The recently released report from the Milken Institute is perhaps the strongest rebuke to date on the impact of Hurricane Maria during the 2017 hurricane season.

The report notes nearly 3,000 people have died in Puerto Rico because of the storm. These numbers provide a more accurate depiction of the devastation and lives lost in Puerto Rico. While sad and troubling, it is important to call out that these updated numbers do not even account for the death toll in the U.S. Virgin Islands.

It’s also important to note that the new estimate demonstrates the very real consequences of fragile infrastructure and preparedness plans in the face of disaster. From my perspective, this report makes an irrefutable case for the need for more investments in health care and public health preparedness. With that, there are a few questions which this report calls us to consider.

How do we build systems that care for the most fragile and most vulnerable? 

The report reminds us that in disaster response, the cascading public health impacts are as important as the direct impacts. In the days, weeks and years after a disaster, public health needs and strains on the health-care system will continue to cause casualties, especially in high-risk populations.

For instance, challenges patients face when trying to access care in the days following a disaster are difficult. But for those at higher risk or need, including medically fragile patients such as the elderly or those suffering from a chronic disease, the challenges can be insurmountable. As emergency managers, we know the ability to access care is a matter of life and death – so we must vow to do better for those affected by disaster.

Many factors lend to the cascading impact of a disaster, such as a failure to prioritize chronic health needs. For every patient that visits an emergency department after a disaster, there are countless more struggling to simply sustain their health or even make it to a health-care facility.

All too often we prioritize acute needs over patients with chronic care needs in the immediate aftermath of a disaster. However, if these individuals continue to be ignored, the consequences will be long lasting and catastrophic, as demonstrated by this report. Protecting patients, specifically those with chronic health conditions, and elevating their importance in emergency response is an ongoing effort in our field and should be made even more urgent after reviewing the revised death toll. 

Will the U.S. resolve to make sustained investments to prevent such death tolls seen after Hurricanes Katrina (1833) and Maria (2975+)?

 Another important element of the report is the impact of the storm across demographics, especially socioeconomic status (SES). For low SES populations, the risk of death was 45 percent higher. In addition, we see that age was also a risk factor in increased likelihood of death. This data reinforces the need for equity in our disaster preparedness and response and should serve as a call to action for the entire field. We must pay attention to those communities and populations who will have a higher risk of fatality after a crisis and are otherwise left to respond with fewer resources. 

Can we make community-level preparedness a priority, recognizing that it is life-saving in crisis?

Often, local communities end up acting as first responders until additional help can arrive (pointed out in Sheri Fink’s latest piece on Hurricane Harvey). We must train and equip these citizens with the capabilities to respond to their community’s needs, as this may be life-saving during an event.

Another example of the widespread impact of Hurricane Maria resonated with our team when speaking with partners on the island during the immediate response. Amid the crisis, they were returning to work to help others while also grieving. I spoke with countless dedicated partners who were supporting the response and would casually mention that they were also dealing with the loss of a loved one or spearheading a major response effort for their local community.

Many of those lost were fighting mental illness, suffered from a chronic disease, or another ailment which went untreated for too long. It’s hard to accept that despite the efforts of those in the field, so many lives were lost due to the lack of preparation and sustained care after the storm. Moving forward, we must ensure that high-risk populations are not only prepared but cared for following disaster.

While storms are inevitable and often destructive, we can and should be better prepared next time. It is my hope that this report sparks discussion across industry and government to consider how we turn these hard lessons into concrete actions not just for Puerto Rico, but the rest of the country as well.

By fostering an open forum for discussion, we can tackle issues like the sporadic influx of investment that’s usually seen immediately following a disaster and abruptly lags once news coverage wanes. As many across the field know, without sustained investment from the federal government and private sector partners, we cannot build resilient communities and infrastructure.

I’m calling on policymakers, emergency management officials and private sector partners to fight for the sustained investment necessary to tackle these issues in emergency preparedness. Lives depend on it and we cannot ignore the facts any longer. Only with proper investment and resources to address these questions can we ensure that all communities, especially those who are high risk, are prepared to withstand and rebound from a disaster.