Health equity in the wake of disasters and extreme weather: evidence from an umbrella review

Abstract

Introduction Natural disasters and climate-related extreme weather events are increasing in frequency and severity, magnifying health inequities and exposing systemic weaknesses in health and social infrastructure. Methods This umbrella review synthesized findings from 33 systematic reviews and meta-analyses published between 2005 and 2025 to assess the physical or mental health outcomes or healthcare access impacts of disasters on populations experiencing health disparities. Results Mental health effects, especially post-traumatic stress, depression, and anxiety, were consistently elevated across disaster types. Geophysical events such as earthquakes and tsunamis produced sustained psychological distress and service disruptions among displaced and low-income populations. Hydrological and meteorological disasters, including floods and hurricanes, increased infectious-disease incidence and maternal and geriatric morbidity. Climatological hazards such as heatwaves, droughts, and wildfires were associated with cardiovascular, respiratory, and metabolic impacts, particularly among older adults and outdoor workers. Reviews addressing multiple hazards emphasized persistent inequities in healthcare access and long-term recovery. Few studies analyzed intersectional determinants, limiting understanding of compounding risk. Conclusion Policy responses should embed social vulnerability assessments into preparedness and recovery planning, invest in behavioral health and primary care surge capacity, and ensure income, housing, and transportation supports for disproportionately affected communities.