Population Health and Health System Resiliency Following Maui's Wildfire Disaster - PROJECT SUMMARY/ABSTRACT In August 2023, the historical town of Lāhainā on the island of Maui in the US state of Hawai‘i experienced the deadliest wildfire in United States history, which destroyed the town and killed at least 100 people, with 4 still missing. During and after the wildfire, there were reports of poor disaster preparedness, response, and recovery efforts including dysfunctional communications, challenges in coordinating emergency services, difficulties in providing needed resources to residents and responders, governmental failures, and cultural insensitivities. This unprecedented disaster has brought new challenges to a community and system already struggling with healthcare provider shortages, poor access to care, and a large population reliant on Medicaid and other social services. The disaster has also introduced new environmental and health threats such as air and water contaminants from chemicals and ash, respiratory diseases, and mental health concerns. Further, the rich ethnocultural diversity of Maui’s populations, including Native Hawaiian and Pacific Islander, Filipino, and Latino communities, with their collective and unique risk and protective health and social factors make the study especially significant. As the global climate crisis increases, it is important to collect and analyze current evidence to inform policies and practices to mitigate short- and long-term consequences of upcoming disasters. This study responds to the Funding Opportunity Announcement PAR-22-233 which establishes an accelerated review/award process to support research to understand health outcomes related to an unexpected and/or time-sensitive event including environmental disasters and other emergent climate threats. This funding mechanism employs a two-phased approach. An R61 phase (year 1) will provide the formative work to inform the aims of an R33 phase (years 2-5) which will test the various mechanisms that potentially explain health risks, system and government responses, and their impacts. Both phases will engage a community advisory board representing various Maui-based stakeholders including community and government leaders, state health department and emergency service representatives, schools, traditional healers, and health providers, and will incorporate the National Institute of Minority Health & Health Disparities research framework adapted to reflect social and cultural influences of health outcomes in Hawai‘i and the Maui wildfire. The R61 phase aims to qualitatively understand the physical and mental health impacts of the wildfire and the personal, family, community, cultural, and institutional factors that influence these impacts, such as governmental responses, and barriers and facilitators to accessing emergency health and social services by residents, first responders, and community and service organizations. The R33 phase aims to quantitatively study the wildfire experiences, patient- and system-level barriers to care during and after the disaster, the mechanisms leading to physical and mental health risks, and health care utilization patterns.
