Understanding the Inequitable Impacts of Hurricanes and Other Natural Disasters in the Wake of Hurricanes Helene and Milton

Extreme weather events used to be once in a century occurrences, but due to climate change, they have increased in both intensity and frequency. Hurricane Helene has claimed over 200 lives and is the deadliest hurricane to hit the continental U.S. since Hurricane Katrina. It is also projected to be one of the most expensive storms to hit the country. Hurricane Milton is one of the worst storms to hit Florida in over 100 years. The Biden-Harris Administration has mobilized resources to support the Federal Emergency Management Agency (FEMA), the Department of Defense and efforts to provide emergency assistance to families. At the same time, FEMA is facing ongoing misinformation and disinformation that may hamper response efforts. Amid recovery and response efforts, it’s important to recognize that hurricanes and other natural disasters have far-reaching impacts on health and well-being in their immediate aftermath and over the long-term. These impacts are uneven, with many groups who already face disparities in health and health care bearing the brunt of storms and other disasters. The uneven impacts reflect disparities in people’s risk of exposure to natural disasters; their ability to prepare for, evacuate from, and to recover from a natural disaster; and long-term impacts as discussed below.

Many of the same factors that contribute to health inequities leave some communities at higher risk of experiencing a natural disaster. Low income communities and communities of color are on the front lines of natural disasters and climate change. Due to historical residential segregation including redlining, people of color are more likely to live in neighborhoods that have worse infrastructure increasing their risk of harm and limiting their ability to prepare or safely shelter-in-place. In most states, homes in formerly redlined neighborhoods are more likely to be in flood zones, however in Florida more blue- and greenlined “desirable” neighborhoods have a higher risk of flooding due to proximity to the beach. Data on patterns of flooding associated with Hurricanes Helene and Milton are not yet available. Rural communities face challenges responding to natural disasters, ranging from physical isolation, high poverty rates, and limited access to health care as well as limited financial capacity.

The Southeast region of the U.S. is particularly vulnerable to severe tropical storms due to climate change, and its persistently high poverty rates inhibit residents’ ability to prepare for and recover from storms. Further, many of the states in the Southeast have not implemented the ACA Medicaid expansion, leaving lower income residents in those states with more limited access to health care, which may contribute to challenges addressing both immediate and longer term health needs. A significant proportion of people of color live in the South, with more than half of Black people residing in Southern states. Moreover, one study finds that Black communities are about twice as likely as other communities in the Southeast to experience a hurricane. It is estimated that, by 2050, homes owned by Black people in this region will be nearly twice as likely to be damaged by hurricanes compared to other communities.

Evacuation efforts for storms have highlighted disparities in peoples’ abilities to prepare for and evacuate in advance of major storms. About half of immigrants have limited English proficiency (LEP) and may face language barriers accessing evacuation and preparation resources. When Hurricane Beryl tore through Houston in 2024, significant portions of the city’s community with LEP felt unprepared as most emergency resources were written in Spanish and English but not other languages spoken by a large number of residents. Low-income communities, many of whom are people of color, are more likely to face financial challenges in preparing for natural disasters. A survey of Hurricane Harvey evacuees finds that people who evacuated spent on average between $1,200 to $2,300, accounting for lodging, transportation, food, and lost income.

There are also gaps in federal disaster management and response efforts. Research finds that recovery efforts are often inequitably distributed and favor White and wealthier communities over lower income communities and communities of color. In a KFF survey of Texas Gulf residents affected by Hurricane Harvey, six in ten affected Black residents reported feeling like they were not getting the help they needed to recover compared to a third of affected White residents. Further, a federal report finds that there were disparities in response efforts to Hurricane Harvey in Texas and Hurricane Maria in Puerto Rico, with Hurricane Harvey survivors receiving more aid faster compared to survivors of Hurricane Maria. The report also cited language barriers as a major issue that contributed to delays in people receiving aid and recovery support. Noncitizen immigrants are less likely to access recovery assistance programs than citizens, reflecting eligibility restrictions, immigration-related fears, and language barriers.

The impacts of hurricanes and other natural disasters are long-lasting. Research finds that hurricanes contribute to excess mortality years after they have passed, with Black people generally experiencing higher cumulative excess deaths compared to their White counterparts. In addition, major storms can increase the risk of illness and injury, disrupt infrastructure, and negatively impact the economy. For example, Hurricane Helene’s damage to a key manufacturer of IV solutions in North Carolina has led to a temporary supply disruption that will affect the broader U.S. medical system. Damage to infrastructure caused by storms can also compromise emergency response efforts, limit access to basic needs, and disrupt access to necessary health care and prescription medications. Storms can also have long-lasting mental health impacts. Data from a KFF survey of New Orleans residents who lived in the area during Katrina reported lingering stress and problems with their mental health due to the hurricane, ten years after the storm.

The federal government has taken steps to advance climate change adaptation and promote risk reduction and community resilience. For example, the Building Resilient Infrastructure and Communities initiative supports states, local governments, Tribes, and territories in designing projects to strengthen infrastructure and minimize risks before disasters occur. FEMA has developed a National Risk Index to identify locations most at risk for 18 natural hazards, adopted climate resilience building standards, and dedicated funding to support communities at risk for climate-related extreme weather events and other natural disasters. Research suggests that efforts at the local, state, Tribal, and federal levels are key to adapting to and mitigating the worsening impacts of climate change.