Analyze

“Under a 1986 federal law titled the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to treat people who come to the ED presenting with an emergency medical condition, defined as a condition that, without treatment, will likely lead to serious impairment or death. … EMTALA is one of the largest federal mandates to provide services to have gone unfunded (Friedman 2011); costs instead fall on states and local health care systems.” 481

“In bringing ethnographic attention to hot spotting as a technique of governance, we find that it provides lifesaving humanitarian interventions while operating within the racialized structures of violence that produce continual life crises. The institutional rationality of hotspotting and the encounters of care that it produces illustrate the often-contradictory role of medicine in the lives of poor people: both caring and coercive, it intertwines care and violence.” 475; “we conclude by suggesting that economic investment and return are becoming a reigning logic in the governance of poverty, generating hot spots as sites of interest for both policing and health care and decentering normative assessments of deviance, illness, and social problems” 476; “Neoliberal social assistance, as it is practiced in the health care safety net, is conceptualized as an “investment “in the population, as a strategic and targeted deployment of basic resources, one that promises to generate a return on investment for the state or health system in the form of cost savings.“ 485

 The authors examine the practice of “hot spotting,” a form of surveillance and intervention through which health care systems in the US intensively direct health and social services towards high-cost patients.  Health care hot spotting is seen as a way to improve population health while also reducing financial expenditures on healthcare for impoverished people. The authors argue that argue that ultimately hot spotting targets zones of racialized urban poverty—the same neighborhoods and individuals that have long been targeted by the police. These practices produce “a convergence of caring and punitive strategies of governance” (474). The boundaries between the spaces of healthcare and policing have shifted as a “financialized logic of governance has come to dominate both health and criminal justice” (474).

The main findings of the article are that the relationship between natural disasters and communicable diseases is not as much due to dead bodies or high trauma as it is to population displacement and a lack of preparredness of the local governing body for the disaster and the crowding of survivors that follows a disaster as this

1: Crowding is shown to be common in displaced populations, and local overpopulation/crowding often facillitates the transmittion of disease

2: Natural disasters that do not cause a displacement of a population are rarely associated with disease outbreaks

3: There is little or no evidence that dead bodies, as some believe, pose a epidemic risk for a population of survivors after a disaster has struck

"The risk for commuicable disease transmission after disasters is associated primarily with the size and characteristics of the population displaced, specifically the proximity of safe water adn functioning latrines, the nutritional status of the displaced population, the level of immunuty to vaccine-preventable diseases..., and the access to healthcare services"

"...natural disasters (regardless of type) that do not result in population displacement are rarely associated with outbreaks"

"When death is directly due to the natural disaster, human remains do not pose a rise for outbreaks"

The main methods that the authors appear to use are reported data from disasters that have happened around the globe, including numbers and types of infections, displacement and crowding data, and knowledge of the disaster incidents examined

Emergency response is addressed in a broad sense of the major risk factors associated with a natural disaster and epidemics. The main points they make are that preparedness, with a focus on availability of safe water and primary healthcare services, along with surveillance for the beginnings of an epidemic, are necessessay for a strong response to a disaster situation   

This article has been referenced in a wide variety of emergency medicine journal articles, ranging from flood protocols, use of cell phones in disaster enviroments, earthquakes and medical complications, to the costs of disaster consequences. Many of the articles referencing this paper appear to go into greater depth for some of the epidemics and diseases that were touched on in the research article. These include hepatitis E, Leptospirosis, cholera, and tetanus.

The object of the study is the evidence in an increase of various types of epidemics (cholera, malaria, menigitis, tetnus, etc) due to displacement of a populatoin from a natural diasaster. Examples of natural disasters discussed include- hurricanes, cyclones, earthquakes and flooding. Despite popular belief (and scientific evidence) deaths due to natural diasters do not spread diasese; unless cause of widespread infection is due to contaminated water sources, malnutrition, residing in a third world country,access to healthcare and adequate bathroom facilities. These points are supported through statistics from the past twenty or more years.