Hurricanes and Health Equity: A Review of Structural Determinants of Vulnerability for Climate and Health Research

Understanding hurricane vulnerability is crucial for targeting and identifying climate adaptation measures. However, vulnerability assessments often focus on proximal factors, which may obscure underlying drivers of health inequities. We sought to describe the literature characterizing hurricane vulnerability in the U.S., from 2000 to 2022. We abstracted the approaches and factors in each hurricane vulnerability assessment study, and developed a conceptual framework to guide data collection on structural determinants of climate vulnerability.

The review included a total of 121 studies. The majority pre-specified vulnerable populations, while 40% empirically derived vulnerability. Downstream factors pertaining to demographics, spatial analysis, and health status were most commonly used to assess vulnerability to hurricanes. Only five studies reported structural vulnerabilities, including racism, governance, institutions, and infrastructure deficiencies, which form the basis of our conceptual framework. Most hurricane vulnerability studies do not consider upstream factors of health inequities. We developed a conceptual framework and provided example data measures for structural determinants to incorporate into climate and health research, facilitating the development of more effective interventions to address root causes.