Alterations to non-traditional care settings during disasters: lessons learned from the COVID-19 response

Abstract

In a typical disaster or public health emergency, there is an expected, and somewhat predictable, temporary discontinuation of care mainly due to damage of healthcare infrastructure. The COVID-19 pandemic exacerbated existing inequities in access to care that to some extent are related to inequities in social determinants of health such as access to housing. One approach to addressing the existing and growing number of health inequities has been the use of community-based interventions that deliver direct care and services such as mobile healthcare clinics. Alternative care settings such as mobile health clinics have been successfully used to address issues related to access to healthcare generally, as well as in response to disasters and emergencies. However, during the COVID-19 pandemic, the largest public health emergency response to date, mobile health units were limited by many of the non-pharmaceutical public health control measures put into place in response to the pandemic. This dissertation documented the utilization of alternative care delivery in disaster situations in international and domestic settings, identified disruptions to alternative care settings that resulted from the response to the COVID-19 pandemic, and identified aspects of structural capacity that could enable the continuity of service provision during disasters and emergencies, which could therefore decrease inequities of the health impacts of disasters. Through a scoping review and the use of convergent methodology, this dissertation highlights the need to improving baseline care within communities prior to a disaster and focusing on community connection, organizational capacity, and informational capacity to ensure the provision of care.