“I realized I don’t know the first thing about what we were supposed to do to care for someone who may be exposed to an environmental pollutant.” George Garrow, a medical doctor, was driving toward East Palestine, Ohio, in February 2023 when that thought hit him. A freight train had derailed about a quarter-mile west of the Ohio-Pennsylvania line, and toxic smoke and hazardous chemicals were pouring into the air above the town.
Garrow runs Primary Health Network, Pennsylvania’s largest federally qualified health center, with 46 community clinics. Centers like his exist to cover gaps in the healthcare system and treat underserved patients whether or not they can pay, Inside Climate News reported.
Smoke from Canada
A few months after the derailment, Canadian wildfires pushed smoke south into Pennsylvania. Garrow saw patients hurt by the poor air. The ones hit hardest, he noticed, were people with little money or unstable housing. “I realized they didn’t teach me about that in medical school either,” he said.
So he went looking for answers. Working with Pennsylvania State University and the Pennsylvania Department of Health, he helped set up a learning collaborative on environmental health. Its aim is to teach primary care providers, especially those in vulnerable rural communities, how weather and other environmental factors affect their patients. Public health researchers call these environmental determinants of health.
The state’s latest climate assessment expects more extreme heat and flooding in Pennsylvania.
Floods and overdoses
Researchers are still working out how that kind of weather shapes health years later, and some findings are unexpected. Kristina Brant, an assistant professor of rural sociology and demography at Penn State, co-authored a paper published in July that links severe floods to more opioid overdose deaths. Deaths rose significantly in the one to two years after a flood, she found, and the effect can last up to a decade.
Her team studied data from 2000 to 2017: 11,744 overdose deaths across 219 rural Appalachian counties, 23 of them in Pennsylvania. They estimated that severe floods caused 1,368 of those deaths.
Trauma is a major reason, Brant said. “Even if someone didn’t lose their home, the flooding was a community-wide traumatic event,” she said. People in recovery are often taught to avoid triggers, “but if a rainstorm was coming, it could make them think back to that traumatic flooding event.”
Other factors played a part. Harm reduction services such as Narcan, which can reverse a life-threatening overdose, became harder to get. Many people lost stable work or housing, and rural areas often have little mental health care to begin with. “Sometimes, there’s not a norm of seeking care regularly,” Brant said. Flood survivors may have no clinician already in place to help them work through what happened.
Victoria Lynch, a postdoctoral research fellow at Columbia University’s Mailman School of Public Health, co-authored a paper earlier this year drawing on 30 years of data that also found more drug-related deaths after severe weather. News coverage tends to stop at deaths, injuries and property damage, she said. “The severity of these events is still under-studied.” She pointed to Hurricane Katrina, after which New Orleans never regained its population.
What can be done
Lynch said public awareness has changed. A decade ago, talk of U.S. floods drew quizzical looks. “That’s no longer the case,” she said. She added that many fixes are within reach and are things communities already do: emergency planning, outreach to residents, and building support networks before a storm hits. New York set up a short-term emotional support program called Project Hope after Hurricane Sandy in 2012 and during the COVID-19 pandemic. In Pennsylvania, the Department of Drug and Alcohol Programs requires the treatment facilities it licenses to keep emergency preparedness plans.
Jill Rosenthal, director of public health policy at the Center for American Progress, a left-leaning Washington think tank, suggested putting renewable energy into rural clinics. She co-authored a 2024 report on a more resilient healthcare system. Federal funding cuts make that harder, she said: “Nearly one-third of rural hospitals across the United States are at risk of closure due to financial instability.”
Garrow says interest is growing. In October he was due to take part in a tabletop exercise on emergency weather preparedness for health center leaders from across Pennsylvania. “It’s our job to begin to have these conversations,” he said.
