Equity In Region 3 Planning

The purpose of the Equity In Region 3 Planning brief is to provide an example of equity inclusion in a recent planning effort and to describe our path forward.

Equity considerations are critical during a biological incident as there may be a lack of resources for people in underserved communities. Populations with disabilities and others with access and functional needs have specified requirements during a response that are considered in both steady state and operational planning.

Federal Civil Rights laws, Post-Katrina Emergency Management Reform Act (PKEMRA), and the Robert T. Stafford Act prohibit discrimination based on race, gender, color, religion, national origin, English proficiency, or economic status.

The operation should use the “Whole Community Approach” by partnering with community organizations, community leaders, and government officials to provide access to transportation for people in underserved/rural communities and people with access and functional needs, language translators for people with limited English proficiency, and Certified Deaf Interpreters for members of the Deaf community.

Support requirements for individuals with access and functional needs, medical at-risk survivors, hospitals and long-term nursing facilities, and federal and state prison and jail populations would need consideration, including relocation options.

Persons with access and functional needs have additional needs before, during, and after an incident in functional areas, including but not limited to maintaining independence, communication, transportation, safety, support, and health care.

Individuals in need of additional response assistance may include those who have disabilities, those who live in long-term care facilities, the elderly, children, populations from diverse cultures, those with limited English proficiency or non-English speaking, low-income populations, or those who are transportation disadvantaged.

Some people with access and functional needs depend on durable medical equipment (DME). These items include but are not limited to wheelchairs (multiple types), canes, white canes, walkers, shower chairs, toilet chairs, raised toilet seats, oxygen equipment, nebulizer tubing and machines, and speech generating devices.

After the initial impact of an incident, life/safety/wellness checks may need to be conducted. This includes door-to-door checks for those stranded at home on their own but not needing life-saving search and rescue. They may need support such as power, food, medications, supplies, and transportation for health care. Required personnel may include the National Guard, public health workers, Community Emergency Response Teams (CERTs), NGOs (who can realistically commit to assisting in visits/searches), and mail carriers.

Life-safety checks should evaluate needs and obtain essential items, not just medical needs. This would include sustenance, medications, supplies, equipment, batteries, waste disposal, home health, and personal assistant services. These visits may also result in evacuation and transportation if warranted. This transportation might be round-trip, short-term (i.e., to facilitate trips to dialysis, chemotherapy and other infusion therapies facilities, or accessible warming/cooling centers) or for longer stays at a shelter.

Providing actionable and accessible information is key to all populations is critical. To support the delivery of public information the National Association for the Deaf have created a rubric for government agencies to use.

Underserved communities often have difficulty accessing resources for various reasons, from lack of infrastructure to public perception. People in underserved communities often reside in poverty and may not have access to proper transportation or other tools needed to access care. Additionally, some rural communities are difficult for rescuers to access with resources. Region 3 communities align with national Medicaid and CHIP participation rates.

As witnessed during the height of the COVID pandemic, people in the Black, Indigenous, and People of Color (BIPOC) communities are often underserved and do not have access to proper medical care and other resources. According to the CDC, data shows that racial and ethnic minority groups throughout the U.S. experience higher rates of illness and death when compared to their white counterparts, with life expectancies of non-Hispanic/Black Americans being four years lower than that of white Americans. Care is often hindered by misrepresentations from medical professionals about how people in BIPOC communities withstand medical issues (i.e., myths that Black people do not feel pain and ignore their symptoms). These disparities are exacerbated by incidents like the COVID-19 pandemic, and its disproportionate impact among racial and ethnic minority populations is another stark example of these enduring health disparities.

During the response to COVID-19 in 2020–2022, the federal government implemented several testing and vaccination sites across the country. Those located in the heart of highly socially vulnerable communities with a dense population, to reduce the barriers to entry required by having a transportation requirement, allowed for access for underserved populations. Region 3 has developed a tool based on these early requirements that pre-identifies areas of high social vulnerability and high population as illustrated in Figure M-2. Region 3 GIS has developed a ArcGIS map to allow for additional specificity down to the census tract level.

Additionally, members of the LGBTQ+ community face multiple challenges during disaster response. In some cases, people in the LGBTQ+ community are denied services or even blamed for certain incidents due to public perception. These can lead to a restriction in access to resources such as access to medication or, in the instance of transgender, non-binary, and gender-fluid people, a denial of access to shelter services when shelters have been assigned by gender.

HHS states that climate change poses current and increasing threats to human health. As the climate continues to change, the risks to human health grow, exacerbating existing health threats and creating new public health challenges. Some of the climate issues affecting health equity are:

• Heat: More frequent and prolonged heat waves with temperatures reaching over 100 degrees in some places can lead to droughts which weaken or kill crops and can strain food chains and therefore decrease access to healthy food options.
• Air Quality: Prolonged exposure to pollen due to lengthened plant growing seasons, mold varieties due to severe storms, and air pollution caused by increased temperature and frequent wildfires can all negative effects on lung diseases such as asthma. This pre-existing condition/comorbidity, weakens the body’s immune system, making it more susceptible to diseases, and is more prevalent in low-income communities, including communities of color.
• Temperature Changes: Increasing temperatures can cause poor air quality that affects the heart and worsens cardiovascular disease and can exacerbate lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). This comorbidity weakens the body’s immune system, making it more susceptible to diseases, and is more prevalent in low-income communities, including communities of color.
• Flooding: Floods contaminate water with harmful bacteria, viruses, and chemicals that may cause foodborne and waterborne illnesses. Flooding can also create conditions that are preferable for a variety of crop/livestock diseases.
• Extreme Weather: In addition to injuries, illnesses, and deaths, more frequent and extreme weather events, such as tornadoes, can damage mental health because of property loss, loss of loved ones, displacement, and chronic stress. Extreme fluctuations in temperature and precipitation levels create conditions that are preferable for a variety of crop diseases.
• Health Care System Impacts: Extreme climate events can place added stress on hospital and public health systems and limit people's ability to obtain adequate health care during crises.

Additionally, many disadvantaged/underserved communities currently bear the brunt of climate-induced health risks from the events listed above. Listed below are some of the factors that can affect individual ability to prepare for, respond to, and cope with the impacts of climate change on health. These include:

• Living in areas particularly vulnerable to extreme weather (e.g., communities along the coast, urban and rural communities)
• Communities with higher levels of existing health risks when compared to other groups
• Living in low-income communities with limited access to quality healthcare or adequate public transportation §Limited access to information or resources for people with limited English proficiency
• Limited ability to relocate or rebuild after a disaster (e.g., Hurricane Katrina in New Orleans and Super Storm Sandy in New York City)

• AAMC-How we fail black patients in pain: Explores how false notions and hidden biases fuel inadequate treatment of minorities’ pain.
• CDC-Health Equity: Explains how to achieve health equity, a state in which everyone has a fair and just opportunity to attain their highest level of health.
• CDC-Racism and Health: Describes racism’s impact on public health.
• FEMA Announces Initial Initiatives to Advance Equity: Measures identified by the FEMA Equity Enterprise Steering group that can be built upon by field leadership to ensure equitable program delivery.
• HHS-Climate Change and Health Equity: Explains how climate change exacerbates existing health threats and creating new public health challenges.
• Journal of Allergy and Clinical Immunology-Disaster differentially affects underserved communities: Explains how patients with barriers to care, including poverty and language barriers, often live in lower-cost, disaster-prone areas.
• Social Vulnerability Index: A CDC mapping tool to identify which areas within a state are more vulnerable and which vulnerabilities exist.

• Develop and welcome a full Climate and Equity Analyst Team (2 analysts)
• Incorporate this integrated Equity in planning approach to all our incident annexes (HIA, POIA, NRIA)
• Complete a review of Regional programmatic work in the Equity space and identify what we as FEMA have to offer
• Identify additional Equity Resources for our leadership and include them in planning products