Spatial analysis of synthetic clusters of risk and resilience in the wake of the Flint water crisis

Natural and anthropogenic disasters often have greater impact on marginalized communities because of structural disinvestment and racism. Impacts may not be uniform across communities; it is important to identify characteristics related to individual- and neighborhood-level resilience in the context of disaster. The Flint Water Crisis (FWC), given its varying, widespread impacts, provides an opportunity to examine these characteristics. Using Speak to Your Health! (STYH) survey data prior to (2013), during (2015), and after (2017) the FWC's onset, a synthetic longitudinal cohort was created, resulting in a cohort of 885 observations (295 per timepoint). Model-based clustering identified trajectory patterns of 4 factors (individual mental health, institutional trust, neighborhood satisfaction, social support). Each individual's cluster membership was mapped, and Getis-Ord Gi* Hot Spot Analysis identified geospatial patterns of cluster concentration. Five clusters were identified with distinct patterns of disaster impact and resilience: stressed; recovery; resilient; resilient-plus; and growth. Hot Spot analysis demonstrated patterns the cluster membership related to neighborhood sociodemographics, including race, SES, and vacancy rates; of note, the growth cluster was concentrated in the poorest and most heavily vacant neighborhoods. These findings have important implications for efforts to reduce the burden of natural and anthropogenic disasters and other community-level traumas. The results highlight the heterogeneity of outcomes within the same community. Mental health factors are particularly vulnerable. This study indicates that with appropriate response and investment, marginalized communities may demonstrate resilience and even growth following community-level trauma.