Response to Hurricane Fiona raises concerns about discrimination and public health : Peoples Dispatch

Devastation in Puerto Rico after Hurricane Fiona. Photo: Annie Dasgupta/Twitter

Almost one million Puerto Ricans are still struggling with power outages caused by Hurricane Fiona, according to data compiled by the PowerOutage.us tracker. The hurricane hit the island on September 17. The power outage was accompanied by a shortage of potable water, leading to serious public health concerns and fears of a repeat of the scenario after Hurricane Maria hit the island in 2017. After Hurricane Maria, the health system collapsed due to lack of fuel and electricity. According to some estimates, this may have contributed to the deaths of over 3,000 people.

The US federal government has made a number of public statements in response to Fiona, but these have already been criticized for their inadequacy and discriminatory nature. A disaster declaration posted Sept. 22 on the Federal Emergency Management Agency (FEMA) website was criticized by local organizations and activists for not providing full support to all communities in Puerto Rico, such as predominantly black and poor people get abandoned.

A day before this disaster declaration was issued, US Department of Health and Human Services (HSS) Secretary Xavier Becerra declared a public health emergency in Puerto Rico, dispatching two teams – of 15 and 10 members – to assist in the health response . HSS also said health officials in Puerto Rico are monitoring Medicare patients who rely on medical equipment that depends on electricity to make sure they have access to the care they need.

Many fear that the lack of an adequate response to the hurricane could lead to the same problems that the health system had in 2017, since no structural improvements have been made since then. The lack of available health care funds in Puerto Rico is primarily related to US colonial policies that left the island with very little room to shape a health care system based on its own needs and priorities.

Instead, Puerto Rico’s health care system has been weakened by government budget cuts and privatization. This has led to long waiting lists even for urgent procedures, as CBS reports, and an erosion of health care workers’ rights. Low wages and poor working conditions continue to cause a mass emigration of health workers from Puerto Rico, leaving few nurses, doctors and other health care workers to provide care.

Weak health infrastructure leads to significantly worse health outcomes than in the US, including higher rates of preterm birth, asthma, diabetes and HIV/AIDS. Yet it is the decisions made in the US that make Puerto Rico’s health care system, and the people who rely on it, particularly vulnerable to the effects of extreme weather. That includes Puerto Rico’s exclusion from the Affordable Care Act, as well as the Trump administration’s prolonged delay in the distribution of hurricane relief aid, which meant hospitals in some areas of the island were not rebuilt for more than three years after Maria.

In this context, after Maria and Fiona, most of the response depends on the efforts of volunteers and organizations such as Taller Salud, which collect water, filters and medical supplies to deliver to those affected by the hurricane.

People’s Health Dispatch is a biweekly newsletter published by Movement for public health and Peoples Dispatch. For more articles and a subscription to the People’s Health Dispatch, click here.

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