This overview of health and social services in Puerto Rico includes 31 courses of action to better recover from health crises, build a more resilient system to future disasters, and actively promote health and well-being.

With its 155 mile-per-hour sustained windspeeds, the near-Category 5 Hurricane Maria brought catastrophic devastation and destruction as it diagonally crossed the Commonwealth of Puerto Rico from the southeast to the northwest on September 20, 2017. The official death toll estimate of 2,975 lost lives means this record storm became one of the most devasting hurricanes not only for Puerto Rico but for the U.S. Many of these deaths, as well as the prolonged human suffering, were attributed to what was described as inadequate disaster response and slow restoration of basic services (including running water, electricity, and the provision and distribution of food and medicine), and not to the direct impact of the hurricane itself. At the same time, Hurricane Maria made landfall when Puerto Rico had been confronting a severe economic crisis surging for over a decade. This crisis, referred to as La Crisis Boricua, was characterized by a significant loss of industry and jobs, a deteriorating infrastructure, record net outmigration, a shrinking and rapidly aging population, rising healthcare under-coverage, a bankrupt government, and federal legislation restricting fiscal policy decisions made by elected officials on the island. Thus, Hurricane Maria exacerbated the effects of La Crisis Boricua on the socioeconomic, health, and demographic outcomes affecting Puerto Ricans on the island and U.S. mainland. Bringing together scholars from a wide variety of disciplines (including economics, sociology, demography, health, psychology, disaster research, political science, education, the arts, and others), this volume represents one of the first interdisciplinary sets of studies dedicated to analyzing the effects of Hurricane Maria on island and stateside Puerto Ricans. Specific topics cover Hurricane Maria’s impact on labor market outcomes, including wages and employment by industry; health implications, including mental health; changes in artistic expression; civic engagement; and disaster response and recovery. A common thread through many of the chapters was the destruction of Puerto Rico’s electrical grid and the prolonged restoration of electricity and other essential services that resulted in the loss of thousands of lives.

Two years after Hurricane Maria hit, Puerto Ricans are still reeling from its effects and aftereffects. Aftershocks collects poems, essays and photos from survivors of Hurricane Maria detailing their determination to persevere. The concept of "aftershocks" is used in the context of earthquakes to describe the jolts felt after the initial quake, but no disaster is a singular event. Aftershocks of Disaster examines the lasting effects of hurricane Maria, not just the effects of the wind or the rain, but delving into what followed: state failure, social abandonment, capitalization on human misery, and the collective trauma produced by the botched response.

Resilient supply chains are crucial to maintaining the consistent delivery of goods and services to the American people. The modern economy has made supply chains more interconnected than ever, while also expanding both their range and fragility. In the third quarter of 2017, Hurricanes Harvey, Irma and Maria revealed some significant vulnerabilities in the national and regional supply chains of Texas, Florida, the U.S. Virgin Islands, and Puerto Rico. The broad impacts and quick succession of these three hurricanes also shed light on the effectiveness of the nation's disaster logistics efforts during response through recovery. Drawing on lessons learned during the 2017 hurricanes, this report explores future strategies to improve supply chain management in disaster situations. This report makes recommendations to strengthen the roles of continuity planning, partnerships between civic leaders with small businesses, and infrastructure investment to ensure that essential supply chains will remain operational in the next major disaster. Focusing on the supply chains food, fuel, water, pharmaceutical, and medical supplies, the recommendations of this report will assist the Federal Emergency Management Agency as well as state and local officials, private sector decision makers, civic leaders, and others who can help ensure that supply chains remain robust and resilient in the face of natural disasters.

This book deals with the immediate effects of, and response to, Hurricane María on the social, ecological, and technological systems (SETS) of Puerto Rico. The SETS approach to analyzing hurricane effects places into historical context the role of social and technological factors, and compares social and ecological resilience on the same temporal scales. Written from the perspective of a Puerto Rican scientist who experienced Maria's wrath first-hand, the book uses extensive empirical knowledge of the ecological effects of hurricanes on Caribbean forests and combines that knowledge with a detailed analysis of the effects of Hurricane María on the social and technological fabric of Puerto Rico. The comparison suggests that the effects of extreme events are dictated not only by the strength of the physical event, but also by the conditions of affected SETS at the time when the event exerts influence over them. Moreover, SETS have historical legacies that influence how resilient they can be when affected by an extreme event. Therefore, preparation and response to extreme events require an integrated social, ecological, and technological effort, known as the SETS response. The SETS response requires an understanding of the energetics of extreme events and their effects on the economy, which in turn determines social and technological resilience. Hurricane María demonstrated that the social and technological systems of Puerto Rico were not adapted to dealing with extreme events, in contrast with the ecological systems, which were. Hurricane María’s effect on Puerto Rico can be used as an example from which valuable lessons emerge for making SETS more adaptable and resilient to extreme events.

When children experience upheaval and trauma, adults often view them as either vulnerable and helpless or as resilient and able to easily “bounce back.” But the reality is far more complex for the children and youth whose lives are suddenly upended by disaster. How are children actually affected by catastrophic events and how do they cope with the damage and disruption? Children of Katrina offers one of the only long-term, multiyear studies of young people following disaster. Sociologists Alice Fothergill and Lori Peek spent seven years after Hurricane Katrina interviewing and observing several hundred children and their family members, friends, neighbors, teachers, and other caregivers. In this book, they focus intimately on seven children between the ages of three and eighteen, selected because they exemplify the varied experiences of the larger group. They find that children followed three different post-disaster trajectories—declining, finding equilibrium, and fluctuating—as they tried to regain stability. The children’s moving stories illuminate how a devastating disaster affects individual health and well-being, family situations, housing and neighborhood contexts, schooling, peer relationships, and extracurricular activities. This work also demonstrates how outcomes were often worse for children who were vulnerable and living in crisis before the storm. Fothergill and Peek clarify what kinds of assistance children need during emergency response and recovery periods, as well as the individual, familial, social, and structural factors that aid or hinder children in getting that support.