Exploring Community Flood Impacts, Vulnerabilities, and Adaptation Strategies to Public Health Concerns

Proceedings of a Workshop—in Brief

INTRODUCTION

Climate change is increasing the frequency and severity of floods, posing serious threats to lives, livelihoods, and the future of affected communities.^1,2 The public health, social, and economic toll of flooding is felt in large cities and rural areas, inland and along the coast, and in the immediate aftermath of disasters, as well as in chronic and long-term impacts that unfold over the course of years. Ensuring that all communities can access the information, resources, and protection measures they need to survive and thrive in the face of flooding is crucial for enhancing health equity and resilience as people plan and adapt for impacts of climate change.

To explore opportunities to prevent and mitigate inequitable health impacts from flooding, the National Academies’ Environmental Health Matters Initiative (EHMI) organized a workshop on March 13 and 18, 2024, titled Communities, Climate Change, and Health Equity: Exploring Flood Adaptation Strategies to Support Health Equity. The workshop was the fourth in a series of EHMI events exploring the state of knowledge on climate-related health disparities. The virtual event convened people with lived experience in communities affected by flooding; experts in climate science, environmental health, and social equity; and people involved in resilience planning and disaster response and recovery. Through presentations, shared stories, and interactive discussions, participants explored health risks posed by flooding events; effective adaptation strategies for community resilience and climate adaptation; and ways to foster partnerships among government, academia, and the private sector to implement these strategies both locally and regionally.

This Proceedings of a Workshop—in Brief has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. The views contained in the proceedings are those of individual workshop participants and do not necessarily represent the views of all workshop participants, the planning committee, or the National Academies of Sciences, Engineering, and Medicine.

CONTEXT

Keynote speakers provided context on the current state of knowledge about flooding, associated health inequities, and opportunities to adapt to a changing environment. Examining multiple facets of flooding as an environmental phenomenon that affects physical health and

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psychosocial well-being, speakers discussed how flooding is addressed in terms of prevention, response, and adaptation. They described the unequal burden borne by people of different racial, cultural, and socioeconomic backgrounds and explored how each community’s unique assets and needs can inform efforts to foster resilience.

Public Health Implications of Flooding

Maureen Lichtveld (University of Pittsburgh) discussed the public health implications of flooding and how proactive, community-engaged approaches can help reduce impacts and inequities.

Increased flooding is one of several ways climate change impacts human health and well-being, and it is affecting a wide range of communities in places that have long grappled with flooding as well as those that have not. “No one is safe anymore from flooding, and no place is safe anymore from flooding,” Lichtveld said. Lichtveld, who moved to New Orleans just before Hurricane Katrina in 2005, has seen firsthand how flooding disasters affect people both physically and psychosocially. For example, in the aftermath of Katrina, she collaborated with the United Houma Nation, a tribe comprising approximately 17,000 members, 60% of whom suffered damage to their homes from the hurricane. She described how the impact of flooding on this community’s sense of place is entwined with their cultural identity; for example, after a tribal center was damaged in the hurricane and then rebuilt, the new center that became their new cultural home was also affected by flooding. These repeated threats to this tribe’s sense of place greatly affect their sense of unity. This story and many others occurring in communities across the country illustrate how flooding is not a one-time event but rather “a pervasive insult on people’s lives,” Lichtveld said.

Where health and environment intersect, Lichtveld stressed that individual outcomes are linked to what occurs at the population and community levels. When examining the cumulative impacts of environmental phenomena on communities, it is, therefore, key to consider the historic burden of disparities and inequities. Much like precision medicine, where the genetic makeup of an individual is used to guide treatment decisions, she posited that understanding the makeup and needs of a community can help to tailor interventions specifically to that community’s assets and gaps. This approach, termed precision public health, can help sustainably address issues like flooding by using data and predictive analytics to target interventions for affected people.3

Features of a community can increase—or decrease—its vulnerability to disasters. Lichtveld emphasized that the “quiet” periods between disasters are the ideal times to invest in community resilience by preserving the natural environment, strengthening infrastructure, enhancing financial stability, nourishing human and cultural facets, fostering strong social connections, and bolstering political systems that support healthy communities.4 She also pointed to five pillars that undergird community resilience: data, funding, governance, infrastructure, and human capital.5 To effectively use precision public health strategies to strengthen communities, she said that it would be critical to eliminate silos across these areas, invest in social capital, and focus on directing resources where and when they are needed the most in reducing vulnerability.

Flood Policy in the United States

Margaret Walls (Resources for the Future) provided an overview of how flooding is addressed in the United States, where flood-related disasters are increasing in both number and cost.

Flood control infrastructure has long been a primary focus of flood preparedness in the United States, which has spent billions of dollars on levees, stormwater infrastructure, dams and reservoirs, and tide gates in an effort to control the flow of water and prevent flooding in developed areas. However, Walls noted that much of this infrastructure is aging and was not built for the extreme events being experienced now. For example, levees collectively span 23,000 miles in the United States, and the average age of these levees is 60 years old. Infrastructure costs a tremendous amount of money to build and main-

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tain, and Walls said that current investments are probably insufficient to meet the need.

An alternative way to mitigate flood risk is to move away from flood-prone areas or avoid building there in the first place. Local governments can do this through land use planning and zoning to create buffers or discourage new development in risky areas, for example. Where development already exists, federal property buyouts are an option. Although moving people and property out of harm’s way could be an effective strategy, in reality, it is difficult to implement for various reasons. For instance, as several speakers and participants noted, there are often challenges related to finding new locations for people to move to, as well as family, social, cultural, and economic ties that they have to their homes.

At the level of individual properties, owners can mitigate flood hazards by taking steps such as elevating and securing heating and air conditioning equipment, and they can mitigate the costs of disasters by buying flood insurance. However, Walls said that the adoption of such measures has been relatively limited where they are voluntary. Insurance and disaster relief programs play important roles in the perceptions and incentives that influence flood preparedness. Floods are not covered in standard homeowner insurance policies, and most flood insurance in the U.S. is provided by the National Flood Insurance Program. Floodplain maps produced by the Federal Emergency Management Agency (FEMA) are used to determine flood insurance requirements for government-backed mortgages and also inform building code requirements. However, a large number of maps do not always reflect a full, accurate, and up-to-date understanding of flood risk. Furthermore, Walls said these maps are often misinterpreted to suggest that places outside of FEMA-designated floodplains are not at risk. Walls shared that this has created a large flood insurance gap in the U.S. that affects low-income communities most acutely.

Low-income populations and people of color are disproportionately exposed to flood risks,^6,7 and factors such as underlying health risks, language barriers, and limited funds for recovery can exacerbate the impacts of disasters in these communities. Even when assistance programs are available, the paperwork and technical requirements involved can make it challenging for individuals to benefit from them. “We have justice and equity challenges bound up in the way a lot of our policies and institutions work,” Walls said. For example, FEMA disaster aid is partly based on property values and grants that require local cost sharing, which may inequitably weigh funding toward communities with higher property values and can be inaccessible for under-resourced communities.

Although there have been some shifts in recent years, Walls said that policies in the U.S. have generally been focused on post-disaster aid. “We need to have our policies more focused on pre-disaster. This is a whole other conversation,” Walls shared. Based on disaster specifics, programs like FEMA provide individual assistance to homeowners and renters as well as public assistance to state and local governments. The U.S. Department of Housing and Urban Development also provides money through its Community Development Block Grant program. To truly build resilience, she urged a greater focus on what can be done before disasters hit.

Rebuilding for Resilience

Amy Chester (Rebuild by Design) discussed how communities can enhance disaster resilience by using data, thinking creatively, and focusing on local needs and solutions. Her organization, Rebuild by Design, was created as part of a design competition to help governments create collaborative processes to enhance disaster resilience after Hurricane Sandy devastated portions of the U.S. East Coast in 2012. Highlighting how principles of product innovation can be applied to infrastructure, Chester described how resilience solutions can achieve multiple benefits at large scales.

Roads, buildings, parks, and other aspects of the built environment can be designed in ways that serve multiple purposes and enhance community resilience. For example, Chester pointed to structures in the Netherlands, Thailand, and Denmark that simultaneously serve as flood protection and parking garages or spaces for public recreation. However, Chester stressed that each place is different and there is no one-size-fits-all solution, so it

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is important for designs to be responsive to the particular conditions, needs, and priorities of the local community.

To spur innovation and inform investments in resilience, it also can be important to identify where the needs and vulnerabilities are. Chester described how her organization developed an Atlas of Disaster8 by analyzing where disasters and power outages occur, where federal assistance is provided, and where social vulnerability is greatest. Overlaying these data points at the county and state level provides important insights that can inform future investments. For example, the analysis revealed for the first time that 90 percent of U.S. counties had a federal extreme weather disaster declaration between 2011 and 2021. It also identified hot spots, such as Louisiana, which ranked highly for both disaster occurrences and per-capita disaster recovery spending, along with gaps, such as a lack of attention to extreme heat, something the U.S. does not issue disaster declarations for despite the heavy impacts of extreme heat events on health and well-being, as discussed during another workshop from this series.⁹

Despite the daunting challenges climate change brings, Chester emphasized that it is possible to build resilient communities by designing with intentionality. To accomplish on-the-ground impact, she said it is critical to engage effectively with communities to gain a deep understanding of what is (and is not) desired within that community, to address distrust and areas of friction between governments and communities, and to fit budgetary constraints in terms of both initial deployment and ongoing maintenance. “The way you get support is with data,” Chester said. This includes data elucidating the challenges a community is likely to face, as well as data and examples showing how different solutions can help to mitigate those risks. Projects including the Big U in Manhattan (which also includes the East Side Coastal Resiliency, Brooklyn Bridge Montgomery Coastal Resilience, Lower Manhattan Coastal Resilience, and Battery Park City Resilience Projects), the living breakwaters in Staten Island, and the flood control infrastructure in Hoboken, New Jersey show how communities of various sizes and characters have successfully navigated community-engaged processes to create solutions that can help them withstand future extreme events. “Climate change is not coming—climate change is here,” Chester said. “And we can do something about it.”

SHARING STORIES

To examine some of the commonalities and differences in how communities experience and respond to flooding and associated health impacts, two workshop sessions focused on the lived experiences of people who have experienced flooding, worked with flood-affected communities, or engaged in cross-sector partnerships to co-produce solutions. Speakers shared the challenges that have spurred action to address flooding and related health inequities in their communities, described solutions that are being pursued, and reflected on the attributes of successful projects and partnerships.

Cumulative Impacts of Flooding in North Carolina

Kemp Burdette (Cape Fear River Watch) spoke about experiences with inland flooding in eastern North Carolina, an area that regularly experiences major storms and hurricanes and has seen two “1,000-year storm” events in less than 40 years. Hurricane Florence, which struck the region in 2018, provides one example. During the storm, flooded roadways and washed-out bridges isolated entire communities. Once the water receded, people worked to clean out their homes as mold spread through structures and piles of garbage mounted up on roadsides. Many affected property owners lacked flood insurance, and hundreds of homes have since been deserted and left to rot. “Tragically, the people who have suffered the most in Florence were the people who were least able to bounce back,” Burdette said.

Effects on the region’s industrial activities further compounded the impacts on communities. Floodwaters inundated massive hog and chicken farms, carrying concentrated animal waste into waterways. Industrial sites such as coal ash storage areas and wastewater treatment plants were also compromised, releasing heavy metals and chemicals into the environment. As a result, community members faced health risks from exposure to contaminants, compromised private wells, and increased

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susceptibility to infections in addition to widespread property damage.

Expressing his frustration that little has changed since Hurricane Florence, Burdette offered several lessons from the experience. Noting that the “impacts from flooding are felt long after waters recede,” he said it is important to recognize that the impacts of disasters are often cumulative. Loss of housing, contamination of water, and mental health challenges, for example, can combine to affect people in multiple ways, underscoring the importance of comprehensive disaster response and equitable support for affected communities, particularly those who have been historically marginalized. In light of the worsening impacts of climate change, he also emphasized the need for proactive planning and sustained efforts to build community resilience. He added that it is important to update floodplain assessments, address potential intentional misrepresentation driven by the interests of industries or developers, and increase awareness of the risks posed when hazardous industries and residential developments are located in flood-prone areas.

Harnessing a Spirit of Solidarity in Kentucky

Mimi Pickering (Appalshop) shared clips from a film she worked on with the Center for Rural Strategies that gathered first-hand accounts of volunteers and survivors of flooding that hit Whitesburg and Eastern Kentucky in 2022. Volunteers recounted stories of harrowing rescues and the absence of immediate governmental aid, which prompted grassroots efforts to help residents muck out houses and provide essential supplies and funds. Despite the overwhelming need for assistance, volunteers persevered, supporting each other in light of the enormity of the task and the limitations of their resources. Survivors expressed gratitude for their lives but struggled with feelings of shame and loss.

The film clips demonstrated a strong sense of community solidarity in the face of adversity but also highlighted the importance of institutional support and resources to aid in recovery efforts. As the community grappled with the aftermath of the disaster, people mourned the loss of lives and homes while expressing their determination to rebuild and revitalize the region. Looking ahead, Pickering noted that mental health impacts like post-traumatic stress disorder can often emerge long after the initial aftermath of a disaster, which makes it important to track such outcomes and ensure access to mental health resources in the long run.

Promoting Preparedness in Puerto Rico

Abigail Matos-Pagan (University of Puerto Rico Mayaguez) spoke about Puerto Rico’s experience with Hurricane Maria in 2017 and subsequent flooding events. Hurricane Maria affected the entire island, causing loss of life and extensive damage to infrastructure, homes, and businesses, as well as power outages that still affect the island today. The breakdown of communication systems further worsened the plight of residents, hampering rescue and relief efforts and delaying the deployment of aid. In the absence of functioning hospitals and pharmacies, residents struggled to access critical medical care, exacerbating health issues and contributing to premature deaths. Older people were particularly vulnerable because in Puerto Rico, many of them live alone and had no support system to help them locate adequate food, water, or medication.

Subsequent flooding events have caused further damage. With rainfall levels reaching up to 30 inches in some areas, flooding has repeatedly inundated homes, destroyed bridges, and overwhelmed critical infrastructure, often leaving many people without electricity for extended periods. Matos-Pagan said that cultural attachments to homes and communities and a lack of places to go have hindered evacuation efforts, leaving many individuals stranded in flooded areas and susceptible to reoccurring flooding events. In addition, shortages of essential supplies such as fuel and medications have compounded the humanitarian crisis during these events, leading to unattended medical emergencies and preventable deaths.

These experiences underscore the critical need for continuous improvement in areas such as infrastructure, communication systems, power grid resilience, and disaster response capabilities, Matos-Pagan said. She added that enhancing communication systems and implementing registries for vulnerable populations could help Puerto Rico better prepare for future disasters. Finally, she noted the importance of attending to the psychological impacts of such events to enhance community well-being and facilitate long-term recovery and resilience.

Community-Centered Flood Planning in Mississippi

Romona Taylor Williams (Mississippi Communities United for Prosperity) shared how her organization addressed flooding in the small community of Duck Hill, Mississippi, through an initiative called Achieving Sustainability Through Education and Economic Development Solutions (ASEEDS). The first phase of the initiative resulted in the successful deployment of green and gray infrastructure that stopped the recurrent flooding in Duck Hill. Following this achievement, the organization turned its attention to fostering economic development in Duck Hill and applied the ASEEDS model to develop sustainability plans for three communities in Jackson, Mississippi, that face significant flooding issues caused by the Pearl River overflowing into the Ross Barnett Reservoir.

Partnering with Columbia University’s School of Climate and Sustainability, the Jackson project initially focused on fostering community collaboration. “The old way was that you’ve got the city planning department and all of the players to the exclusion of our community,” said Williams. “We want to change that trajectory and make it more community-centered and more community-driven.” To do this, Williams’ team engaged Columbia University students to develop a comprehensive community communications plan. Over subsequent cohorts, they formed a community advisory board and collaborated on a sustainability plan, addressing systemic issues like exclusion from planning processes.

The resulting plan incorporates nature-based solutions, economic interventions, and community-centered governance, with strategic partnerships with universities being crucial for success. The project team and the involved communities are now advancing toward implementing the plan, securing funding, and further engaging residents. “The main thing that we want to highlight is the importance of having strategic partners,” Williams said. “They bring so many resources and intelligence to the work that we are doing to make our community safer, healthier, and more sustainable.”

Leveraging Digital Technologies in Michigan

Branko Kerkez (University of Michigan) discussed efforts to mitigate flooding in Detroit, Michigan, using digital technologies to gather data, upgrade stormwater infrastructure, and inform immediate and long-term responses to flooding.

Floods happen quickly, and having access to real-time information about where soils are becoming saturated or where water is flowing can be immensely valuable. To inform prevention strategies, the Digital Water Lab at the University of Michigan deployed a sensor system that provides real-time information during storms and creates a historical record to track flooding patterns. In addition, to help inform response efforts during flooding events, the team developed a map interface that allows users to see what is happening on the ground in different areas of the city. For longer-term resilience planning within communities, they also developed an interactive web tool called Sewer Tycoon, which allows residents and community groups to get feedback on how well different solutions might work using the same back-end data and models that city and state planners use.

In addition to improving resilience planning and helping people avoid danger when floods occur, technologies can also enable real-time interventions to redirect the water. Kerkez described how his team collaborated with the city of Detroit to deploy “digital upgrades” to existing stormwater infrastructure using flood control valves, pumps, and inflatable pillows that can be used to block or direct water strategically. This effectively allows officials to “reprogram” the stormwater controls as potential flooding events unfold. “It is one thing to get measurements; it is a completely different thing to do something about it when you are sensing it,” said Kerkez. Noting that a digitally enhanced stormwater system can perform as well as a passive system that is about twice as large, Kerkez said that upgrading existing infrastructure can be far less expensive than building new infrastructure (or recovering from disasters when they occur).

Interdisciplinary Engagement and Research Translation in Maryland

Priscilla B. Ramalho Alves (University of Maryland) described a project of the University of Maryland’s Stormwater Infrastructure Resilience and Justice Lab aimed at addressing sanitary sewage overflows and basement backups. These events release untreated or partially treated sewage into the environment or into homes, causing property damage, water contamination,

and additional threats to public health. It is estimated that more than 3,900 sanitary sewage overflows have occurred across Baltimore, Maryland, since 2011, releasing more than 110 million gallons of sewage into streets, homes, and bodies of water.

The team used a community-driven approach to understand residents’ experiences with these events, assess bacterial contamination, and share the results with affected community members. They conducted surveys, inspected homes, collected and analyzed samples from homes affected by overflows and backups, and reported the results back to individual residents and groups. To date, the team has sampled 88 houses and attended 10 community events to raise awareness of basement backups and help residents understand the potential health threats they pose. Alves said that the project’s interdisciplinary approach, consideration for context-specific conditions, and community collaboration and engagement have all been instrumental in helping the project to have a meaningful impact for study participants in addressing this pervasive health threat affecting the community.

Collective Action for Tangible Impacts in Louisiana

Angela Chalk (Healthy Community Services) discussed lessons learned from her organization’s experience with deploying green infrastructure projects in New Orleans, which experiences frequent flooding not only from hurricanes but during everyday rainstorms, including in places that have not historically flooded. The organization’s projects to mitigate flooding at the neighborhood level have included planting more than 770 trees, installing 146 rain barrels, and implementing more than 113 other projects, such as building rain gardens and bioswales, removing concrete, and installing French drains and pervious pavement.

A community-led approach has been critical to the success of these efforts. Chalk emphasized that she and her colleagues work with communities rather than studying them or imposing solutions upon them: the organization strives to leave tangible assets in every community they work with and communities are fully engaged throughout the process and have ownership over what is produced. A network of 175 neighborhood champions helps to link residents with resources in ways that align with each community’s unique needs and priorities. Even though many community organizers are themselves residents of the communities they serve, Chalk stressed that it is important to separate the role of a resident from the role of someone securing funding and resources for programs. “I cannot presume what someone wants in a community just down the street from me unless we engage residents to understand what their needs are,” she said. “All of us as community organizations—we take that step back from being a resident and let the residents see things through a different lens that we may not be seeing.”

From an organizational standpoint, Chalk and her colleagues take a collective approach, pooling resources with other organizations at the intersection of climate and public health to complement each other’s work rather than competing for funding or duplicating efforts. She added that operating as a collective has also helped to sustain these efforts by providing professional support and relief for personnel, supporting a healthy work-life balance.

OVERCOMING BARRIERS TO IMPLEMENTING FLOODING SOLUTIONS

Attendees engaged in two breakout sessions and a panel discussion to examine the implementation barriers, knowledge gaps, and lapses in communication that can hinder the ability to address flooding and its health impacts, along with potential opportunities to overcome these challenges and advance solutions that enhance health equity and flood resilience.

Several cross-cutting issues and suggestions emerged from these conversations. First, many participants noted that continuing to build in flood-prone areas clearly increases the number of people and properties exposed to flood risks. Several participants posited that improving understanding and awareness of flood risks and then incorporating that understanding into zoning and development decisions could significantly reduce the impacts of future disasters. As Palencia Mobley (Mode Collective) stated, “It really does come [down] to where we allow things to go.” However, Mobley and other participants noted that land use planning is often disjointed, making it challenging to implement a flood-resilient development strategy consistently, especially across different jurisdictions. In addition, regulatory, economic, social, and political drivers can sometimes wind up encouraging development in risky areas, whether intentionally or not. Several participants also pointed out that confusion around flood

maps, along with the fact that flood risk changes over time, is difficult to accurately predict and can undermine the ability of individuals and decision-makers to know which areas are at risk.

Another common thread throughout the discussions was the importance of collaboration and partnerships to design and implement cohesive, effective, and equitable systems for handling stormwater and reducing the risk that people and properties will be exposed to flooding. Mobley noted that “water does not know the boundaries” between various political or administrative purviews, and Anne Baker (American Flood Coalition) stressed that watershed-level governance can allow a holistic approach for decision-makers to recognize where the vulnerabilities lie, consider how different types of communities are affected, and prioritize projects. Several participants underscored the importance of aligning efforts across federal, state, and local levels to advance systematic solutions that are informed by and carried out in partnership with communities.

Many pathways already exist for individuals and communities to get funding and other resources to recover from disasters and increase flood resilience. However, several participants said that the impacts of grants and other opportunities are often limited by the significant barriers people face in accessing them. Many participants pointed to the importance of improving access to resources across the full spectrum of programs, from micro-level grants that help individuals protect their homes to large programs that pool federal, state, and local resources to implement flood-resilient infrastructure. To address this, Jesse Bell (University of Nebraska Medical Center) suggested that private-public-academic partnerships could help communities apply for and manage grant funding. Other participants added that communities might benefit from technical assistance from the government or even enlist the help of artificial intelligence or other tools to improve their capacity to seek and obtain grants. Several participants also noted that better coordination among agencies and between agencies and communities could help to increase awareness of available resources and reduce red tape for relevant grant programs.

In addition to these cross-cutting topics, participants delved deeper into specific challenges and potential solutions related to four main areas: green, blue, and gray infrastructure; economic recovery, resilience, and stability; health and healthcare; and social cohesion and housing.

Green, Blue, and Gray Infrastructure

Features of the built and natural environment influence where water flows, where it accumulates, and how much damage it causes. Green infrastructure (natural or nature-based solutions), such as rain gardens and green roofs, blue infrastructure (water features) like ponds and wetlands, and gray infrastructure (traditional infrastructure), such as concrete sewer networks and levees, play a significant role in flood risk. The impervious surfaces of gray infrastructure have traditionally been used to channel stormwater away from people and properties, but these practices have also modified urban watershed hydrology, leading to higher stormwater flow rates and volume, erosion, and mobilization of non-point source pollutants. Green and blue infrastructure have the potential to reduce these risks by slowing the flow of water, reducing its volume, and storing and filtering water locally. However, many places lack flood-resilient infrastructure and many participants noted that much of the infrastructure that does exist is aging or insufficient to meet the need.

In breakout discussions, several participants identified green infrastructure as an important subject but noted that it can be challenging to obtain funding, permits, and community support for this type of infrastructure. They said that it can be particularly challenging to build trust in new or innovative approaches that are unfamiliar to people, and it can also be difficult to find engineers and construction workers with the knowledge and skills to build green infrastructure.

Infrastructure is costly to build and maintain—especially as the cost of materials continues to rise—making it important to invest wisely. Local governments are often constrained by limited resources, short-term priorities, and the need to balance infrastructure investments with other competing priorities, such as affordable housing, which adds to the complexity of implementing proactive flood prevention strategies. Many infrastructure projects have the potential to bring multiple co-benefits for flood resilience, health, and equity, but several participants

cautioned that embedding the full range of benefits into infrastructure planning may require a nuanced approach and intentional tailoring. Future research was suggested to understand the relationship between stormwater infrastructure and community health benefits.

To guide infrastructure investments and solutions, many participants emphasized the importance of collaborating across sectors to identify vulnerabilities and invest in infrastructure before problems occur. Several panelists commented that although the amount of funding being allocated to infrastructure improvements may seem large, the cost of implementation is extremely high, and it is, therefore, critical to ensure that investments are directed toward solutions that respond to community interests at multiple scales. “While we are partnering with communities and while we are going super local and ground-up, we also have to have our eye on the big things that we have to do at this giant landscape scale that is going to make a huge difference for giant pieces of our populations,” said Charles Sutcliffe (National Wildlife Federation). “We cannot lose track of either of those two things.”

Economic Recovery, Resilience, and Stability

Economic disparities and instabilities can exacerbate the challenges faced by flooding-affected communities, hindering recovery as well as long-term resilience. Several participants described how factors such as risk communication gaps, lack of pre-planned support for vulnerable populations, and unequal access to resources and information contribute to prolonged recovery timelines and reinforce feedback loops of poverty and vulnerability. On the other hand, other participants highlighted the phenomenon of “green gentrification,” speaking to the concern that investments in green infrastructure can raise property values and housing prices, creating a risk that these investments could wind up pushing less-resourced people out of their own neighborhoods.10

To address these concerns, some participants suggested emphasizing policies and initiatives that focus on vulnerable communities and prioritize people over places, equitably distribute amenities, and support affordable housing solutions with mixed-use development. In addition, several participants suggested that planners could rethink metrics for success in order to recognize the economic value of social and environmental benefits. For example, Mobley and Sutcliffe noted that resilience plans are often focused on square footage or the value of properties that are protected rather than the number of homes or the number of people who would be affected by a flood. Changing the metrics could lead to policies that better serve the interests of diverse and under-resourced communities, they suggested.

Other actions panelists and attendees suggested to help improve economic resilience include harmonizing federal resources and policies, investing in the resilience of local small businesses, and promoting community-led initiatives to mitigate flood risks. To meaningfully engage communities in these efforts, several participants stressed that it is important to focus on pathways for implementation rather than continually asking communities for their input while failing to act upon their ideas and priorities. In addition, many participants said it is important to recognize the amount of time and effort it takes for community members to engage in resilience initiatives and suggested finding ways to compensate community leaders for their contributions, such as by providing stipends for community leaders.

Health and Healthcare

Flooding poses many complex challenges for health and healthcare, both during crises and often for years afterward. Multiple participants described how climate change acts as a threat multiplier that enlarges existing inequities in health and other areas. For example, they described how numerous barriers can keep emergency medical services from reaching marginalized populations during and after floods and posited that there has been inadequate attention to evacuation and preparedness plans for vulnerable populations such as individuals with disabilities and older adults. This can be further compounded by systemic issues such as biases in empathy and care, gaps in understanding community needs and priorities, and the distrust of government or healthcare systems among some communities as a result of historical discrimination, several participants noted. In addition to the impacts on individuals, flooding can also phys-

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ically damage healthcare facilities or make it hard for medical personnel and patients to reach them.

After the immediate disaster ends, other health challenges can emerge over time, including mental health issues, effects from exposure to mold and contaminants, and the impacts of losing one’s home and support network. “Health and wealth are intricately connected in this country,” said Ben Money (National Association of Community Health Centers), noting that losing a home takes away a key source of intergenerational wealth and thus has economic and health impacts that can reverberate for decades. While these impacts are real and multifaceted, several participants noted that, in general, there is a dearth of data to track the health impacts of flooding, which can be exacerbated by legal restrictions on data sharing.

Potential solutions to some of these challenges that were suggested include better integrating climate change considerations into healthcare policies and practices and finding creative ways to strengthen linkages between the healthcare system and post-disaster services, such as home repair, to help connect people with the resources and assistance they need. Many participants also suggested that tailored, proactive communication strategies and education on disaster preparedness could be leveraged to increase awareness and disseminate relevant information through churches, hospitals, and schools, for example. Participants noted a knowledge gap in strategies to build more resilient healthcare systems, and future research was suggested in this area.

In addition, several participants said that better coordination among healthcare providers, public health agencies, and community stakeholders can improve the effectiveness of emergency medical response and enhance preflood planning. For example, agencies and emergency responders could collaborate to identify which healthcare facilities are most vulnerable to flooding and plan how to send patients to alternate service locations when needed, Sutcliffe suggested. Nicole Boothman-Shepard (AECOM) added that such collaborations can also help prevent loss of life by making sure critical facilities such as hospitals and retirement homes are built to modern building codes and consensus standards and adequately prepared to withstand extreme events. “It is really essential that we support health-serving institutions, to understand their vulnerabilities and risks, and also making sure that the people who are connected to the community webs that support our most vulnerable populations have real authority to shape decisions during incident management and disaster response and recovery,” said Boothman-Shepard.

Social Cohesion and Housing

Flooding profoundly impacts social cohesion and housing within communities. Losing a home to a flood or moving away from flood-prone areas (whether ahead of time or in the aftermath of a disaster) can disrupt a person’s sense of belonging and uproot established social networks. Several participants noted that cultural, social, economic, and other ties to land and buildings situated in floodplains often lead to a reluctance to evacuate or relocate despite the risks. In addition, not everyone can afford to move, and many face barriers to accessing programs that could provide assistance.

Other key challenges include rental housing located in floodplains that involves a combination of proactive measures landlords may bypass for several reasons, leaving renters vulnerable to health risks and financial hardship, inaccurate flood zone designations, and economic drivers that encourage continued development in flood-prone areas, several participants said. Moreover, they suggested that regulatory limitations, such as the lack of authority to regulate land use in unincorporated areas, pose additional barriers to addressing these housing-related issues.

To address these challenges, many participants underscored the role of community-led initiatives in ensuring that recovery and resilience efforts are inclusive and equitable. Preparedness happens at the family, community, and systems-levels, and at each of these levels several participants emphasized the importance of centering solutions around the people living in flood-affected or at-risk areas. Funding is also a crucial component. Many participants said that building resilience and enhancing preparedness could be well served by sustained, long-term adaptation funding directed toward at-risk and vulnerable communities. Providing resources and services for those who are displaced or relocated may also be

critical to help them reconnect with social supports and access assistance.

Policies also have a profound impact on housing. “If you permit risky development in flood-prone zones […], you are asking for trouble,” said Venkataraman Lakshmi (University of Virginia), summarizing a point raised during a breakout group discussion. Having access to accurate floodplain maps, other data sources on flood risks, and enough context to interpret these resources appropriately is important for informing policies that promote resilience rather than further increasing risk. Many participants suggested that federal policies that mandate accurate floodplain designations and prohibit development in flood-prone areas could help reduce the number of homes at risk. Additional ideas raised include means-testing National Flood Insurance Program coverage, subsidizing hazard mitigation efforts for low-income families, and creating tax credits to encourage resilience measures.

Finally, several panelists stressed the importance of “de-vilifying” people who live in flood-prone areas, especially in light of the fact that many such communities are located in risky areas as a result of unjust marginalization and discriminatory practices such as redlining. Even if they would prefer to move away from a flood zone, many people lack the means to do so. In any effort to enhance recovery or improve flood resilience, many participants said that it is important to stay focused on the goal of helping people and increasing equity. “At the end of the day, this is about humanity and civility,” said Mobley. “There are ultimately multiple benefits for us making sure everyone can thrive.”

REFLECTIONS

Workshop planning committee members highlighted several themes that emerged over the course of the workshop.

One common thread was the value of engaging with and investing in communities to build long-term resilience. Several speakers underscored the importance of co-creation in developing solutions that are responsive to, driven by, and appropriate for the community. This emphasizes the importance of sustained partnerships that elicit and listen to community voices, are built on mutual respect and prioritize equity, and are adequately funded to translate ideas into concrete actions to advance community-centered solutions. In these efforts, many participants also underscored the importance of representation, intentional allyship, and sharing best practices.

Examples of key challenges identified included the need for better access to funding for climate resilience and adaptation to climate change investments, especially in lower-income communities; barriers created by silos within and between organizations and government bodies; and a general lack of disaster mitigation efforts before an event occurs. Several participants suggested the importance of forging connections across different areas, from engineering and landscape planning to social sciences and community advocacy. Noting the complexity of accessing available funding, programs, and navigating regulations and requirements, they also pointed to the importance of breaking down institutional barriers and better harmonizing funding and policies. Additionally, many participants suggested more attention to planning for long-term recovery and addressing biases in institutional structures.

The role of data was also highlighted as an important tool for informing solutions that are responsive to the on-the-ground realities, which can sometimes defy assumptions, and can be useful in allowing planners to learn from examples and solutions implemented in other places. Speakers said that data is critical to generating public support for resilience initiatives, and panelists stressed the importance of ensuring that data sources are accurate, community-driven, and usable.

Finally, many participants underscored the importance of emphasizing prevention over recovery, while recognizing that flood resilience is not a stationary goal but may require continual adaptation in light of evolving risks, technologies, and priorities. To support efforts to better understand, communicate, and mitigate risks, several participants suggested the importance to update flood maps; advance interventions at multiple touchpoints such as insurance, zoning, and health clinics; and focus on follow-through, funding, and effective implementation of plans.

COMMITTEE MEMBERS Casi L. Callaway (Co-Chair), City of Mobile; Venkataraman Lakshmi (Co-Chair), University of Virginia; Laura A. Bozzi, New York City Department of Health and Mental Hygiene; Jennifer A. Horney, University of Delaware; Sara Hughes, University of Michigan; Anuli U. Njoku, Southern Connecticut State University; Meagan Williams, City of New Orleans Office of Resilience and Sustainability; Kateryna Wowk, The Water Institute.

STAFF Audrey Thévenon, Charles Burgis, Sabina Vadnais, and Layla Garyk, National Academies of Sciences, Engineering, and Medicine Division on Earth and Life Studies.

DISCLAIMER This Proceedings of a Workshop—in Brief was prepared by Anne Johnson and Charles Burgis, Audrey Thévenon, and Sabina Vadnay as a factual summary of what occurred at the workshop. The statements made are those of the rapporteurs or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Laura Bozzi, NYC Department of Health and Mental Hygiene, Nicole Boothman-Shepard, AECOM, and Eric Tate, Princeton University. Lauren Everett, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator.

SPONSORS This workshop was supported by the Centers for Disease Control and Prevention, the Environmental Protection Agency, and the National Institute of Environmental Health Sciences.

SUGGESTED CITATION National Academies of Sciences, Engineering, and Medicine. 2024. Exploring Community Flood Impacts, Vulnerabilities, and Adaptation Strategies to Public Health Concerns: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press: https://doi.org/10.17226/27791.