CHAPTER 4 SUDDEN IMPACT: THE SEVERE WEATHER EVENTS OF 2017 State of Public Health in the Caribbean Report 2017-2018 Climate and Health: Averting and Responding to an Unfolding Health Crisis CHAPTER 4: SUDDEN IMPACT: THE SEVERE WEATHER EVENTS OF 2017 Source: “Hurricane Irma turns Virgin Islands brown,” NASA Earth Observatory (https://earthobservatory.nasa.gov/IOTD/view.php?id=90952) State of Public Health in the Caribbean Report 2017-2018 Climate and Health: Averting and Responding to an Unfolding Health Crisis CONTENTS List of Figures ........................................................................................................................................................................... iii List of Tables ............................................................................................................................................................................. iv Introduction .......................................................................................................................................................................... 124 1. Conceptual framework for analysis of health impact and response ................................................... 124 2. Methodology for data collection ......................................................................................................................... 127 3. Description of the severe weather events of 2017 ..................................................................................... 128 3.1 Hurricanes Irma and Maria ................................................................................................................................ 128 3.2 The vulnerability of Dominica ........................................................................................................................... 133 4. Health outcomes ....................................................................................................................................................... 134 4.1 Mortality, injury and displacement ................................................................................................................. 134 4.2 Safety and security ................................................................................................................................................. 136 4.3 Mental health ........................................................................................................................................................... 137 4.4 Gastro-intestinal disease ..................................................................................................................................... 138 4.5 Malnutrition: under- and over-nutrition ...................................................................................................... 141 4.6 Fever ............................................................................................................................................................................ 141 4.7 Respiratory conditions ......................................................................................................................................... 143 4.8 Mosquito-borne disease ...................................................................................................................................... 144 4.9 Leptospirosis ............................................................................................................................................................ 148 5. Environmental determinants of health ........................................................................................................... 150 5.1 Buildings and infrastructure .............................................................................................................................. 150 Impact ............................................................................................................................................................................ 150 Response ...................................................................................................................................................................... 161 5.2 Safe drinking water and sanitation ................................................................................................................. 167 Impact ............................................................................................................................................................................ 167 Response ...................................................................................................................................................................... 168 5.3 Food security, safety and nutrition ................................................................................................................. 170 Impact ............................................................................................................................................................................ 170 Response ...................................................................................................................................................................... 171 5.4 Disease vectors ........................................................................................................................................................ 174 Impact ............................................................................................................................................................................ 174 Response ...................................................................................................................................................................... 175 5.5 Air quality and pollution ..................................................................................................................................... 176 Impact ............................................................................................................................................................................ 176 Response ...................................................................................................................................................................... 177 6. Building blocks of health systems ...................................................................................................................... 177 6.1 Leadership and governance ............................................................................................................................... 177 Impact ............................................................................................................................................................................ 177 Response ...................................................................................................................................................................... 177 6.2 Health workforce .................................................................................................................................................... 181 Impact ............................................................................................................................................................................ 181 Response ...................................................................................................................................................................... 183 6.3 Health information systems ............................................................................................................................... 185 Impact ............................................................................................................................................................................ 185 Response ...................................................................................................................................................................... 186 6.4 Medical products and technologies ................................................................................................................ 188 Impact ............................................................................................................................................................................ 188 ii | State of Public Health in the Caribbean Report 2017-2018 Climate and Health: Averting and Responding to an Unfolding Health Crisis Response ...................................................................................................................................................................... 188 6.5 Service delivery ....................................................................................................................................................... 188 6.6 Finance ........................................................................................................................................................................ 189 Impact ............................................................................................................................................................................ 189 Response ...................................................................................................................................................................... 193 Conclusion ............................................................................................................................................................................