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Disasters and At-Risk Populations
Topic Collection
February 1, 2025

Topic Collection: Disasters and At-Risk Populations

 

Accessing healthcare may be a challenge to at-risk populations across the U.S. The rate of disasters has increased over the years and the COVID-19 pandemic affected communities of color, rural communities, and other underserved populations especially hard. Healthcare professionals and emergency managers may benefit from a better understanding of the complex relationships that affect fair access to healthcare.

Healthy People 2030 lists five domains of social determinants of health: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context.

The resources in this Topic Collection highlight these considerations and lessons learned from a variety of natural and human-caused disasters and provide guidance for healthcare practitioners who are committed to improving at-risk populations’ access to healthcare.

Stakeholders may also wish to access the Populations with Access and Functional Needs and Rural Disaster Health Topic Collections.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

Alderwick, A. and Gottlieb, L.. (2019). Meanings and Misunderstandings: A Social Determinants of Health Lexicon for Health Care Systems. Milbank Quarterly. 97(0):1-13.
This article reviews definitions for key terms related to social determinants of health, with the goal of clarifying differences between terms that are sometimes confused.
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American Hospital Association. (2020). Ensuring Access in Vulnerable Communities *.
This taskforce report outlines nine emerging strategies that can help preserve access to healthcare services in vulnerable rural and urban communities.
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American Medical Association. (n.d.). Reducing Disparities in Health Care. (Accessed 11/15/2021.)
This webpage outlines the American Medical Association’s work to reduce healthcare disparities, and provides resources for physicians, and other healthcare practitioners. The resources provided include: a downloadable toolkit targeted to physicians to provide education on cultural competence and literacy; research on eliminating healthcare inequalities, and related articles on healthcare disparities.
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Crimmins, A.R., C.W. Avery, D.R. Easterling, K.E., et al. (Eds). (2023). Fifth National Climate Assessment. U.S. Global Change Research Program.
This report highlights observed and projected vulnerabilities, risks, and impacts associated with climate change across the country. It includes sections on physical science, national topics, and concerns by region. Examples of response actions that focus on community mitigation and adaptation are also included.
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Office of Minority Health. (2013). Cultural Competency Curriculum for Disaster Preparedness and Crisis Response. U.S. Department of Health and Human Services.
This set of courses is designed to integrate knowledge, attitudes, and skills related to cultural competency to help lessen racial and ethnic healthcare disparities brought on by disaster situations.
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Rural Info Hub. (2019). Rural Health Disparities.
This webpage describes health disparities faced by rural Americans. Responses to frequently asked questions are provided, as are links to supporting resources.
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Santana, M.P. (2020). Community Mobilization as a Model for Preparedness with Equity. Migrant Clinicians Network.
This blog post describes a “community mobilization” model used in Puerto Rico to incorporate equity into emergency preparedness and response. In this model, community health centers build connections between their patients and government agencies before an emergency happens, and then leverage those connections to have government support communities, which define barriers to preparedness and response for themselves.
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Trust for America’s Health. (2021). Ready or Not: 2021 Protecting The Public’s Health from Diseases, Disasters, and Bioterrorism.
Included in the 2021 issue of this annual report that serves as a “scorecard” of states’ preparedness, is an interview with public health professionals about obstacles to vaccination in communities of color entitled, “Earning Vaccine Confidence in Communities of Color” (see p. 12). Practical communication strategies for addressing barriers, such as misinformation and distrust of government, are discussed.
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Education and Training

* American Hospital Association. (2020). Ensuring Access in Vulnerable Communities *.
This taskforce report outlines nine emerging strategies that can help preserve access to healthcare services in vulnerable rural and urban communities.
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* Office of Minority Health. (n.d.). National Culturally and Linguistically Appropriate Services Standards. (Accessed 11/16/2021.) U.S. Department of Health and Human Services.
The National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care are a set of 15 action steps that provide guidance for providing health care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs.
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Office of Minority Health. (2013). Cultural Competency Curriculum for Disaster Preparedness and Crisis Response. U.S. Department of Health and Human Services.
This set of courses is designed to integrate knowledge, attitudes, and skills related to cultural competency to help lessen racial and ethnic healthcare disparities brought on by disaster situations.
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U.S. Food and Drug Administration. (2021). Topics in Public Health.
These free webinars offered by the U.S. Food and Drug Administration focus on a variety of topics, including disparity in disaster response.
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Guidance and Frameworks

Alderwick, A. and Gottlieb, L.. (2019). Meanings and Misunderstandings: A Social Determinants of Health Lexicon for Health Care Systems. Milbank Quarterly. 97(0):1-13.
This article reviews definitions for key terms related to social determinants of health, with the goal of clarifying differences between terms that are sometimes confused.
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* American Hospital Association. (2020). Ensuring Access in Vulnerable Communities *.
This taskforce report outlines nine emerging strategies that can help preserve access to healthcare services in vulnerable rural and urban communities.
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American Medical Association. (n.d.). Reducing Disparities in Health Care. (Accessed 11/15/2021.)
This webpage outlines the American Medical Association’s work to reduce healthcare disparities, and provides resources for physicians, and other healthcare practitioners. The resources provided include: a downloadable toolkit targeted to physicians to provide education on cultural competence and literacy; research on eliminating healthcare inequalities, and related articles on healthcare disparities.
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Centers for Disease Control and Prevention. (2021). Social Determinants of Health: Know What Effects Health.
This webpage includes resources on social determinants of health, the “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes.” There are links to data, research, and tools for action, programs, and policy which may be used by public health and health care professionals.
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Gilbert, N., Savoia, E., Elqura, L., et al. (2009). Emergency Preparedness for Vulnerable Populations: People with Special Health-care Needs. Public Health Reports. 124: 338-343.
The authors describe a conceptual framework developed by participants of “Equity in Preparedness: A Collaborative Symposium for Populations with Special Health-Care Needs in Boston.” The framework addresses medical, communication, supervision, and transportation needs while maintaining functional independence.
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Los Angeles County Department of Public Health (LACDPH). (n.d.). Strategies for Inclusive Planning in Emergency Response. (Accessed 11/15/2021.)
This resource was developed following a 2017 workshop hosted by LACDPH entitled “Incorporating Inclusive Planning into EOC Activations” with contributions from public health, emergency management, and subject matter experts. The overview document discusses inclusion planning generally, while the appendices offer tools and examples planners may use to ensure that operations center plans include considerations for individuals that are disproportionately affected by disasters.
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Rural Info Hub. (2019). Rural Health Disparities.
This webpage describes health disparities faced by rural Americans. Responses to frequently asked questions are provided, as are links to supporting resources.
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The Bay Area Regional Health Inequities Initiative (BARHII). (2020). Farther Together: Seven Best Practices for Engaging Communities to Create a Healthy, Resilient Region for All.
This resource provides guidance for public agencies to “engage communities impacted by inequities in climate resilience planning.” It includes case studies of promising practices.
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Vawter, D.E., Garrett, J.E., Gervais, K.G., et al. (2011). Attending to Social Vulnerability When Rationing Pandemic Resources. (Abstract only.) Journal of Clinical Ethics.
The authors provide an overview of the Minnesota Pandemic Ethics Project, an effort focused on rationing scarce health resources during a severe influenza pandemic. The authors list seven recommendations that can help vulnerable populations (and those who serve and treat them) before, during, and after an influenza pandemic.
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Guidance and Frameworks: COVID-19 Vaccines

DeCosta-Klipa, N. (2021). 4 Proposals to Improve the Massachusetts Vaccine Rollout. Boston Globe.
This newspaper article describes strategies for supporting equitable vaccine access in Massachusetts. It includes considerations for a “one-stop” appointment portal and phone hotline to streamline registration and improve access for seniors and others struggling with technology; a pre-registration system so people could register and then be notified when an appointment was available, instead of having to check back repeatedly for open appointments; and mobile vaccination sites staffed by medical professionals and community workers to bring vaccines to communities with high case counts.
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Lessons Learned

* Crimmins, A.R., C.W. Avery, D.R. Easterling, K.E., et al. (Eds). (2023). Fifth National Climate Assessment. U.S. Global Change Research Program.
This report highlights observed and projected vulnerabilities, risks, and impacts associated with climate change across the country. It includes sections on physical science, national topics, and concerns by region. Examples of response actions that focus on community mitigation and adaptation are also included.
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Crowder, S., Tanner, A., Dawson, M., et al. (2022). Better Together: Coalitions Committed to Advancing Health Equity. Nursing Outlook.
The authors reviewed information collected from five coalitions developed to address healthcare disparities (Latinx Advocacy Team and Interdisciplinary Network for COVID-19, Black Coalition Against COVID, Camden Coalition, National Coalition of Ethnic Minority Nurse Associations, and The Future of Nursing: Campaign for Action). This article provides an overview of each coalition and how they emphasized relationship building and unique strategies to serve their populations and address COVID-19, different kinds of disparities, and other barriers to health.
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Do, V., McBrien, H., Flores, N., et al. (2023). Spatiotemporal Distribution of Power Outages with Climate Events and Social Vulnerability in the USA. Nature Communications. 14. .
The authors reviewed power outages from 2018–2020, and found "an average of 520 million customer-hours total without power annually across 2447 US counties (73.7% of the US population)." Longer outages were more likely to occur in northeastern, southern, and Appalachian counties, while counties in Arkansas, Louisiana, and Michigan experienced both frequent 8+ hour outages and higher social vulnerability and prevalence of electricity-dependent durable medical equipment use. Considerations for disaster preparedness and response are included.
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Farber, D. (2007). Disaster Law and Inequality. Minnesota Journal of Law and Inequality. 25:2; 297-321.
This slightly dated resource provides an extensive overview of disparities experienced by vulnerable groups, and how they are worsened during disasters. The author also discusses potential legal remedies to address disparities in disaster preparation, response, and recovery, which include mitigation of disparities before disasters happen.
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Knox, R. (2009). Officials Find Swine Flu Hits Minorities Harder. National Public Radio (NPR).
The author of this article discusses how certain factors (e.g., lower income, higher incidence of asthma, lower rates of vaccination) contribute to the disproportionate effect of swine flu on minorities.
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Lichtveld, M. (2018). Disasters Through the Lens of Disparities: Elevate Community Resilience as an Essential Public Health Service. American Journal of Public Health. 108(1): 28–30.
Using examples from past disasters, the author discusses how inequities prevent communities from adequately preparing for disasters, and how poor preparedness negatively impacts mitigation, response, and recovery. She advocates for making resiliency an essential public health service.
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National Network of Public Health Institutes. (2019). Community Resilience and Equity in Disaster-Related Recovery: An Interview with Robin Pfohman, Public Health – Seattle & King County.
In this interview transcript, the Community Resilience + Equity Program Manager from a county health department discusses her experience working to address health recovery needs of “groups impacted by inequity” after disasters. She advocates for “getting into the community, building relationships, [and] listening” to learn about a community’s capacity to partner with public health and emergency management agencies in preparedness and response activities.
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Plough, A., Bristow, B., Fielding, J., et al. (2011). Pandemics and Health Equity: Lessons Learned from the H1N1 Response in Los Angeles County. (Abstract only.) Journal of Public Health Management and Practice. 17(1): 20-7.
The authors examine data from an H1N1 mass vaccination clinic provided by the Los Angeles County Department of Public Health in 2009. African American residents reported the lowest vaccination rate, followed by white residents. The authors note that informal community messaging was running counter to “official” messaging that was highlighting equity in vaccination access.
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Quinn, C.S. and Kumar, S. (2014). Health Inequalities and Infectious Disease Epidemics: A Challenge for Global Health Security. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 12(5):263-273.
The authors advocate for addressing health inequalities and social determinants of health to improve global health security.
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Santana, M.P. (2020). Community Mobilization as a Model for Preparedness with Equity. Migrant Clinicians Network.
This blog post describes a “community mobilization” model used in Puerto Rico to incorporate equity into emergency preparedness and response. In this model, community health centers build connections between their patients and government agencies before an emergency happens, and then leverage those connections to have government support communities, which define barriers to preparedness and response for themselves.
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Smiley, K., Noy, I., Wehner, M., et al. (2022). Social Inequalities in Climate Change-Attributed Impacts of Hurricane Harvey. Nature Communications. 13, 3418. .
Using land-parcel and census tract socio-economic data, the authors examine the relationship between social inequalities and climate change-related (specifically due to Hurricane Harvey) extreme weather event effects. They found that Latina/x/o neighborhoods--specifically those that were low-income and located outside of FEMA’s 100-year floodplain--were disproportionately affected. They emphasize the need to address the impact climate change is already disproportionately having on certain populations in addition to planning for future events.
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* The National Academies of Sciences, Engineering, and Medicine. (2021). Contact Tracing and the Challenges of Health Equity in Vulnerable Latino and Native American Communities.
This resource summarizes the discussion from a July 2020 workshop that was focused on the role of contact tracing for vulnerable groups, specifically Latino and Native American communities. Considerations related to distrust in government, cultural competency, and identifying case contacts without health care access or insurance, are included.
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The RISK Project. (n.d.). The Resilience in Survivors of Katrina (“RISK”) Project. (Accessed 11/16/2021.)
This longitudinal research project followed low-income parents who lived in New Orleans to better understand the role of different variables on educational attainment. The study began before Hurricane Katrina struck the area; the researchers were able to also examine consequences related to the disaster, including physical and mental health outcomes.
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Trust for America’s Health. (2021). Ready or Not: 2021 Protecting The Public’s Health from Diseases, Disasters, and Bioterrorism.
Included in the 2021 issue of this annual report that serves as a “scorecard” of states’ preparedness, is an interview with public health professionals about obstacles to vaccination in communities of color entitled, “Earning Vaccine Confidence in Communities of Color” (see p. 12). Practical communication strategies for addressing barriers, such as misinformation and distrust of government, are discussed.
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Lessons Learned: COVID-19

* The National Academies of Sciences, Engineering, and Medicine. (2021). Contact Tracing and the Challenges of Health Equity in Vulnerable Latino and Native American Communities.
This resource summarizes the discussion from a July 2020 workshop that was focused on the role of contact tracing for vulnerable groups, specifically Latino and Native American communities. Considerations related to distrust in government, cultural competency, and identifying case contacts without health care access or insurance, are included.
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Plans, Tools, and Templates

Administration for Strategic Preparedness and Response. (2021). HHS Maternal-Child Emergency Planning Toolkit. U.S. Department of Health and Human Services.
This toolkit outlines basic planning steps, highlights key resources and promising practices, and explains critical data and information to be integrated into emergency planning for maternal-child health populations. It provides guidance and advice to address the needs of people who are pregnant, postpartum, and/or lactating and typically developing infants and young children in emergencies.
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Center for Care Innovations. (2021). Telemedicine for Health Equity Toolkit.
This toolkit provides information and guidance for safety-net healthcare systems seeking to initiate, expand, or improve their telemedicine programs in equitable ways.
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Flanagan, B., Gregory, E., Hallisey, E., et al. (2011). A Social Vulnerability Index for Disaster Management. Journal of Homeland Security and Emergency Management. 8(1):Article 3.
This resource describes the development of a social vulnerability index (SVI) for emergency management based on 15 census variables at the census tract level. It includes a case study where the SVI is used to “explore the impact of Hurricane Katrina on local populations.”
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National Consensus Panel on Emergency Preparedness and Cultural Diversity. (2011). Guidance for Integrating Culturally Diverse Communities into Planning for and Responding to Emergencies: A Toolkit. American Hospital Association.
This toolkit was developed to provide preparedness planning and response agencies, organizations, and professionals with practical strategies, resources and examples of models for improving existing activities and developing new programs to meet the needs of racially and ethnically diverse populations.
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* Office of Minority Health. (n.d.). National Culturally and Linguistically Appropriate Services Standards. (Accessed 11/16/2021.) U.S. Department of Health and Human Services.
The National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care are a set of 15 action steps that provide guidance for providing health care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (2023). Cultural and Linguistic Competency for Disaster Preparedness Planning and Crisis Response.
This webpage includes links to resources and tools that enhance and address cultural and linguistic competency to help mitigate the impact of disasters and emergency events.
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U.S. Food and Drug Administration. (2021). #VaccineReady Social Media Toolkit. U.S. Department of Health and Human Services.
This web page includes various social media resources to encourage members of diverse communities to be vaccinated. Resources include graphics and messages for Twitter and Facebook and links to videos.
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University of Wisconsin School of Medicine and Public Health. (n.d.). Neighborhood Atlas. (Accessed 11/16/2021.)
This webpage provides a description of the Area Deprivation Index (ADI), which uses data from the American Community Survey to assess income, education, employment, and housing quality for each census block tract in the United States and Puerto Rico. The ADI provides each neighborhood a score representing level of socioeconomic disadvantage that may be used to inform emergency planning.
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Research

Andrulis, D., Siddiqui, N., and Purtle, J. (2009). California’s Emergency Preparedness Efforts for Culturally Diverse Communities: Status, Challenges and Directions for the Future. Drexel University school of Public Health, Center for Health Equity.
The authors of this report examine the challenges and barriers to meeting the emergency preparedness needs of culturally diverse communities. The report also highlights gaps in programs and policies and provides promising practices and strategies to guide efforts at 5 the state, regional, and local levels. Although it focuses on California, the overall framework may be relevant to other states and jurisdictions.
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Andrulis, D.P., Siddiqui, N.J., and Purtle, J.P. (2011). Integrating Racially and Ethnically Diverse Communities into Planning for Disasters: The California Experience. (Abstract only.) Disaster Medicine and Public Health Preparedness. 5(3): 227-34.
The authors of this study conducted a literature review, environmental scan of organizational website providing preparedness materials for diverse communities, and key informant interviews with public health and emergency management professionals. Using California as a locus of study, the objective was to identify challenges and barriers to meeting the preparedness needs of racially and ethnically diverse communities, and highlight promising strategies, gaps in the programs, and future priorities. Impact: Results identified at least four intervention priorities for California and across the United States: engaging diverse communities in all aspects of emergency planning, implementation, and evaluation; mitigating fear and stigma; building organizational cultural competence; and enhancing coordination of information and resources.
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Bethel, J., Burke, S., and Britt, A. (2013). Disparity in Disaster Preparedness Between Racial/Ethnic Groups. Disaster Health. 1(2): 110-116.
Behavioral Risk Factor Surveillance System survey respondent data was examined to determine the relationship between race/ethnicity (independent variable) and disaster preparedness (three dependent variables). The authors found that people from racial/ethnic minority groups were less likely to have three days’ worth of medical supplies. Only Spanish-speaking Hispanics were less likely to have an emergency evacuation plan than white respondents.
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Brite, J., Alper, H., Friedman, S., et al. (2020). Association Between Socioeconomic Status and Asthma-Related Emergency Department Visits Among World Trade Center Rescue and Recovery Workers and Survivors. JAMA Network Open. 3(3): e201600.
The authors sought to examine the relationship between barriers to care (in this case, race, education, and income) and asthma-related emergency department visits among responders and survivors of the 9/11 World Trade Center bombing. Of the 448 subjects who had at least one ED visit during the study period, 28% (p < .001). The authors highlight other associations and suggest there may be additional variables (e.g., lower health literacy and gaps in asthma-specific knowledge) at play.
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Burger, A.E., Reither, E.N., Hofmann, E.T. and Mamelund, S.E. (2017). The Influence of Hispanic Ethnicity and Nativity Status on 2009 H1N1 Pandemic Vaccination Uptake in the United States. Journal of Immigrant and Minority Health. 20:561–568.
The authors examined data from the 2010 National Health Interview Survey to estimate rates of 2009 H1N1 vaccination among Hispanics. They concluded that foreign-born Hispanics were least likely to be vaccinated compared with native-born Hispanics and Whites, due to “insufficient access to flexible resources and healthcare coverage among foreign-born Hispanics.”
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Cox, K. and Kim, B. (2017). Race and Income Disparities in Disaster Preparedness in Old Age. (Abstract only.) Journal of Gerontological Social Work. 61(7):719-734.
The authors used data from the 2010 Health and Retirement Study to explore race and income disparities in preparedness in old age. They concluded that their data analysis “suggests that preparedness programs should target minority and low income elders.”
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* Crimmins, A.R., C.W. Avery, D.R. Easterling, K.E., et al. (Eds). (2023). Fifth National Climate Assessment. U.S. Global Change Research Program.
This report highlights observed and projected vulnerabilities, risks, and impacts associated with climate change across the country. It includes sections on physical science, national topics, and concerns by region. Examples of response actions that focus on community mitigation and adaptation are also included.
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Crouse Quinn, S. (2008). Crisis and Emergency Risk Communication in a Pandemic: A Model for Building Capacity and Resilience of Minority Communities. (Abstract only.) Health Promotion Practice 9(4 Suppl):18S-25S.
The author addresses the challenges public health agencies have when communicating risk to certain populations during a pandemic (e.g., distrust of government, existing health disparities). The author also suggests the use of a risk communication strategy based on community engagement, disaster risk education, and crisis and emergency risk communication to help prepare minority communities and government agencies to prepare, respond, and work together in a pandemic.
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Davis, J., Wilson, S., Brock-Martin, A., et al. (2010). The Impact of Disasters on Populations With Health and Health Care Disparities. Disaster Medical Public Health Preparedness. 4(1): 3038.
The authors performed an extensive literature review to examine the effects of a disaster and living in an area with existing health or healthcare disparities on a community’s overall health and quality of life and access to health resources.
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Dee, D.L., Bensyl, D.M., Gindler, J., et al. (2011). Racial and Ethnic Disparities in Hospitalizations and Deaths Associated with 2009 Pandemic Influenza A (H1N1) Virus Infections in the United States. (Abstract only.) Annals of Epidemiology. (8):623-30.
The authors used various data sources to examine racial-ethnic disparities in the 2009 pandemic influenza A (H1N1) illness severity and health consequences for U.S. minority populations. The authors noted racial-ethnic disparities in H1N1-associated healthcare seeking behavior, hospitalizations, and pediatric deaths.
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Evidence Aid. (2024). Humanitarian Impact of Climate Change.
This evidence collection contains summaries of research related to the global humanitarian impact of climate change.
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Gabe, T., Falk, G., McCarty, M., et al. (2005). Hurricane Katrina: Social-Demographic Characteristics of Impacted Areas. Congressional Research Service.
This document provides data about areas impacted by Hurricane Katrina in 2005, including estimates of the population who were most affected and most likely displaced by the storm, in total and in each of the three affected states: Louisiana, Mississippi, and Alabama. It presents a social-demographic profile of the affected population, looking at characteristics such as poverty and race/ ethnicity status, homeownership, and housing status. Separate topics are also addressed for the elderly, children, and working-age adults.
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Hahn, M., Van Wyck, R., Lessard, L., and Fried, R. (2021). Compounding Effects of Social Vulnerability and Recurring Natural Disasters on Mental and Physical Health. Disaster Medicine and Public Health Preparedness. March 24: 1-9..
The authors used census tract level data from 500 U.S. cities to model “self-reported, poor mental and physical health, or a clinical diagnosis of high blood pressure or asthma” in those that had experienced recent or recurring natural disasters from 2001-2015. They controlled for social and environmental risk factors in the study and found that communities that experienced a disaster within 5 years had poorer health outcomes compared to communities that did not.
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Henkel, P. and Marvanova, M. (2019). Basic Disaster Preparedness of Rural Community Pharmacies in 5 States. (Free registration required; request full text from authors.) Disaster Medicine and Public Health Preparedness. 14(3):329-334.
Community pharmacies in rural areas in North and South Dakota, West Virginia, Southern Oregon and Northern California were surveyed via telephone to determine their levels of disaster preparedness. The authors concluded that “being in a rural, low-income, or high-elderly area was associated with lower likelihood” of basic community pharmacy disaster preparedness.
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Icenogle, M., Eastburn, S., and Arrieta, M. (2016). Katrina's Legacy: Processes for Patient Disaster Preparation Have Improved but Important Gaps Remain. American Journal of Medical Science. 352(5): 455–465.
The authors present findings from a qualitative study of participants representing healthcare and social services organizations serving health disparate residents of the Mississippi and Alabama Gulf Coast. They note that participant organizations have implemented changes to ensure continuity of care for the chronically ill in case of disasters (e.g., evacuation planning and assistance; support to find resources in evacuation destinations; equipping patients with prescription information, diagnoses, treatment plans, and advance medications when a disaster is imminent), but that additional solutions are necessary to meet the needs of disparate populations more fully.
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Marmot, M., Allen, J., Boyce, T., et al. (2020). Health Equity in England: The Marmot Review 10 Years on. Institute of Health Equity.
The authors review what has happened in England in the 10 years since the first report was published. Findings are presented based on five social determinants of health and followed by a section on governance for health equity. The authors emphasize the need to address “the twin problems of social inequalities and climate change…at the same time.”
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National Healthcare Quality Report and National Healthcare Disaprities Report. (2020). National Healthcare Quality Report and National Healthcare Disparities Report.
AHRQ has produced the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR) annually since 2003. These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness and efficiency of care. Chapter topics include care coordination of health system infrastructure. The reports present, in chart form, the latest available findings on quality of and access to health care.
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Niles, S. and Contreras, S. (2019). Social Vulnerability and the Role of Puerto Rico’s Healthcare Workers after Hurricane Maria. Natural Hazards Center, University of Colorado.
The authors used observation data and health worker interviews after Hurricane Maria to understand how the storm impacted health, and how healthcare workers reached those who were most impacted. They describe who was most vulnerable to the health impacts of the storm and extended disruptions to infrastructure after the storm and note that healthcare worker flexibility, local knowledge, and collaboration within affected communities supported successful medical outreach through existing clinics, mobile clinics, and by traveling door-to-door.
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Nkechi, C., Gagliardi, J., McGahee, S., et al. (2022). Medical Mistrust in Perinatal Mental Health. (Abstract only.) Harvard Review of Psychiatry. 30(4):238-247.
Community health centers (CHCs) can improve disparities by addressing mistrust of the health system among historically marginalized populations. CHCs can commit to financing, let people in the community lead, and learn from past obstacles to reach marginalized groups.
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Pettit Cornelius, A., Char, D., Doyle, C., et al. (2022). Disparities in Disaster Healthcare: A Review of Past Disasters. (Abstract only.) American Journal of Disaster Medicine. 17(2):171-184.
The authors reviewed the literature to understand how social determinants of health affected outcomes after disasters. They found that disaster plans did not sufficiently prepare marginalized communities for these events and emphasize the need for further research.
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Pettit Cornelius, A., Char, D., Gustafson Ista, L., et al. (2024). Disaster Healthcare Disparities Solutions: Part 1-Preparation. (Abstract only.) American Journal of Disaster Medicine. 19(2):91-100.
As part of a series of three articles on understanding and addressing disparity in disasters, the authors focused this article on inequities in the preparedness phase of disasters. While some solutions identified have been implemented, others remain theoretical; both types could have a positive effect on disaster healthcare. Access the authors’ Part 2-Response here: https://pubmed.ncbi.nlm.nih.gov/38698508/ and Part 3-Recovery and Mitigation here: https://pubmed.ncbi.nlm.nih.gov/38698509/
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Quinn, S.C., Kumar, S., Freimuth, V.S., et al. (2011). Racial Disparities in Exposure, Susceptibility, and Access to Health Care in the US H1N1 Influenza Pandemic. American Journal of Public Health. 101(2):285-93 .
The authors of this study examined racial disparities in H1N1 exposure, susceptibility to H1N1 complications, and access to healthcare during the 2009 H1N1 influenza pandemic. They noted disparities in the risks of exposure, susceptibility (particularly to severe disease), and access to healthcare.
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Raker, E., Arcaya, M., Lowe, S., et al. (2020). Mitigating Health Disparities After Natural Disasters: Lessons from The RISK Project. Health Affairs. 39(12).
The Resilience in Survivors of Katrina (RISK) project examined 15 years of data specific to 1,109 low-income, primarily Black parents to determine the short- and long-term effects of disasters on vulnerable populations. The study authors categorized their findings into five priorities: primary prevention of disaster exposure (and associated trauma); improve post-disaster health care; integrate social services; aid survivors in social support and community building; and provide targeted, long-term services for highly affected survivors.
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Runkle, J., Brock-Martin, A., Karmaus, W., and Svendsen, E. (2012). Secondary Surge Capacity: A Framework for Understanding Long-Term Access to Primary Care for Medically Vulnerable Populations in Disaster Recovery. American Journal of Public Health. 102(12):e24-32.
The authors advocate for the expansion of surge capacity plans to meet the chronic health care needs of vulnerable populations that increase following the acute phase of disaster response. They use a health services model to identify factors that perpetuate health disparities following disasters. To address these disparities, the authors recommend a baseline assessment of needs, with the expectation that such health care needs will expand post-disaster.
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Substance Abuse and Mental Health Services Administration. (2022). National Network to Eliminate Disparities in Behavioral Health. U.S. Department of Health and Human Services.
This network is comprised of community-based organizations focused on issues that impact diverse populations. This network provides information, training, and technical assistance to increase equity in behavioral health service distribution.
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Toldson, I., Ray, K., Hatcher, S.S., and Louis, L.S. (2011). Examining the Long-Term Racial Disparities in Health and Economic Conditions Among Hurricane Katrina Survivors: Policy Implications for Gulf Coast Recovery. (Abstract only.) Journal of Black Studies. 42(3):360-78.
This article reviews findings from a 2006 survey of Hurricane Katrina survivors to evaluate health and economic disparities one year after the storm. Based on self-reported data, black survivors were found to have more hurricane-related problems with personal health, emotional well-being, and finances.
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Uscher-Pines, L., Maurer, J., and Harris, K.M. (2011). Racial and Ethnic Disparities in Uptake and Location of Vaccination for 2009-H1N1 and Seasonal Influenza.
The authors analyzed nationally representative survey data of US adults collected in March 2010 to “learn more about racial and ethnic disparities in influenza vaccination during the 2009-H1N1 pandemic.” The concluded that Blacks were significantly less likely to be vaccinated against seasonal influenza and 2009-H1N1 than were Whites, and advocate for additional study of how communication and vaccine distribution methods affect vaccine uptake within minority communities.
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Various Authors. (2021). Structural Racism and Discrimination: Impact on Minority Health and Health Disparities. Ethnicity and Disease. Volume 31, Supplement 1.
This supplemental issue of Ethnicity & Disease features research articles dedicated to the study of the impact of structural racism and discrimination on minority health. Authors highlight findings and make recommendations for studying the impact and designing interventions.
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Williams, D., Lawrence, J., and Davis, B. (2019). Racism and Health: Evidence and Needed Research. Annual Review of Public Health. 40:105-125.
The authors summarize the evidence linking the primary domains of racism (structural, cultural, and individual-level discrimination) to various health outcomes. They also highlight key findings, priorities for future research, and areas that still need more research.
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Agencies and Organizations

Centers for Disease Control and Prevention. Health Equity.
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Drexel University School of Public Health. Diversity Preparedness.
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Healthy People 2030. Social Determinants of Health.
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National Health Council. Addressing Discrimination & Health Disparities.
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Rural Info Hub. Rural Health Disparities.
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U.S. Department of Health and Human Services. Office of Minority Health.
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U.S. Department of Health and Human Services, Office of Civil Rights. Emergency Preparedness.
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This ASPR TRACIE Topic Collection was comprehensively reviewed in October and November 2021 by the following subject matter experts (listed in alphabetical order): Dianna Havner Bryant, PhD, CIH, CSP, Institute for Rural Emergency Management, University of Central Missouri; John Hick, MD, Hennepin Healthcare; Roslyn Holliday Moore, MS, Deputy Director for Programs, HHS Office of Minority Health; Maggie Jarry, M.Div., MS, Emergency Coordinator, Substance Abuse and Mental Health Services Administration; Rachel Kaul, LCSW, CTS, Senior Program Analyst, Behavioral Health Lead, HHS ASPR; Cheryl Levine, PhD, At-Risk Individuals Program Director, HHS ASPR; Kayla Siviy, MSW, Behavioral Health Program Analyst, HHS ASPR; members of the HHS Office of Climate Change and Health Equity; and Kandra Strauss-Riggs, MPH, Senior Advisor, Division of Community Mitigation & Recovery, HHS ASPR.  
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