July 13, 2017 - One of the most crucial elements that must be monitored during hurricane season is how patients with chronic diseases receive care, especially during crises. While we take these special cases into consideration when planning, we may not always acknowledge the broader diverse needs of each community. Every community presents different vulnerabilities, and the unique needs of a community must be taken into account during disasters. For patients living in food deserts and low income communities, disaster response and relief can often look different compared to communities with more abundant resources.
During my internship, I have been able to see how local and government organizations collaborate in order to bring aid and supplies to communities and patients in need. Patients with chronic conditions require special attention from these organizations due to their dependency on specific medications and medical equipment. These revelations made me speculate on how patients living in low income areas receive emergency care during disasters. As a child, I watched my mother spend large amounts of her time helping my grandmother manage her diabetes. One of the most arduous challenges they faced was finding healthy and high quality food in nearby grocery stores. Unfortunately, this issue was not unique to our neighborhood. As I have gotten older I have noticed more instances of low income areas having fewer options for healthy food sources. Healthy, high quality food is too often either too far to find or too expensive to purchase. This leaves many low income and minority families at risk of developing a chronic disease.
"Food deserts," are described as areas that have relatively poor access to healthy and affordable food. These factors often contribute to social disparities in diet and diet-related health outcomes, such as kidney disease, cardiovascular disease and obesity. These populations are more vulnerable during a natural disaster (or other emergency) because there isn’t a large supply of healthy food that is readily available for consumption and they have very specific healthcare needs and dietary restrictions. Resources don’t flow as efficiently and frequently in these neighborhoods. Additionally, when aid does arrive many of the packaged food options provided to disaster relief shelters are not suitable for patients with chronic diseases. These packaged foods can be high in sodium and carbohydrates which have a large impact on blood sugar levels in diabetic patients. Effort to supply more portable and durable food to these areas continues but as a result of logistical and other challenges, many chronic care patients living in these communities don’t receive the food and resources they need. Ultimately, existing vulnerabilities and lack of access to sustained and healthy nutrition will only be exacerbated during a disaster. As a result of these existing vulnerabilities, people living in these areas are more negatively impacted by disasters, especially in areas where infrastructure may already be compromised.
In most low income neighborhoods, the majority of residents are ethnic minorities. Blacks and African Americans had the highest incidence of poverty in 2015 (33.8%), while American Indians and Alaskan natives had the second highest rate (32.4%). Hispanics had the third-highest poverty rate, which was 25.9% (USDA). Racial and ethnic minorities,(including American Indians, black or African Americans, Hispanics or Latinos, and Asian Americans) have a higher prevalence and greater burden of diabetes compared to whites, and some minority groups also have higher rates of diabetes related complications. A total of 4.9 million African-American adults, or 18.7% of all African Americans ≥ 20 years of age, have diagnosed or undiagnosed diabetes, compared to 7.1% of white Americans. Similarly, Hispanics or Latinos are 1.7 times more likely to start treatment for ESRD related to diabetes than whites (ADA). These statistics exemplify the increased need for quality nutrition in lower income areas. Treating patients with these chronic diseases is only half of the battle. Part of preventative healthcare is creating accessible resources people can use to live healthier lives. Having access to healthy and high quality food is just as important as having access to medicine and medical care.
For patients living in low income areas, access to healthy food and other resources is often limited. Many of these same patients are also at a higher risk of inheriting a chronic illness due to the lack of resources they have available. These patients are increasingly vulnerable during an event and must have access to facilities with proper medical equipment, medications, and foods that comply with their dietary restrictions. For example, it is imperative that patients in these communities living with diabetes remain on a strict diet that maintains high fiber intake, and that they can continue to monitor their blood glucose levels. Patients with cardiovascular disease must be able to maintain a diet that limits cholesterol, salt, and saturated fats, and serves more protein enriched foods. These health challenges can be exacerbated during a disaster for patients in food deserts. In order to better address these areas during a disaster; responders must take into account the amount of resources already available, including access to healthy food. Understanding the unique needs of low income communities is a crucial component of emergency preparedness and response.