Economic Stability

Social determinants of health (SDOH) are non-medical factors that influence health outcomes. They are the conditions in which people are born, live, learn, work, play, worship, and age, and the wider set of forces and systems shaping the conditions of daily life.

SDOH are grouped by Healthy People 2030 into five key areas. This discussion guide focuses on the area of economic stability. This area refers to the connection between the financial resources people have—income, cost of living, and socioeconomic status—and their health.

If you have not already done so, please take the following steps:

• Review the introduction and discussion guide instructions for information on how to use this guide.
• Learn more about SDOH (e.g., economic stability), key issues, and the lived experiences of people living with economic instability (i.e., understanding of your audience).
• Familiarize yourself with local voluntary organizations active in disaster (VOAD) and the services they provide.
• Create a list of partner government and community-based agencies to invite to your discussion. Use the prework questions to help you decide who to invite. Invitees should include VOAD whose services support people living with economic instability.
• Decide if you will distribute the prework questions to participants in advance of the activity or answer the questions as a group before the activity. If you opt for the former, ask participants to record their answers and bring them to the activity.

Economic Stability

Economic stability includes key issues, such as poverty, employment, food security, and housing stability. These issues can affect how people prepare for and respond to an emergency. For example,

• Many people, including those living on low or fixed incomes, may not have the financial means to evacuate before an emergency.
• People may find it difficult to build an emergency fund.
• People experiencing homelessness, including families and those with companion animals, may find it difficult to find shelter during an emergency.

The objectives of this discussion-based activity are to help emergency planners

• better understand how conditions associated with economic stability affect how people prepare for and respond to emergencies.
• identify gaps in emergency planning and partnerships associated with the impacts of economic stability on people’s preparedness for and response to emergencies.
• ideate ways to build new and leverage existing partnerships in the whole community to reduce or remove barriers to personal health preparedness for and response to emergencies.

Just promoting healthy choices and protective actions won’t eliminate the impacts of SDOH. Public health departments and their partners must act to understand and address conditions of economic stability in their planning and processes.

Scenario Overview

The discussion guides in this series use the scenario of a mass evacuation. Mass evacuations are possible in response to many different types of emergencies, including hurricanes, chemical spills, and wildfires.

An evacuation order may raise questions in the minds of many people in the community.

• “Can I afford the expense of an evacuation? How will I pay for gas, food, shelter, etc.?”
• “Can I afford to leave? Will I lose my job if I can’t make it back before my next shift?”
• “Where can I go with my companion animal that is close?”

Often, it’s not a matter of following an evacuation order; it’s also a matter of the financial means necessary to leave and stay healthy during an evacuation.

Please note that neither this scenario nor the discussion questions address all key issues associated with economic stability. Examples and evidence of SDOH impacts and interventions are likely to evolve with additional research and experience.

Lessons from the Field

Review the below key issues and barriers that a mass evacuation might cause members of your community.

Think of past events that caused perceptible preparedness and response challenges in/to your community. Incorporate identified gaps and lessons learned from those events into your discussion. Lived experiences can add depth to your discussion.

Key Issues & Barriers

Your community is under an evacuation order.

Many do not have transportation because they cannot afford a car or the gas required to run it. And they cannot afford a taxi or ride-share service.

Although they cannot afford to leave, they cannot afford to stay because their homes offer little in terms of “shelter from the storm.” If they do leave, they have no place to go and no means to take care of themselves. As a result, these community members will need evacuation and financial assistance.

Many people do not have an emergency fund.

Discussion Questions

• What plans and procedures does your community have for helping people prepare for the financial shock of an emergency (e.g., evacuation)?
  • How can your community communicate the risk of financial shock related to emergencies (e.g., evacuations)?
  • How can your community promote financial literacy?
  • What resources are available to help people build an emergency fund?
• What plans and procedures do you have for helping people avoid the financial shock of an emergency (e.g., evacuation)?
  • What kinds of evacuation assistance (e.g., sheltering and feeding) are available to people in your community?
  • What emergency price controls does your state have to limit or prohibit price gouging?
  • Does your state offer a sales tax holiday on the purchase of preparedness supplies?
• What plans and procedures do you have for helping people through the financial shock of an emergency (e.g., evacuation)?
  • How can your community support the response and long-term recovery needs of survivors?
  • Can your community fund an individual assistance program? If so, how?
  • What role do volunteer organizations (e.g., volunteer, faith-based, private sector, and non-governmental organizations) have in a disaster to help meet the needs of survivors?
• What programs do you offer to help people make their homes more resilient?
  • How can your community help make supplemental hazards (e.g., earthquakes and floods) insurance more affordable for people living on low or fixed incomes?
  • How can your community help inspect homes and recommend improvements that reduce the occupants’ risk of damage and loss?
  • How can your community help people make these home improvements?
    • What trusted community- or faith-based organizations can participate in making these improvements?
    • Who can interface with building authorities to secure the permits and authorizations (if needed) to make these home improvements? What free or reduced-cost services, such as mental health and substance use disorder-related support, veterinary care for companion animals, or housing options, are available to people experiencing homelessness?
  • What plans and procedures do you have to provide evacuation assistance (e.g., sheltering and feeding) to people experiencing homelessness?
  • What mental health first aid and trauma-informed care training and resources are available to and/or required of shelter staff (e.g., volunteers)? Individuals experiencing homelessness often experience trauma as part of homelessness. They may also have histories of trauma. Because disasters may involve trauma, they can re-traumatize people experiencing homelessness, which can involve intense reactions.
  • How can or to what extent does your community engage with homeless service providers?

After Your Discussion

A lot of useful information should come out of your discussion. Use this information to take actions that better prepare your community for an evacuation. Next steps may include the following:

1. Collect written or typed notes and any additional feedback from the note taker and participants. If the meeting is virtual, consider reviewing the transcript for additional insights, if you chose to record the meeting.
2. Summarize the discussion and detail any after actions in a written report (optional). A simple follow-up e-mail with highlights of the discussion and action items can help ensure these ideas are implemented in future planning and response efforts.
3. Stay informed of contributions to the preparedness and response knowledge base and evidence-based resources related to economic stability. Evidence of SDOH impacts in emergency response is likely to evolve with additional research and experience.
4. Seek out promising practices (i.e., interventions that include measurable results and report successful outcomes) that have removed or reduced economic stability barriers on people’s preparedness for and response to emergencies. Examples of SDOH interventions are likely to evolve with additional research and experience.

Promising Practice

Summer Faerman was on a walk in early 2020 when she saw a small wooden box at the entrance of a neighborhood. She investigated. The box was a free library, where people could take a book for themselves and leave them for others. The idea inspired her to create something similar—a self-serve food pantry.

Faerman started with one pantry in front of a The Salvation Army. It was a strategic choice. The Salvation Army is known in the community as a place to donate goods. It’s also a block away from a local elementary school and a public housing development. Over the past year, one pantry has turned into 52 TLC Little Free Pantries located around South Florida.

Resources

1. About Social Determinants of Health, CDC
2. Building Safety Month: 5 Tips for a More Resilient Home, Federal Emergency Management Agency
3. CDC and OMH Minority Health Social Vulnerability Index, U.S. Department of Health and Human Services
4. Community Assessment for Public Health Emergency Response (CASPER), CDC
5. Disaster Planning for People Experiencing Homelessness, National Health Care for the Homeless Council
6. Financial Preparedness, U.S. Department of Homeland Security
7. Greater Impact: How Disasters Affect People of Low Socioeconomic Status, Substance Abuse and Mental Health Services Administration
8. Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health, CDC
9. Science Bites – Use Participatory Design, CDC