After a hurricane strikes and flooding overwhelms a region, the effects can last for years. Life expectancy typically declines in the community, a trend that can persist for up to 15 years, research has found.
When the remnants of Hurricane Helene tore through central Appalachia in late 2024, Julia Gohlke became concerned about the health recovery of residents in the area. She wants to know why, exactly, life expectancy decreases after a major flooding event, and how the recovery process can be improved.
Gohlke, a professor of environmental health in the Department of Population Health Sciences in the Virginia-Maryland College of Veterinary Medicine, studies environmental disasters that affect long-term health. Now she’s leading a five-year, multiuniversity study on the lasting health impacts of flooding in central Appalachia.
Her interest is both professional and personal. As a West Virginia native, Gohlke grew up hearing stories about flash flooding from family members. She also pointed to the region’s unique topography and rural status as key factors that shape how disasters unfold and how communities recover.
In Appalachia, storms can escalate quickly. Rainwater rushes off steep mountains into narrow valleys, leaving little room for rivers and creeks to expand. Flooding can happen within minutes.
Gohlke’s project spans 20 counties across Southwest Virginia, western North Carolina and eastern Tennessee. An initial $791,037 grant from the National Institutes of Health’s Institute of Nursing Research supports the work, with the potential to grow to $3.7 million over five years as the team meets key milestones.
Her goal is to generate data that helps local, state and federal leaders better prepare for and respond to flooding events.
“Ideally, it would initiate change to really support better care for those health outcomes and potentially even some preventative measures for preventing health outcomes from flooding,” Gohlke said.
Flooding has been linked to cardiovascular diseases, infectious diseases and mental health conditions. Unmitigated mold growth can cause respiratory infections, Gohlke said. But more research is needed to understand death rates from specific causes and the broader impacts on public health.
Rural challenges shape disaster response
Gohlke saw stark differences between urban and rural disaster response when she studied Hurricane Harvey, which hit Texas and Louisiana in 2017. In Houston, alternate routes allowed emergency supplies to reach affected communities. In Appalachia, access is far more limited.
“Some communities used mules to even get supplies to the area [after Helene]. You don’t see that in urban areas,” Gohlke said.
Hurricane Helene also knocked out cell towers, cutting off communication for hundreds of residents. Many relied on neighbors and local networks to find help.
The storm hit a number of communities with high levels of social vulnerability, according to data from the U.S. Census Bureau. Through its Community Resilience Estimates program, the bureau identifies areas where residents may struggle to withstand and recover from disasters.
Several counties in Southwest and Southside Virginia have a high percentage of residents who have three or more components of social vulnerability. For example, in parts of Grayson, Washington, Carroll, Bland and Scott counties, 31% or more of the population matched the bureau’s definition of social vulnerability.
Factors such as poverty, caregiving responsibilities, communication barriers, lack of health insurance, limited broadband access and disabilities all contribute to vulnerability. Communities facing multiple challenges often have a harder time recovering.
Plans for the research
In the first year, Gohlke’s team will interview school and hospital administrators across the region. Cooperative extension agents, local educators affiliated with land-grant universities, will conduct interviews and serve as community liaisons.
The team includes faculty members from Virginia Tech, Appalachian State, the University of Tennessee at Knoxville, Johns Hopkins University and North Carolina State University. Representatives from extension offices across the 20-county research area will help conduct interviews for the project.
Later, researchers will organize a “knowledge exchange” with communities in West Virginia and eastern Kentucky that experienced major floods in 2016 and 2022. Those conversations will focus on what helped recovery efforts and what lessons could apply to areas affected by Helene.
Beginning in the second year, the team will analyze emergency department and urgent care visits in flooded and non-flooded areas. Comparing data before and after the storm will help researchers understand how flooding disasters disrupt health care.
The team will also map flooding more precisely by combining ZIP code data, satellite imagery and physical evidence such as high-water marks. That analysis will help identify which communities were hit hardest.
Federal funding cuts impact local research
Gohlke and her team submitted their grant proposal about six weeks after Hurricane Helene made landfall, aiming to begin work within months. But when the Trump administration came into office, federal funding for scientific research underwent a 35% cut, amounting to $32 billion nationwide.
Last year, more than 7,800 research grants were terminated or frozen, according to Nature, an international scientific journal. That included Gohlke’s research in central Appalachia.
Gohlke’s team finally received its funding in the fall, she said, a year after the flooding occurred. The team is now making some adjustments to its approach. For example, identifying high-water marks may prove more difficult more than a year after the storm. Interviews are also taking place later than originally planned.
The delays also mean it will take longer for results to be published and made publicly available.
More funding cuts to research may be on the horizon. President Donald Trump’s 2027 budget request, released Friday, includes a $5 billion cut to the National Institutes of Health.
The administration also requested the elimination of the National Institute on Minority Health and Health Disparities, the National Institute on Complementary and Integrative Health and the Fogarty International Center, which supports global health research conducted by U.S. and international researchers.
