From turning the lights on to powering life-sustaining medical equipment, access to electricity is vital. With this in mind, I started with a basic question: where and when do power outages occur in the US? Unfortunately, I couldn’t find a great answer. Given my interest in environmental justice, I also asked, does exposure vary across vulnerable populations? Also, what is the relationship of outages with climate events (e.g., hurricanes, wildfires)? As a PhD student, I am training to study environmental factors and population health. Power outages are very under-studied in this context (see the mostly un-answered questions above). We brought together a team to examine these questions using descriptive statistics, correlations, and maps.

For our study, we analyzed 2018-2020 US county-level data collected by utility APIs to characterize outages, generating three power outage metrics: 8+ hour outages, 1+ hour outages, and customers without power. We conceptualized vulnerabilities to mean social vulnerability measured via the Centers for Disease Control’s Social Vulnerability Index and medical vulnerability measured as individuals reliant on electricity-dependent durable medical equipment. Though we observed 8+ and 1+ hour outages in most US counties, they concentrated in the Northeastern, Southern, and Appalachian counties, with 8+ hour outages occurring most frequently during the summer evenings. Counties in Arkansas, Louisiana, and Michigan experienced both recurrent 8+ hour outages and high medical/social vulnerability. Additionally, 8+ hour outages were much more common when a county also experienced a weather or climate event. From this study, we learned basic, yet crucial information about power outages, but as this is one of the earlier studies to characterize outages in relation to climate events and vulnerability, there are so many future directions the field can take.

As one who grew up in what is considered a disadvantaged community and lives in an era where climate change is front and center, I am acutely aware that exposures and circumstances coalesce and compound to shape health. Thus, a pressing research direction is understanding how the triple overlap of power outages, climate events, and vulnerabilities affect health outcomes. Vulnerability is not limited to the conceptualizations we used in our study and can broadly be thought of as factors that situate individuals or communities to have worse health outcomes than others when faced with the same exposure. For example, a city can encounter power outages and a hurricane simultaneously, but individuals living in poverty may experience higher stress levels and worse health outcomes because they lack resources to fully prepare for this doubly disastrous situation. This is one of many ways in which power outages, climate events, and vulnerabilities work together to impact health. Advancing our knowledge about this relationship is the first step to designing policies and strategies to effectively protect population health for all.

Large-scale epidemiological studies will contribute to our understanding, but qualitative research and methods also play a crucial role. Qualitative research, which can include focus groups or interviews, is an opportunity for meaningful community engagement, which can center community experiences so that proposed interventions are designed with them in mind. Power outages and climate events are complex, stressful scenarios that shape individual behavior, but the behavior of particularly vulnerable communities (e.g., those facing material hardship, those with medical conditions) likely differ from others. Qualitative work can not only identify behavioral drivers at the intersection of power outages, climate events, and vulnerability, but also illuminate pathways to health outcomes. Localized qualitative research is as necessary as larger scale epidemiological studies. Together, they provide a rich understanding of how power outages, climate events, and vulnerabilities affect population health and more importantly inform ways to protect population health.

Our study answered my initial questions about power outages, but there is so much more to learn about power outages and their relationship to climate events and vulnerability. For me, the goal of public health research is to improve the health of communities equitably, and expanding our understanding of this triple overlap is necessary to doing so. Before we can design and implement protective strategies, we must first investigate how this triple overlap affects health using both large-scale epidemiological studies and localized qualitative work.