Hurricanes and the Environmental Justice Island: Irma and Maria in Puerto Rico

Hurricane impact

In September 2017, Hurricane Maria, following upon the destruction of Hurricane Irma, devastated Puerto Rico, directly killing 64 people and leading to nearly 990 excess deaths, for a total of 1054 attributable deaths, ^{1 , 2} causing an estimated $90 billion in damage, ³ destroying virtually the entire electric grid and 80% of the agricultural sector, making thousands homeless, driving over 215,000 to leave for the mainland, ^{4 , 5} and leaving damage from which it will take many years to recover.

Official sources downplayed the mortality from the hurricanes. The 990 excess deaths, in addition to the 64 direct ones, were determined by a common demographic technique that examines similar time periods in past years. Sepsis, pneumonia, emphysema, other breathing disorders, diabetes, and Alzheimer's and Parkinson's were the main causes of excess deaths. Official agencies initially called these “natural,” but in line with our earlier discussion of “natural disasters,” we find these to be anything but natural. Eventually the National Center for Health Statistics agreed that these excesses were largely attributable to the hurricanes. ⁶

Weak federal disaster response, combined with the current administration's criticism of Puerto Rico

Most notable in the federal response was a combination of slowness to act, and statements by Donald Trump and others that placed the blame on the island for its economic precariousness. That was theatrically cemented by Donald Trump throwing rolls of paper towels to the audience in San Juan, a very insulting action. The limited amount of federal disaster aid passed on October 24, 2017, $4.9 billion, was simply not enough, and in fact consists of loans rather than outright grants in aid. Recognizing the inadequacy of that aid for an island in such dramatic debt, Senators Elizabeth Warren and Bernie Sanders introduced a bill in November to provide $62 billion to the governments of Puerto Rico and the U.S. Virgin Islands. ⁷

Environmental injustice as central to hurricane effects

With so many forms of environmental injustice over more than a century already affecting the island before Irma and Maria, the dual attack of these hurricanes had an especially harsh impact. The devastating consequences of these hurricanes are affecting everyone, but particularly catastrophic for communities that have already been made vulnerable by negative social determinants of health that were worsened by colonial history and underdevelopment. ⁸ To situate our disaster response, we describe our team's environmental health work in Puerto Rico, and then give a theoretical/conceptual framework for this article, which includes a brief historical context that led to the island's special vulnerability in 2017. In Section II, we discuss how our PROTECT and CRECE teams responded by providing general disaster response. Finally, we conclude by posing “visionary rebuilding,” a comprehensive model of what a compassionate federal response would have looked like.

Our work in Puerto Rico as environmental health researchers

As noted in the opening, our team consists of two major environmental health research centers: PROTECT, the Superfund Research Program, and CRECE, the Children's Environmental Health Center. The centers also take part in the NIH-wide Environmental Influences on Children's Health Outcomes (ECHO) national super-cohort, and are supplemented by NIEHS to contribute to the Centers for Disease Central and Prevention ZIP super-cohort. We are located at two campuses of the University of Puerto Rico (School of Public Health in the Medical Sciences Campus in San Juan and the Mayaguez Campus), Northeastern University, University of Michigan, University of Georgia, and West Virginia University. PROTECT, with its cohort of over 1440 women, studies the effects of exposures to phthalates and trichloroethylene, which are exceptionally high in Puerto Rico, on preterm birth. CRECE, with its cohort of nearly 200 children, examines the effects of exposure to air pollution, phenol, and paraben, and other chemicals on fetal and child development. Our team is strongly embedded in four Federally Qualified Health Centers (FQHCs) in Ciales, Morovis, Camuy, and Lares and has strong relationships with Manati Medical Center, Delta Ob/Gyn clinic, Pavia Arecibo Hospital, medical and other professional associations (i.e., Association of Primary Health Care of Puerto Rico), non-for-profit health organizations such as March of Dimes, and environmental organizations such as COTICAM (El Comité Timón de Calidad Ambiental de Puerto Rico/Puerto Rico Environmental Quality Committee) and Ciudadanos del Karso (Citizens of the Karst).

Our theoretical and conceptual framework

We approach our work through the lens of EJ and social determinants of health, and are proud to be part of the NIEHS family with its longstanding contribution to EJ organizations and research. While much of the EJ literature, as well as EPA designations, refer to “EJ communities” based on their race and/or income levels (a metric that is often criticized), Puerto Rico is an entire EJ island, based on not only its racial/ethnic composition and poor income levels, but also on its long history of annexation, colonial exploitation, high number of Superfund and other hazardous waste sites, the Vieques naval bombardment site, unethical contraceptive testing in the 1960s, massive sterilization during the first half of the twentieth century, and the Jones Act which requires that all goods transported by sea between U.S. ports be transported by U.S.-owned and -operated ships. Before the strike of Hurricanes Irma and Maria, Puerto Rico had a Gini coefficient (a comparable indicator between countries on economic inequality or the income gap between households) that ranked among the 10 worst in the world. ⁹ This socioeconomic inequality has been increasing since the last decade and it is feared that the onslaught of the hurricanes has exacerbated this inequality, since the hurricanes hit the most vulnerable communities with more force.

Also central to our framework is the environmental sociology approach that focuses on the centrality of human causes of disasters and the human-caused exacerbations of climatic conditions, combined with the failures of public agencies to rescue and rebuild, with particular attention to the racial bias in response. ¹⁰ We are also influenced by the notion of “social autopsy,” developed by Eric Klinenberg ¹¹ in his groundbreaking book on the Chicago heat wave deaths of 1995 to show the impact of multiple social factors in excess death. Klinenberg wrote in the New York Times ¹² about parallels between Chicago and Puerto Rico. In particular, he notes the failure of Chicago public health officials to quickly respond and thus save lives, much as the federal slowness in Maria response led to preventable deaths. Klinenberg also notes the denial of the mortality figures: conservative mayor Daley's denial of the disaster's effects on excess death mirrored that of Donald Trump's similar denial in his belated visit.

General disaster relief

Since Hurricanes Irma and Maria hit Puerto Rico in September 2017, the PROTECT, CRECE, ZIP, and ECHO Centers have been very active in the recovery; collaborating with various organizations to ensure the safety and welfare of team members, study participants, community health center partners, and members of the surrounding communities. As previously mentioned, the study teams have multiple research partnerships with whom we have provided support to obtain urgent and necessary supplies and medicine for the communities they serve. The PROTECT Community Engagement Core, CRECE Community Outreach and Translation Core, and nurses on our team held discussions early on with collaborators at these FQHCs as well as with study participants, identifying needs that were of highest priority in the communities of our research programs. They included: drinking water, mosquito repellent, mosquito nets, hand sanitizer, insulin, nebulizers, oxygen, disposable diapers, baby wipes, and baby food. PROTECT/CRECE and ZIP personnel established collaboration with various organizations to provide significant quantities of these materials.

In some cases, organizations that our team has long-standing relationships with, like the SePARE organization of Vega Baja (for expectant mothers), contacted our personnel to request various items for the expecting parents they serve. The entire PROTECT/CRECE and ZIP team on the ground in Puerto Rico collaborated with MPH students at the UPR School of Public Health to organize, pack, and distribute donated goods and materials; working tirelessly within our own difficult circumstances. Donated materials arrived from multiple sources, including Northeastern University, University of Georgia, University of Rochester (UOR), and nonprofit organizations, such as Aquamundo and Kumpimayo Foundations, and the Jesuit Corporation of San Ignacio de Loyola in Puerto Rico.

We prepared over 500 packages and are still delivering them to our participants and their children. These packages were prepared with the donations received from the aforementioned sources, as well as individual donations thanks to the request of our team. The packages consist of needs identified by our Community Engagement Core, nursing staff, in addition to items that were considered essential in the current context. This effort has been on the ground constantly since the first week after the Hurricane Maria's passage to the present.

Given the need for safe drinking water and healthcare needs, we have been supported by the Center for Research in Global Health at the UOR. With their grand effort of soliciting these resources and transporting them to Puerto Rico, our collaborative teams have delivered over 40 water purification systems delivered to all the FQHCs who collaborate with our team, as well as clinics in Vieques, Culebra, and Loiza, community-based organizations, and individual families in surrounding communities. UOR also coordinated the donation of 14 tents and solar generators to organize mobile health clinics for rural and extremely vulnerable communities that do not have transportation to access health services. In coordination with the UPR Research Centers for Minority Institutions we are providing education and support in getting water filters for other communities in Puerto Rico that are affected by Superfund sites.

Warning people to not drink contaminated water

PROTECT and CRECE have developed educational materials related to food and water consumption during this emergency, also addressing other public health issues relevant in the recovery phase, such as preventing injuries and appropriate use of generators. In particular, officials at the national office of NIEHSs Superfund Research Program have contacted team leaders with requests to advise communities near the Superfund Sites. The area surrounding Dorado is of greatest concern due to reports of contaminated drinking water in this area. PROTECT and CRECE student trainees on the ground in Puerto Rico organized a group of student volunteers to support communities impacted by the Superfund sites and educate them about the potential health impacts of water use posthurricanes.

Research on contamination outcomes

Many water resources became contaminated with debris, fuels, pesticides, coliforms, sediments, among many other contaminants. The PROTECT team from the fate and transport project at the University of Puerto Rico-Mayaguez embarked on a mission to assess preliminary impacts of water sources in Puerto Rico after the passage of Hurricane Maria. Qualitative observations were annotated on the water sources and use. Water samples were also collected from ground water, surface water, and tap water sources and analyzed for water quality, targeted contaminants, as well as overall toxicity of water from mixture of contaminants. Initial observations indicate that people were using water for multiple purposes from unsafe sources, particularly many distress communities. Water was either untreated or overchlorinated, which create other potential harmful effects. Initial measurements of standard water quality indicated high turbidity, bacteria counts, and concentrations of chlorinated volatile organic contaminants, relative to conditions before the hurricane. Preliminary results indicate that people were being exposed to contaminated water, and that this is to continue for an extended period of time.

Ability to still recruit participants shortly after the hurricanes

Despite complications of hurricanes, Irma and Maria, recruitment and evaluations of all aforementioned projects have continued since early October. We have continued in spite of great challenges that are slowly and inconsistently improving. Puerto Rico, posthurricanes, is another context with great inequities that were previously present and have been exacerbated by this disaster.

The research team at the sites in Puerto Rico has worked diligently with long-time collaborators at the FQHCs and other Community Organizations; with the logistic and moral support of our team at the other institutions that make up PROTECT, CRECE, and ZIP we were able to reestablish contact with participants and continue recruitment to nearly pre-Irma numbers. Key to success was the support provided to participants and collaborators, throughout these months after the disaster. The team provided first-hand material necessities and was present to support relief efforts during a time of great disarray and confusion. These are the bonds that tie and make for long-lasting collaborations that are bidirectional, maintaining the trust that our projects' team have established with participants, recruitment sites, and community collaborators. Some of the best evidence for those connections is that since Hurricanes Irma and Maria, our study team has recruited 76 new participants in PROTECT (n = 1481), 88 new participants in CRECE (n = 248), and 101 new participants in ZIP (n = 376).

FEMA

FEMA would take the opportunity to thoroughly restructure its bureaucracy to facilitate quicker response. It would develop a more effective emergency preparedness for the future, with extensive input from residents and local environmental organizations, and provide training for Puerto Rican agencies and organizations to take many more preventive measures, rather than just dealing with disasters after the fact.

HUD

HUD would rapidly rebuild housing, constructing homes that are hurricane proof, environmentally friendly, chemically safe, and affordable, while training local residents in building skills for future use, in conjunction with local unions and training programs. It would bring in the Green Building Council to consult on environmentally safe building products. In light of the existing mortgage foreclosure rate that is far higher than the mainland, the high amount of underwater mortgages, and the increase in foreclosure vulnerability posthurricane, HUD would prevent foreclosures and would provide a substantial amount of funds to assist homeowners who have been behind on payments due to the hurricane and their loss of income.

Department of Agriculture

The Department of Agriculture would help with rapid provision of seeds, seedlings, sapling, organic fertilizer, job training for agricultural workers, creation of more weather-proof greenhouses, and other facilities. Agricultural reformers have already pushed for “agroecology” approaches utilizing traditional knowledge combined with modern technology, to use Puerto Rico's fertile land to grow locally sourced food, rather than import 80% of its food. Already the agroecology group Boricuá Organization for Ecological Agriculture has been delivering seeds to farmers with such goals in mind. ¹⁴

Department of Labor

The Department of Labor could create a massive job training program to get people back to work and prepare unemployed and underemployed workers for a large range of jobs. Some of this could be in conjunction with EPAs Groundworks program (discussed below).

Health and Human Services

HHS could aid in rapid building of clinics, similar to military zone clinics, to provide continuity of care. The CDC could add Puerto Rico to the biomonitoring portion of the National Health and Nutrition Examination Survey (NHANES) that provides body burden data on a representative national sample, that is, often used as a benchmark for understanding the extent of contamination in people's bodies.

Environmental Protection Agency

The ideal approach would be rapid testing of sludge for contaminants and providing alternate water sources when necessary. The disaster could be an occasion for massive increase in cleanups of Superfund and other hazardous waste sites, as well as large increases in regular monitoring of current and abandoned industrial sites that are potential sources of contamination. Funds could also be provided for research on in situ remediation processes. As with past EPA funding through its Environmental Justice Program, Tribal Program, CARE, Healthy Communities Program, and Environmental Education Program, funding could be made available that would support local environmental and related organizations to do much of this work, while building capacity of those organizations and their surrounding communities. EPA would add major funding for expanding its Groundworks program that trains unemployed and underemployed people in environmental cleanup.

Department of Energy

The Department of Energy would work on rapid development of decentralized grid structures for more secure power supply and increase renewable energy sources. In a place where 98% of energy comes from fossil fuels, sustainable energy is critical. The organization, Resilient Power Puerto Rico, has been distributing solar-powered generators to some of the most remote parts of the island, with the goal of a “full-blown, permanent solar revolution designed and controlled by Puerto Ricans themselves.” ¹⁵ Massive funding could support their efforts, while encouraging and supporting many other alternative energy sources, such as wind power.

Department of Education

The Department of Education would develop curriculum for students at all levels about climate change-induced weather disasters and the mitigation and adaptation necessary. Colleges and universities would be given funds to develop new undergraduate and graduate programs in areas such as environmental engineering, landscape architecture, sustainability science, occupational/industrial hygiene and environmental epidemiology and toxicology, to help analyze the hurricane effects and to prepare for future occurrences.

Department of Defense

Knowing that hurricanes, tornadoes, and floods spread existing contamination, and seeking to right a long-standing wrong, the Department of Defense would begin a thorough cleanup of Vieques, ensuring safe removal of contamination, and making this a model of military site cleanups. It would conduct health studies and exposure studies to learn the true extent of Vieques' contamination, and provide health monitoring and care for affected people.

Congress

Congress would repeal the Jones Act, grant Congressional representation to Puerto Rico along the same lines as a state, provide long-term debt relief, and establish a special program of long-term development funds for business of all sizes. Congress would make no more penalties on Puerto Rico, such as the export tax in the 2017 tax bill.