The Real Risks in Puerto Rico Have Only Just Begun

Key Factors:

  • Warmer Weather = More Emergency Room Visits: The medium-term weather forecast is not looking favorable to the health of Puerto Ricans. Not only will the power not return for some time, but temperatures are likely to remain near or above record highs for several days longer at least.If the heat continues and the generators fail, there will surely be many people whose health risks start to rise dramatically.
  • Power. Water. Food: Power plants were among the first structures laid low by Maria, but electricity is hardly the only concern. Potable water and food supplies are already in short supply. Puerto Ricans already imports about 85 percent of their food, and the farms that produce that remaining 15 percent have been totally destroyed.
  • Zika Virus Outbreak: Puerto Rico lagged far behind not only in treatment options but in basic vector control measures as well, which resulted in very high levels of local disease transmission. By the time mosquito populations have a chance to recover from the destruction of their breeding grounds sometime next year, similar effects may be felt.
  • Crippling Debt: Prior to Maria’s landfall, Puerto Rico was wedged into fiscal austerity measures. That meant both short term and long term cuts to basic health services.

Rising Temperatures, Lack of Power Increase Health Risks for Puerto Rico’s Most Vulnerable

The map above shows where residents above the age of 65 are concentrated relative to Hurricane Maria’s storm path. Factors like age can increase vulnerability to natural disasters. Click the map to explore more. (Map by Andrew Schroeder/Direct Relief)

Several days after Hurricane Maria tore through Puerto Rico, the heat index is reaching 102 F, and the entire island is still without power. Given the extent of damage to an already fragile electrical grid, the best estimates are that power will be out for most of Puerto Rico for the next six months, in some parts longer. Generators strain to run critical machinery, including air conditioning and fans for medically vulnerable, hospitalized or elderly people. Some studies have found a direct correlation between sustained high heat index levels and visits to emergency rooms, with rates of medical emergencies being highest for those who are elderly or otherwise in medical need.

With that in mind, the medium-term weather forecast is not looking favorable to the health of Puerto Ricans. Not only will the power not return for some time, but temperatures are likely to remain near or above record highs for several days longer at least. Clinical and nursing home staff are watching nervously as fuel supplies for generators dwindle. Hope for resupply, especially in the harder to reach areas outside the capital San Juan, is uncertain at best. Inland Puerto Rico is a terrain of steep hills and valleys, with many interior regions being normally hard to reach.

If the heat continues and the generators fail, there will surely be many people whose health risks start to rise dramatically.

Puerto Rico’s power grid was especially exposed to Hurricane Maria because virtually all of their generation capacity was clustered on the southeastern coast, where the storm initially made landfall. Power plants were among the first structures laid low by Maria, virtually all in the exact same moment.

Electricity is hardly the only concern. Potable water is already in short supply throughout much of Puerto Rico, with reliable estimates indicating as much as 60 percent of the population now lacking access to clean drinking water.  Likewise, food supplies are running short in many places and agriculture has been decimated.  Puerto Ricans already imports about 85 percent of their food, but that remaining 15 percent has been totally destroyed. Vegetation on the nearby island of Vieques, for instance, normally a lush growing region, has been stripped down to the topsoil. And communications have been decimated, with virtually all cell phone communications still cut off due to a combination of wind damage to cell towers and power outages.

Much has been made already of Puerto Rico’s crippling public debt burden. It’s easy to overstate those risks, especially given the infusions of disaster aid that are sure to come even from the delayed federal effort, some of which will likely offset local spending shortfalls. But it’s worth pausing for a moment to understand how the debt burden impacts Puerto Rico’s post-hurricane health system.

Prior to Maria’s landfall, Puerto Rico was wedged into fiscal austerity measures, called the PROMESA agreement, which forced severe cutbacks in public services in order to reduce spending and divert funds toward repayment of the island’s creditors. That meant both short term and long term cuts to basic health services, including wage and job cutbacks across the health sector.

During the recent Zika virus outbreak, Puerto Rico lagged far behind not only in treatment options but in basic vector control measures as well, which resulted in very high levels of local disease transmission. By the time mosquito populations have a chance to recover from the destruction of their breeding grounds sometime next year, similar effects may be felt.

The peculiar form of fiscal austerity, which puts Puerto Rico’s health system at risk through public budget cuts has a lot to do with the peculiar status of Puerto Rico as a U.S. territory, and therefore as an administrative and geographic unit somewhere in-between a sovereign country and a state among others in the United States. Although Puerto Ricans are American citizens and entitled to federal disaster relief funds just as any other state, they lack representation in Congress. Likewise, Puerto Rico cannot simply default on its debt like a sovereign country might in its circumstances. Instead, the territory is caught between options and is required to follow most, if not all, of the instructions of their creditors, which in this case are mostly large hedge funds.

The long-term rebuilding of Puerto Rico as a disaster resilient society will require many different efforts simultaneously. It will require rethinking the power grid so that generation capacity is more distributed and no longer clustered in such a way that all of it can be knocked out by a single storm. Water, food and communications systems will require patient investment during challenging economic circumstances to regrow their profitability and sustainability.  And healthcare systems will require additional staff, supplies, and structural rehabilitation.  All of these will require support from individuals, organizations, and corporations, both within and without Puerto Rico, to ensure short-term alleviation of suffering at the apex of crisis.  They will also require an alternate pathway out of austerity so that public systems can come back online stronger than they were before. It’s a combination of social, philanthropic and political will that all of us, not only Puerto Ricans, may need to get behind to genuinely recover from the devastation of Hurricane Maria.