Municipal-Level Risk Communication Practices in Puerto Rico

Publication Date: 2024

Abstract

This continuation project assesses risk communication policies and practices of municipal government officials in Puerto Rico who are responsible for reaching out to local populations during emergencies. The 12 sites selected for the study were six coastal and six inland municipalities with high levels of at-risk populations. Municipal Emergency Management Offices (MEMO) officials were interviewed regarding their risk communication protocols and practices, especially concerning vulnerable populations, and their challenges and most pressing needs for improving communication efforts before, during, and after disasters and other emergency situations. We used a qualitative research approach employing interviews with open-ended and targeted questions as the primary method of data collection. Results show that MEMOs use emergency management protocols tailored to their specific geographic and community needs, that their staff are generally well trained on emergency management but not enough on risk communication, and that MEMOS face multiple challenges related to efficiently reaching out to vulnerable populations. It was evident from our findings that Puerto Rican municipal authorities are struggling to address the needs of populations with cumulative vulnerabilities related to poverty and geographic isolation of older adults. It is imperative that MEMOs, as well as other government agencies and community organizations develop competence in risk communication and that policies practices are based on frameworks that incorporate values and principles of bioethics in order to safeguard essential health care and services for these populations in times of emergencies and disasters.

The authors of this report were funded as part of Continuation Award 2: Extending Public Health Disaster Research and Community Engagement in Understudied Areas. They received a Track 1 Award for Additional Data Collection and Analysis.

Introduction

Nestled in Caribbean waters, Puerto Rico is at heightened risk for severe weather events (Subervi-Vélez et al., in press¹). During the past decade, emergency management efforts have included procedures and policies revisions, personnel training, risk communication protocols, community involvement, and education to the public. In terms of social vulnerability, the data are very revealing. For example, data from the 2020 Census indicate that almost 24% of the population is 65 years or older (U.S. Census Bureau, 2023²). A staggering 42% of Puerto Rico’s total population is classified as poor and 57.6% of children under 18 are living in poverty. Per capita income for the period 2018-2022 averaged less than $16,000; the median annual household income for the same period was only slightly above $24,000. A report from just five years ago pointed out that the median income had dropped notably in more than fifty of the Island’s 78 municipalities (Instituto de Estadísticas de Puerto Rico, 2019³).

Yet another vulnerability stems from the fact that that 37.41% of the Puerto Rican population lives in places with high to extreme risk of landslides (West et al., 2023⁴). It can be easily assumed that thousands, especially the most vulnerable, face enormous challenges in their daily lives, even more so during extreme weather conditions. Puerto Rico’s residents also face significant health vulnerabilities. For example, they have been significantly afflicted by recent epidemics such as the coronavirus, chikungunya, dengue, and zika viruses; after Hurricane Maria, leptospirosis sickened hundreds and killed dozens of people (Torres, 2019⁵). Not surprisingly, mortality rates in Puerto Rico have increased from 6.2 per 1,000 habitants in 2019 to 7.9 in 2022 (Departamento de Salud de Puerto Rico, 2022⁶).

While Puerto Rico’s central government, in collaboration with the U.S. Federal Government, takes center stage in responding to serious weather and health emergencies, the dissemination of risk information and emergency preparedness and response actions ultimately depend on health and government officials at more local levels (Kim & Kreps, 2020⁷; Rowan et al., 2010⁸). In light of this, the goal of this continuation project is to expand assessments of emergency risk communication policies and practices at the municipal level with a special focus on vulnerable populations. It builds on lessons from previous research after Hurricane Fiona that revealed the need for improved risk communication education and training for personnel responsible for gathering and disseminating news and information prior to, during and after weather related emergencies (Subervi-Vélez et al., 2023⁹).

Building on the assumption that risk communication efforts during extreme weather events and other emergencies can be most effective—and most accurately assessed—at the local level, this study queried officials of the Municipal Emergency Management Offices (MEMOs) in 12 municipalities with high levels of vulnerable populations. In contrast to the previous study, which focused on a specific disaster event, this research project addressed general risk communication policies and practices, including municipal protocols to attend to vulnerable populations, such as those with chronic conditions, mobility issues, and special needs. It employed a qualitative research approach including in-depth semi-structured interviews with MEMO personnel about their professional training and experience as well as their municipalities’ emergency communication protocols, plans, challenges, and needs. The data gathered in this study serve as the foundation for building a broader understanding of the health implications of the MEMO policies and practices. The study’s findings also served as the basis for policy recommendations that investigators have made to the MEMOs and the central government’s Department of Emergency Management and Disaster Administration (NMEAD, for its abbreviation in Spanish).

Literature Review

Cumulative Vulnerabilities

It is well known that disasters cause an increased demand for health services and create challenges for delivery of social and health care. The term cumulative vulnerabilities is used to describe individuals or groups who are vulnerable to disasters for multiple, overlapping reasons (Fothergill & Peek, 2015¹⁰). For instance, people living in isolated areas who also have chronic health conditions and low incomes have cumulative vulnerabilities, each of which needs to be addressed to protect them from disaster impacts. The concept of cumulative vulnerabilities is particularly important to the Puerto Rican experience given the large share of the population over age 65 and living in poverty. For example, older adults with fewer economic resources may be unable to access medications during crises, increasing their exposure to health risks after storms (Niles, 2019¹¹). Aggregated vulnerabilities simultaneously increase the risk of illness and mortality following a hurricane (Niles, 2019) and during concurrent disasters (CONVERGE, n.d.¹²). To reduce health disparities, systemic change is needed at all levels (Angeli & Montefusco, 2020¹³; Kreps, 2021¹⁴; Lafarga Previdi & Vélez Vega, 2020¹⁵). Effective risk communication by local governments is one strategy to reduce cumulative vulnerabilities, including those related to health, especially in geographic locations, such as Puerto Rico, which are frequently impacted by severe weather and dangerous geological events (earthquakes, tsunamis, landslides, and volcanic activity) (Kreps et al., 2005a¹⁶).

Risk Communication and Bioethics

The work of Dickmann and collaborators (2016¹⁷) addresses some key insights regarding the scope of definitions and approaches to risk communication and crisis communication. Although the current study does not address the latter type of communication, the work by these authors accurately points out that the merits of risk communication during public health threats should be emphasized among the concerned authorities. Risk communication should start before a crisis and continues throughout and even after the critical event focusing on prevention, mobilization, and response to crises (Kreps, et al, 2005b¹⁸). This continuum provides for more time and opportunity to be more strategic, especially when the clarification of contradicting scientific information is needed (Dickman, et al., 2016). Complementing the above, Grimm (2005¹⁹), affirms that the three main goals of risk communication are to create trust and credibility, educate the public, and involve community leaders in the decision-making process. Moreover, risk communication is a core capacity of the International Health Regulations and is one of five strategies within the Pandemic Influenza Preparedness framework (World Health Organization, n.d.²⁰).

Strategic risk communication is vital for preparedness and disaster mitigation; properly focused strategies are needed to address specific practices and procedures (Kreps, 2021). Central, integrated, and coordinated communication plans—those that establish chains of command, prevention, mitigation, and recovery priorities, as well as training—are crucial as guiding directives for national or regional emergencies. However, at the local level, some specific needs and challenges may not be addressed by centrally generated policies and practices. For instance, populations in coastal vis-à-vis inland, mountainous locations vary in their exposure to tsunamis, flooding, landslides, and other hazards; their access to communication infrastructure, food and water supplies, transportation, and information. Thus, policies and practices should be tailored to those local characteristics and realities.

Another aspect that merits consideration for risk communication efforts relates to bioethics, which encompasses among other objectives, including responsible civic engagement and professionalism in public health (Fábregas & Rodríguez, 2023²¹; Fábregas & Kreps, 1999²²). These and other objectives offer guidance on designing and implementing the appropriate messages and strategies for addressing health concerns during disasters (Bruce, et al., 2016²³, Kreps et al, 2005a). Some ethicists, such as Middleton (2019²⁴), propose the integration of ethical goals and frameworks for disaster planning that are anchored in bioethics.

Risk Communication Practices in Puerto Rico

In times of emergencies, government officials and news media workers face enormous communication challenges, which they must respond to in a proactive manner to reduce potential disaster risks (Kim & Kreps, 2020; Rowan et al., 2010; Nyondo, 2006²⁵). However, as documented in a study in the aftermath of Hurricane Maria, the failure of Puerto Rico’s telecommunication infrastructure left thousands of people completely without access to phones, internet, or other communication services, therefore isolated for days and even weeks, thus affecting their recovery from the emergency (Modestti, 2018²⁶).

The Milken Institute of Public Health’s (2018²⁷) study of Hurricane Maria—a highly cited report on the storm’s mortality rate—drew several important conclusions about the government’s disaster preparedness and response that are relevant to our current study. For example, regarding the coordination of the central government with municipal governments during emergencies, the report concluded,

[T]he personnel structure between central and municipal governments to facilitate emergency communication was inefficient and ineffective for catastrophic disasters. […] the Municipal Affairs Office in the Governor’s Office interacts with municipalities, but not for emergency communication functions” (p. 27).

Key leaders interviewed for the report indicated that even though preparations were taken to attend to vulnerable populations in their communities, there were communication failures related to lack of planning. The failures identified by the Milken Institute study included: “less health-related prevention or risk messages, such as potential consequences of failures in critical infrastructure and key resource sectors that one might anticipate from a Category 4 or 5 hurricane, subsequent health implications and how to navigate these challenges” (p. 27).

Findings of a study by Subervi-Vélez et al. (2023), related to Hurricane Fiona in 2022, revealed that some communication improvements had been made in Puerto Rico since 2017, yet various limitations persisted in the island’s government and media policies and practices related to health and risk communication. The previous study, however, did not assess the local or municipal level health and risk communication policies and practices, particularly those focused on the community’s most vulnerable populations.

On June 13, 2023, the Puerto Rico Department of Health (Departamento de Salud de Puerto Rico, 2023²⁸) issued its Emergency Operational Plan for 2023-24, which serves as a basic guide to address strategies and actions for the preparation, response, recovery, and mitigation of events that affect the health care system, medical services, and mental services in Puerto Rico. This plan received the approval of NMEAD, the Department of Emergency Management and Disaster Administration for the central government which was referenced earlier.

One section of the Emergency Operations Plan is dedicated to communication; among its indications is one assigning the Health Department’s communications director to the Operational Committee. The directive states that public communication during emergencies will be coordinated by the Office of Communication and Public Affairs at the Department of Health, which will manage information and risk communication through press releases and social media with preventive measures and other contents specially targeted to populations with access and functional needs. Furthermore, the new directive indicates that a Joint Information Center could be activated to coordinate information for the public and to support the compilation, verification, and dissemination of precise, accessible, and timely information. Concomitant to that directive to promote healthcare measures in emergencies, the Department of Health issued a public health guide for emergencies and disasters (Departamento de Salud de Puerto Rico, 2024²⁹). For catastrophic events, there is also a Puerto Rico All-Hazards Plan, developed by the federal and local governments and the private sector (Puerto Rico Department of Public Safety & Puerto Rico Emergency Management Bureau, 2020³⁰).

Research Questions

To date, some research has assessed practices that contribute to community resiliency (e.g., Guerra Velázquez, 2022³¹). However, questions have yet to address if and how any of those directives, guides, and plans, including those related to communication, are applied at the municipal level. The present study sheds light on these gaps by answering two research questions:

1. What are the risk communication policies and practices used by municipal emergency management officials to safeguard their local communities, especially those constituents who are most vulnerable and isolated, before, during, and after disasters?

2. What are the most pressing needs of the municipal emergency management officials to improve their risk communication policies and practices—including the evaluation of their outreach efforts—with vulnerable populations?

Research Design

The present study uses a qualitative research method approach (Ngenye & Kreps, 2020³²) in which semi-structured personal interviews were conducted via Zoom with officials of twelve MEMOs in Puerto Rico, selected based on their high number of vulnerable residents. During the interviews, which lasted 45-90 minutes, subjects were asked in a conversational manner, a mix of targeted and open-ended questions about their MEMO work experience and personnel training, as well as about their municipalities’ emergency communication protocols and plans for preparedness, response, and recovery from extreme weather events. Other queries were about the challenges and needs of their respective local MEMOs. Additional questions were asked specifically about the communication policies and practices for reaching out before, during, and after extreme weather events to local vulnerable populations, including people with physical or mobility issues, special needs, and those in isolated areas.

Study Site and Access

The municipalities selected for the study are from the four main geographic regions of Puerto Rico and included the same number of coastal and inland (mountainous) sites. As shown in Table 1, all have high levels of at-risk populations in terms of poverty, age, health limitations, and landslides or coastal flooding risk. For example, as the table shows, more than 50% of the population is poor (Instituto de Estadísticas de Puerto Rico, 2019). In all except one, more than 40% of the households have a resident over 65 years of age (Sin Comillas, 2022³³). All the selected municipalities have notable percentages of the population with a disability. In five municipalities, the percentage of population with some physical or limited mobility disability number is between 20.1-30%, in five others it is between 30.1-40%; and in two, more than 40% of the population has physical or limited mobility disability challenges (Departamento de Salud de Puerto Rico, 2023). Although some of the aforementioned statistics vary by neighborhood (barrios), the data clearly point to large numbers of vulnerable populations. So does the social vulnerability index, which brings together data about populations that “are socially vulnerable based on factors like socioeconomic status, household characteristics, racial and ethnic minority status, or housing type and transportation” (Centers for Disease Control and Prevention, n.d.³⁴). That vulnerability indicator, which ranges from 0 (less vulnerable) to 1 (most vulnerable), is above .60 in one municipality and above .75 in the other eleven (Ramírez-Ríos et al., 2022³⁵). Even access to the internet and computers is available in less than half of most households (Instituto de Estadísticas de Puerto Rico, 2018³⁶).

Table 1. Indicators of Social Vulnerability and Hazard Exposure in Research Sites

Two additional indicators also point to hazard exposure: For coastal municipalities, it is coastal flooding from storm surges and tsunamis, although the potential impacts vary (Dieppa et al., 2020³⁷). In Arroyo, Guánica, and Loíza, coastal flooding, storm surges, and tsunamis could affect town centers and large numbers of their citizens. In Lajas and Cabo Rojo, coastal flooding, surges, or tsunamis may not reach the town centers as these are located further inland. However, in each of these locations, hundreds of people live in homes adjacent to coasts and cater year-round to local and international tourists. One of the inland municipalities’ respondents expressed concerns about not having equipment or means (sirens) to alert local residents, as well as tourists, about potential flash floods from swollen rivers.

For mountainous sites, it is their susceptibility to landslides and river swellings (West et al., 2023). And while landslides may not equally afflict the town centers of those municipalities, each has thousands of residents in the rural areas that are more isolated and not only prone to landslides or flooding, but also to delays in emergency assistance. Regardless of these caveats, selected municipalities represent a range of communities from coastal and inland areas of Puerto Rico. And the selected municipalities have indicators that suggest that their populations are among the most vulnerable regarding health and risk conditions.

Interview Sample and Sampling Strategy

Between January 15 and February 22, 2024, we interviewed officials of the Municipal Emergency Management Offices (MEMO) in each of the 12 municipalities in our study. These individuals are appointed by the municipal leadership (typically, the mayor) to carry out emergency management and risk communication information and outreach efforts before, during, and after extreme weather events and epidemics. For a qualitative study, this is a robust sample, especially since eight of these 12 sites constitute 53% of the Island’s 15 municipalities with high vulnerability indexes (>.75).

Obtaining names and contact information of the MEMO officials required various searches. For most of the municipalities, information was not always available via the Internet. When information was found, listed phone numbers were often not answered or were not working numbers, even when the information was provided by the corresponding mayors’ offices. Eventually, all names and general contact phone numbers were obtained and 12 MEMO officials agreed to the interviews and collaborated with the interviewers.

Participant Consent and Other Details

Participants were instructed that their participation was voluntary, that they could refuse to participate or withdraw from the study at any time, that their confidentiality would be protected, and that they would not be cited, or would be cited anonymously, and that they would not receive any compensation for their participation, other than the satisfaction of helping build knowledge on the field of health and risk communication. They all agreed to participate and signed the consent forms.

Interviews and Document Analysis

An 11-item interview guide was developed and tested during a pilot interview with a MEMO official in one of the municipalities. Following the pilot interview, the interview guide was refined. The questions were divided into topics: policies and procedures, vulnerable populations identification, office personnel and training, and needs and challenges. As agreed with all participants, all interviews were performed via the Zoom platform. In addition to the 12 interviews, we analyzed two written municipal-level emergency management manuals (from Guánica and Arroyo) that were provided to us by MEMO officials, and which served to corroborate responses related to policies and practices.

Data Analysis Procedures

The data gathered in the interviews were analyzed through qualitative analysis methods, creating themes and categories and comparing interviewees answers. The data were also compared with the findings from the Subervi-Vélez et. al. (2023) previous study to determine similarities and differences in risk and health communication policies, procedures, and emergency management between central government and municipal authorities.

Ethical Considerations and Researcher Positionality

IRB approval was obtained on November 20, 2023, from the University of Wisconsin-Madison (submission ID no. 2023-1582), based on the understanding that this is minimal risk research. The study does not present major ethical concerns, except regarding the potential for identification of participants because of their positions. Confidentiality was discussed with participants and, although they agreed to be cited and identified, researchers decided to withhold citing them directly or presenting data that could connect their identity to any information included in reports or presentations related to this study. Since no confidential information was asked for by the interviewers or offered by the interviewees, possible negative consequences for the participants are negligible. None of the research team members were involved in conducting emergency risk communication during the health crises in Puerto Rico, so there were no direct or implied conflicts of interest.

Findings

Some of the respondents had been in their MEMO position for many years and even decades; others were relatively new, having been appointed after a new mayor took office after the last election in 2020. Nevertheless, all interviewees recognize the importance of their local MEMO, and indicated they personally work heart-in-hand to serve their respective communities, especially in times of emergencies or other crises for which they were called upon. The other findings of this study can be organized into five major topics: (1) identification of vulnerable populations, (2) policies and practices related to the general public, (3) policies and practices related to vulnerable populations, (4) training and personnel, and (5) pressing needs and challenges.

Identification of Vulnerable Populations

When asked about risk communication outreach and attention to vulnerable populations, 10 out of 12 participants were able to describe their vulnerable populations with some level of detail. For example, several interviewees spoke of residents who have limited mobility, low vision, or who are hard of hearing. They also mentioned older adults who live isolated in rural areas or have no one living nearby who can care for them on a regular basis. All mentioned that prior to the annual hurricane season, lists of such populations are usually gathered by the municipal citizen assistance office, with the support of community organizations in some locations. That office then shares the information with their local MEMO. Even so, most respondents did not know if these lists were regularly updated, or if the sharing of such information is consistent across all interested parties, such as with the community organizations, police, and other entities that take part in emergency preparation, response, and recovery efforts. Respondents also mentioned that tsunami alert systems did not necessarily reach all vulnerable populations, especially those who live in isolated areas. MEMO staff were aware of this latter problem and point out that they did make efforts to reach out to people in those locations.

Policies and Practices Related to the General Public

Respondents indicated that they knew of the central government’s emergency policies and practices. It was not clear, however, if local MEMOs thoroughly followed those policies and practices. For example, respondents stated that decisions and protocols for the use of communication channels and technologies during emergency situations were primarily based on local possibilities and needs. Two participants said that while they submit their local policies to the central government for approval, which seems to be required, the implementation of such plans could vary depending on the local situation at hand.

When responding to questions about risk communication efforts aimed at the population at large, all MEMO interviewees mentioned the use of various resources, procedures, and channels. The most widespread method to convey emergency related messages was the use of sound-system vehicles with loudspeakers that rove throughout the barrios disseminating a variety of messages about pending storms and alerting the public to prepare and/or take shelter. Some sound systems allowed for messages to be pre-recorded and repeated throughout the vehicles’ journeys. Other sound systems allowed for receiving and disseminating messages directly from the MEMO or from the mayor’s office, depending on the location and changing emergency circumstances.

The number of official sound-system vehicles available in each municipality varies, however. Privately-owned sound system vehicles were customarily contracted for special occasions, such as when information regarding impending storms or floods must be disseminated quickly to the whole population of a municipality. The reliance on multiple sound-system vehicles was mentioned repeatedly by MEMO respondents of municipalities whose populations reside in rural areas that are both distant and isolated from the town center and where it could take more than an hour to reach the most distant locations where residents live.

MEMO interviewees in each of the coastal municipalities described their tsunami alert systems, at least one of which was present in each coastal site. In some of the coastal sites, the population is alerted of a potential tsunami by a blaring sound. Residents would need to know that the alarm means they should seek higher ground as no other message is delivered. In other coastal towns, the alert system is more advanced and allows MEMO officials to convey messages regarding the potential tsunami and also inform the public about other emergency situations such as surging high tides due to storms, road blockages, and fires. In all of the coastal municipalities, MEMO staff raised concerns about the limited range of the tsunami alert systems, pointing out that they do not reach all coastal populations, especially those in more isolated communities. Some of the isolated areas that currently do not have tsunami alert systems are recreational locations known to be regularly populated by local and foreign tourists. However, the signage related to the tsunami alerts as well as the messages disseminated in the aforementioned mobile sound systems are almost exclusively available in Spanish.

Other risk communication efforts are those that rely on local or regional radio stations and newspapers, which may convey news and information provided by the MEMO and/or the mayor’s office. Some MEMO staff also have contact with news reporters. One of the MEMO respondents indicated that the challenge is getting the media outlets to disseminate official information vetted by the emergency managers and other authorities instead of alarmist news, which can unnecessarily scare and misinform the public. That stated, the MEMO interviewees acknowledged that they depended on radio stations and regional newspapers to disseminate their emergency messages. Practically all the broadcast television stations in Puerto Rico operate from the greater San Juan metropolitan area. Thus, MEMOs in the studied sites were dependent on external outlets for disseminating emergency communication messages.

Another resource and procedure mentioned by the respondents to address risk communication is via volunteer Ham radio operators who can receive and transmit messages to their local communities. Because Ham radios can be powered by rechargeable batteries, they are reliable when electric power is lost (at least for short periods). This resource requires that operators be present at their stations during emergencies and have the assistance of volunteers to relay crucial information to other members of their respective communities. Examples mentioned were either MEMO employees and/or volunteers who conveyed crucial information to their designated barrios, including especially vulnerable people.

In-person human resources were also mentioned as ways to disseminate emergency communication information. Across all studied sites, the most common of these are community and religious leaders of the municipalities’ barrios. Many such leaders and volunteers from their organizations and churches have participated in informational meetings and even training sessions (e.g., CERT) to help prepare for and overcome diverse types of emergency events. On numerous occasions, especially in the aftermath of Hurricanes Irma, Maria, and Fiona, community leaders and their organizations not only disseminated risk communication information but were also frontline in the local recovery efforts that took place before municipal and/or NMEAD assistance could arrive.

Interviewees also said they, and their staff, used social media to deliver and receive emergency related information from the general public. All MEMO respondents indicated regularly using various social media outlets—the most prominent being Facebook—to convey risk communication messages to their corresponding populations. And although all agreed that social media are not reliable outlets for emergency communication, most admitted that those media are their principal means of communication with the public. However, multiple problems and challenges with such outlets were mentioned. For example, Facebook pages had gone dormant or ceased to operate when MEMO staff or volunteers changed, and the corresponding indispensable passwords were not shared with the incoming MEMO personnel. Also mentioned was the fact that devices that depend on electricity for charging have limited use during extended power failures, which were very common during weather events. Other problems with social media, as noted during the investigators’ own searches, are that many MEMO Facebook pages and other Internet sites often lacked names of essential emergency contacts and did not offer standardized and regularly updated content. Although those sites may well provide emergency preparedness information and resources, they sometime include non-emergency content such as social, cultural, or even political public relations messages posted by the mayor’s office.

Policies and Practices Related to Vulnerable Populations

Questions that probed specifically about risk communication policies and procedures aimed at vulnerable populations yielded few direct responses. Most interviewees mentioned the use of mobile sound systems (see above), but only two referred to an operational “manual” that offered guidelines to communicate risk to vulnerable and isolated people in their municipality. One respondent affirmed that his office has emergency operations protocols to communicate with vulnerable populations, specifically regarding the use of sign language. Another pointed out its MEMO had a plan that includes a call tree and an organization chart that states the tasks to be performed by employees, including reaching out to older adults and isolated individuals. That plan is submitted every two years to the central emergency management bureau for approval. One respondent indicated that his office makes its own plans that “never expire” and that they make amends when necessary; specifics of that plan related to vulnerable populations were not mentioned.

The use of social media for emergency communication (see previous section) presents even more challenges for vulnerable populations with limited access to smart phones, the Internet, or computers (see Table 1). Digital access limitations can be most prominent among older adults and those with physical or mobility disabilities, and more so for people in isolated areas where, at best, only phone landlines are available.

Training and Personnel

Most participants expressed that MEMO personnel are well trained in emergency management, some of them having obtained advanced certifications in topics like search and rescue, emergency evacuations, and incident management. Very few respondents, however, recognized that they and most of their staff lack and need specific risk communication training, especially to deal with vulnerable populations. Only one respondent indicated having had some sign-language training for himself and another staff person.

During the interviews, it was repeatedly mentioned that risk communication in their communities is not handled by the MEMOs, but instead are primarily conducted through the municipal communications office (e.g., the mayor’s press officer). However, few respondents knew if that person had received any risk communication training.

When respondents were asked for their opinion regarding that the position of emergency management director is a political appointment—a position of trust appointed by the mayor—10 out of 12 interviewees believed that the position should be a career position so that there could be continuity in work plans and services to the constituents. They acknowledge that whenever a different political party wins the local elections, all positions of trust, including their own, are subject to the decision of the winning mayor, who almost always replaces all personnel in positions of trust. Those changes, which at times imply that the top position is occupied by someone with limited training or experience in emergency management, affect work plans and sometimes even emergency action policies. On the other hand, two interviewees believed that top MEMO posts should remain as positions of trust because constituents would be better served that way. They argued that if a MEMO director were from a different political party than the mayor, services to the public could be obstructed “to make the mayor look bad.”

When interviewers inquired if the MEMO directors had other jobs or responsibilities, various interviewees indicated that they frequently hold other positions in their municipality, such as police director, paramedic, and even president of local public bids board. No one acknowledged that having multiple jobs could represent potential conflicts of interest or be ethically inappropriate.

Pressing Needs and Challenges

All respondents stated that they needed more funds for better managing their local MEMO. Most participants said they also needed more staff. Although it was mentioned that, in emergency situations, all municipal employees are under direct MEMO supervision and become emergency management support personnel, most are not trained in emergency response, much less trained in risk communication related to vulnerable populations. Also, some respondents pointed out that they needed to upgrade or expand their tsunami siren system and needed additional funds to do so. Only two interviewees stated they were satisfied with their communication infrastructure.

Several interviewees agreed that working with community organizations and religious leaders is essential to communicating with vulnerable populations. Time and again, participants highlighted the importance of those leaders and organizations and the need to strengthen collaborative efforts with them.

Finally, most interviewees spoke of challenges in risk management, rather than risk communication. They expressed that their major difficulties were getting people to follow evacuation plans during disaster threats. There is also concern about not having equipment or means (sirens) to alert people about potential extreme weather conditions.

Discussion

The information shared by officials of the 12 MEMO officials allows us to conclude they are very dedicated to their responsibilities to serve their communities in times of emergencies. They also seem to be aware of central NMEAD policies and procedures, but they tailor those to better address their municipalities’ particular needs and realities.

Our sources mentioned the various ways that they and their staff make efforts to communicate emergency matters to their constituents. However, numerous limitations—particularly related to risk communication with vulnerable populations—were mentioned by the interviewees and also noted during our own inquiries of related materials, including the social media sites of MEMOs. For example, risk communication training, especially crucial for vulnerable populations, is almost completely absent among MEMO personnel (and possibly absent among the mayors’ communications officers), which is a limitation also noted by the Milken Institute study in 2018. Although all interviewees pointed out that most of their vulnerable populations do not have access to the Internet, they all admitted relying heavily on social media for risk and health communication. This gap is alarming, especially since the most vulnerable populations to disasters in Puerto Rico—adults over age 65, people with disabilities or pre-existing health conditions, and/or those who live in rural or isolated areas—are also the same people who will have limited internet access. Most interviewees expressed the need for more MEMO staff, risk communication training, and resources to improve communication and care for the most vulnerable populations of their municipalities.

Conclusions

The present study provides a transdisciplinary approach to assessing and understanding how municipal emergency officials communicate risk in places that are highly exposed to hazards and have large vulnerable populations. MEMOs need support in understanding and addressing cumulative vulnerabilities. To reduce health disparities before, during and after disasters, risk communication should be guided by bioethical frameworks and competencies in healthcare and services for vulnerable populations.

Public Health Implications

The present study draws attention to numerous risk communication limitations that present many challenges for the safety and health of the general public and, more so, for vulnerable citizens. Of particular concern is the large number of people facing cumulative vulnerabilities and potential concurrent disasters. Lack of adequate emergency risk information can lead to inadequate preparedness, as well as limited access to medications and health services. This, in turn, increases the number of people who could be afflicted by illnesses that frequently follow a disaster (e.g., infections, malnutrition, dengue, leptospirosis, etc.). In the absence of adequate risk communication in extreme weather events, which unfortunately affect Puerto Rico very frequently, people with limited income, and with mobility or hearing conditions living in isolated areas will experience increased negative health consequences. If the risk communication limitations documented in this study are also evident in other MEMOs in Puerto Rico, the negative health consequences could be even greater across the island.

The enclosed Appendix presents detailed recommendations in two categories: Recommendations to the NMEAD, the central government’s emergency management bureau, and recommendations for MEMOs. Researchers strongly recommend the incorporation and application of bioethics objectives and principles to guide the implementation of risk communication efforts to safeguard communities. Responsible civic engagement and professionalism in the risk and public health communication plans and strategies is of utmost importance. Also, given the fact that municipal employees are expected to be at the service of local MEMOs, the officials of those offices as well as mayors should receive additional vetting and training. As Middleton (2019) instructs:

[Emergency managers] should assess who among the staff is willing to: serve during a crisis; work collaboratively with stakeholders and professional staff in advance to establish practice guidelines; work collaboratively to develop fair and accountable processes to resolve disputes; and provide support to ease the moral burden of those with the duty to care.” (paragraph 17).

Community and religious organizations should also apply this advice by Middleton and strive to include bioethical lessons and practices as part of their public training.

Limitations

Due to time and funding limitations, this study did not assess the perceptions of community leaders and subjects from vulnerable populations about the activities, plans and/or shortcomings of local emergency communication and services carried out by their local MEMO. Also, the study did not assess emergency communication policies and practices of MEMOs in large municipalities like San Juan, the capital city, where other challenges exist.

Future Research Directions

Recommendations for future research in this arena include replication and expansion of this study using a larger sample of municipalities and surveying press officials of the mayors’ offices. To gain insights into the risk communication practices that could confirm or otherwise challenge the participants’ perceptions of how their work impact vulnerable communities, it would also be valuable to survey community members, especially from vulnerable populations. Moreover, to gain additional insights into communication practices and outcomes during emergencies, it would be worthwhile to survey healthcare professionals, including and especially pharmacists, who may be the most accessible for medication needs (Ahmer Raza, et al., 2021³⁸).

Acknowledgments. Special thanks to Mr. Ángel Vázquez, Regional MEMO director and Mr. Félix García, communication and federal liaisons official for their support in identifying and contacting the research subjects. Cristina Miranda Palacios, executive director of the Liga de Ciudades de Puerto Rico for her special interest in our research and aid in the divulgation efforts of our findings and recommendations. Researchers are especially thankful to Julia Subervi for her constant and unconditional support and assistance in all of our research activities.

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