Disasters are a recurring fact of life, and major incidents can have both immediate and long-lasting negative effects on the health and well-being of people, communities, and economies. A primary goal of many disaster preparedness, response, and recovery plans is to reduce the likelihood and severity of disaster impacts through increased resilience of individuals and communities. Unfortunately, most plans do not address directly major drivers of long-term disaster impacts on humans-that is, acute, chronic, and cumulative stress-and therefore do less to enhance resilience than they could. Stress has been shown to lead to or exacerbate ailments ranging from mental illness, domestic violence, substance abuse, post-traumatic stress disorders, and suicide to cardiovascular disease, respiratory problems, and other infirmities. Individuals, groups, communities, organizations, and social ties are all vulnerable to stress. Based on a targeted review of what we considered to be key literature about disasters, resilience, and disaster-associated stress effects, we recommend eight actions to improve resiliency through inclusion of stress alleviation in disaster planning: (1) Improve existing disaster behavioral and physical health programs to better address, leverage, and coordinate resources for stress reduction, relief, and treatment in disaster planning and response. (2) Emphasize pre- and post-disaster collection of relevant biomarker and other health-related data to provide a baseline of health status against which disaster impacts could be assessed, and continued monitoring of these indicators to evaluate recovery. (3) Enhance capacity of science and public health early-responders. (4) Use natural infrastructure to minimize disaster damage. (5) Expand the geography of disaster response and relief to better incorporate the displacement of affected people. (6) Utilize nature-based treatment to alleviate pre- and post-disaster stress effects on health. (7) Review disaster laws, policies, and regulations to identify opportunities to strengthen public health preparedness and responses including for stress-related impacts, better engage affected communities, and enhance provision of health services. (8) With community participation, develop and institute equitable processes pre-disaster for dealing with damage assessments, litigation, payments, and housing.

The Gulf of Mexico Research Initiative (GoMRI) was established in 2010 with $500 million in funding provided by British Petroleum over a 10‐year period to support research on the impacts of the Deepwater Horizon oil spill and recovery. Contributions of the GoMRI program to date focused on human health are presented in more than 32 peer‐reviewed papers published between 2011 and May 2019. Primary findings from review of these papers are (i) the large quantity of dispersants used in the oil cleanup have been associated with human health concerns, including through obesogenicity, toxicity, and illnesses from aerosolization of the agents; (ii) oil contamination has been associated with potential for increases in harmful algal blooms and numbers of pathogenic Vibrio bacteria in oil‐impacted waters; and (iii) members of Gulf communities who are heavily reliant upon natural resources for their livelihoods were found to be vulnerable to high levels of life disruptions and institutional distrust. Positive correlations include a finding that a high level of community attachment was beneficial for recovery. Actions taken to improve disaster response and reduce stress‐associated health effects could lessen negative impacts of similar disasters in the future. Furthermore, GoMRI has supported annual conferences beginning in 2013 at which informative human health‐related presentations have been made. Based on this review, it is recommended that the Oil Pollution Act of 1990 be updated to include enhanced funding for oil spill impacts to human health.

Incidences of harmful algal blooms (HABs) and Vibrio infections have increased over recent decades. Numerous studies have tried to identify environmental factors driving HABs and pathogenic Vibrio populations separately. Few have considered the two simultaneously, though emerging evidence suggests that algal blooms enhance Vibrio growth and survival. This study examined various physical, nutrient, and temporal factors associated with incidences of HABs, V. vulnificus, and V. parahaemolyticus in South Carolina coastal stormwater detention ponds, managed systems where HABs often proliferate, and their receiving tidal creek waters. Five blooms occurred during the study (2008–2009): two during relatively warmer months (an August 2008 cyanobacteria bloom and a November 2008 dinoflagellate bloom) followed by increases in both Vibrio species and V. parahaemolyticus, respectively, and three during cooler months (December 2008 through February 2009) caused by dinoflagellates and euglenophytes that were not associated with marked changes in Vibrio abundances. Vibrio concentrations were positively and significantly associated with temperature and dissolved organic matter, dinoflagellate blooms, negatively and significantly associated with suspended solids, but not significantly correlated with chlorophyll or nitrogen. While more research involving longer time series is needed to increase robustness, findings herein suggest that certain HAB species may augment Vibrio occurrences during warmer months.

The Deepwater Horizon (DWH) oil spill is the only declared Spill of National Significance in US history, and it significantly impacted the health of people and communities in the Gulf of Mexico region. These impacts amplified adverse effects of prior disasters and may compound those of future traumas. Studies, both to date and ongoing, show some negative mental and physical health outcomes associated with DWH in some spill workers, as well as some coastal residents in all Gulf States. The spill was also associated with negative effects in the living resources, tourism, and recreation sectors, at least in the short term. Compared with others, people dependent on these sectors reported more health and financial concerns. Consumer concerns about the safety and marketability of seafood persisted well after data demonstrated very low risk. Parents were concerned about possible exposures of children as they played on beaches, but this risk was found to be minor. Spill-related stress was an overarching factor associated with adverse health outcomes, and some residents reported greater stress from navigating the legal and claims processes following the spill than from the spill itself. Research revealed a serious lack of baseline health, environmental, and socioeconomic data against which to compare spill effects. This finding highlighted the need for ongoing observing systems to monitor health and socioeconomic parameters and establish continuous baselines of such information.

This paper builds upon Friedman et al. (2020) and other reviews and statements but provides an explicit focus on research needed to improve the resilience and survivability of coastal communities as they face existential threats from climate change. It does not attempt a prescriptive analysis of potential research emphases, but instead recommends some key research areas that we believe will help provide a solid foundation for community adaptation. Our perspective is based on our experiences over a combined nearly 95 years of work in research, management, and policy, much of it related to coastal environments and their communities, rather than expert deliberation within a large group or a systematic review. We present a list of 25 research priorities binned into 12 categories and targeted to leaders of coastal communities, interested researchers, funders, students, and the public. These priorities are intended to help start more discussion of research needs with and within communities, and help focus attention of researchers on actions that have potential to identify critical decision points and make positive differences for communities. We conclude that priority research should be undertaken with urgency and a much greater level of trans- and interdisciplinarity and community-participatory approaches than yet seen.

Few conceptual frameworks attempt to connect disaster‐associated environmental injuries to impacts on ecosystem services (the benefits humans derive from nature) and thence to both psychological and physiological human health effects. To our knowledge, this study is one of the first, if not the first, to develop a detailed conceptual model of how degraded ecosystem services affect cumulative stress impacts on the health of individual humans and communities. Our comprehensive Disaster‐Pressure State‐Ecosystem Services‐Response‐Health model demonstrates that oil spills, hurricanes, and other disasters can change key ecosystem components resulting in reductions in individual and multiple ecosystem services that support people's livelihoods, health, and way of life. Further, the model elucidates how damage to ecosystem services produces acute, chronic, and cumulative stress in humans which increases risk of adverse psychological and physiological health outcomes. While developed and initially applied within the context of the Gulf of Mexico, it should work equally well in other geographies and for many disasters that cause impairment of ecosystem services. Use of this new tool will improve planning for responses to future disasters and help society more fully account for the costs and benefits of potential management responses. The model also can be used to help direct investments in improving response capabilities of the public health community, biomedical researchers, and environmental scientists. Finally, the model illustrates why the broad range of potential human health effects of disasters should receive equal attention to that accorded environmental damages in assessing restoration and recovery costs and time frames.