The social determinants of health can affect the likelihood a family has met key public health emergency preparedness guidelines.
Race and income are top social determinants of health influencing household preparedness in the case of emergency, according to new research published in JAMA Network Open.
These findings, showing that high-income families are more likely to have the resources in place to prepare for disaster while black families were more likely to have established action plans, have serious implications for public health.
More specifically, they may offer a window into how families with different sociodemographic makeups have fared when preparing for stay at home orders during the novel coronavirus outbreak, although the data was collected before the outbreak.
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Disaster preparedness is a key public health issue pushed to the forefront by the US following the 9/11 attacks in 2001. Leadership at FEMA, the CDC, and in state or local governments have encouraged families to be well-informed during times of crisis, have concrete action plans, and to have the rations in place to sustain the family in times of crisis.
But delivering on those recommendations may be easier said than done for some families, the researchers pointed out, but the data on this matter are mixed.
“High socioeconomic status has been consistently found to be associated with preparedness, but there are conflicting findings regarding other demographic characteristics,” wrote the team, which hailed from Rockefeller College of Public Affairs and Policy at the University at Albany-State University of New York.
“Higher socioeconomic status increases households’ odds of being prepared, and the likelihood of evacuating when required,” the researchers continued. “However, results for racial and ethnic minority households are contradictory: some studies have found that these groups encounter more challenges to being prepared, while others have found that they are more likely to have emergency plans and supplies.”
An analysis of just under 17,000 households across the country confirmed those mixed results. The team looked at the different demographic elements of each of those households, specifically income and race, and assessed whether those households had key material items and action plans in place that would constitute disaster preparedness.
Material resources included an emergency carry-on kit and adequate food and water stockpiles. Action items included alternative communication plans should disaster hit and an agreed-upon family meeting spot. Preparedness was defined as having at least half of these material and action plans in place.
Overall, households were more likely to have the material resources lined up than action plans, with 65 and 41 percent of all households have each, respectively.
Households with heads who earned a high income and were over age 65 were more likely to have the material items gathered than their younger or low-income peers.
“While it is promising that many households met several of the recommended preparedness actions, the items frequently met are not exclusive to disaster preparedness,” the researchers noted. “Having stockpiles available, evacuation vehicles, or financial resources for evacuation may not be the result of explicit disaster preparedness actions but evidence of general consumption patterns.”
However, further analysis showed that these households are less likely to have the action plans in place upon disaster strike. Instead, households with a head who is black were more likely to set in place an alternate plan for communication and a central meeting location, although they were less likely to have material resources in place.
“The shifts in the direction of the association were more evident when considering each individual preparedness item, with differences in these households’ odds of fulfilling resource-based items requiring larger financial investments (eg, electric generators, financial resources evacuation, and evacuation vehicle) vs resource-based items that are specific to emergency preparedness (eg, water stockpiles and carry-on emergency kits),” the team said.
Households with children were likewise less likely to have the material items spelled out in disaster preparedness plans, likely because these items require a larger financial investment.
“These households may have had less disposable income available for resource-based items, but having an alternative communication plan and an alternative meeting location may have been a spillover effect from managing households with children where these may be school requirements,” the researchers posited.
These findings have some key policy implications, namely in public health messaging. With the understanding that different social demographics fulfilled varying parts of disaster preparedness plans, it may be prudent to target different public health outreach based on the cultural needs and norms of each demographic group. This will require further research into the rationale behind these diverging preparedness trends.
Additionally, assistance programs to aid populations — especially those with disabilities who were unlikely to have fulfilled any elements of disaster preparedness — will likewise be essential.
This study could provide some important insights into preparedness for stay at home orders in response to the coronavirus pandemic, although the data was collected in 2017.
Research is showing that various sociodemographics are faring differently during the pandemic, whether because of system limitations leading to higher occurrence of chronic illness and therefore COVID-19 risk, or issues during social distancing.
Notably, families that are low-income or older adults are struggling to obtain the materials they need during a stay at home order.
Source: PatientEngagement HIT