Long-term effects of disasters: an ongoing threat to public health
2025 was a costly extreme weather year. January kicked off with the Palisades and Eaton wildfires, which caused an estimated 31 deaths in Los Angeles County and billions of dollars in economic damages. Texas experienced some of its worst flooding in decades in July, resulting in the deaths of more than 100 people, many of whom were children staying at an overnight summer camp. In October, flooding in Alaska led to at least one person’s death and the displacement of more than 1,500 others as whole villages were inundated from the remnants of Typhoon Halong.
However, even though 2025 is over, the effects of these disasters are not.
There is considerable interest from both sides of the political aisle in reforming FEMA. The reform conversation has largely focused on where responsibility for disaster response should sit – with the federal government, or with the states? But from a public health perspective, we should be talking about something even more important: our hyperfocus on short-term disaster effects that causes us to neglect the longer-term needs of disaster-affected survivors and communities.
Disasters create ripple effects on health that can extend into the months, years, and even decades after fires are put out, winds die down, and floodwaters recede. While these effects are hard to precisely measure, they are undeniably potent. Official data, for instance, indicate that hurricanes and other tropical cyclones cause an average of 24 deaths per storm. That number is too high – every death is a tragedy – but it pales in comparison to the 7,000 – 11,000 deaths that studies estimate actually come from storms’ longer-term consequences.
With extreme weather events becoming ever-more common, there is a national and moral imperative to rethink not just who responds to disasters, but for how long and to what end. This issue brief presents an overview of the ways in which disasters affect public health and well-being in the long term, as well as suggestions for disaster governance reform viewed through a public health lens.
Disasters impose sustained effects on physical and mental health
The evidence is clear: disasters cause suffering that persists long after national attention turns elsewhere. The same study cited above also found that the adverse health effects of hurricanes and other tropical cyclones were most pronounced in infants under the age of one almost two years after a given storm. If you do the math, this means the storms continued to increase the infants’ risk of death despite them not having even been conceived at landfall, suggesting that the true damage from hurricanes (and likely other natural hazards) comes from the stress they put on families and communities. This doesn’t just apply to infants, but other vulnerable groups, such as older adults. For example, older adults who lived through Superstorm Sandy had higher risks of cardiovascular disease and all-cause mortality five years after the storm had passed.
Why do exposures to extreme weather events have these long-term health impacts? More research is needed, but so far at least three likely pathways have been identified.
Disasters can expose survivors to hazardous conditions that increase their risk of chronic illnesses. For example, hazardous particles from wildfire smoke can settle into people’s lungs and negatively affect lung function for years, which is especially dangerous when individuals have pre-existing respiratory conditions like asthma or COPD. This decreased lung function has been shown to last at least two years after the wildfire for some individuals. Individuals living in high-risk areas where wildfires frequently occur may never get the chance to fully recover.
The physical damages from a disaster to the built and natural environments that surround survivors can become hazardous to human health. For instance, when disasters knock out power during a heatwave or cold snap, individuals can be exposed to dangerous temperature extremes. Heatwaves alone can increase the risk of chronic kidney disease, and can even make the body age faster, while those who have experienced heat illness and heat stroke are at risk of organ damage, including damage to the brain. Other disasters can spread harmful toxins. Floodwaters often contain hazardous waste from runoff and sewage system overflow, increasing the risk of illness in the months following the flood. Homes and businesses that flooded are also at risk of growing toxic mold, especially in warm and humid environments (like the hurricane-prone Southeast United States). What is especially challenging about mold is that it can be difficult to detect and can persist for years unless treated, leading to families living in toxic environments without ever knowing it. Exposure to mold increases the risk for various diseases and health problems, including asthma attacks and infections, and are particularly concerning for sensitive individuals, like those who are immunocompromised. Similarly, when wildfires burn houses, vehicles, and other infrastructure, this releases toxic ash and other debris into the air for hundreds of miles, contaminating the lands and waters of communities for years. Airborne toxins released during wildfires can settle on indoor surfaces and in heating, ventilation, and air conditioning systems. These harmful exposures can contribute to serious long-term health conditions like cardiovascular and respiratory diseases and cancer.
Living through a disaster and then navigating a byzantine recovery landscape can contribute to chronic stress that takes a toll on mental and physical health. Several studies suggest that exposure to disasters increases the risk of mental health challenges like depression, anxiety, and post-traumatic stress, affects people of all age groups, including children, and can last for years. One study found that survivors of Hurricane Katrina were still dealing with post-traumatic stress symptoms twelve years later. Poor mental health can lead to poor physical health in the long term (such as an increased risk of chronic diseases and premature death), as people deal with the toll chronic stress can have on the body. This stress can also increase risk of cognitive decline and dementia, and considering that chronic stress is common among disaster survivors, it’s no wonder that wildfires, hurricanes, and heat waves have all been found to be associated with cognitive decline and dementia too.
Disasters disrupt healthcare delivery and operations
Access to healthcare, including going to doctor’s appointments, getting prescription refills, and receiving specialty treatment (like chemotherapy or dialysis), is critical for keeping people healthy and maintaining quality of life. Unfortunately, disasters often displace people from their homes, communities, and from the healthcare services they depend on. For many people, displacement after a disaster is permanent. These people must then navigate entirely new environments, find new healthcare providers, and become re-established with the medical system all the while securing a place to live, meeting their other needs, and dealing with the stress of losing their life as they knew it. Medical care often falls to the wayside in the chaos of disaster recovery, leaving survivors vulnerable to worsening health conditions over time.
Disasters often displace people from their homes, communities, and from the healthcare services they depend on. Take for instance, these flooded homes adjacent to the Red River in North Dakota, via Wikimedia Commons
Even if displacement is only temporary, when residents return to their homes and communities they may find that their healthcare options no longer exist, as disasters can disrupt or destroy entire healthcare systems. Damaged clinics and hospitals may be temporarily or permanently shut down, creating healthcare “deserts” that lack sufficient healthcare infrastructure to treat people. Rural areas are particularly vulnerable to these disruptions, as they already face limited budgets and fewer resources – leaving less “cushion” to absorb disaster impacts. Disasters can also disrupt supply chains, impacting the quality of medical care for entire regions. This occurred when Hurricane Helene flooded one of the major medical IV suppliers in the United States, leading to IV shortages at healthcare facilities that persisted even months after the hurricane.
Disasters drive housing insecurity
Having an affordable and stable place to live is one of the most important social determinants of health. Access to housing that is safe, clean, and sheltered from the elements can affect everything from risk of hospitalization, the number of medications someone takes, mortality, and overall quality of life. Unfortunately, housing is also one of the most vulnerable and deeply personal domains to be affected by disasters. Many are forced to flee from fires, floods, high winds, or other dangerous conditions presented by natural hazards, and people can be displaced from their homes for months or years at a time – or even permanently. This displacement is associated with numerous mental and physical health issues, including risk of death. And as insurance premiums continue to increase or insurance companies withdraw from states altogether because of the increasing frequency and intensity of disasters, homeowners may be unable to afford property insurance altogether in the near future, further reducing the chances of ever being able to return home.
Even for those who could return home, the cost of recovery may be too prohibitive. For wildfire survivors, many insurance companies do not include smoke damage testing and remediation costs under their policies, and even some plans that cover smoke damage may refuse to remediate, which can cost thousands of dollars out-of-pocket. For flood survivors, mold can be difficult to detect and may require the services of a professional cleaner, which can be prohibitively expensive. Even if someone has flood insurance through the National Flood Insurance Program (NFIP), mold remediation is not typically covered, creating barriers for people trying to make their homes healthy to live in again. If someone’s insurance plan covers mold remediation, many plans make exceptions if action to prevent mold growth is not taken in the immediate days after the flood, which can pose a problem for those blocked from returning under emergency orders. These policy barriers result in survivors having to either relocate away from their homes and communities, or continue to live in unsafe conditions that can chronically affect their health.
Opportunities for Action
Our nation needs policies that understand and address the true public health effects of disasters over the months and years after the disaster is technically “over”. Opportunities for action include:
Update how health impacts are measured. Tracking of health impacts from disasters is generally limited to the direct impacts of disasters (i.e., injuries and deaths, like drownings from floods and smoke asphyxiation from wildfires). Few official data sources capture the indirect effects of disasters that take more time to manifest. Impact assessments should include epidemiological methodology that can capture these indirect effects, such as excess death calculations, to begin to truly understand and quantify the extent of disasters on peoples’ health.
Reinstate disrupted grants and other funding for health research relevant to disasters. Recent budget cuts, terminated grants, and increased hostility towards public health threaten our ability to understand – and therefore effectively address – the health impacts of disasters. Policymakers should reinstate such funding, and look for opportunities to prioritize research related to the longer-term and often overlooked impacts.
Invest in the physical resilience of healthcare infrastructure. Investments in the physical resilience of healthcare infrastructure (such as the installation of hurricane-proof glass, flood barriers, air filtration systems, etc.) strengthens disaster resilience and reduces the overall health impacts of disasters in the short and long terms. Studies show that these investments pay off in the long run, with every dollar dedicated to resilience yielding multiple dollars in avoided societal costs – and providing strong justification for state and federal resources to catalyze and support such investments.
Strengthen medical supply chains. The Strategic National Stockpile (SNS) provides a critical reserve of essential medical equipment, buffering health supply chains against disruptions from events like disasters. Congress should act to increase the SNS, particularly in locations that could provide rapid response of medical provisions to disaster-affected areas, and ensure that key medical suppliers are adequately prepared for future disasters.
Help with housing. One of the most efficient and effective means of disaster recovery is ensuring survivors have access to stable, safe, and healthy housing. One way to achieve this is by creating a centralized agency or entity (such as the Joint County-State Housing Task Force established in the wake of the 2025 Los Angeles wildfires) to handle housing-specific needs from disasters and for those displaced. At the federal level, this could look like integration of housing-relevant capabilities and authorities across agencies such as the Federal Emergency Management Administration (FEMA, particularly FEMA’s National Flood Insurance Program), the Department of Housing and Urban Development, and the Small Business Administration. Other options could include streamlining access to housing relief funds (such as by creating a consolidated hub for applications for assistance), creating pre-approved resilient home designs that can be fast-tracked for permitting and construction, and establishing well-defined responsibilities for remediation efforts, including cleaning of contaminated lands and homes. (Note: many of these issues are addressed in the proposed FEMA Act of 2025.)
Support on-the-ground efforts. Federal and state agencies can support nonprofit rapid response teams (such as SBP) equipped with cleaning and rebuilding supplies. These teams can be rapidly organized and deployed to mitigate physical damage from disasters, making it faster and safer for survivors to return home. As these teams often include members of affected communities, they often have a deep understanding of what the needs of survivors truly are, enabling more efficient use of resources.
Conclusion
Disaster survivors want reform – but drastically reducing FEMA’s workforce without investing in any new disaster-response capabilities isn’t the type of reform they want. Rather, survivors are looking for leaders to institute more holistic disaster-governance strategies that include efforts to minimize long-term negative impacts, instead of the drop-in/rapid withdrawal pattern historically demonstrated. If we are to make (and keep) Americans healthy, then it’s time to make sure considerations for the long-term health needs of disaster survivors are being met, even after the winds, floods, and fires are gone.
Hurricanes cause around 24 deaths per storm – but the longer-term consequences kill thousands more. With extreme weather events becoming ever-more common, there is a national and moral imperative to rethink not just who responds to disasters, but for how long and to what end.
This year’s Red Sky Summit was an opportunity to further consider what the role of fire tech can and should be – and how public policy can support its development, scaling, and application.
Promising examples of progress are emerging from the Boston metropolitan area that show the power of partnership between researchers, government officials, practitioners, and community-based organizations.
FAS supports the bipartisan Regional Leadership in Wildland Fire Research Act under review in the House, just as we supported the earlier Senate version. Rep. David Min (D-CA) and Rep. Gabe Evans (R-CO) are leading the bill.