The Political Determinants of Disaster Risk: Assessing the Unfolding Aftermath of Hurricane Maria for People with Disabilities in Puerto Rico

A physical vulnerability model

A physical vulnerability model focuses on disability from a medical and charitable lens that is focused on individual deficiencies and needs. Two recent reports, from the U.S. Global Change Research Program (USGCRP) and the United Nations Intergovernmental Panel on Climate Change (IPCC), assess climate change impacts and specifically identify persons with disabilities as needing particular attention in preparing for and responding to climate-related extreme weather events such as hurricanes, floods, and droughts. Analysis from the National Council on Disabilities (NCD) about the aftermath of hurricane Katrina serves as another example of this model.

In 2016, the USGCRP published a comprehensive study health study title The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. ⁴ This assessment, subsequently published and shared by both the Environmental Protection Agency and the Center for Disease Control, focuses on the health risks from climate change on population groups in the United States. The report identifies people with disabilities as being at an increased risk to extreme weather events and coastal flooding because of their “specific access and functional needs,” ⁵ dependence on caregivers and others for assistance, and potential reliance on medical equipment that could be damaged or inoperable during power outages. ⁶ People with disabilities may also have difficulty following or accessing evacuation orders or be unable to understand warnings or communicate their needs. Hence, although social, political, and economic factors are acknowledged as furthering vulnerability to disaster risk, the most pressing concerns in the USGCRP report in terms of persons with disabilities are related to communication, transportation, and evacuation before during and after extreme weather events or other climate-related disasters (fire, flooding, drought, or heat emergencies).

The IPCC presents a similar model of physical vulnerability but begins to address the sociopolitical drivers of climate change risk. ⁷ The report frames these risks in terms of vulnerability versus capacity, including the capacity to anticipate risk, respond to risk, and recover and change after an experienced hazard. ⁸ However, this capacity is driven by more than just individual physical vulnerability. In the context of recovery, for example, “capacity is driven by numerous factors, including mental and physical ability to recover, financial and environmental viability, and political will” (p. 75).

In the NCD report on the aftermath of hurricanes Katrina and Rita, people with disabilities are identified as a high-risk group for a variety of reasons, such as the inability to receive or respond to early alert systems, and contending with physical structures that are not responsive to their needs. ⁹ Both the NCD and IPCC reports begin to identify social causes of these risks, including lack of adequate support and transportation even in good times, as well as lack of financial and social support. However, in most of the discourse on climate change risk and disability, the focus remains on preparation and response around individual needs, including preparation for evacuation, communication, and accessibility for individuals with a variety of physical and mental impairments. Less attention has been paid to the causes of disadvantages within these already vulnerable groups and methods and mechanisms to address these before, during, and after disasters.

Sociopolitical models

Over the past 30 years, disability rights scholars and advocates have advanced a social model of disability that views the participation barriers faced by people with disabilities as stemming not from their individual impairments but from social and environmental barriers. ¹⁰ Priestley and Hemingway review the literature on disaster recovery and argue for the incorporation of a social model of disability approach for understanding the disaster risk experienced by people with disabilities. ¹¹ Unlike a physical vulnerability model, the social model of disability is more in line with the ICF definition of disability, in which it emphasizes that the disaster risk experienced by a person with disabilities stems primarily from the societal shortcomings in the predisaster societies. ¹² In this light, high rates of poverty and low employment rates of people with disabilities are viewed as significant impediments to disaster resilience, and are themselves attributable to societal phenomena such as discrimination in the workplace, inadequate accommodations, and insufficient safety net programs.

The pressure and release model of disaster risk similarly seeks to highlight the underlying societal determinants of disaster risk. ¹³ This perspective views disaster risk as a product of both physical hazards, including the medical impairment, and social vulnerability caused by socioeconomic factors. Social vulnerability to disaster risk, moreover, is understood as progressing from root causes that include economic and political systems, which creates social inequalities along familiar lines of gender, class, race, immigration status, and ability and, in turn, “determine unequal access to opportunities and unequal exposure to hazards.” ¹⁴

An environmental justice model

Like the sociopolitical model, an EJ model also acknowledges that an understanding of disaster risk cannot neglect the societal determinants of risk, including historic inequities in the distribution of environmental hazards, systemic oppression, and the disproportionate burden of environmental risk experienced in racial and ethnic minority communities. The EJ framework challenges the notion that “natural disasters” are intractable phenomena that cannot be prevented or mitigated. ¹⁵ Drawing attention to their man-made attributes, this perspective identifies how disasters are to varying degrees socially and politically produced. ¹⁶

Understanding disaster risk through an EJ lens further identifies that those most at risk for bearing a disproportionate share of impacts from climate change-related impacts, (i.e., increased heat, rising sea levels, and extreme weather events) are persons living in poverty, racial minorities, and other marginalized populations, such as people with disabilities. ¹⁷ An EJ framework addresses unequal protection from environmental risks among vulnerable groups within political and ethical contexts. ¹⁸ In the case of extreme weather events such as hurricanes, mounting evidence suggests that environmental injustice provides an explanation for the impact of such events. ¹⁹ An EJ framework further highlights how disaster planning fails to consult with stakeholder groups, including people with disabilities. ²⁰ Inequities related to EJ also impact resources available to respond to disasters, as well as rates of and responses to displacement. ²¹

Environmental colonialism

This history of disaster vulnerability in Puerto Rico cannot be understood outside of >500 years of colonialism, which has resulted in significant resource depletion and under development across all basic services, including access to water, infrastructure, food and delivery systems, housing, and waste management systems. ²² Puerto Rico has a history of experience with environmental injustice resulting from colonial and postcolonial development. ²³ Development and privatization of coasts and beaches, military contamination with limited clean up (most notably on the island of Vieques), and planned and sanctioned extraction and exploitation of natural resources have been linked to advocacy efforts that are anticolonial and emancipatory. ²⁴ In addition to the overall vulnerability of the island as a whole, there is also uneven distribution of environmental hazards and pollutants across the island. ²⁵

There are two mechanisms through which environmental degradation influences the disaster risk experienced by people living with disabilities in Puerto Rico. The first concerns the history of environmental injustice as a determinant of poor health. For example, in Vieques, a former U.S. military test site, women of childbearing age were found to have sufficient mercury to cause neurological damage in their unborn babies. ²⁶ In comparison with the rest of the island, those living in Vieques also are shown to have an increased risk for hypertension, asthma, diabetes, heart disease, and some cancers. ²⁷ Improper disposal of toxic waste has further resulted in the identification of dangerous pollutants in the groundwater largely attributable to the 18 Superfund sites in Puerto Rico. ²⁸ Processing of coal and unregulated disposal of coal ash are additional sources of pollution shown to affect the health of Puerto Rican residents. ²⁹ Insofar as the physical and mental health of a person affects the ability to adapt to a disaster (e.g., the physical vulnerability model), environmental degradation can be understood as a significant cause of vulnerability.

A second mechanism that influences the disaster risk of people with disabilities is the environmental degradation that reduces the protection from storms that the natural ecosystem would have otherwise provided and thereby increases vulnerability to extreme weather events. Dietrich and colleagues note that the unregulated construction along the coast damaged the ecosystems that could have provided greater protection from the storm. ³⁰ Given that people with disabilities are already disproportionately impacted by extreme weather events, the reduced protection only enhances the risk. Recent media reports suggest that many individuals with chronic health issues were unable to access needed health services and clean water due to the lack of electricity and poor quality of the infrastructure in Puerto Rico. ³¹ For example, it is estimated that 6000 Puerto Ricans with kidney failure depend on regular dialysis treatment. Yet, many of the territory's dialysis centers were closed after Hurricane Maria. ³² Local news organizations have further highlighted the extreme vulnerability experienced by people with disabilities during the storm. A quadriplegic man who relies on a ventilator and a young boy with brittle bone disease who uses a machine to help him breath are both shown to be fighting for their lives without access to electricity and the personal funds needed to adapt to the crisis. ³³ The severe impact of the storm can thus be understood as a consequence of unregulated construction that is part of a larger arc of colonial oppression experienced by the people of Puerto Rico.

The neglected welfare state in Puerto Rico

In comparison with other advanced economic countries, the United States is generally viewed as providing fewer protections against major social risks, such as unemployment, sickness, and old age. ³⁴ However, looking within the federal and territorial United States, one finds wide variation with some states providing more generous social assistance benefits (Temporary Assistance for Needy Families) and others greater access to medical assistance (Medicaid) for the poor. ³⁵ Yet, even when taking into account the wide discrepancies in risk protection, the meager basket of social welfare programs available to those in Puerto Rico stands out, particularly for those with disabilities. The lack of adequate social assistance and access to medical care, in particular, decreases the ability of people with disabilities to cope with and recover from disasters. The bare bones social welfare system in Puerto Rico can also be understood as a consequence of the island's colonial status. Unlike other U.S. states, Puerto Ricans have no direct voting representation in the U.S. Congress. This structural disadvantage reduces the power and influence over the policymaking processes relevant to those with disabilities on the island.

The Supplemental Security Income (SSI) is arguably the single most important safety net program in the United States. SSI provides a guaranteed income to those of low means who are aged 65 or older or who are blind or disabled adults and children. As of 2015, 8.3 million people in the United States received SSI payments, which average about $541 a month. ³⁶ SSI is an essential safety net program for those with disabilities, which comprise >85% of SSI recipients. ³⁷ Yet, Puerto Ricans are unable to access SSI benefits. SSI was created in 1971 and expanded upon the previous aged, blind, and disabled (ABD) program. But the SSI program was not made available in the U.S. territories, including Puerto Rico. As a result, Puerto Rico still provides the original ABD program, which has considerably less generous benefits ($75 a month vs. $541) than the modern SSI safety net for those with disabilities. ³⁸ Congress, recognizing this wide discrepancy in benefit levels, has many times considered expanding the SSI program to the territories, but expansion has, nevertheless, failed to pass both chambers of Congress. ³⁹ This policy leaves those with disabilities extremely economically vulnerable and thus less able to cope with and recover from disasters. This is especially stark when one considers that Puerto Rico has the highest rate of disabled adults living in poverty in the United States. ⁴⁰

In addition to the lack of SSI, Puerto Rico also receives a lower share of Medicaid funding from the federal government than other U.S. states. Nearly half of all Puerto Ricans receive health insurance through the Medicaid program. ⁴¹ Yet, unlike the 50 states and the District of Columbia, federal funding for Puerto Rico's Medicaid program is capped at an annual amount rather than through cost sharing with the federal government like the other U.S. states. ⁴² This means that if the island requires additional funds for low-income healthcare programs, it must use its own territorial funds, which is itself hampered by the general fiscal crisis on the island and the imposition of wide ranging austerity measures. ⁴³ This structural inequity has created an enormous fiscal strain on the healthcare system in Puerto Rico and limits its ability to provide much needed care after the storm. ⁴⁴