Hostname: page-component-848d4c4894-8bljj Total loading time: 0 Render date: 2024-06-21T03:02:11.607Z Has data issue: false hasContentIssue false

Risks, Health Consequences, and Response Challenges for Small-Island-Based Populations: Observations From the 2017 Atlantic Hurricane Season

Published online by Cambridge University Press:  06 April 2018

James M. Shultz*
Center for Disaster & Extreme Event Preparedness (DEEP Center), Department of Public Health Sciences (DPHS), University of Miami Miller School of Medicine, Miami, FL, USA
James P. Kossin
NOAA’s National Centers for Environmental Information (NCEI), Center for Weather and Climate, University of Wisconsin, Madison, WI, USA
J. Marshall Shepherd
UGA Athletic Association, Atmospheric Sciences Program, University of Georgia, Athens, GA, USA
Justine M. Ransdell
Division of Epidemiology, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
Rory Walshe
Department of Geography, King’s College London Strand Campus, London WC UK, Institute for Risk and Disaster Reduction, University College London
Ilan Kelman
Institute for Risk and Disaster Reduction, Institute for Global Health, University College London, Gower Street London, UK, University of Agder, Kristiansand, Norway
Sandro Galea
School of Public Health, Boston University, Boston, MA
Correspondence and request reprints to e-mail address James M. Shultz, (e-mail:


The intensely active 2017 Atlantic basin hurricane season provided an opportunity to examine how climate drivers, including warming oceans and rising seas, exacerbated tropical cyclone hazards. The season also highlighted the unique vulnerabilities of populations residing on Small Island Developing States (SIDS) to the catastrophic potential of these storms. During 2017, 22 of the 29 Caribbean SIDS were affected by at least one named storm, and multiple SIDS experienced extreme damage. This paper aims to review the multiplicity of storm impacts on Caribbean SIDS throughout the 2017 season, to explicate the influences of climate drivers on storm formation and intensity, to explore the propensity of SIDS to sustain severe damage and prolonged disruption of essential services, to document the spectrum of public health consequences, and to delineate the daunting hurdles that challenged emergency response and recovery operations for island-based, disaster-affected populations. (Disaster Med Public Health Preparedness. 2019;13:5–17)

Policy Analysis
Copyright © Society for Disaster Medicine and Public Health, Inc. 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1. United Nations. Small Island Developing States: Small Islands Big(ger) Stakes. New York: Office of the High Representative for the Least Developed Countries, Landlocked Developing Countries and Small Island Developing States; 2011. Accessed December 28, 2017.Google Scholar
2. United Nations Department of Economic and Social Affairs. Steering Committee on SIDS Partnerships. Partnerships on Small Island Developing States 2016. Accessed March 10, 2018.Google Scholar
3. United Nations. Sustainable Development Knowledge Platform: Small Island Developing States. Accessed March 10, 2018.Google Scholar
4. National Hurricane Center. Tropical Cyclone Advisory Archive; 2017. Accessed December 28, 2017.Google Scholar
5. Shultz, JM, Russell, JA, Espinel, Z. Epidemiology of tropical cyclones: the dynamics of disaster, disease, and development. Epidemiol Rev. 2005;27(1):21-35.10.1093/epirev/mxi011Google Scholar
6. National Hurricane Center. Saffir-Simpson Hurricane Wind Scale; 2017. Accessed December 28, 2017.Google Scholar
7. Harvey, Irma Damages Predicted to Cost $290 Billion; Atlantic Hurricane Season Only at Midpoint. Published September 12, 2017. Accessed December 28, 2017.Google Scholar
8. Drye, W 2017; Hurricane Season Was the Most Expensive in U.S. History. National Geographic. Published November 30, 2017. Accessed December 28, 2017.Google Scholar
9. Shultz, JM, Galea, S. Mitigating the mental and physical health consequences of Hurricane Harvey. JAMA. 2017;318(15):1437-1438.Google Scholar
10. Capucci, M. September Is the Most Energetic Month For Hurricanes Ever Recorded in the Atlantic. Published September 27, 2017. Accessed December 28, 2017.Google Scholar
11. Klotzbach, PJ, Bell, MM. Summary of the 2017 Atlantic Tropical Cyclone Activity and Verification of the Authors’ Seasonal and Two-Week Forecasts. Colorado State University. Published November 30, 2017. Accessed December 28, 2017.Google Scholar
12. Myhre, G, Shindell, D, Bréon, F-M, et al. Anthropogenic and natural radiative forcing. In: Stocker TF, Qin D, Plattner G-K, et al., eds. Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, UK, and New York: Cambridge University Press; 2013:659-728.Google Scholar
13. Walsh, KJE, McBride, JL, Klotzbach, PJ, et al. Tropical cyclones and climate change. WIREs Clim Change. 2016;7:65-89.10.1002/wcc.371Google Scholar
14. Knutson, TR, McBride, JL, Chan, J, et al. Tropical cyclones and climate change. Nat Geosci. 2010;3:157-163.Google Scholar
15. Shultz, JM, Shepherd, JM, Bagrodia, R, et al. Disaster health briefing: tropical cyclones in a year of rising global temperatures and a strengthening El Niño. Disaster Health. 2015;2(3-4):151-162.Google Scholar
16. Emanuel, KA. The hurricane-climate connection. Bull Amer Meteor Soc. 2008;89:ES10-ES20.Google Scholar
17. Kossin, JP. Hurricane intensification along United States coast suppressed during active hurricane periods. Nature. 2017;549:390-393.Google Scholar
18. Kossin, JP, Olander, TL, Knapp, KR. Trend analysis with a new global record of tropical cyclone intensity. J Clim. 2013;26:9960-9976.Google Scholar
19. Shultz, JM, Galea, S. Preparing for the next Harvey, Irma, or Maria – addressing research gaps. N Engl J Med. 2017;377(19):1804-1806.Google Scholar
20. Jin, FF, Boucharel, J, Lin, II. Eastern Pacific tropical cyclones intensified by El Niño delivery of subsurface ocean heat. Nature. 2014;516(7529):82-85.Google Scholar
21. Emanuel, KA. Increasing destructiveness of tropical cyclones over the past 30 years. Nature. 2005;436:686-688.Google Scholar
22. Mann, ME, Emanuel, KA. Atlantic hurricane trends linked to climate change. EOS. 2006;87:233-244.Google Scholar
23. Reed, AJ, Mann, ME, Emanuel, KA, et al. Increased threat of tropical cyclones and coastal flooding to New York City during the anthropogenic era. Proc Nat Acad Sci. 2015;112:12610-12615.Google Scholar
24. Coumou, D, Robinson, A, Rahmstorf, S. Global increase in record-breaking monthly-mean temperatures. Clim Change. 2013;118:771-782.Google Scholar
25. Cai, W, Borlace, S, Lengaigne, M, et al. Increasing frequency of extreme El Niño events due to greenhouse warming. Nat Clim Change. 2014;4:111-116.Google Scholar
26. Rahmstorf, S, Coumou, D. Increase of extreme events in a warming world. PNAS. 2011;108:17905-17909.Google Scholar
27. Sun, Y, Zhong, Z, Li, T, et al. Impact of ocean warming on tropical cyclone size and its destructiveness. Sci Rep. 2017;7:8154.Google Scholar
28. United Nations. Sustainable development goals: 17 goals to transform our world; 2017. Accessed December 28, 2017.Google Scholar
29. Seil, K, Spira-Cohen, A, Marcum, J. Injury deaths related to Hurricane Sandy, New York City, 2012. Disaster Med Public Health Prep. 2016;10(3):378-385.Google Scholar
30. Ching, PK, Carr de los Reyes, V, Sucaldito, MN, et al. An assessment of disaster-related mortality post-Haiyan in Tacloban City. Western Pac Surveill Response J. 2015;6(Suppl 1):34-38.Google Scholar
31. Robles, F, Davis, K, Fink, S, Almukhtar, S. Official toll in Puerto Rico: 64. Actual deaths may be 1,052. New York Times. December 9, 2017. Accessed December 28, 2017.Google Scholar
32. Mazzei, P. Puerto Rico orders review and recount of hurricane deaths. New York Times. December 18, 2017. Accessed December 28, 2017.Google Scholar
33. Wellenius, GA, Eliot, MN, Bush, KF, et al. Heat-related morbidity and mortality in New England: evidence for local policy. Environ Res. 2017;156:845-853.Google Scholar
34. Patz, JA, Frumkin, H, Holloway, T, et al. Climate change challenges and opportunities for global health. JAMA. 2014;312(15):1565-1580.Google Scholar
35. Patz, JA, Grabow, ML, Limaye, VS. When it rains, it pours: future climate extremes and health. Ann Glob Health. 2014;80:332-344.Google Scholar
36. Bobb, JF, Peng, RD, Bell, ML, et al. Heat-related mortality and adaptation to heat in the United States. Environ Health Perspect. 2014;122(8):811-816.Google Scholar
37. Peng, RD, Bobb, JF, Tebaldi, C, et al. Toward a quantitative estimate of future heat wave mortality under global climate change. Environ Health Perspect. 2011;119(5):701-706.Google Scholar
38. Anderson, BG, Bell, ML. Weather-related mortality: how heat, cold, and heat waves affect mortality in the United States. Epidemiology. 2009;20(2):205-213.Google Scholar
39. Lee, JY, Kim, H. Projection of future temperature-related mortality due to climate and demographic changes. Environ Int. 2016;94:489-494.Google Scholar
40. Nordio, F, Zanobetti, A, Colicino, E, et al. Changing patterns of the temperature–mortality association by time and location in the US, and implications for climate change. Environ Int. 2015;81:80-86.Google Scholar
41. Levy, BS, Patz, JA. Climate change, human rights, and social justice. Ann Glob Health. 2015;81(3):310-322.Google Scholar
42. Keller, RC. Social dimensions of heat waves. In Levy BS, Patz JA, eds. Climate Change and Public Health. New York: Oxford University Press; 2015:97e8.Google Scholar
43. Boeckmann, M, Zeeb, H. Justice and equity implications of climate change adaptation: a theoretical evaluation framework. Healthcare (Basel). 2016;4(3):65. doi:10.3390/healthcare4030065.Google Scholar
44. Harlan, SL, Brazel, AJ, Prashad, L, et al. Neighborhood microclimates and vulnerability to heat stress. Soc Sci Med. 2006;63:2847-2863.Google Scholar
45. Schaffer, A, Muscatello, D, Broome, R, et al. Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: a time-series analysis. Environ Health. 2012;11(1):3.Google Scholar
46. Huang, C, Barnett, AG, Wang, X, et al. Effects of extreme temperatures on years of life lost for cardiovascular deaths: a time series study in Brisbane, Australia. Circ Cardiovasc Qual Outcomes. 2012;5:609-614.Google Scholar
47. Kim, YW, Kim, SY, Kim, H, et al. Disaster-related injury management: high prevalence of wound infection after Super Typhoon Haiyan. Disaster Med Public Health Prep. 2016;10(1):28-33.Google Scholar
48. Garbern, SC, Ebbeling, LG, Bartels, SA. A systematic review of health outcomes among disaster and humanitarian responders. Prehosp Disaster Med. 2016;31(6):635-642.Google Scholar
49. Brackbill, RM, Caramanica, K, Maliniak, M, et al. Nonfatal injuries 1 week after Hurricane Sandy – New York City metropolitan area, October 2012. MMWR. 2014;63(42):950-954.Google Scholar
50. Forzieri, G, Cescatti, A, Batista e Silva, F, Feyen, L. Increasing risk over time of weather-related hazards to the European population: a data-driven prognostic study. Lancet Planet Health. 2017;1:e200-e208.Google Scholar
51. Lin, S, Luo, M, Walker, RJ, et al. Extreme high temperatures and hospital admissions for respiratory and cardiovascular diseases. Epidemiology. 2009;20:738.Google Scholar
52. Petkova, EP, Bader, DA, Anderson, GB, et al. Heat-related mortality in a warming climate: projections for 12 U.S. cities. Int J Environ Res Public Health. 2014;11:11371-11383.Google Scholar
53. Mathes, RW, Ito, K, Lane, K, et al. Real-time surveillance of heat-related morbidity: relation to excess mortality associated with extreme heat. PLoS One. 2017;12(9):e0184364.Google Scholar
54. Anderson, GB, Bell, ML. Heat waves in the United States: mortality risk during heat waves and effect modification by heat wave characteristics in 43 U.S. communities. Environ Health Perspect. 2011;119:210-218.Google Scholar
55. Benigno, MR, Kleinitz, P, Calina, L, et al. Responding to the health and rehabilitation needs of people with disabilities post-Haiyan. Western Pac Surveill Response J. 2015;6(Suppl 1):53-59.Google Scholar
56. Patz, JA, Epstein, PR, Burke, TA, et al. Global climate change and emerging infectious diseases. JAMA. 1996;275(3):217-223.Google Scholar
57. Patz, JA, Hahn, MB. Climate change and human health: a one health approach. In Mackenzie JS, Jeggo M, Daszak P, Richt JA, eds. One Health: The Human-Animal-Environment Interfaces in Emerging Infectious Diseases. New York: Springer; 2013:141-171.Google Scholar
58. Kovats, R, Campbell-Lendrum, D, McMichel, A, et al. Early effects of climate change: do they include changes in vector-borne disease? Philos Trans R Soc Lond B Biol Sci. 2001;356:1057-1068.Google Scholar
59. Mills, JN, Gage, KL, Khan, AS. Potential influence of climate change on vector-borne and zoonotic diseases: a review and proposed research plan. Environ Health Perspect. 2010;118:1507-1514.Google Scholar
60. Reiter, P. Climate change and mosquito-borne disease. Environ Health Perspect. 2001;109(Suppl 1):141-161.Google Scholar
61. Aumentado, C, Cerro, BR, Olobia, L, et al. The prevention and control of dengue after Typhoon Haiyan. Western Pac Surveill Response J. 2015;6(Suppl 1):60-65.Google Scholar
62. McMichael, AJ. Extreme weather events and infectious disease outbreaks. Virulence. 2015;6(6):543-547.Google Scholar
63. Altizer, S, Ostfeld, RS, Johnson, PT, et al. Climate change and infectious diseases: from evidence to a predictive framework. Science. 2013;341(6145):514-519.Google Scholar
64. Goldman, E, Galea, S. Mental health consequences of disasters. Annu Rev Public Health. 2014;35:169-183.Google Scholar
65. Neria, Y, Shultz, JM. Mental health effects of Hurricane Sandy: characteristics, potential aftermath, and response. JAMA. 2012;308(24):2571-2572.Google Scholar
66. Ruggiero, KJ, Gros, K, McCauley, JL, et al. Mental health outcomes among adults in Galveston and Chambers counties after Hurricane Ike. Disaster Med Public Health Prep. 2012;6(1):26-32.Google Scholar
67. Shultz, JM, Cela, T, Marcelin, LH, et al. The trauma signature of 2016 Hurricane Matthew and the psychosocial impact on Haiti. Disaster Health. 2016;3(4):121-138.Google Scholar
68. Schwartz, R, Liu, B, Sison, C, et al. Study design and results of a population-based study on perceived stress following Hurricane Sandy. Disaster Med Public Health Prep. 2016;10(3):325-332.Google Scholar
69. Galea, S, Brewin, CR, Gruber, M, et al. Exposure to hurricane-related stressors and mental illness after Hurricane Katrina. Arch Gen Psychiatry. 2007;64:1427-1434.Google Scholar
70. Lowe, SR, Tracy, M, Cerdá, M, et al. Immediate and longer-term stressors and the mental health of Hurricane Ike survivors. J Trauma Stress. 2013;26(6):753-761.Google Scholar
71. Galea, S, Nandi, A, Vlahov, D. The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev. 2005;27(1):78-91.Google Scholar
72. Neria, Y, Nandi, A, Galea, S. Posttraumatic stress disorder following disasters: a systematic review. Psychol Med. 2008;38(4):467-480.Google Scholar
73. Tracy, M, Norris, FH, Galea, S. Differences in the determinants of posttraumatic stress disorder and depression after a mass traumatic event. Depress Anxiety. 2011;28(8):666-675.Google Scholar
74. Galea, S, Tracy, M, Norris, F, et al. Financial and social circumstances and the incidence and course of PTSD in Mississippi during the first two years after Hurricane Katrina. J Trauma Stress. 2008;21:357-368.Google Scholar
75. Rechkemmer, A, O’Connor, A, Rai, A, et al. A complex social-ecological disaster: environmentally-induced forced migration. Disaster Health. 2016;3(4):112-120.Google Scholar
76. Shepherd, M. Are hurricanes creating climate refugees in the Caribbean? Forbes. September 21, 2017. Accessed December 28, 2017.Google Scholar
77. Alvarez, L. A great migration from Puerto Rico is set to transform Orlando. New York Times. November 17, 2017. Accessed December 28, 2017.Google Scholar
78. McKenna, P. What’s happening in Puerto Rico is environmental injustice. Climate experts have long warned of the increasing risks of such a catastrophe. Inside Climate News/Republished by Published September 27, 2017. Accessed December 28, 2017.Google Scholar
79. Patz, JA, Gibbs, HK, Foley, JA, et al. Climate change and global health: quantifying a growing ethical crisis. EcoHealth. 2007;4:397-405.Google Scholar