors that create an environmentally unjust landscape of swine production in Iowa and the Upper Midwest is also crucial. Finally, we highlight the important role of publicly accessible and high quality data in the analysis of these upstream and downstream EJ questions.

Unequal Recovery? Federal Resource Distribution after a Midwest Flood Disaster.

Following severe flooding in 2008, three Iowa communities acquired over 1000 damaged properties to support disaster recovery and mitigation. This research applies a distributive justice framework to analyze the distribution of disaster recovery funds for property acquisition. Two research questions drive the analysis: (1) how does recovery vary by acquisition funding source; and (2) what is the relationship between recovery and vulnerable populations? Through spatial econometric modeling, relative recovery is compared between two federal programs that funded the acquisitions, and across socially vulnerable populations. The results indicate both distributive and temporal inequalities in the allocation of federal recovery funds. In particular, Latino and elderly populations were associated with lower recovery rates. Recommendations for future research in flood recovery and acquisitions are provided.

Monsoon harvests: the living legacies of rainwater harvesting systems in South India.

Rainwater harvesting, a "soft path" approach toward water management, is increasingly recognized as a key strategy toward ensuring food security and alleviating problems of water scarcity. Interestingly this "modern" approach has been in use for millennia in numerous older civilizations. This article uses India as a case study to explore the social, economic, and environmental dimensions of agricultural rainwater harvesting ponds, and evaluates the viability of these centuries-old systems under current climate and population pressures. A holistic watershed-scale approach that accounts for trade-offs in water availability and socioeconomic wellbeing is recommended for assessing the sustainability of these systems.