Associate Professor Sue Anne Bell’s research on large-scale emergencies and their effect on older adults and people with disabilities informs disaster preparedness and response policy at the national level
Disasters can disrupt essential health care services and lead to an increased risk of morbidity and mortality that can persist for years.
Disasters and other large-scale emergencies can happen anywhere. Hurricanes, tornadoes, wildfires, earthquakes, pandemics and other human-caused or environmental catastrophes can disrupt daily life and limit access to health care and other essential services. For older adults, people with disabilities, and those with chronic illnesses, disaster-related disruptions are not only inconvenient, they can be especially harmful and deadly.
Sue Anne Bell, Ph.D., FNP-BC, FAAN, associate professor at the U-M School of Nursing, works to understand how disasters affect different populations, such as older adults and people with chronic health conditions, to inform policy and improve disaster preparedness across the United States. Drawing on her experience as a nurse practitioner who deploys to disaster-affected areas, Bell has conducted numerous studies on the effects disasters have on older adults and people with chronic health conditions. She also actively engages with policy leaders and other stakeholders to create equitable, research-informed disaster preparedness plans and response strategies.
Gaps in preparedness and post-disaster health outcomes
Bell’s research shows both health service agencies and individuals struggle to prepare for and navigate disasters – and the consequences can be severe. Her findings indicate disasters not only increase the risk of poor health and loss of life during and immediately following an emergency, but for many years after the event as well.
Home-based care providers often work with aging adults and their families throughout a disaster. However, in an analysis of Hurricanes Irma and Harvey, Bell found that even with this additional support older adults can still face challenges in preparing for disasters, maintaining continuity of care, and accessing complex governmental support.
Making matters more difficult, in an analysis of Hurricane Harvey, Bell found 76% of Houston-area home health agencies experienced a disruption in services, despite 99% having an emergency preparedness plan in place. Nearly half of the disruptions lasted one week or longer.
In a 2019 U-M National Poll on Healthy Aging report, Bell found more than half of older adults in the U.S. believed they would likely experience a disaster or emergency in the coming year. The poll also found many older adults had not taken key steps recommended by disaster preparedness agencies, such as signing up for community emergency alerts, discussing evacuation plans, or securing alternative power sources for critical medical equipment.
This lack of disaster preparedness planning is especially concerning given the poor health outcomes among older adults, people with disabilities, and those with chronic illnesses following extreme storms. Bell found exposure to a hurricane was associated with an increase in hospitalizations for older adults with chronic conditions. Her work also showed that those living with Alzheimer’s disease and other dementias experienced increased rates of mortality following Hurricanes Irma and Harvey.
A disruption in access to health care services, even as short as one week, can also have long-lasting negative impacts on the health of cancer patients. In another study, Bell found breast cancer patients who were affected by Hurricane Katrina had significantly higher death rates in the decade following the storm than similar patients who were not exposed to it due to interruptions in the continuity of oncology (cancer) care.
Policy engagement and sustained impact
Bell’s work emphasizes the need for policies that center older adults and people with disabilities as key stakeholders in disaster response and recovery, as well as the importance of support services and assistance programs that are equitable, easily accessible, and well-coordinated.
In 2021, Bell was invited as an expert to testify before the U.S. Special Committee on Aging hearing, “Inclusive Disaster Management: Improving Preparedness, Response, and Recovery.” Her testimony was used to inform the REAADI for Disasters Act, which was introduced in both the U.S. Senate and House in 2021 and 2023, respectively. This legislation would establish programs and services to assist disaster preparedness for individuals with disabilities and older adults.
Bell’s expertise has also been called upon by the federal government in other ways. She currently serves by appointment on the National Advisory Committee for Seniors and Disasters at the U.S. Department of Health and Human Services Agency for Strategic Preparedness and Response. In 2023, she completed a six-year term on the Federal Emergency Management Agency’s (FEMA) National Advisory Council. She also served as vice chair of the FEMA National Advisory Council’s Subcommittee on Advancing Equity, where she led the development of recommendations to instill equitable principles in disaster preparedness and response planning.
In recognition of her dedication to enhancing preparedness and response across the U.S., Bell has earned numerous honors and awards, including the U.S. Department of Health and Human Services Civilian COVID-19 Response Medal. In 2022, she was named a recipient of the Institute for Healthcare Policy & Innovation’s Policy Impact Award.
Future research
Bell’s future research will explore ways to improve the disaster management cycle (mitigation, preparedness, response, and recovery). This work will include examining gaps in services for older adults and other populations through all phases of disaster management, as well as evidence-based interventions to prevent adverse outcomes for older adults exposed to disasters.
More about Sue Anne Bell's Policy Impact
Policy Products
- IHPI Video: Climate Change & Health interview featuring Sue Anne Bell
- IHPI Policy Brief: After the storm: The health impacts of weather and climate-related disasters on older adults in the U.S.
- National Poll on Healthy Aging Report: Emergency Planning Among Older Adults
Policymaker Engagement
- U.S. Senate testimony: Bell testifies before Senate Aging Committee about inclusive disaster management
Recent Committee Assignments
- National Academies of Medicine, Science and Engineering, Sustaining Essential Health Care Services Related to Intimate Partner Violence During Public Health Emergencies Committee
- U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, National Advisory Committee for Seniors and Disasters
- Federal Emergency Management Agency, National Advisory Council, Health Science Advisor
- Advancing Equity, Sub-Committee Chair
- Establishing FEMA’s 20-year Vision, Sub-Committee Chair
- National Quality Forum, Attribution for Critical Illness and Injury Committee
- National Academies of Medicine, Science and Engineering, Best Practices to Assess Morbidity and Mortality after Large-Scale Disasters Committee National Quality Forum, Health System Readiness Committee
- National Quality Forum, Health System Readiness Committee
More information about Sue Anne Bell’s work can be found in her IHPI Profile and in Michigan Experts.