Hurricane Ike damaged or destroyed 70% of Galveston, Texas’ residential and commercial buildings when it struck the barrier island in September 2008. Pre-storm poverty levels and poor health and social indicators made it challenging for community members to bounce back quickly. In the post-storm political and planning environment, decision makers were afforded the opportunity to address social determinants of health and the impact of policies on health.
During this window of opportunity, the Center to Eliminate Health Disparities (CEHD) and the National Outreach and Education Core at the University of Texas Medical Branch (UTMB) received funding from the National Institutes of Health to implement the Galveston Health in All Policies Project, which focused on efforts to integrate health considerations into Galveston’s recovery planning efforts, such as adapting the Healthy Development Measurement Tool (HDMT) to their post-disaster recovery situation and raising awareness about social determinants of health among post-disaster planning initiatives by providing technical assistance and workshops.
The HDMT was originally developed by the San Francisco Department of Public Health in 2007 after completion of a health impact assessment to analyze the health impacts of neighborhood development decisions in San Francisco and is described as “a comprehensive evaluation metric to consider health needs in urban development plans and projects.” The tool addresses six main elements that are believed to contribute to a healthy city: environmental stewardship, sustainable and safe transportation, social cohesion, public infrastructure, adequate and healthy housing, and healthy economy. Among these elements, there are 28 community health objectives and 125 indicators.
The CEHD chose 17 indicators, taken from the HDMT and a few they developed on their own, that they felt contributed to local recovery planning, including the proportion of households without a motor vehicle, the proportion living below the poverty level, the proportion of population within ½ mile of a supermarket, and the proportion of land zoned for commercial and residential uses. The indicators were mapped using the most up-to-date local data in an effort to visualize data and raise awareness about the impact of policy on health.
The mapped indicators and actual health outcomes of previous hurricanes were used as a guide to develop a one-day workshop and accompanying workbook titled Galveston Hurricane and Healthy Neighborhood Scenarios. The workbook contains three hurricane recovery scenarios, taking place in the future after a fictional hurricane named Tina, that underscore the health effects resulting from different planning strategies: business as usual, a healthy neighborhoods approach, and a healthier and more resilient neighborhoods approach.
The first scenario, business as usual, incorporates lessons from Hurricane Ike and current recovery planning initiatives. The second scenario, a healthy neighborhoods approach, builds upon the first scenario by significantly investing in healthy neighborhood policies that are shown to improve health. Finally, a healthier and more resilient neighborhoods approach, builds upon the first two scenarios by investing in resiliency interventions.
Adapting HDMT indicators to create local maps and scenarios for post-disaster planning is an innovative way to raise awareness about social determinants of health, connect health impacts to policy, restructure planning efforts following disasters and create more disaster resilient communities.