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Q&A: Dr Michael Ashley Stein Speaks on How Natural Disasters Can Affect Disabled Individuals

Key Takeaways

  • Disabled individuals are disproportionately affected by natural disasters due to systemic planning failures and lack of accessible emergency alerts and shelters.
  • There is a significant overlap between disability and age-related vulnerabilities, with societal marginalization exacerbating risks for these groups.
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Michael Ashley Stein, PhD, JD, speaks about how disabled individuals are at a disadvantage when it comes to preparing for natural disasters, specifically during wildfires.

Michael Ashley Stein, PhD, JD, professor of law at Harvard Law School, spoke with The American Journal of Managed Care® (AJMC®) about the response for disabled individuals during natural disasters, especially wildfires, discussing the ways in which they are vulnerable and how these vulnerabilities could be closed in the future.

This Q&A has been lightly edited for clarity.

AJMC: With the recent climate disaster in California, we have learned that at least 3 of the victims were in some way disabled, be it from cerebral palsy or a leg amputation. How are people who are in some way disabled more vulnerable to serious injury and death in a natural disaster?

Stein: Persons with disabilities, empirically, are more vulnerable to natural disasters. We know that from the study of Australia over 15 years, wherein something like 90% of the victims of wildfires were people with 1 or more disabilities. We know that from British Columbia, which came up with the same numbers. We know that people with psychosocial disabilities are 2 to 4 times more likely to die during heat waves and other natural disasters. That's the empirical evidence.

As to why they are more vulnerable, it is not because people with disabilities are inherently vulnerable, but because we put them in positions of vulnerability. So you know, in many parts of the world, including parts of the United States, we don't have accessible emergency alerts. Of course, finding out that a hurricane is hitting three days after it hits does no good. The evacuation shelters are infrequently accessible to people with different types of disabilities. People with disabilities can be separated from their medication, from assistive devices, from caregivers and others who help support them, and that's true, by the way, of people who are elders, either with or without disabilities as well. So we render them vulnerable by not planning ahead of time and thinking about how to create the means by which to escape and by which to survive natural disasters and other climate change induced stressors.

AJMC: Are there overlaps in how to address the needs of older adults and people with disabilities amid natural disasters, whether it be through communication or transportation?

Stein: Epidemiologically, we know that the incidence of disability increases dramatically as one ages. If you are lucky enough to live to old age, you will have 1 or more forms of disability, and we know that in this country, at least by 2040, we will double the number of adults over the age of 65 [years]. So there is an empirical overlap there. It's a Venn diagram that significantly overlaps. And there are commonalities as to why older adults and why people with disabilities tend to be put into situations of risk and not come through well. Some of those areas of overlap include accessible communication, transportation, evacuation, access to medication and supports. But the underlying reasons why we don't have those those provisions laid out is that as a society, we unfortunately tend to marginalize individuals that we view as less productive and more vulnerable and less valuable.

That may sound harsh, but one only has to look at what happened during [the] COVID-19 [pandemic]. The numbers of individuals with disabilities and the numbers of individuals who were older adults who died in nursing homes or who were left without vaccination, without support, are dramatic. 20% of all deaths during COVID were people in nursing homes. That's not a coincidence. It's a reflection of what our society apparently values and apparently doesn't value. And now that we are in the second Trump administration, those of us who are concerned about policy and about threats to Medicaid blocks and threats to home- and community-based services and threats to the idea that people ought to age with supports in their homes, are thinking a lot and being very concerned about what's down the road.

Michael Ashley Stein | Image credit: Harvard Law School

Michael Ashley Stein | Image credit: Harvard Law School

AJMC: What are some areas where gaps are most noticeable when it comes to response for natural disasters, especially wildfires?

Stein: Well, Having plans set out ahead of time that are designed to ensure that no one is left behind. The people who respond to natural disasters, including wildfires, are amazingly brave and giving and put themselves in the way of harm. And it's not a reflection on them, but they're following the plans that are laid out. We have, as a country, advanced somewhat in those areas. Before hurricanes Rita and Katrina, President George W. Bush actually ordered, by executive order, that evacuation plans be developed by all states and local municipalities. They did not do so, and we saw the result of that, which was people with psychiatric disabilities being left locked up without their medication, either suffering because of that, or even drowning and having secondary disabilities.

We should have learned from that. We didn't really, as is evidenced by New York City having been sued by disability rights advocates because of their lack of accessible alert responses in advance of Hurricane Sandy and other endeavors. The Obama administration made some great headway by appointing the disability point person to try to integrate FEMA responses to natural disasters and other situations of risk. There was a pause during the first Trump administration. There was renewed vigor during the Biden administration, and it remains to be seen, what will occur now during the second Trump administration. So we've progressed overall, and our planning has improved and our inclusion has improved, but it's still a work in progress.

AJMC: What are some things that policymakers, emergency workers, scientists, and even the community can do to help close those gaps?

Stein: Most of us who work on disability inclusion, from either a legal or a policy point of view, would argue that including people with disabilities in the initial design and then the implementation of natural disaster planning, responses to climate change more generally, would help improve it, because we always say that nobody knows their needs and priorities better than the stakeholders themselves. In this case, people with disabilities. So co-design, highlighting of priorities, highlighting of best practices, and perhaps some clever responses to natural disasters and other climate change would be useful as a knowledge sharing.

AJMC: What should be the biggest takeaway about accounting for disabled people during natural disasters?

Stein: Climate change is not going away. We're at a critical existential tipping point, and 1 of the first enactments of the Trump administration was to withdraw from the Paris Agreement. So one has to be concerned, given that we're now having wildfires in the middle of winter in addition to summer. Now that we're having hurricanes and other natural disasters increasingly affecting the Southeast United States, tornadoes in the Midwest, that rather than pulling back, we need to advance and think about how to how to do a better job of ensuring that our vulnerable populations rendered vulnerable because of our policy neglects are protected and included.

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