Global climate change has been implicated in the increasing severity of tropical storms. Even so, evolving knowledge about tropical activity has yet to be incorporated into storm preparedness techniques. In a Viewpoint piece published in JAMA, James M. Shultz, MD; James P. Kossin, PhD; and Sandro Galea, MD, DPH, urged public health officials to consider climate change science in updated strategies to mitigate storm damage.

Climate change has driven changes in the speed, intensification, and associated risks for tropical cyclones. Specifically, the “forward speed” of storms over land has been slowing, posing significant water hazards to coastal populations. Both Hurricane Harvey and Hurricane Florence stalled over land, causing record rainfall totals in their respective vicinities. In addition, each of these hurricanes deviated from their predicted courses, developments that further complicated emergency response. Rapid intensification of tropical storms has also become more frequent, as was observed with storms Harvey, Irma, and Maria in 2017.

Further, storms have begun to reach peak intensity at greater distances from the equator, and populations once outside the trajectories of major storms are now at risk. The authors underscored the disproportionate risk for storm-related public health consequences carried by small island developing states. Hurricane Maria exemplified each of these characteristics (rapid intensification over warm waters, rainfall hazards, and severe consequences for island residents) when it struck Puerto Rico. Although advanced storm detection and warning systems minimized fatalities from hurricane winds and surge, the inability to restore infrastructure, power, and healthcare services contributed to thousands of excess deaths.

The consequences of Hurricane Maria underscore the necessity of updated public health preparedness measures. The authors first emphasized public health surveillance of storm-affected populations. The physical and mental health conditions of storm survivors must be monitored to better titrate public health response in affected areas. In addition, given the increasing risk for surge, rain, and flood hazards during storms, advanced flood mitigation and water management techniques must be developed. Water rescue capabilities must also be augmented in at-risk areas. Similarly, infrastructure should be upgraded to withstand stronger storms, particularly in island-built environments. Community storm resilience is essential to minimizing public health consequences.

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Finally, the field of preparedness must “expand its purview,” according to the authors, who added, “In 2017, across all storms and affected populations, the single deadliest hazard was storm-damaged infrastructure…Anticipating this challenge requires state-of-the-art reformulation of electrical power, water, and health care systems and training cadres of specialized response professionals.”

The risks associated with tropical storms will only increase in the current years: Enhanced preparedness response systems are a necessary investment to mitigate damage and save lives.


Schultz JM, Kossin JP, Galea S. The need to integrate climate science into public health preparedness for hurricanes and tropical cyclones. JAMA. 2018;320(16):1637-1638.