Comprehensive Assessment of Health Needs 2 Months After Hurricane Andrew -- Dade County, Florida, 1992

On August 24, 1992, Hurricane Andrew struck southern Florida. More than 28,000 houses, mobile homes, and apartment buildings were destroyed, and approximately 107,000 additional dwellings sustained major damage (1). An estimated 180,000 persons were left homeless; insured damages were estimated at $15.5 billion and total damages at more than $30 billion. During the recovery period, many private and public health-care facilities damaged or destroyed in the storm were not functional. During November 3-13, to help prioritize health needs and direct public health resources, the Dade County Public Health Unit of the Florida Department of Health and Rehabilitative Services conducted a survey to assess health needs and the availability of health-care services during the recovery phase with funds provided by the Federal Emergency Management Agency (FEMA). This report summarizes the results of the survey.

For this survey, the county was divided into six zones according to the extent of hurricane damage (Figure 1) -- Hialeah and Miami/Miami Beach (the northernmost zones) sustained the least damage and Homestead (the southernmost zone) was affected most severely. Within each zone, a two-stage cluster design was used to randomly select households for interview. Information was obtained by interviewing one member of each selected household who was considered capable of understanding the questions. Respondents were asked about demographic characteristics, transportation, environmental problems, food supplies, health insurance status, sources of health care (primary medical, dental, mental, and emergency care), barriers to adequate care, indicators of mental health status, and evacuation behaviors.

Questionnaires were completed by 1353 (75%) of the 1800 selected households. Overcrowding (i.e., at least one new person living in the household since the storm) was greatest in the Homestead zone (38%) and decreased progressively with distance from the storm track (Table 1). The proportion of households in which at least one person had symptoms of stress or anxiety also was highest in the Homestead zone (53%) and decreased progressively to 18% in the northernmost zones. The proportion of households reporting that at least one person needed counseling services ranged from 5% in the northernmost zone to 13% in the Homestead zone.

In the Homestead zone, 12% of households reported that at least one person had lost health insurance because of the hurricane, compared with 5%-6% for other zones in the county (Table 1). More than twice the number of households in the Homestead zone (14%) had at least one person who needed unemployment compensation than in other zones (3%-7%). Twenty-eight percent of households in the Homestead zone reported they used community or neighborhood health centers for primary health care, including preventive care, compared with 11% of households in the entire county. Use of public programs for dental care was also greatest in the Homestead zone.

Reported by: C Carmichael, MD, A Neasman, MS, L Rivera, G Wurm, MD, Dade County Public Health Unit, Miami; L Elliott, WG Hlady, MD, K Mason, EdD, J Sims, PhD, RS Hopkins, MD, State Epidemiologist, Florida Dept of Health and Rehabilitative Svcs. Applications Br, and Statistics and Analytic Methods Br, Div of Surveillance and Epidemiology, Epidemiology Program Office; Women's Health and Fertility Br, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Disaster Assessment and Epidemiology Section, Health Studies Br, Div of Environmental Hazards and Health Effects, and Emergency Response and Coordination Group, National Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Approximately every 5 years, a hurricane with catastrophic potential makes landfall in the United States (3). Hurricane Andrew was one of the most devastating in 25 years. Although hurricane warning systems in the United States are well developed, the population density in hurricane-vulnerable areas has increased substantially during the past 20 years (4). Adequate means of evacuation and safe refuge are necessary for residents in communities on barrier islands and other vulnerable coastal communities to minimize injury and death associated with future hurricanes. However, as the findings in this report indicate, even if effective evacuation procedures are in place, the long-term health and economic impact of hurricanes may be substantial.

This assessment indicates that 2 months after Hurricane Andrew, unmet health needs -- particularly mental health -- persisted in Dade County. This information has been used to target health services more effectively, particularly in areas with a high degree of dependence on public programs. Based in part on these findings, community health centers in southernmost zones were rebuilt and enlarged. Health and social services also were expanded through community health teams that provided vaccinations, counseling, information on financial assistance and health and social services.

Health needs assessments during the early part of the recovery phase are effective in ensuring that decisions regarding the allocation of resources are based on actual needs (5). In both Florida and Louisiana, rapid needs assessments conducted 3-10 days after the storm were used to direct relief efforts in the early part of the recovery phase (6). This survey is the first for which FEMA has allocated relief funds for evaluating health-care needs and resources in the latter part of a recovery phase of a disaster. A second survey to further guide continued recovery efforts is planned.

References

1. Governor's Disaster Planning and Response Review Committee. Final report, Hurricane Andrew. Tallahassee, Florida: State of Florida, January 15, 1993.

2. Dean AD, Dean JA, Burton JH, Dicker RC. Epi Info, version 5: a word processing, database, and statistics program for epidemiology on microcomputers. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1990.

3. Herbert P, Taylor G, Case R. Hurricane experience levels of coastal county population -- Texas to Maine. Miami: US Department of Commerce, National Oceanographic and Atmospheric Administration, 1984; technical memorandum NWS NHC 25.

4. French JG. Hurricanes. In: Gregg MB, ed. The public health consequences of disasters, 1989. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1989:33-7.

5. CDC. Famine-affected, refugee, and displaced populations: recommendations for public health issues. MMWR 1992;41(no. RR-13).

6. CDC. Rapid health needs assessment following Hurricane Andrew -- Florida and Louisiana, 1992. MMWR 1992;41:685-8.

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