A 2019 Social Health Flood Assessment: Improving Health Services and Post-Disaster Psychosocial Response Aimed at Community Resilience to Hydrometeorological Extremes

In 2019-2020, a consortium of three Quebec universities, three Regional Directorates of Public Health (DRSP), and the Institut national de santé publique du Québec (INSPQ) studied the psychosocial impact of the 2017 and 2019 floods in southern Quebec.

The main objective of the project is to learn from current flood response practices in the province, with the aim of adopting better practices to protect the physical and psychological health of flood victims and the professionals who assist them. This study project was structured around two components. The first component was a follow-up quantitative study (survey) to examine the impact of flooding on the health and well-being of exposed individuals through two population-based health surveys conducted one year apart. The second component was a qualitative study aimed at determining the most effective health and social response strategies related to flooding events through focus groups on the experiences of health workers and municipal responders.

Understanding and Assessing Impacts

One of the effects of climate change in Quebec is a greater variability in the precipitation patterns, as well as changes in spring melt. This situation is likely to increase the frequency and magnitude of flooding in the territory. Many communities will experience increased impacts on their environment, finances, physical and psychological health, and community cohesion when waters rise. For example, respiratory problems related to mould exposure, as well as mood or anxiety disorders, post-traumatic stress disorder and substance abuse are common consequences in the months and years following flooding. However, several factors have been shown to improve community resilience and provide a protective factor against health problems. Furthermore, in Quebec, when a major disaster occurs, a large number of first-line responders (e.g. firefighters, police officers, ambulance attendants) and second-line responders (e.g. social workers, psychologists) are mobilized for a period of time varying from a few days to several months. These workers must support the victims and their family members while screening for people suffering, or at risk of suffering, from mental health problems. Although they can draw on a variety of international research to guide their interventions, Quebec researchers and practitioners have little local data to better understand the long-term impacts of flooding on affected populations.

Consequently, while following up with individuals affected by flooding in the Montreal area in 2017, public health physicians noted the need to better measure and understand the impacts of local flooding on psychological health in order to adjust response protocols and disaster assistance programs, while taking into account the local context.

Identifying Actions

In 2019, a first draft of the study was developed and submitted to the Green Fund for funding. However, a series of severe spring floods occurred across the province while the project was still under assessment. The researchers therefore seized the opportunity to apply this research protocol with the affected populations and field workers.

The purpose of the research was to learn from: 1) the consequences of this type of disaster on the physical and psychological health of populations; 2) the associated risks and protective factors; 3) and the social and health response strategies to support.

The project was structured around two components; a quantitative component consisting of a follow-up study based on surveys cross-referenced with hydrometeorological information, and a qualitative component based on group interviews with responders during the two series of floods.

Regarding the affected population (quantitative component), the objective of the study was to 1) describe the populations affected by the floods according to the different types of exposure; 2) document the medium and long-term consequences of the floods on physical and psychological health according to the different types of exposure; 3) identify risk and protective factors for health problems associated with flooding on physical and psychological health; 4) determine the most effective social health response strategies in the context of hydrometeorological extremes to support resilience, by assessing responses in areas affected by the 2019 floods and their impacts.

As for the responders (qualitative component), the objective of the study was to identify, through group discussions, the responses that seemed to have been effective in supporting the resilience of individuals during the “prevention”, “response” and “recovery” phases of various disasters.

Ultimately, the combined results of the two components should lead to the development of response plans and processes to reduce the social impacts of future floods, respond more quickly, and foster individual and community resilience.


As a result of funding from the 2013-2020 Climate Change Action Plan and additional funding from the Réseau intersectoriel des inondations du Québec (RIISQ), the University of Sherbrooke was able to coordinate work carried out in collaboration with two other university research teams (University of Quebec in Montréal and University of Quebec in Chicoutimi), three DRSPs, and the INSPQ.

This study project was structured around two components. The first component was a follow-up quantitative study (survey) to examine the impact of flooding on the health and well-being of exposed individuals through two population-based health surveys conducted one year apart. The study was also to be complemented by a hydrometeorological assessment to better document the exposure to flooding. The second component was a qualitative study aimed at determining the most effective health and social response strategies related to flooding events through focus groups on the experiences of health workers and municipal responders.

At the qualitative level, from October to November 2019, 19 focus groups and one individual interview were conducted with various stakeholders involved in the 2019 post-flood social health responses from four of the six targeted regions. The participants were coordinators and people in charge of emergency measures for the psychosocial component within integrated health and social services centers and integrated university health and social services centers (CISSS/CIUSSS), civil protection officials, psychosocial workers from CISSSs and CIUSSSs, community organizations and municipal employees. They were required to have been involved in at least one of the different stages of disaster management: preparedness, response and recovery. Participants and group composition were selected based on roles, levels of experience, and other specific criteria (e.g., rural vs. urban) to ensure adequate representation.

As for data on affected populations (quantitative component), 11,500 letters were randomly sent in December 2019 to citizens living in areas flooded during the previous spring to inform them of the research and invite them to participate by completing an online survey. Six affected health regions were targeted: Laval, Laurentides, Mauricie-et-Centre-du-Québec, Montérégie, Montreal and Outaouais. The municipal governments in these regions were also informed of the research efforts underway in their territories. Subsequently, some households that did not complete the online survey were randomly contacted by telephone by a survey firm in order to reach a minimum of 3,000 participants in total. Lists of potential participants were compiled from lists of residents classified as flood victims by the ministère de la Sécurité publique in the zip codes targeted by the study. The response rate for both survey rounds was relatively low, but this was expected since individuals in post-disaster situations have little time and energy to devote to such initiatives.

The survey was structured around four blocks of information; the first focused on the overall physical health status of individuals and how it has changed since the floods; the second focused on the psychological health status; the third on the level of exposure to the flood (unaffected, disrupted, flooded), and finally, the fourth focused on individual and collective resources (insurance, family support, etc.).

Outcomes and Monitoring Progress

The results of the qualitative component show a wide range of experiences according to the information obtained from the focus groups. While some participants had little psychological impacts and considered themselves to have been put in a well-managed and controlled situation, others experienced a great deal of stress and considered their organization to be unprepared. However, most agreed that the 2019 floods were more difficult because of the size of the area affected and their duration. Paradoxically, these would have affected fewer citizens, as many homes in the flooded areas had been demolished following the 2017 floods. Moreover, in addition to these two close series of floods, some territories had also experienced high wind events and even a tornado. This recurrence of disasters had both positive (team experience) and negative (population and responder fatigue, financial limitations, etc.) impacts on the response processes and professionals involved. Furthermore, in several regions, the various disasters occurred in the same economically vulnerable areas, where sometimes the victims were still recovering from previous flood events.

Several lessons to better manage these types of events were learned, including the relevance of complementing conventional support services, such as home visits by firefighters or police officers, with the presence of psychosocial workers. Another example, this one taken from the 2017 floods, would be not to mandate residential evacuations, even if a local state of emergency has been declared. It is far more effective to “strongly” suggest or insist on doing so, all on a voluntary basis. Thus, a more humane and collaborative approach, rather than a coercive one, was suggested by focus group participants. Likewise, it was suggested that municipal staff should accept the fact that people attach a great deal of importance to their homes, and respect their choice not to evacuate them. Consequently, the focus groups were an opportunity for feedback, as well as an opportunity to strengthen collaborations in disaster management.

On the quantitative side, the study shows, among other things, that flood victims are four to five times more likely than unaffected people to have a mental health disorder. This psychological response is greatly influenced by exposure to primary stressors (e.g., the height of the water in the home and the extent of material losses), but also to secondary stressors (e.g., insufficient assistance received, financial difficulties, ongoing material damage over time). In addition, a significantly higher number of flood victims reported physical health problems, especially respiratory problems. Thus, they report almost three times more respiratory symptoms, and more diagnoses of rhinitis and asthma than those who are not affected.

However, it was not possible to adequately cross-reference the results of the first part of the follow-up study with the hydrometeorological data as originally planned due to the COVID pandemic. Being affiliated with different public health authorities, the research team members had to shift their efforts to other tasks, which delayed and complicated the data collection. In addition, the technology initially chosen proved not to be optimal for collecting the data needed for this specific study and efficiently creating the required maps. The research team considers that another strategy should be adopted if the study involves new phases or if it is replicated elsewhere.

Finally, a particular feature of the data collected in both components of the study is the over-representation of the small municipality of Sainte-Marthe-sur-le-Lac in the sample. The victims in this town seem to have been more willing to respond, having been more severely impacted than the average for other disaster areas (value of financial losses, duration of relocation, etc.). The distinctive feature of this flood was that it was caused by both a natural phenomenon (spring flooding) and a technological failure (dam failure).

Next Steps

The next step to complete the project cycle is the finalization of the data analysis for the quantitative study of the populations. Due to the delay caused by the COVID-19 pandemic as well as problems with hydrometeorological data collection, the results have been slow to be published and shared. The results of the responder component are being published in a report and summary sheet. In addition, a book should be published in the fall of 2022. Two scientific papers on the project and its various components should be published in the next few years.

Beyond the scientific publications, the research teams wish above all to share their results with the municipal world and emergency response specialists in order to better prepare responses to future floods. This has already begun in the form of virtual presentations by invitation from certain municipalities and summary sheets. The RIISQ and various public health departments have begun to transmit information about this research, but as the assessment of the results is not fully finalized, the research team is waiting to establish more structured training. The research team also hopes to produce a summary research report that can be easily shared with municipalities and used as a guide to improve disaster management.