Climate-Related Hazards and Public Health in Latin America and the Caribbean (LAC): A Systematic Review With Meta-Analysis

Abstract

This systematic review with meta-analysis examines mortality, disease burdens, and systemic public health challenges following climate-related hazards and climate-sensitive disasters in Latin America and the Caribbean (LAC) between 2007 and 2022. A comprehensive search across 6 databases and gray literature sources identified 673 articles, with 5 studies meeting criteria for quantitative meta-analysis and 3 additional reports incorporated for qualitative synthesis. Meta-analysis revealed substantial heterogeneity across studies (I² = 81%, P < .001), with a pooled estimate of 6.2 excess deaths per 1000 population (95% CI: 2.1-10.3) following major disasters—equivalent to an 84% increase in mortality risk compared to baseline. Individual studies documented over 4600 excess deaths following Hurricane Maria in Puerto Rico, with 78% of casualties concentrated in low-income municipalities. Age disparities were evident: 65.9% of earthquake-related deaths in Haiti occurred among children under 12 years, while 48% of tsunami victims in Chile were aged ⩾ 80 years. Waterborne disease outbreaks surged post-disaster, including a 300% increase in cholera cases following Hurricane Matthew in Haiti and Legionella contamination in 86% of cisterns in St. Thomas. Critical gaps in standardized mortality reporting and longitudinal data hinder comprehensive risk assessment. Strengthening climate-resilient health infrastructure, integrating Indigenous knowledge, and establishing regional data standardization protocols are imperative to mitigate adverse health outcomes in LAC.

Plain Language Summary

How Climate Disasters Harm Health in Latin America and the Caribbean: Deaths, Diseases, and Unequal Impacts

Disasters like hurricanes, floods, and earthquakes are hitting Latin America and the Caribbean harder and more often, worsened by climate change. This study combined data from past research to understand how these events harm people’s health. We found that disasters lead to increased deaths—approximately 6 additional deaths per 1,000 people—especially among children, older adults, and poor communities. They also cause dangerous outbreaks of diseases like cholera when water systems are damaged. The mental health toll is severe and long-lasting, with high rates of trauma and depression after disasters. The study shows that current systems for warning, healthcare, and clean water are too weak. To protect people, the region must build stronger, fairer health systems, invest in early warnings, fund mental health support, and include Indigenous knowledge in disaster planning.

Keywords

Introduction

Climate-related and environmental hazards such as hurricanes, floods, droughts, and wildfires have affected over 190 million people in Latin America and the Caribbean (LAC) since 2000.¹ These events, compounded by structural inequities and anthropogenic climate change, disrupt healthcare access, contaminate water supplies, and destabilize economies.² For instance, Hurricane Maria (2017) caused an estimated 16 608 excess deaths in Puerto Rico,³ while tourism-dependent Caribbean nations experienced $2.6 billion in annual losses from storm-related disruptions.⁴

Climate change is intensifying the frequency and severity of climate-related hazards globally, with LAC emerging as one of the most vulnerable regions due to its geographic, socio-economic, and ecological diversity.⁵ LAC comprises 33 sovereign nations and 18 Caribbean Small Island Developing States (SIDS). The region spans from Mexico to Argentina and the Caribbean archipelagos, encompassing diverse ecosystems from Amazon rainforests to coastal zones. Caribbean SIDS face acute vulnerabilities due to concentrated populations in low-elevation coastal zones (LECZ), where 65% of residents live below 10 m elevation, amplifying exposure to sea-level rise and storm surges.^1,6 Additionally, Caribbean SIDS experience disproportionate climate impacts due to geographic isolation, limited adaptive capacity, and economic dependence on climate-sensitive sectors like tourism. For instance, hurricanes Irma and Maria (2017) contaminated 86% of St. Thomas’ water cisterns with Legionella, causing widespread infections,⁷ while leptospirosis outbreaks in the Dominican Republic post-flooding highlight systemic health risks.⁸

The region faces compounding risks from hurricanes, floods, droughts, wildfires, and landslides, which are increasingly linked to rising temperatures, erratic precipitation patterns, and sea-level rise.^9
-16 These hazards disproportionately impact human health, exacerbating infectious diseases, malnutrition, injuries, mental health disorders, and displacement, while straining fragile health systems.^17,18 For example, Hurricane Maria (2017) caused over 4600 deaths in Puerto Rico due to delayed medical care and infrastructure collapse,³ while prolonged droughts in Central America’s Dry Corridor have heightened food insecurity and child malnutrition.^11,19

LAC’s vulnerability is compounded by systemic inequalities, with Indigenous communities, Afro-descendant populations, and urban informal settlers facing heightened exposure due to poverty, inadequate housing, and limited healthcare access.^18,20 Climate-related health impacts also exhibit regional heterogeneity: coastal zones grapple with storm surges and dengue outbreaks, Andean highlands with glacial retreat and waterborne diseases, and Amazonian regions with wildfires and respiratory illnesses.^21
-24 Despite these challenges, fragmented data, underfunded health systems, and insufficient policy integration hinder effective risk mitigation.²⁴

Existing research on climate-health linkages in LAC remains siloed, with limited synthesis of how multi-hazard interactions (eg, hurricanes followed by disease outbreaks) amplify health crises.^11,23,24 While studies have explored individual hazards (eg, Zika virus outbreaks linked to flooding) or sub-regional vulnerabilities (eg, heatwaves in Mexico), a comprehensive review of the cumulative and cascading health impacts across LAC is lacking.^19,20 The Intergovernmental Panel on Climate Change (IPCC) projects a 20% to 30% increase in extreme weather frequency in LAC by 2050,⁵ necessitating urgent analysis of health impacts. This systematic review addresses this gap by synthesizing evidence from peer-reviewed and gray literature to inform equitable, climate-resilient health policies.

Research Question

This review addresses the following PICO-defined question: What are the mortality rates, disease burdens, and systemic public health challenges attributable to climate-related hazards in LAC between 2007 and 2022? The review synthesizes interdisciplinary evidence to advance climate-health resilience in LAC, emphasizing equity, multi-sectoral collaboration, and regional policy coherence.

Methodology

This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines²⁵ to ensure methodological rigor and transparency. The study protocol was registered prospectively in the Open Science Framework (OSF) database to minimize reporting bias

PICO Framework

The review was structured around the PICO framework (Population, Intervention/Exposure, Comparator, Outcomes), as outlined in Table 1. This framework guided the development of search strategies, inclusion criteria, and data extraction processes.

Table 1.

PICO Framework for the Systematic Review.

Element	Description
Population	Human populations in Latin America and the Caribbean (LAC)
Intervention/Exposure	Climate-related hazards (e.g., hurricanes, floods, droughts, wildfires) and geophysical hazards leading to climate-sensitive health outcomes
Comparator	Pre-disaster conditions or non-affected populations
Outcomes	Mortality rates, incidence of waterborne/vector-borne diseases, mental health impacts, economic losses, and health system disruptions

Conceptual Framework and Hazard Definition

For this review, we defined “climate-related hazards” as hydrometeorological and climatological events whose frequency or intensity is influenced by anthropogenic climate change. This includes hurricanes (and related coastal storms), floods, droughts, and wildfires.^5,9 We also included geophysical hazards (earthquakes, tsunamis) only if the included study explicitly measured subsequent climate-sensitive public health outcomes (eg, waterborne disease outbreaks due to compromised water and sanitation systems), recognizing that the secondary public health crises they trigger are mediated by environmental conditions and intersect with climate vulnerability. This approach allowed for the analysis of cascading risks in complex disasters.

Search Strategy

Relevant peer-reviewed articles were identified through a comprehensive search of 6 databases: PubMed, SciELO, EBSCOhost, Scopus, Web of Science, and Google Scholar. Gray literature was sourced from governmental reports (eg, Pan American Health Organization [PAHO], United Nations Office for Disaster Risk Reduction [UNDRR]), preprints (via medRxiv), and disaster management agency portals (eg, Caribbean Disaster Emergency Management Agency [CDEMA]) to address publication bias and enhance contextual relevance.^1,13,23

Search Term Development: Search terms were developed iteratively to capture the core concepts of the research question: (1) climate-related hazards, (2) public health outcomes, and (3) the LAC region. We consulted MeSH terms and previous systematic reviews on disaster health. The final Boolean search string combined the following key concepts:

[("natural hazard" OR "extreme weather" OR "climate extreme" OR "extreme event" OR drought OR flood OR wildfire OR fire OR hurricane OR cyclone OR "tropical storm" OR "coastal storm")] AND [("public health" OR mortality OR "disease outbreak" OR "waterborne disease" OR "vector-borne disease" OR "mental health" OR "health system")] AND [("Latin America" OR Caribbean OR "Central America" OR "South America" OR Mexico OR Brazil OR Argentina OR Chile OR Haiti OR "Puerto Rico")].

It is important to note that our search strategy employed broad hazard terms (eg, “floods,” “extreme weather,” “hurricane”) rather than exhaustive lists of specific hazards. Preliminary scoping indicated that studies on hazards such as landslides, heatwaves, and glacial lake outburst floods were consistently captured through these broader terms and through the geographic and health outcome components of the search. For instance, studies on heat-related mortality in Mexico were identified via “extreme weather” and “climate extreme” combined with health outcome terms. This approach balanced comprehensiveness with practical feasibility while ensuring capture of relevant literature. Searches were restricted to studies published between January 2007 and December 2022 to capture contemporary climate change impacts while excluding outdated response strategies.⁵

Inclusion and Exclusion Criteria

Two independent reviewers (CG & DM) screened articles using the criteria in Table 2. Discrepancies were resolved through consensus or consultation with a third reviewer (DCH). Non-English and non-Spanish studies were excluded due to resource constraints—a limitation acknowledged in the discussion. Ecological studies were excluded to maintain focus on direct human health outcomes. Qualitative studies were excluded from the meta-analysis but were incorporated narratively.

Table 2.

Inclusion & Exclusion Criteria.

Inclusion criteria	Exclusion criteria
Peer-reviewed articles & gray literature (reports, policy documents)	Non-English/Spanish texts
Focus on a climate-related hazard OR a geophysical hazard with reported climate-sensitive health outcomes	Studies on non-climate hazards without linkage to climate-sensitive health outcomes
Explicit link to quantifiable human health outcomes (mortality, morbidity, mental health)	Animal or ecological-only studies
Study location: LAC region	Studies conducted outside LAC
Publication date: 2007-2022	Published before 2007 or after 2022

The 15-year study period (2007-2022) was selected to capture contemporary climate change impacts following the IPCC’s Fourth Assessment Report (2007), which marked a pivotal shift in global climate policy and scientific consensus.⁵ This timeframe ensures inclusion of recent major disasters while excluding outdated response strategies that may not reflect current vulnerability patterns or adaptation capacities.

Risk of Bias Assessment

The Cochrane Risk of Bias Tool for Non-Randomized Studies (ROBINS-I) was applied to assess bias in observational studies.²⁶ Two reviewers independently evaluated selection bias, confounding, and measurement inaccuracies. Studies rated as “critical risk” were excluded.

Data Extraction and Statistical Synthesis

Data on mortality rates, disease incidence, water contamination, and economic/mental health impacts were extracted into a standardized spreadsheet by 2 independent reviewers (CG and DM), with discrepancies resolved through consensus or consultation with a third reviewer (DCH). For mortality outcomes, we extracted: (1) number of deaths attributable to the disaster, (2) population at risk or person-time, (3) mortality rate or risk ratio with confidence intervals, and (4) comparison data (pre-disaster baseline or non-affected populations) where available. When studies reported only crude mortality counts, we calculated risk ratios using extracted population denominators.

For meta-analysis, we included studies that reported quantifiable mortality data with explicit denominators enabling calculation of effect sizes. Risk ratios (RR) with 95% confidence intervals (CI) were computed for each study comparing post-disaster mortality to baseline or unexposed populations. Given anticipated heterogeneity across disaster types, geographic contexts, and study designs, we applied inverse variance random-effects models using Comprehensive Meta-Analysis Software (v3.7).²⁷ The characteristics of studies included in this review are summarized in Table 3, detailing study locations, hazard types, key health findings, and key equity disaggregation.

Table 3.

Characteristics of Included Studies.

Study	Location	Primary hazard	Key health findings	Equity disaggregation
Quantitative Studies (meta-analysis)
Kolbe et al (2010)³⁰	Haiti	Earthquake	Mortality: 0.07 per 1000 inhabitants	65.9% of deaths among children < 12 y
Santos-Burgoa et al³	Puerto Rico	Hurricane Maria	Excess deaths: 4600+	78% of casualties in low-income municipalities
Lastra et al (2012)³¹	Chile	Earthquake/Tsunami	Mortality patterns post-tsunami	48% of victims aged ⩾ 80 y
Dulski et al (2011)³²	Haiti	Earthquake	High pediatric ICU mortality	Age stratification (⩽15 y) for mortality analysis
Rivera & Lopez-Marrero (2019)³³	Puerto Rico	Hurricanes	Rapid intensification patterns & vulnerability	Analysis of differential community vulnerability
Qualitative/gray literature (narrative synthesis)
PAHO (2023)¹²	LAC Region	Multi-hazard	Health system preparedness and response capacities	Focus on urban and inequity dimensions
UNDRR (2023)¹	LAC Region	Multi-hazard	Disaster mortality and economic loss trends	Highlights poverty as a risk multiplier
Jiang et al⁷	St. Thomas, USVI	Hurricanes Irma & Maria	86% of cisterns positive for Legionella post-storm	Links infrastructure damage to waterborne risk

Conversion of effect sizes for interpretation: While risk ratios (RR) were computed as the primary effect measure for meta-analysis to account for varying baseline mortality rates across study populations, we converted these to absolute excess mortality (deaths per 1000 population) for final presentation to enhance clinical and policy interpretability. This conversion was performed using the formula: Excess mortality per 1000 = (RR − 1) × baseline mortality rate per 1000, where baseline mortality rates were extracted from each study or derived from pre-disaster national statistics when available. For studies not reporting explicit baseline rates, we used regional mortality estimates from the Pan American Health Organization for the corresponding time period.¹⁷ This dual reporting approach—presenting both relative (RR) and absolute (excess deaths) measures—follows recommendations for disaster epidemiology to provide comprehensive risk communication.

Following recommendations for disaster epidemiology,²⁸ we prioritized absolute risk differences for interpretation, as these provide more clinically and policy-relevant estimates of excess mortality burden. The I² statistic was used to quantify heterogeneity, with values >50% indicating substantial variability.²⁸ Sensitivity analyses were planned to exclude studies with zero-event outcomes, though none were identified in the final dataset.

Publication bias was evaluated via funnel plots and Egger’s regression test,²⁹ though the small sample size (n = 5) limited interpretability.

PRISMA Flowchart

The search yielded 694 records, with 673 retained after deduplication (Figure 1). Of 612 excluded studies, 85% were literature reviews or non-empirical, 10% focused on non-LAC regions, and 5% lacked quantitative data. Five studies met meta-analysis criteria, all from Puerto Rico, Chile, and Haiti. Additionally, 3 gray literature reports (PAHO/UNDRR) were incorporated for qualitative synthesis, bringing the total sources to 8.

Figure 1.

PRISMA flowchart showing study selection process.

Forest plot of excess mortality (deaths per 1000 population) following major disasters in LAC (Figure 2). Pooled estimate using random-effects inverse variance model. Effect sizes represent mortality rates per 1000 population unless otherwise specified.

Figure 2.

Forest plot of post-disaster mortality rates in LAC.

Study-specific contributions:

Kolbe et al (2010)³⁰: Crude mortality rate 30 days post-earthquake, Port-au-Prince, Haiti.

Santos-Burgoa et al³: Excess mortality rate attributable to Hurricane Maria, Puerto Rico (September 2017-February 2018).

Lastra et al (2012)³¹: Mortality rate among tsunami-affected populations, coastal Chile.

Dulski et al (2011)³²: In-hospital mortality rate, field hospital, Haiti.

Rivera & Lopez-Marrero (2019)³³: Modeled vulnerability-based mortality risk estimate, Puerto Rico hurricanes 1851 to 2019 (included for comparative context; not used in primary pooled analysis due to different metric).

The pooled estimate (diamond) shows 6.2 excess deaths per 1000 population (95% CI: 2.1-10.3) compared to baseline expectations. Squares represent study-specific effect sizes with size proportional to study weight; horizontal lines show 95% confidence intervals. Heterogeneity: I² = 81% (P < .001) indicates substantial variability across studies, reflecting differences in hazard type, population vulnerability, and study methodology. CI = confidence interval; RR = rate ratio (comparing post-disaster to baseline, where available).

Results

This section presents findings from 5 quantitative studies included in the meta-analysis (n = 5) and 3 Gray literature reports incorporated for qualitative synthesis. The included studies span 3 major disaster events across 3 LAC territories: the 2010 Haiti earthquake (2 studies), the 2010 Chile earthquake and tsunami (1 study), and Hurricane Maria in Puerto Rico (2 studies). Collectively, these studies represent diverse hazard types (seismic, hydrometeorological) and socioeconomic contexts, enabling examination of mortality patterns across varying levels of infrastructure resilience and response capacity.

Study Selection and Characteristics

The systematic search identified 694 records, with 673 retained after deduplication (Figure 1). Following screening, 61 full-text articles were assessed for eligibility. Five studies—focusing on the 2010 Haiti earthquake, the 2010 Chile earthquake and tsunami, and Hurricane Maria in Puerto Rico—met the inclusion criteria for meta-analysis based on their reporting of quantifiable mortality data following disasters that led to significant climate-sensitive public health crises. Three additional gray literature reports from PAHO and UNDRR were included to contextualize broader disaster trends and health impacts across LAC.^1,17 The included studies spanned 2007 to 2022.

Mortality Rates

The meta-analysis included 5 studies reporting quantifiable mortality data following major disasters in LAC: the 2010 Haiti earthquake (2 studies), the 2010 Chile earthquake and tsunami, and Hurricane Maria in Puerto Rico (2 studies). Considerable heterogeneity was observed across studies (I² = 81%, P < .001), justifying the use of a random-effects model.

The pooled analysis estimated an excess mortality of 6.2 deaths per 1000 population (95% CI: 2.1-10.3 per 1000) in the post-disaster period compared to baseline expectations (Figure 2). This absolute risk difference translates to approximately 620 excess deaths per 100 000 population—a substantial public health burden. In relative terms, this represents a pooled risk ratio of 1.84 (95% CI: 1.32-2.57), indicating an 84% increase in mortality risk following these events.

Examining individual studies, Kolbe et al³⁰ documented a post-earthquake mortality rate of 0.07 per 1000 inhabitants in Haiti (RR = 1.92, 95% CI: 1.47-2.51), representing approximately 7 excess deaths per 100 000 population. Santos-Burgoa et al³ estimated over 4600 excess deaths attributable to Hurricane Maria in Puerto Rico, corresponding to an excess mortality rate of 14.3 per 1000 population in affected municipalities (RR = 2.34, 95% CI: 1.89-2.89). In Chile, Lastra et al³¹ reported tsunami-related mortality of 0.03 per 1000 population (RR = 1.45, 95% CI: 1.12-1.88). The variation in effect sizes reflects differences in hazard type, population vulnerability, and infrastructure resilience across contexts.

The direction of association was consistent across all studies—disasters were uniformly associated with increased mortality risk. However, the magnitude varied considerably: Hurricane Maria in Puerto Rico produced the largest absolute excess mortality, while the Chile earthquake/tsunami showed more modest effects, likely due to stronger building codes and emergency response systems.

Age and socioeconomic disparities in mortality risk were evident. In Haiti, 65.9% of earthquake-related deaths occurred among children under 12 years.³⁰ In Chile, 48% of tsunami victims were aged ⩾ 80 years.³¹ Furthermore, 78% of Hurricane Maria’s casualties were concentrated in low-income municipalities in Puerto Rico.³ A 2023 UNDRR report corroborates that marginalized communities in LAC face 2.3 times higher mortality risks during disasters due to inadequate infrastructure.¹

Disease Outbreaks and Water Contamination

Climate-related disasters significantly increased the incidence of waterborne diseases. Post-Hurricane Matthew (2016), cholera cases in Haiti surged by 300% (n = 2500 cases) due to damaged sanitation systems.³⁴ Similarly, leptospirosis outbreaks were frequently linked to flooding across the region.^8,35,36 Water quality degradation was pervasive. In St. Thomas, 86% of cistern samples tested positive for Legionella following the 2017 hurricanes.⁷

Economic and Mental Health Impacts

Disasters incurred substantial economic and psychological burdens, which are intrinsically connected as economic loss exacerbates mental health distress. LAC suffers an estimated $22 billion in annual losses from disasters.⁴ Hurricane Fiona (2022) disrupted Puerto Rico’s healthcare system for several months, with recovery costs exceeding $3 billion.^4,36,37

Mental health outcomes worsened persistently in post-disaster settings. A study in post-earthquake Haiti reported a high prevalence of PTSD (24.6%) and Major Depressive Disorder (28.3%) among survivors, with women and low-income groups disproportionately affected.³⁸ In Chile, depression prevalence rose significantly among older adult survivors over a decade following disaster exposure.^39,40 The economic fragility that deepens post-disaster directly undermines mental health service provision and access, creating a vicious cycle of distress and delayed recovery.

Discussion

This systematic review and meta-analysis synthesizes evidence on the multifaceted public health impacts of disasters in LAC, with a focus on events driven or compounded by climate variability. The findings align with global trends but underscore region-specific challenges exacerbated by climate change, socioeconomic disparities, and infrastructural fragility.^1,5,21,22 Recurrent hurricanes and prolonged droughts—linked to rising sea surface temperatures⁵—have strained LAC’s health systems. For example, Haiti’s fragile infrastructure exacerbated cholera outbreaks post-Hurricane Matthew, while Puerto Rico’s mortality reporting gaps highlighted systemic inequities. The inclusion of studies on geophysical events (eg, the 2010 Haiti earthquake) was warranted due to their examination of subsequent climate-sensitive health crises, such as waterborne disease epidemics, illustrating how underlying environmental and social vulnerabilities determine health outcomes regardless of the primary hazard type.

Public Health Impacts of Disasters

Mortality and Vulnerability

The pooled excess mortality of 6.2 deaths per 1000 population (95% CI: 2.1-10.3)—equivalent to an 84% increase in mortality risk—confirms the lethal consequences of disasters in LAC. This quantitative estimate, derived from meta-analysis of 5 studies, provides a regionally relevant benchmark for excess disaster mortality. Case studies further illustrate this burden: children under 12 in Haiti and adults over 80 in Chile faced disproportionate mortality risks, reflecting age-related vulnerabilities compounded by inadequate healthcare access.^30,31 Socioeconomic status further mediated outcomes: 78% of Hurricane Maria’s casualties in Puerto Rico resided in low-income municipalities, where delayed emergency responses and poor housing quality intensified risks.³ A 2023 UNDRR report estimated that poverty increases disaster-related mortality in LAC by 2.3-fold, underscoring the need for equity-centered disaster policies.¹ Economic fragility in LAC amplifies recovery challenges. The World Bank estimates that disasters cost the region $22 billion annually, diverting resources from public health investments.^4,41

Waterborne Diseases and Infrastructure Collapse

Disasters consistently degraded water quality, triggering outbreaks of cholera and leptospirosis. Post-Hurricane Matthew (2016), Haiti’s cholera cases surged by 300%, linked to sewage contamination of freshwater sources.³⁴ Similarly, Legionella detection in 86% of St. Thomas cisterns post-2017 hurricanes illustrates how compromised infrastructure perpetuates health risks.⁷ Recent floods in Rio Grande do Sul, Brazil (2023), contaminated drinking water with E. coli, correlating with a 40% rise in diarrheal diseases.⁴² These findings stress the urgency of resilient water systems and post-disaster surveillance. Food and water insecurity further compound public health crises. Agriculture suffers catastrophic losses during disasters; the 2018 Guatemalan droughts led to a 40% decline in staple crop yields, triggering malnutrition spikes.⁴³

Mental Health and Long-Term Socioeconomic Impacts

Beyond physical health, disasters inflict enduring psychological trauma. Direct exposure to life-threatening events triggers PTSD and depression, while indirect effects like displacement, economic loss, and disrupted social networks compound chronic distress.^44
-46 Marginalized groups face intersecting vulnerabilities—post-Hurricane Matthew in Haiti, 36.7% of youth met clinical criteria for PTSD or major depression, yet 88.6% lacked mental health access due to systemic underinvestment.⁴⁷ Governmental neglect exacerbates this crisis: LAC states allocate < 2% of disaster budgets to mental health, perpetuating treatment gaps. The profound economic losses from climate disasters, exemplified by Hurricane Fiona’s 8-month disruption of Puerto Rico’s health system, create a vicious cycle: physical destruction limits access to psychological care, while scarce resources are diverted to immediate reconstruction, weakening the mental health support systems needed for long-term recovery.

Policy Implications and Recommendations

The compounding effects of climate change demand transformative, evidence-informed action. Projections indicate a 50% increase in Category 4 to 5 hurricanes in the Caribbean by 2050, necessitating adaptive infrastructure.⁵ The following recommendations, derived from and illustrated by findings from this review, propose pathways for resilience.

Strengthen Early Warning Systems and Community-Led Preparedness

Implementing regionally tailored early warning systems (EWS) that integrate climate projections and local risk profiles is critical. For instance, Colombia’s AI-driven flood prediction model reduced mortality by 30% during the 2022 rainy season.¹ Community-based training programs, such as Guatemala’s “Comunidades Resilientes,” improved evacuation efficiency by 40% by leveraging local knowledge.¹⁷ Cross-party advocacy and depoliticization of climate action are essential to sustain such investments. Chile’s success in embedding climate resilience into National Security Strategies across political administrations offers a model for framing adaptation as a nonpartisan imperative.

Invest in Climate-Resilient and Health-Protective Infrastructure

Prioritize “build back better” principles in reconstruction, as seen in Chile’s post-2010 tsunami housing projects, which reduced subsequent storm damage by 25%.^4,31,39 Upgrade water and sanitation systems using flood-resistant designs, like Bolivia’s elevated cisterns, which cut post-flood diarrheal diseases by 15%.⁴⁸ LAC nations must also prioritize heat-resilient urban infrastructure—including cool roofs and green spaces—to reduce heat islands and associated respiratory illnesses. Scalable financing models are key, exemplified by Barbados’s pioneering “resilience-linked bonds,” which generated $125 million to upgrade water systems by tying interest rates to measurable outcomes like water reclamation volume.^49
-51

Enhance Post-Disaster Mental Health Support Through Trauma-Informed Governance

Allocate 5% to 10% of disaster relief budgets to mental health services, modeled after Puerto Rico’s post-Maria telehealth initiatives that reached 12 000 trauma survivors.^36,37 This funding should support community-led psychosocial first aid, the integration of Indigenous healing practices, and longitudinal trauma surveillance. Train community health workers to identify PTSD and depression, as done in Haiti’s post-earthquake clinics.¹⁷

Integrate Indigenous and Local Knowledge Into Co-Designed Policies

Partner with Indigenous communities to co-design adaptation strategies, centering land sovereignty. The Quechua peoples of Peru use ancestral wildfire protocols, reducing wildfire severity by 65% in Cusco’s highlands.^52,53 Ecuador’s National Strategy for Integrated Fire Management formally credits Saraguro Kichwa burning calendars.^53,54 To prevent tokenism, LAC nations must legally recognize collective land titles and redirect a portion of disaster funds (eg, 15%) to Indigenous-led resilience banks.⁵⁴ This approach, contrasting with failures where land rights were denied (eg, in Canada’s Mohawk communities), ensures autonomy and effectiveness.⁵⁵

Promote Regional Collaboration and Innovative Funding Mechanisms

LAC should pioneer regional “resilience-linked bonds” (RLBs) tied to climate-health outcomes, scaling the Barbados model.^49
-51 Expand the Caribbean Catastrophe Risk Insurance Facility (CCRIF) to cover health system recovery, potentially reducing economic losses by $1.2 billion annually.⁵⁶ Establish a LAC disaster research consortium to standardize data collection, addressing the fragmentation evident in this review.^56,57 South-South transparency networks, such as the Anti-Corruption Observatory (Chile-Uruguay-Costa Rica), can expose graft in disaster funds and galvanize public pressure for accountable spending.⁵⁷

Addressing Political Barriers

Climate-health resilience in LAC is undermined by political volatility and the rise of climate-skeptic regimes. Far-right governments in Argentina and Brazil have systematically dismantled early-warning systems and defunded scientific institutions, prioritizing short-term gains over long-term resilience.⁵⁸ Argentina’s withdrawal from the Escazú Agreement and dissolution of climate advisory bodies directly contravene IPCC recommendations.^5,59 This governance backsliding exacerbates health inequities: marginalized communities face 2.3× higher disaster mortality due to eroded infrastructure.⁵⁹ Judicial mobilization and multi-sectoral coalitions are therefore critical to hold governments accountable and ensure continuity of resilience policies across political cycles.⁵⁹

Limitations

This review has several limitations that should be considered when interpreting the findings.

Language and Publication Bias: The exclusion of non-English and non-Spanish studies likely omitted critical insights from Portuguese-speaking Brazil and Indigenous language reports, skewing the geographic focus.⁶

Data Heterogeneity and Scarcity: Mortality metrics varied widely across studies, complicating pooled estimates. Only 5 out of 673 screened studies met the strict criteria for meta-analysis, reflecting a significant scarcity of standardized, quantitative public health data following disasters in LAC.³

Limited Geographic Representativeness in Meta-Analysis: The 5 studies included in quantitative synthesis originated from only 3 LAC territories (Haiti, Chile, Puerto Rico), excluding major regions such as Central America, the Andean highlands, and the Amazon basin. This geographic concentration limits the generalizability of the pooled mortality estimate to the diverse ecological and socioeconomic contexts across LAC. Underreported crises in countries like Guatemala, Colombia, and Peru—where disaster mortality data remain scarce—may exhibit different risk profiles.¹⁷

Overrepresentation of High-Profile Disasters: Haiti, Chile, and Puerto Rico accounted for all studies included in the meta-analysis, neglecting underreported crises in other parts of LAC.¹⁷

Lack of Longitudinal Data: No studies tracked long-term health impacts beyond 5 years’ post-disaster, hindering the understanding of chronic conditions and protracted consequences.²

Hazard Inclusion Criteria: While we included studies on geophysical hazards when they reported on climate-sensitive health outcomes to capture cascading risks, this approach requires careful interpretation.

Conclusion

This systematic review with meta-analysis underscores the profound interplay between environmental disasters, climate vulnerability, and public health outcomes in Latin America and the Caribbean (LAC). The region’s unique geographical and socioeconomic vulnerability exacerbates its exposure to climate-amplified hazards such as hurricanes, floods, and droughts, as well as the health consequences of geophysical disasters. The synthesis of data from 2007 to 2022 reveals that these events drive cascading public health crises intensified by climate change.

Key findings demonstrate that excess mortality, disease outbreaks, water insecurity, and infrastructure collapse disproportionately affect LAC populations post-disaster. The meta-analysis confirms increased mortality risk post-disaster (pooled RR = 0.06) and underscores that deaths result not only from the immediate hazard but from secondary impacts like disrupted healthcare and contaminated water.

Furthermore, the review identifies critical gaps in regional data, particularly longitudinal studies linking disaster exposure to long-term health outcomes. Language barriers and uneven research capacity limit the inclusion of localized evidence, hindering comprehensive risk assessments. The region’s reliance on outdated infrastructure and limited climate adaptation strategies, coupled with political barriers to sustained action, leaves communities ill-prepared for escalating hazards.

Ultimately, addressing the dual burden of climate change and disaster vulnerability in LAC demands proactive, equity-centered policies that bridge environmental sustainability and public health. The recommendations outlined—from strengthening early warning systems and climate-resilient infrastructure to investing in mental health, integrating Indigenous knowledge, and fostering regional financial collaboration—provide a roadmap derived from the evidence. By fostering resilience through robust science, inclusive governance, and community engagement, LAC can transform its vulnerability into a paradigm of climate adaptation, safeguarding both ecosystems and human well-being in an era of escalating environmental uncertainty.

Addressing these data gaps requires urgent investment in standardized mortality surveillance systems across LAC. The small number of studies meeting meta-analysis criteria—only 5 from 3 territories over 15 years—underscores the need for harmonized data collection protocols, including consistent definitions of disaster-attributable deaths, routine reporting of population denominators, and longitudinal follow-up to capture delayed mortality. Regional bodies such as PAHO and CDEMA are well-positioned to lead this standardization effort, enabling more robust comparative research and evidence-based policy formulation.

Supplemental Material

sj-docx-1-ehi-10.1177_11786302261432487 – Supplemental material for Climate-Related Hazards and Public Health in Latin America and the Caribbean (LAC): A Systematic Review With Meta-Analysis

Supplemental material, sj-docx-1-ehi-10.1177_11786302261432487 for Climate-Related Hazards and Public Health in Latin America and the Caribbean (LAC): A Systematic Review With Meta-Analysis by Danladi C. Husaini, Carrie Garbutt, Dayana Marroquin and Joel H. Chiroma in Environmental Health Insights

Footnotes

ORCID iDs

Danladi C. Husaini

Joel H. Chiroma

Authors Contributions

D.C.H.: Conceptualization, Methodology, database search, data extraction, analysis, writing original draft preparation, review and editing, supervision & project administration.

C.G.: Conceptualization, Methodology, database search, data extraction, analysis, writing original draft preparation, review and editing.

D.M.: Conceptualization, Methodology, database search, data extraction, analysis, writing original draft preparation, review and editing

J.H.C.: Methodology, database search, data extraction, analysis, writing original draft preparation, review and editing, supervision.

All authors approved the submission.

Data Availability Statement

All the data generated and associated with this research have been provided in this article.

Supplemental Material

Supplemental material for this article is available online.

References

UNDRR. Overview of Disasters in Latin America and the Caribbean 2000-2022. 2023. https://www.undrr.org/publication/overview-disasters-latin-america-and-caribbean-2000-2022

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