Reducing health inequalities in disasters: A cross-sectional study of the viability of 'vulnerability' terminology and of priority lists in the UK.

Background: In disasters, people with certain characteristics repeatedly experience health inequalities. In the UK, people predicted to experience poorer health outcomes are often described as 'vulnerable'. Various services compile lists of 'vulnerable' people eligible for interventions in disasters to reduce health disparities. Study aim: To explore the viability of current approaches to reducing health inequalities in disasters, we tested whether people typically described as 'vulnerable' by public health and emergency planners self-identify as 'vulnerable' in a disaster, and whether they are registered on a 'vulnerability list'. Study design: We collected data from 5148 UK-based adults using a cross-sectional online survey from July-September 2022, using nationally representative quotas for age, gender, disability, and social grade. Methods: We calculated the proportions of respondents with perceived indicators of 'vulnerability' who self-described as 'vulnerable during a disaster', and who reported being on a Priority Service Register or another 'vulnerability list'. We used odds ratios to assess whether access to resources or risk mitigation plans explained low rates of self-identification as 'vulnerable' and registration. Results: Among people with perceived indicators of 'vulnerability', self-description as 'vulnerable in a disaster' ranged from 22.4 % (of people dependent on false teeth) to 60.7 % (of people reporting significant difficulty running errands alone). Registration on a Priority Service Register ranged from 11.4 % (of people who were pregnant) to 35.7 % (of people reporting difficulties dressing, bathing, or using the toilet independently). Respondents without alternative plans or resources were generally no more likely to consider themselves 'vulnerable' or be registered on a 'vulnerability list' than those with alternative plans or resources. Conclusions: Communications using the term 'vulnerable' may not reach target audiences. Using priority lists to reduce health disparities is impractical as most people facing inequitable risk are not registered. We suggest shifting UK terminology and discourse surrounding disaster risk, focussing on making mainstream strategies inclusive and accessible to reduce health inequalities in disasters.