{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:42:59Z","timestamp":1792064579072,"version":"4.4.0"},"reference-count":15,"publisher":"American Public Health Association","issue":"S6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:p> Puerto Rico, a territory of the United States since 1898, has recently experienced an increasing frequency and intensity of natural disasters and public health emergencies. In 2022, Hurricane Fiona became the latest storm to attract media attention and cast a light on Puerto Rico\u2019s deteriorating conditions, including infrastructural failings, health care provider shortages, and high levels of chronic illness. Although recent events have been uniquely devastating, decades of inequitable US federal policy practices have fueled the persistence of health inequities in the territory. <\/jats:p><jats:p> Here we demonstrate how existing health and health care inequities in Puerto Rico have been exacerbated by compounding disasters but are rooted in the differential treatment of the territory under US federal policies. <\/jats:p><jats:p> Specifically, we focus on the unequal US Federal Emergency Management Agency response to disasters in the territory, the lack of parity in federal Medicaid funding for Puerto Rico, and Puerto Rico\u2019s limited political power as a territory of the United States. We also provide empirically supported policy recommendations aimed at reducing health and health care inequities in the often-forgotten US territory of Puerto Rico. ( Am J Public Health. 2024;114(S6):S478\u2013S484. https:\/\/doi.org\/10.2105\/AJPH.2024.307585 ) <\/jats:p><jats:p> [Formula: see text] <\/jats:p>","DOI":"10.2105\/ajph.2024.307585","type":"journal-article","created":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T20:01:34Z","timestamp":1722456094000},"page":"S478-S484","source":"Crossref","is-referenced-by-count":22,"title":["United States Federal Policies Contributing to Health and Health Care Inequities in Puerto Rico"],"prefix":"10.2105","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7631-5880","authenticated-orcid":false,"given":"Anna-Michelle Marie","family":"McSorley","sequence":"first","affiliation":[{"name":"Anna-Michelle Marie McSorley is with the Center for Anti-racism, Social Justice, and Public Health, and the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY. Alexandra C. Rivera-Gonz\u00e1lez is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Damaris Lopez Mercado is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0198-6599","authenticated-orcid":false,"given":"Alexandra C.","family":"Rivera-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Anna-Michelle Marie McSorley is with the Center for Anti-racism, Social Justice, and Public Health, and the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY. Alexandra C. Rivera-Gonz\u00e1lez is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Damaris Lopez Mercado is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0161-6208","authenticated-orcid":false,"given":"Damaris Lopez","family":"Mercado","sequence":"additional","affiliation":[{"name":"Anna-Michelle Marie McSorley is with the Center for Anti-racism, Social Justice, and Public Health, and the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY. Alexandra C. Rivera-Gonz\u00e1lez is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Damaris Lopez Mercado is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8915-9602","authenticated-orcid":false,"given":"Jos\u00e9 A.","family":"Pag\u00e1n","sequence":"additional","affiliation":[{"name":"Anna-Michelle Marie McSorley is with the Center for Anti-racism, Social Justice, and Public Health, and the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY. Alexandra C. Rivera-Gonz\u00e1lez is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Damaris Lopez Mercado is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Purtle","sequence":"additional","affiliation":[{"name":"Anna-Michelle Marie McSorley is with the Center for Anti-racism, Social Justice, and Public Health, and the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY. Alexandra C. Rivera-Gonz\u00e1lez is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Damaris Lopez Mercado is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6861-6993","authenticated-orcid":false,"given":"Alexander N.","family":"Ortega","sequence":"additional","affiliation":[{"name":"Anna-Michelle Marie McSorley is with the Center for Anti-racism, Social Justice, and Public Health, and the Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY. Alexandra C. Rivera-Gonz\u00e1lez is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Damaris Lopez Mercado is with the Department of Health Management and Policy, Dornsife School of Public Health, Drexel University,..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"844","reference":[{"key":"bib3","doi-asserted-by":"publisher","DOI":"10.1186\/s41256-021-00228-w"},{"key":"bib9","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2020.305814"},{"key":"bib11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-001191"},{"key":"bib14","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2017.304138"},{"key":"bib15","doi-asserted-by":"publisher","DOI":"10.1001\/amajethics.2022.305"},{"key":"bib16","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnac082"},{"key":"bib17","doi-asserted-by":"publisher","DOI":"10.1007\/s10903-022-01391-z"},{"issue":"1","key":"bib18","first-page":"13","volume":"101","author":"Wilkinson E","year":"2020","journal-title":"Am Fam Physician."},{"key":"bib20","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14036"},{"key":"bib23","doi-asserted-by":"publisher","DOI":"10.1093\/ei\/cbg023"},{"key":"bib33","doi-asserted-by":"publisher","DOI":"10.2190\/HS.44.4.b"},{"key":"bib34","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30569-X"},{"key":"bib36","volume-title":"Puerto Rico: A Political and Cultural History.","author":"Carri\u00f3n AM","year":"1983"},{"key":"bib38","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.01414"},{"key":"bib39","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2012.300933"}],"container-title":["American Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ajph.aphapublications.org\/doi\/pdf\/10.2105\/AJPH.2024.307585","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T20:03:02Z","timestamp":1722456182000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajph.aphapublications.org\/doi\/full\/10.2105\/AJPH.2024.307585"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":15,"journal-issue":{"issue":"S6","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.2105\/AJPH.2024.307585"],"URL":"https:\/\/doi.org\/10.2105\/ajph.2024.307585","relation":{},"ISSN":["0090-0036","1541-0048"],"issn-type":[{"value":"0090-0036","type":"print"},{"value":"1541-0048","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7]]}}}