摘要：Objectives. To evaluate health impacts of drought during the most severe drought in California’s recorded history with a rapid assessment method. Methods. We conducted Community Assessments for Public Health Emergency Response during October through November 2015 in Tulare County and Mariposa County to evaluate household water access, acute stressors, exacerbations of chronic diseases and behavioral health issues, and financial impacts. We evaluated pairwise associations by logistic regression with pooled data. Results. By assessment area, households reported not having running water (3%–12%); impacts on finances (25%–39%), property (39%–54%), health (10%–20%), and peace of mind (33%–61%); worsening of a chronic disease (16%–46%); acute stress (8%–26%); and considering moving (14%–34%). Impacts on finances or property were each associated with impacts on health and peace of mind, and acute stress. Conclusions. Drought-impacted households might perceive physical and mental health effects and might experience financial or property impacts related to the drought. Public Health Implications. Local jurisdictions should consider implementing drought assistance programs, including behavioral health, and consider rapid assessments to inform public health action. Drought has been defined in hydrological, meteorological, agricultural, and socioeconomic contexts 1 ; however, the population health impacts of drought have not been well-described. Drought can reduce available surface water and deplete water-bearing aquifers, potentially disproportionately affecting persons served by private wells or small water systems. Unlike acute disasters, years may pass before water supplies become limited, and years of recovery might be necessary before water supplies normalize. Severe droughts are slow-onset and long-duration disasters with far-reaching impacts on the economy, environment, and affected communities. Previous studies have identified economic losses, infrastructure changes, diminished access to services, environmental degradation, and social network disruptions as potential impacts of drought. 2–4 The extent of direct and indirect health consequences might depend on drought severity and duration as well as the underlying population vulnerability and available resources. 5,6 Among the hypothesized adverse effects are exacerbations of respiratory diseases (e.g., asthma, allergies, dust pneumonia, bronchitis) resulting from increased airborne dust and particulate matter; increases in vector-borne disease incidence because of environmental degradation; increases in waterborne diseases attributable to worsening surface water quality or increased groundwater catchment areas when wells are over-pumped; and infectious diseases resulting from compromised hygienic practices. 7 Among persons living in drought-impacted environments, including those who depend on agriculture for their livelihood, financial stressors (e.g., lost work, food affordability, and infrastructure costs such as well drilling) and population loss resulting from migration 8 might lead to adverse outcomes such as depression and anxiety 2,3,9 and possibly suicide. 10,11 Poverty, a social determinant of health, can increase during a drought because of closures of business, job losses, and incurred debts. 5,7 Migration has an impact on community-level cohesion and family structures, further eroding community resources. 4 In 2015, California was in its fourth year of the most severe drought since becoming a state in 1850. 12 Approximately 2 million Californians are served by private wells or small water systems, 13 and from summer 2014 to November 2015, 2455 private wells had been reported as dry statewide, affecting an estimated 12 275 residents. 14 California’s governor, Edmund G. Brown Jr, proclaimed a State of Emergency in January 2014, 15 and as of November 2015, California recorded 63 emergency proclamations from cities, counties, tribal governments, and special districts. 14 The drought has also devastated California’s forests, potentially increasing wildfire risks; in October 2015 Governor Brown issued a State of Emergency proclamation addressing drought-associated tree mortality. 16 In 2015, the California Department of Public Health collaborated with Mariposa County Health Department (Mariposa County) and Tulare County Health and Human Services Agency (Tulare County) to gather data about the health status of drought-stricken communities. We conducted Community Assessments for Public Health Emergency Response (CASPERs), 17 an epidemiological method that allows household-level data, gathered from 210 interviews, to be generalized to the sampling frame of interest. 18 CASPER methodology is designed to rapidly provide evidence-based actionable information to inform public health and emergency management decisions and action. This project was done in response to a governor-declared state of emergency and, to our knowledge, this is the first time CASPER methodology has been applied to a slow-onset natural disaster. This report describes our use of CASPER to quantify the public health impacts of drought.
