Case Synopsis

This case examines the complexity of responding to a natural disaster. Leona Hernandez, a water and sanitation engineer from the Pan American Health Organization, is in charge of coordinating the water and sanitation response on the island of Dominica following Hurricane Maria in October of 2017. Upon visiting one of the shelters in the remote fishing village of Scotts Head, she becomes aware of the precarious environmental conditions in the community. Many of the residents are distressed by the complete destruction of their surroundings, and a lack of running water has led to a reliance on drinking from the river. Of immediate concern is the potential for an outbreak of leptospirosis; however, issues of the disaster’s impacts on mental health are also emphasized. The Water, Sanitation and Hygiene team members each have a different idea about how to act and which response actions to prioritize. Leona must unite the team and coordinate an effective response, which becomes more complex with another storm system threatening to develop near the island.

Case Objectives

1. Apply systems thinking to determine the relationship between climate change, natural disasters, human health, and Small Island Developing States.

2. Explore strategies to set priorities and balance competing needs around environmental health and mental health issues following a natural disaster.

3. Use a framework approach to water and sanitation concerns after a disaster and discuss the public health implications.

4. Discuss broader implications of natural disasters and sustainability.

Case Study Questions

1. How important is the role of the environment in determining health? Is it sensitive to change?

2. How do you determine the mental health needs of a community? Who is responsible?

3. How important is the context of a Small Island Developing State? How would the influence diagrams (from the instructor guidance) stay the same and how would they change if we were talking about the response to a hurricane in North America (e.g., Hurricane Harvey in Texas, August 2017)

4. How do you prioritize the response to a disaster? What helps to inform the decision?

5. What does sustainable development mean? Is it about the resilience of the people? The environment? The climate?


Environmental health; mental health; sustainable development; systems thinking

Additional Author Information

Vendela Edmonds, BSc, MPH

Leonardo Hernandez, MD, Chief (AI) Emergency Operations Unit, Department of Emergency Preparedness and Disaster Relief

Regna Darnell, PhD, Professor

Charles Trick, PhD, Professor



Recommended Citation

Edmonds, V., Hernandez, L., Darnell, R. & Trick, C. (2019). Hurricanes and Health: A Systems Thinking Approach to Understanding Complexity and Context. In: Sibbald, S.L. & McKinley, G. [eds] Western Public Health Casebook 2019. London, ON: Public Health Casebook Publishing.