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Caleb Dresser, Satchit Balsari, and Jennifer Leaning

Hurricanes, also referred to as tropical cyclones or typhoons, are powerful storms that originate over warm ocean waters. Throughout history, these storms have had lasting impacts on societies around the world. High winds, rain, storm surges, and floods affect lives, land, and livelihoods and have a variety of effects on human health. The direct health impacts of hurricanes include drowning due to flooding and trauma resulting from storm surges, blown debris, and structural collapse. Systems for detection, forecasting, early warning, and communications can give populations time to make preparations before hurricane landfall. Evacuation, shelter use, and other preparedness efforts have reduced mortality from hurricanes in many parts of Asia and the Americas. Engineered defenses such as sea walls, flood barriers, and raised structures provide added protection in some settings. While effective in the medium term, such approaches are costly and require dedicated resources, and therefore they have not been implemented in many at-risk sites around the world. Indirect health impacts of hurricanes arise from damage to housing, electricity, water, and transportation infrastructure, and from effects on social supports, economies, and healthcare systems. Indirect health impacts can include infectious diseases, carbon monoxide poisoning, trauma sustained during cleanup, mental health effects, exacerbations of chronic disease, and increases in all-cause mortality. Indirect and long-term health consequences are poorly understood because dedicated study of specific impacts has occurred in only a handful of settings, and, given the diverse array of societies and geographies affected by hurricanes, it is unclear how generalizable the results of these studies may be. Policy makers face three interlinked challenges in protecting human health from hurricanes. First, climate change is leading to increased hazards in many locations by altering hurricane dynamics and contributing to sea-level rise. Second, patterns of intensifying coastal settlement and development are expected to increase population exposure. Third, unequal patterns of exposure and impact on specific populations will continue to raise issues of climate and environmental injustice. Situationally appropriate strategies to protect health from future storms will vary widely, as they must both address the locally relevant manifestations of hurricane hazards and adapt to the cultural and economic context of the affected population. In some areas, inexorable ocean encroachment may lead to consideration of managed retreat from high-risk coastlines; in others, the presence of very large coastal urban populations that cannot feasibly evacuate may lead to design and use of vertical shelters for temporary protection during storms. New ideas and programs are urgently needed in many settings to address hazards associated with extreme rainfall, rising seas on floodplains and low-lying islands, landslide risk in areas undergoing rapid deforestation, and structurally unsound housing in some urban settings. Policies to reduce greenhouse gas emissions will help reduce long-term risk from hurricanes and sea-level rise. Without concrete actions to address both hurricane hazards and population vulnerabiliy, the 21st century may be marked by increasingly dangerous hurricanes affecting growing coastal populations that will be left with few viable options for seeking safety.