Supporting flood recovery in rural, mountainous areas through health systems knowledge exchange and fine-scale healthcare utilization data analysis - PROJECT SUMMARY There is a critical gap in understanding the health impacts of inland flooding, particularly in rural Health Professional Shortage Areas (HPSAs). These challenges are currently hindering ongoing recovery efforts following Hurricane Helene in rural Appalachian areas of North Carolina, Tennessee, and Virginia. While previous studies demonstrate increased pregnancy complications and mental health issues following flooding events, the disease burden, barriers to healthcare utilization, and exposure pathways are less studied, particularly in rural areas already grappling with a shortage of mental health services and the consolidation or closure of obstetric units. These gaps prevent effective planning and resource allocation and exacerbate uncertainties around the effectiveness of preparedness strategies designed to minimize the effects of future flooding. Collecting time-sensitive data will support recovery efforts and guide future planning and preparedness strategies. Our team has developed methods to rapidly collect data from healthcare delivery organizations, local agencies, recovery organizations, and school staff to document challenges in meeting health-related needs and identify priority populations and outcomes. We propose to undertake three aims. In the R61 phase, we will identify critical health-related barriers encountered during the Helene response and recovery efforts in affected areas of North Carolina, Virginia, and Tennessee, and we will support ongoing recovery via knowledge exchange sessions with health systems in Kentucky and West Virginia that experienced major floods in 2022 and 2016, respectively. In the R33 phase, we will integrate R61 collected data with healthcare visit data and implement a quasi-experimental controlled before and after study design to estimate flood-related changes in overall healthcare encounters, as well as pregnancy and mental health- related encounters. R61 data will be merged with satellite-derived and modeled estimates of floodwater extents to improve the spatiotemporal characterization of exposures, as well as displacement and outmigration variables. Based on our findings, we will develop and test communication, coordination, and guidance strategies with partners in local health systems and agencies. Results will provide data-driven recommendations for improving the coordination and management of long-term health risks, including mental and maternal health risk during recovery, and identify specific opportunities to enhance flood recovery strategies. We expect that this work will support ongoing recovery efforts in the aftermath of Hurricane Helene and inform future disaster preparedness and flood mitigation strategies in Appalachia and other rural, mountainous areas, contributing to more resilient health systems and communities.
