Implications of Hurricane Harvey on Environmental Public Health in Harris County, Texas.

Author:Ratnapradipa, Dhitinut
Position::ADVANCEMENT OF THE PRACTICE - Report
 
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Introduction

On Friday, August 25, 2017, at approximately 10 p.m. local time, Hurricane Harvey made landfall near Rockport, Texas, as a Category 4 major hurricane (National Weather Service, 2017). Over the next 7 days, the slowmoving storm caused widespread, intense rainfalls throughout southeast Texas, with Houston receiving 24 in. of rain in 48 hr (Di Liberto, 2017). Storm totals across the region ranged from 20-40 or more inches of rain (Figure 1), with a record amount of 49.6 in. reported near Clear Creek at Interstate Highway 45 in Houston and over 1 trillion gallons of water falling in Harris County (Di Liberto, 2017; Harris County Flood Control District [HCFCD], 2017). The rainfall led to record flooding, closing major roads throughout the area, flooding an estimated 136,000 structures in Harris County, and resulting in 38 storm-related deaths (HCFCD, 2017; Houston Recovers, 2017).

The devastation was not limited to Houston. According to the Federal Emergency Management Agency (FEMA) summary, across southeast Texas nearly 80,000 homes had at least 18 in. of floodwater in them, and 23,000 had more than 5 ft of water. More than 780,000 individuals evacuated, with more than 42,000 Texans temporarily housed in 692 shelters. First responders rescued 122,331 people in addition to pets (Federal Emergency Management Agency [FEMA], 2017a). The rescue numbers might not include the countless numbers of people and animals rescued by individual residents.

Geography of Harris County, Texas

Harris County is located on the Gulf of Mexico in southeast Texas, and is comprised of 1,777 [mi.sup.2], 4.1% (72.5 [mi.sup.2]) of which are covered by water (U.S. Census Bureau, 2017a). Most of the waterways are in the eastern portion of the county, including Lake Houston and the multiple smaller lakes and bays formed at the mouth of the San Jacinto River. The area also has numerous bayous, or slow-moving coastal rivers or streams. Several small creeks are not actively monitored, while 22 named waterways are actively monitored by the Harris County Flood Control District (HCFCD, 2017). Approximately 25% of Harris County lies within the 100-year flood plain, including low-lying areas near the creeks and bayous, as well as coastal areas (Harris County, 2007).

Buffalo Bayou forms part of Port Houston, a 25-mile complex of diversified public and private land that includes the Houston Ship Channel. In 2016, Port Houston was the largest U.S. port for foreign tonnage and third-largest U.S. port for total foreign cargo value (Port Houston, n.d.). In addition to shipping-related facilities, Harris County is also home to numerous industrial complexes, including a number of petrochemical facilities. The county has 16 current and former federally designated Superfund sites in addition to 9 other sites identified by the Texas Commission on Environmental Quality (TCEQ) as in need of cleanup and remediation (TCEQ, 2013).

Community Overview

Harris County is the third-largest county in the U.S. by population; the county seat is Houston, the fourth-largest city in the U.S., with a 2016 estimated population of 2,303,482 (U.S. Census Bureau, 2016). Table 1 presents a community overview of both Harris County and Houston. Only 1.2% of the county is considered rural (Texas Association of Counties, 2015). Many parts of Texas, and in particular Harris County, have experienced a rapid, ongoing population increase since 2000. From 2010-2016, Houston is estimated to have grown by 9.7%, while Harris County has grown by 12.1% (U.S. Census Bureau, 2016). In the wake of Hurricane Katrina in September 2005, Harris County experienced an influx of displaced people from Louisiana, and many people made Houston their permanent residence. While estimates vary, one report indicated that approximately 250,000 Katrina evacuees came to Houston in 2005, with an estimated 100,000 living there 10 years later (Dart, 2015).

Harris County residents are more mobile than the state or national averages. In 2010, 44% of people living in Harris County had moved within the past 5 years, and 18% had moved within the past year. Among Harris County residents who had moved during the past 5 years, 71% had moved from another house in the same county, 12% from elsewhere in Texas, 12% from another state, and 5.4% had moved from abroad (Harris County, 2007).

Harris County has high income inequality, which continues to increase. In 2015, the ratio of mean income for the top quintile of earners compared with the bottom quintile was 17.3, up from 16.1 in 2010 (U.S. Census Bureau, 2017b). Numerous neighborhoods experience social vulnerability due to high poverty/ low income rates, high unemployment rates, and low high school graduation rates (Figure 2). Another measure of social vulnerability is defined by housing and transportation (Figure 3). According to FEMA, there are only 245,249 flood insurance policies in force in Harris County through the National Flood Insurance Program, meaning that only 15.3% of housing units in Harris County have flood insurance (FEMA, 2017b).

Disaster Response Planning for Vulnerable Populations

Houston's population is diverse, and as such, there are several identifiable vulnerable populations. Specifically, individuals with disabilities, noncitizens, the poor, and older and pediatric populations each present unique challenges in the face of disaster.

People With Disabilities

Due to differing transportation requirements, disabled individuals face difficulties in evacuating, and they also pose potential challenges for rescuers if they choose to stay. For example, the morbidly obese and those in wheelchairs both affect the weight limitations that are in place for boat and helicopter rescue units, which can slow rescue times for others and subject those with decreased mobility to a longer exposure to flood waters and risk of drowning. Following Hurricane Sandy, disabled New Yorkers sued Mayor Bloomberg, citing the city's failure to offer people with disabilities meaningful access to New York's emergency preparedness program.

The Court identified the following failures of New York's plan and specified a need to 1) modify evacuation transportation to meet the needs of the disabled, 2) make shelter provisions for the disabled, 3) canvass buildings and neighborhoods for the disabled who might not be able to notify rescue workers of their locations, 4) notify disabled individuals of shelters with resources for them, 5) educate and encourage disabled people to form their own emergency preparedness plans, and 6) confirm the existence and location of accessible services for disabled people in an emergency (Brooklyn Ctr for the Independence of the Disabled v. Bloomberg, 2013).

Houston's disabled population encountered many of the same issues during and after Harvey. It should be noted that the State of Texas Emergency Assistance Registry maintains a free, voluntary special-assistance registry for residents of the Gulf Coast who might need assistance during a general evacuation (dial 2-1-1), but individuals must register in advance and services vary by community (Texas Department of Public Safety, 2018).

Noncitizens

Noncitizens face unique healthcare challenges, especially in regard to insurance. For instance, Houston's large refugee population has access to refugee medical assistance coverage for 9 months after arrival, and then they are eligible for several different public health insurance programs through the Affordable Care Act (ACA), but many of them require language translation services that are not widely available (Siskin & Lunder, 2016). Despite public insurance options for refugees and those granted asylum, "Dreamers" under the Deferred Action for Childhood Arrivals (DACA) provision is the only legally deferred action group that is ineligible for ACA coverage (Siskin & Lunder, 2016). Therefore, their only option for healthcare is to pay out of pocket or obtain health insurance coverage through private insurance, which is often unaffordable, leaving many DACA recipients uninsured. Even more problematic, several DACA recipients contributed to Harvey rescue efforts, which exposed them to increased risk of injury (Lavandera, Morris, & Kopan, 2017).

Low-Income Housing Recipients

Many impoverished noncitizens and citizens living in Houston avail themselves of low-income housing. Houston, however, has suffered from a shortage of affordable residences in recent years, and...

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