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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
Governor's Disaster Planning and Response Review Committee.
Final report, Hurricane Andrew. Tallahassee, Florida: State of
Florida, January 15, 1993.
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.
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.
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.
CDC. Famine-affected, refugee, and displaced populations:
recommendations for public health issues. MMWR 1992;41(no. RR-13).
CDC. Rapid health needs assessment following Hurricane Andrew --
Florida and Louisiana, 1992. MMWR 1992;41:685-8.
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