Analyzing major challenges facing vulnerable populations

For many residents in the greater Houston area, two recent disasters have had lasting impact on their lives — Hurricane Harvey and the COVID-19 pandemic. The former dumped up to 60 inches of unrelenting rain that devastated neighborhood after neighborhood. COVID-19, of course, has hit the entire world and filled hospitals and unemployment rolls, including in our region.

Although a hurricane and a pandemic are very different crises, the lives they upend are often the same. The many negative economic, environmental and public health impacts of disasters exacerbate pre-existing vulnerabilities in these areas. In other words, those who are vulnerable before a catastrophic event are much more impacted during the disaster event and will likely continue to suffer long after it is over.

To provide policymakers, funders and stakeholders with reliable information about the impact of these disasters on Texans and inform their relief and recovery efforts, the Episcopal Health Foundation, in partnership with several research and funding collaborators, conducted public opinion surveys of Texans in 24 affected counties (for Hurricane Harvey) and the state (for the pandemic).1 Both surveys explored the disaster’s effects on income/employment, healthcare and mental health among various populations. Consistent with established research, findings from both surveys reveal that lower-income, non-white and undocumented communities are disproportionately impacted by these disasters.2

How Hurricane Harvey and COVID-19 impact income and employment 

Beyond the collateral damage disasters leave in their wake, the myriad disruptions to infrastructure, economic/market activity, access to resources and more can cause substantial job loss — either temporarily or more long-term. In the months following Hurricane Harvey and COVID-19, many residents throughout Harris County and the state lost income and/or employment. (Loss includes someone in their household lost a job, lost their business, had hours/wages cut back at work, or experienced some other loss of income, including furloughed, as a result of disaster.)

Nearly half of Texas Gulf Coast residents affected by Hurricane Harvey reported income and/or employment losses three months after the event. Meanwhile, nearly four in 10 Texans reported similar effects six months after the COVID-19 pandemic began. Effects in Harris County appear more pronounced as a higher percentage of respondents reported income and/or employment losses over these two time periods. 

While a direct comparison between surveys of income/job loss by household income is difficult due to the questions’ wording, the Hurricane Harvey report found that respondents with lower incomes were much more likely to experience income/employment loss than those with higher incomes. Across the 24 affected counties, 59% of respondents with incomes at or below the federal poverty level (FPL) reported income or job loss compared to 50% of those between 100%-200% FPL, 48% of those 200%-400% FPL, and 29% of those more than four times the FPL. Data from the Census Bureau finds that low-income adults are among those hit hardest financially by COVID-19.

Both surveys also reveal consistent disparities across race/ethnicity. Following existing trends in poverty and income inequality, Hispanics consistently bore the largest economic impact during these disasters, followed by Black Texans. In Harris County, a staggering 82% of Hispanic respondents reported income and employment loss three months after Hurricane Harvey and 43% reported similar losses six months after the pandemic began. 

In both the Hurricane Harvey and COVID-19 reports, we paid special attention to the experiences of those who are potentially undocumented immigrants. For our purposes, Texans who were not born in the U.S., did not have permanent resident status when they moved to the U.S., or who have not had their status changed since, were considered potentially undocumented immigrants. This population has lower job security and typically does not qualify for or access many governmental benefits which increases their vulnerability to economic shocks from a disaster.

About nine in 10 potentially undocumented residents affected by Hurricane Harvey in the region had experienced job/income loss three months after the storm. About half of potentially undocumented residents reported job/income loss six months after the pandemic began. In the Hurricane Harvey report, six in 10 potentially undocumented immigrants worried that they will draw attention to their or their family’s immigration status if they seek assistance. 

How Hurricane Harvey and COVID-19 impact health care in Texas

Lost income and strained resources often force people to make difficult decisions regarding their expenses, which can cause people to delay or forego health care in the period following a crisis — especially if they have lost health insurance. Not surprising given the income/employment losses, many Houston and Texas residents chose to skip or delay health care in the months that followed both Hurricane Harvey and COVID-19.

Texans skipped or delayed health care at a higher rate during COVID-19 than in the first three months after Hurricane Harvey. These differences are consistent across both the state/region and Harris County, and may be explained by personal health and safety concerns associated with visiting doctor offices during a pandemic. 

The COVID-19 report finds that 44% of Texans with incomes above $75,000 a year skipped or delayed health care compared to 31% of respondents with incomes below $75,000. This  is  likely  because higher-income households tend to have higher rates of health insurance  coverage, allowing for greater access to health care that preceded the pandemic.

The mental health impacts of Hurricane Harvey and COVID-19

Disasters in any form take a toll on our individual and collective health. The fear and worry of potential or actual financial and personal loss from a disaster can have serious emotional impacts — including PTSD, anxiety, depression and others. The impacts on our mental health can be as severe and long-lasting as the more visible physical and economic damage, and in some cases more so. 

The pandemic appears to have had worse effects on mental health than Hurricane Harvey. Close to half of Texans and Harris County residents said the worry or stress related to COVID-19 has had a negative impact on their mental health. Three months after Hurricane Harvey, 13% of Texans and 12% of Harris County residents reported that their mental health worsened as a result of the storm. This difference is likely due to the time-limited nature of Hurricane Harvey and that some neighborhoods were more affected than others.

Key takeaways and what comes next

Aside from the obvious differences between these two major crises, the findings from both surveys reinforce the fact that lower-income, non-white and undocumented populations are more likely to experience financial hardships and have a harder time coping with both disasters than their peers.

These findings signal that public- and private-sector leaders need to do more to address economic, health and mental health needs related to the pandemic, particularly for our region’s most vulnerable residents. We must pay attention to the needs of a group that is critical to our region’s local economy, workforce, and social fabric — undocumented immigrants. As both surveys show, they are suffering even more than their peers during COVID-19. Policymakers and philanthropy should devise long-term assistance, relief and rebuilding strategies to assist these vulnerable populations.

1. See An Early Assessment of Hurricane Harvey’s Impact on Vulnerable Texans in the Gulf Coast Region, Texans’ Views on the COVID Pandemic and Texans’ Views on the COVID-19 Pandemic in Harris County.

2. In discussing some common threads of these reports, we should note that Hurricane Harvey is a one-time natural disaster event that impacted 41 counties in Southeast Texas while the COVID-19 pandemic is both a global and national public health emergency that continues to impact the entire state. Nonetheless, it is useful to compare the data relating to how these events have impacted the vulnerable populations in Texas and Harris County. 

Published by Shao-Chee Sim, PhD

Vice President for Research and Evaluation, Episcopal Health Foundation

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