Association for Public Policy Analysis & Management

It is well established in the public health literature that environmental factors such as natural disasters not only affect population health, but also produce health disparities across different social groups. Nevertheless, little is known about the specific mechanisms that link environmental factors to disparate health outcomes, particularly how the characteristics of health care systems might alter the link between the external environment and subpopulation health outcomes. In this proposed research, we extend the literature on disasters, risk management and health by focusing on the interplay between natural disasters, the resilience of local health care networks and population health outcomes. We conceptualize natural disasters as exogenous shocks to local communities, which have negative impacts on population health. Moreover, the negative impacts of natural disasters on health are mediated by the resilience of local health care networks. Our empirical analysis links natural disaster data from the Spatial Hazard Events and Losses Database for the US (SHELDUS^TM Version 15.2), historical weather data from the US National Oceanic and Atmospheric Administration to US Centers for Diseases Control infant mortality data in the past three decades. We measure the characteristics of local health care systems at the county level and based on the intensity of collaborative health care service delivery and the resource capacity of these local health care networks. We expect that the effect of natural disasters on health is smaller in communities with collaborative and more resourceful health care networks than in those with isolated and less resourceful health care providers.