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Dissertation
The population health impacts of large-scale disasters in Puerto Rico
Doctor of Philosophy (Ph.D.), Drexel University
Sep 2025
DOI:
https://doi.org/10.17918/00011147
Abstract
Puerto Rico has experienced multiple public health disasters in recent years, including Hurricanes Irma and Maria, the 2019/2020 earthquake sequence, and the COVID-19 pandemic. These events occurred within a broader context of territorial inequality, economic hardship, aging infrastructure, and a chronically underfunded healthcare system. While studies have examined the effects of disasters in Puerto Rico, important gaps remain in understanding how these events impact the health of its residents. This dissertation uses an adapted version of the Wisconsin-based Center for Urban Population Health (CUPH) Framework to examine how disasters affect population health in Puerto Rico, with a focus on mental health outcomes, health factors, and the healthcare workforce. The dissertation consists of three interrelated studies that (1) estimate changes in psychiatric and substance use disorder prevalence before and after Hurricane Maria in 2017 and identifies risk factors for post-hurricane psychiatric and substance use disorders; (2) examine the role of hurricane-related exposures, including unsanitary experiences, in predicting post-hurricane psychiatric and substance use disorders; and (3) explore how successive disasters have impacted the healthcare workforce and care delivery through qualitative interviews with healthcare system leaders. Collectively, these papers offer original insights into how disasters shape healthcare service demand, strain workforce capacity, and affect the quality of care within Puerto Rico's distinct sociopolitical context.
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Details
- Title
- The population health impacts of large-scale disasters in Puerto Rico
- Creators
- Damaris Lopez Mercado
- Contributors
- Alexander N. Ortega (Advisor)Jan M. Eberth (Advisor)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Number of pages
- vi, 161 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Dana and David Dornsife School of Public Health; Health Management and Policy; Drexel University
- Other Identifier
- 991022083152804721