The top threats to the widespread health and safety of New Yorkers over the next 100 years are coastal squalls, infectious disease outbreaks and computer outages, according to a new five-year assessment from the city Department of Health and Mental Hygiene.
The report, funded by an emergency preparedness aid program through the Centers for Disease Control and Prevention, examines the factors most likely to cause mass illness based on responses from hundreds of health care providers, emergency response groups and other entities. It lists the likely frequency of major natural and human-made catastrophes with the potential to debilitate the city’s health care system and emergency infrastructure over the next 100 years.
Flooding, which is likely to occur frequently or even annually, is “the most pressing public health threat” to the city, according to the report, which is known as the Jurisdictional Risk Assessment. The city has experienced the impacts of flooding on its electrical grid, housing stock and hospital network multiple times since Superstorm Sandy in 2012. At least 13 people drowned in flooded basements after Hurricane Ida, which also knocked out infrastructure and displaced residents in 2021.
Natural disasters can continue to impact population health long after the clouds have parted.
The worst health harms come later, the result of interruptions in access to health care, housing damage and economic instability, said Dr. Caleb Dresser, an emergency medicine physician and faculty member of Harvard University’s Center for Climate, Health, and the Global Environment. After Sandy, mortality in New Jersey went up for months afterward.
“That is where some of the impacts can be least visible but we have an increasing amount of evidence from the past decade showing this is where a lot of the health harms actually occur,” he said.
There are also lasting impacts on the health care system. Once a hospital is damaged, it can take a long time to bring it back online and cost much more than it would to harden infrastructure upfront, he said. That would mean things like moving generators out of flood-prone areas, building flood barriers and fortifying windows.
Health systems can also take proactive measures to prepare their communities for a deluge.
Hospitals can offer pre-storm dialysis, which could give people an extra day or two to find a provider after the dust settles. The time is important; for people who need dialysis, mortality rises quickly seven to ten days after the last session, said Dresser.
Infectious disease outbreaks and pandemics are two other threats that are likely to occur multiple times over the next century, according to the Health Department. That could include diseases like Ebola, Measles and Legionnaires, outbreaks that are contained but can still overwhelm a health system, and pandemics, which are global and can disrupt supply chains.
As with Covid-19, New York is often hit hard because of its status as a global crossroads and the socio-economic vulnerability of residents, said Mitch Stribling, director of the NYC Preparedness & Recovery Institute at Columbia University.
The city faces new challenges since the pandemic. The health system is still recovering from the burnout and decline in trust at a time when providers and public health agencies are facing devastating cuts from Washington, Stribling said. The city Health Department alone is facing a $100 million reduction in federal aid used for infectious disease preparedness, surveillance and vaccination under an executive order from President Donald Trump that is currently halted in federal court.
“Our health care system is fragile. It is barely hanging on day to day. It’s expensive, it’s for-profit, for the most part…and therefore it’s not really equipped for pandemics,” Stribling said.
Also included on the Health Department’s list of top risks are cyberattacks, which can disable the city’s increasingly web-dependent health and emergency response functions, chemical threats, extreme heat and the release of hazardous waste.
