PDF(Pubmed)
Abstract：
Puerto Rico, a territory of the United States since 1898, has recently experienced an increasing frequency and intensity of natural disasters and public health emergencies. In 2022, Hurricane Fiona became the latest storm to attract media attention and cast a light on Puerto Rico\'s deteriorating conditions, including infrastructural failings, health care provider shortages, and high levels of chronic illness. Although recent events have been uniquely devastating, decades of inequitable US federal policy practices have fueled the persistence of health inequities in the territory. Here we demonstrate how existing health and health care inequities in Puerto Rico have been exacerbated by compounding disasters but are rooted in the differential treatment of the territory under US federal policies. Specifically, we focus on the unequal US Federal Emergency Management Agency response to disasters in the territory, the lack of parity in federal Medicaid funding for Puerto Rico, and Puerto Rico\'s limited political power as a territory of the United States. We also provide empirically supported policy recommendations aimed at reducing health and health care inequities in the often-forgotten US territory of Puerto Rico. (Am J Public Health. 2024;114(S6):S478-S484. https://doi.org/10.2105/AJPH.2024.307585) [Formula: see text].
摘要：
波多黎各,自1898年以来，美国的一个领土，最近经历了越来越频繁和强度的自然灾害和突发公共卫生事件。2022年，飓风菲奥娜成为最新的风暴，吸引了媒体的关注，并揭示了波多黎各不断恶化的状况。包括基础设施故障，医疗保健提供者短缺，和高水平的慢性病。尽管最近的事件具有独特的破坏性，几十年来不公平的美国联邦政策做法助长了该地区健康不平等的持续存在。在这里，我们展示了波多黎各现有的健康和医疗保健不平等如何因加剧灾难而加剧，但植根于美国联邦政策对领土的区别对待。具体来说,我们关注美国联邦紧急事务管理局对该地区灾难的不平等反应，波多黎各联邦医疗补助资金缺乏平等，和波多黎各作为美国领土的有限政治权力。我们还提供了经验支持的政策建议，旨在减少经常被遗忘的波多黎各美国领土上的健康和医疗保健不平等。（AmJ公共卫生。2024;114(S6):S478-S484。https://doi.org/10.2105/AJPH.2024.307585)[公式：见正文]。
