Expert Research: Hurricanes and Natural Disasters Linked to “Grocery Tax” for Lower-Income Americans

Jun 20, 2024

5 min

William Schmidt



Research from Goizueta’s William Schmidt uncovers the disproportionate impact of natural disasters on low-income families’ access to essentials.


Global warming is accelerating severe weather with cataclysmic outcomes for communities all over the world. In 2023, the hottest year on record, no fewer than 23 weather-related disasters struck the United States. These natural disasters claimed hundreds of lives and caused $57 billion in damage. Recently, the federal government has come under scrutiny for uneven aid response to communities affected by hurricanes, fires, and flooding in America.


William Schmidt


But might there be other factors at play that see disadvantaged groups more vulnerable to the impact of severe weather events? Weighing into this is award-winning research by Goizueta Business School’s William Schmidt, associate professor of Information Systems and Operations Management. He and Xabier Barriola from INSEAD Business School look at the effect of three major hurricanes in the U.S. in the last 20 years. They find evidence of higher paid prices for basic groceries in the aftermath of each storm that disproportionately impact lower-income communities in affected states. In fact, says Schmidt, when severe weather hits communities, these families end up paying anywhere between one and five percent more relative to high income households for essential food and goods. This puts a major strain on already-strained resources in times of massive disruption.


"We see a spike in the prices paid for household groceries of up to five percent hitting low-income groups immediately after a major storm hits."


William Schmidt


“Then you have to factor in the reality that poorer households spend around eight times more of their disposable income on basic groceries than high-income households,” says Schmidt. “It becomes clear that the aftermath of severe weather is harder for them to bear. And in our research, this is an effect that lasts for months, not weeks or days.”


Exposing Hidden Costs on Those Hit Hardest


To get to these findings, Schmidt and Barriola worked from a hunch. They figured that in low-income areas, a lack of infrastructure, lower-quality construction, and fewer grocery store outlets could translate into supply shortages in emergencies. Ensuing stockouts might then lead to knock-on price inflation for customers. These are low-income families for whom inflation has serious and significant consequences, Schmidt says.


"We know that inflation hurts poorer communities. High-income families have the option of switching between high and low-priced goods according to needs or preference. But families with lower incomes are already purchasing low-priced groceries."


William Schmidt


“When there are disaster-induced stockouts to their preferred products, those families are forced to substitute to higher priced groceries,” Schmidt continues.


Then there’s retailer behavior. Following large environmental disasters, store managers may be unable to keep necessities in stock. Under those circumstances, it is difficult to justify running promotions or implementing planned price decreases.


To test these ideas, Schmidt and his colleagues looked at data from the weeks and months following Hurricanes Katarina (2005), Ike (2008), and Sandy (2012). They decided to pinpoint those locations immediately impacted at the county level. To do so, they used major disaster declarations issued by the federal government at the time. Then they integrated this with detailed grocery store sales data provided by Information Resources Inc (IRI) with zip code-level household income and demographic data from the U.S. Census Bureau. With each hurricane, the researchers looked at IRI data covering 30 different product categories and around 200 million transactions over a 12-week period.


Schmidt and his colleagues then ran a set of analyses comparing prices paid by communities before and after each hurricane. They also contrasted price increases paid by low-income and high-income households as well as communities outside of the areas affected by the storms.


Crunching the Numbers


“Doing this triple-difference regression analysis, we find that lower-income communities pay an average 2.9 percent more for their groceries. That’s in the eight weeks following each of these disasters,” says Schmidt.


"The effect varies. But it is roughly commensurate with the overall economic damage wrought by each hurricane, with Katrina being the worst. Here low-income families were seeing a 5.1 percent increase in the cost of food and basic goods, relative to richer households."


William Schmidt


The study points to a variety of mechanisms driving these effects. As Schmidt and his co-authors hypothesize, there is evidence that the same disruptions lead to fewer price promotions. They also see more frequent stockouts of low-priced goods. At the same time, there’s a shift in household purchasing from low to higher-priced products. These effects are long-lasting, says Schmidt.


According to the study, post-hurricane inflation in the prices paid by consumers continues to affect poorer families for eight or more weeks. This amounts to months of economic hardship for those least resilient to its effects. Schmidt calls this “permanent inflation.”


Pursuing Equity in Crisis


Operations managers and policymakers should factor these findings into emergency relief efforts, say Schmidt and his colleague. The goal should be to service communities more equitably. So, there should be more thought to the provision of essential food and household goods. Also, there should be a particular focus on those most vulnerable to natural disasters and their effects.


Current disaster nutrition relief programs are typically short. Authorities might do better by vulnerable communities by also extending things like cash and voucher programs, says Schmidt. And they should prioritize the ordering, shipment, and warehousing of essential goods.


“Our research shows that hurricanes cost certain groups of Americans more than others in the longer run. The permanent inflation on food stuff and household necessities that we find constitutes an additional burden on part of our national fabric. These are people who are least positioned to afford it.”


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William Schmidt is an associate professor of Information Systems & Operations Management at Emory University’s Goizueta Business School. His research focuses on understanding and mitigating operational disruptions, and applications of machine learning in operational decision making. 


To connect with William to arrange an interview - simply click his icon now.

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Associate Professor of Information Systems & Operations Management

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Expert Insight: Training Innovative AI to Provide Expert Guidance on Prescription Medications

A new wave of medications meant to treat Type II diabetes is grabbing headlines around the world for their ability to help people lose a significant amount of weight. They are called GLP-1 receptor agonists. By mimicking a glucagon-like peptide (GLP) naturally released by the body during digestion, they not only lower blood sugar but also slow digestion and increase the sense of fullness after eating. The two big names in GLP-1 agonists are Ozempic and Wegovy, and both are a form of semaglutide. Another medication, tirzepatide, is sold as Mounjaro and Zepbound. It is also a glucose-dependent insulinotropic polypeptide (GIP) agonist as well as GLP-1. Physicians have been prescribing semaglutide and tirzepatide with increasing frequency. However, both medications come with a host of side effects, including nausea and stomach pain, and are not suitable for every patient. Many clinics and physicians do not have immediate access to expert second opinions, as do the physicians at Emory Healthcare. Creating a Digital Twin That lack of an expert is one of the reasons Karl Kuhnert, professor in the practice of organization and management at Emory University’s Goizueta Business School, is using artificial intelligence to capture the expertise of physicians like Caroline Collins MD through the Tacit Object Modeler™, or TOM. By using TOM, developed by Merlynn Intelligence Technologies, Kuhnert and Collins can create her “decision-making digital twin.” This allows Collins to reveal her expertise as a primary care physician with Emory Healthcare and an Assistant Professor at Emory School of Medicine, where she has been leading the field in integrating lifestyle medicine into clinical practices and education. Traditional AI, like ChatGPT, uses massive amount of data points to predict outcomes using what’s known as explicit knowledge. But it isn’t necessarily learning as it goes. According to Kuhnert, TOM has been designed to learn how an expert, like Collins, decides whether or not to prescribe a drug like semaglutide to a patient. Wisdom or tacit knowledge is intuitive and rooted in experience and context. It is hard to communicate, and usually resides only in the expert’s mind. TOM’s ability to “peek into the expert’s mind makes it a compelling technology for accessing wisdom.” “Objective or explicit knowledge is known and can be shared with others,” says Kuhnert. "For example, ChatGPT uses explicit knowledge in its answers. It’s not creating something new. It may be new to you as you read it, but somebody, somewhere, before you, has created it. It’s understood as coming from some source." Karl Kuhnert “Tacit knowledge is subjective wisdom. Experts offer this, and we use their tacit know-how, their implicit knowledge, to make their decisions. If it were objective, everyone could do it. This is why we hire experts: They see things and know things others don’t; they see around corners.” Mimicking the Mind of a Medical Expert Teaching TOM to see around the corners requires Collins to work with the AI over the course of a few days. “Essentially what I do is I sit down with, in this case, a physician, and ask them, ‘What are thinking about when you make this decision?'” says Kuhnert. “The layperson might think that there are hundreds of variables in making a medical decision like this. With the expert’s tacit knowledge and experience, it is usually between seven and twelve variables. They decide based on these critical variables,” he says. "These experts have so much experience, they can cut away a lot of the noise around a decision and get right to the point and ask, ‘What am I looking at?’" Karl Kuhnert As TOM learns, it presents Collins with more and different scenarios for prescribing semaglutide. As she makes decisions, it remembers the variables present during her decision-making process. “Obviously, some variables are going to be more important than other variables. Certain combinations are going to be challenging,” says Collins. “Sometimes there are going to be some variables where I think, yes, this patient needs a GLP-1. Then there may be some variables where I think, no, this person really doesn’t need that. And which ones are going to win out? That’s really where TOM is valuable. It can say, okay, when in these difficult circumstances where there are conflicting variables, which one will ultimately be most important in making that decision?” The Process: Trusting AI After working with TOM for several hours, Collins will have reacted to enough scenarios for TOM to learn to make her decision. The Twin will need to demonstrate that it can replicate her decision-making with acceptable accuracy—high 90s to 100 percent. Once there, Collins’ Twin is ready to use. “I think it’s important to have concordance between what I would say in a situation and then what my digital twin would say in a situation because that’s our ultimate goal is to have an AI algorithm that can duplicate what my recommendation would be given these circumstances for a patient,” Collins says. “So, someone, whether that be an insurance company, or a patient themselves or another provider, would be able to consult TOM, and in essence, me, and say, in this scenario, would you prescribe a GLP-1 or not given this specific patient’s situation?” The patient’s current health and family history are critical when deciding whether or not to prescribe semaglutide. For example, according to Novo Nordisk, the makers of Ozempic, the drug should not be prescribed to patients with a history of problems with the pancreas or kidneys or with a family history of thyroid cancer. Those are just the start of a list of reasons why a patient may or may not be a good candidate for the medication. Kuhnert says, “What we’re learning is that there are so many primary care physicians right now that if you come in with a BMI over 25 and are prediabetic, you’re going to get (a prescription). But there’s much more data around this to suggest that there are people who are health marginalized, and they can’t do this. They should not have this (medication). It’s got to be distributed to people who can tolerate it and are safe.” Accessing the Digital Twin on TOM Collins’s digital twin could be available via something as easy to access as an iPhone app. “Part of my job is to provide the latest information to primary care physicians. Now, I can do this in a way that is very powerful for primary care physicians to go on their phones and put it in. It’s pretty remarkable, according to Colllins.” It is also transparent and importantly sourced information. Any physician using a digital twin created with TOM will know exactly whose expertise they are accessing, so anyone asking for a second opinion from Colllins will know they are using an expert physician from Emory University. In addition to patient safety, there are a number of ways TOM can be useful to the healthcare industry when prescribing medications like semaglutide. This includes interfacing with insurance companies and the prior approval process, often lengthy and handled by non-physician staff. “Why is a non-expert at an insurance company determining whether a patient needs a medication or not? Would it be better to have an expert?” says Collins. “I’m an expert in internal medicine and lifestyle medicine. So, I help people not only lose weight, but also help people change their behaviors to optimize their health. My take on GLP-1 medications is not that everyone needs them, it’s that they need to be utilized in a meaningful way, so patients will get benefit, given risks and benefits for these medications.” The Power of a Second Opinion Getting second, and sometimes third, opinions is a common practice among physicians and patients both. When a patient presents symptoms to their primary care physician, that physician may have studied the possible disease in school but isn’t necessarily an expert. In a community like Emory Healthcare, the experts are readily available, like Collins. She often serves as a second opinion for her colleagues and others around the country. “What we’re providing folks is more of a second opinion. Because we want this actually to work alongside someone, you can look at this opinion that this expert gave, and now, based on sourced information, you can choose. This person may be one of the best in the country, if not the world, in making this decision. But we’re not replacing people here. We’re not dislocating people with this technology. We need people. We need today’s and tomorrow’s experts as well,” according to Kuhnert. But also, you now have the ability to take an Emory physician’s diagnosing capabilities to physicians in rural areas and make use of this information, this knowledge, this decision, and how they make this decision. We have people here that could really help these small hospitals across the country. Caroline Collin MD Rural Americans have significant health disparities when compared to those living in urban centers. They are more likely to die from heart disease, cancer, injury, chronic respiratory disease, and stroke. Rural areas are finding primary care physicians in short supply, and patients in rural areas are 64 percent less likely to have access to medical specialists for needed referrals. Smaller communities might not have immediate access to experts like a rheumatologist, for example. 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But now I can ask the digital twin acting as a rheumatologist, given these variables, ‘Does this patient have lupus?’ And the digital twin could give me a second opinion.” Sometimes, those experts are incredibly busy and might not have the physical availability for a full consult. In this case, someone could use TOM to create the digital twin of that expert. This allows them to give advice and second opinions to a wider range of fellow physicians. As Kuhnert says, TOM is not designed or intended to be a substitute for a physician. It should only work alongside one. Collins agreed, saying, “This doesn’t take the place of a provider in actual clinical decision-making. That’s where I think someone could use it inappropriately and could get patients into trouble. You still have to have a person there with clinical decision-making capacity to take on additional variables that TOM can’t yet do. And so that’s why it’s a second opinion.” “We’re not there yet in AI says Collins. We have to be really careful about having AI make actual medical decisions for people without someone there to say, ‘Wait a minute, does this make sense?’” AI Implications in the Classroom and Beyond Because organizations use TOM to create digital twins of their experts, the public cannot use the twins to shop for willing doctors. “We don’t want gaming the system,” says Collins. “We don’t want doctor shopping. What we want is a person there who can utilize AI in a meaningful way – not in a dangerous way. I think we’ll eventually get there where we can have AI making clinical decisions. But I don’t think I’d feel comfortable with that yet.” The implications of using decision-making digital twins in healthcare reach far beyond a second opinion for prescription drugs. Kuhnert sees it as an integral part of the future of medical school classrooms at Emory. In the past, teaching case studies have come from books, journals, and papers. Now, they could come alive in the classroom with AI simulation programs like TOM. "I think this would be great for teaching residents. Imagine that we could create a simulation and put this in a classroom, have (the students) do the simulation, and then have the physician come in and talk about how she makes her decisions." Karl Kuhnert “And then these residents could take this decision, and now it’s theirs. They can keep it with them. It would be awesome to have a library of critical health decisions made in Emory hospitals,” Kuhnert says. Collins agreed. “We do a lot of case teaching in the medical school. I teach both residents and medical students at Emory School of Medicine. This would be a really great tool to say, okay, given these set of circumstances, what decision would you make for this patient? Then, you could see what the expert’s decision would have been. That could be a great way to see if you are actually in lockstep with the decision-making process that you’re supposed to be learning.” Kuhnert sees decision-making twins moving beyond the healthcare system and into other arenas like the courtroom, public safety, and financial industries and has been working with other experts to digitize their knowledge in those fields. "The way to think about this is: say there is a subjective decision that gets made that has significant ramifications for that company and maybe for the community. What would it mean if I could digitize experts and make it available to other people who need an expert or an expert’s decision-making?" Karl Kuhnert “You think about how many people aren’t available. Maybe you have a physician who’s not available. You have executives who are not available. Often expertise resides in the minds of just a few people in an organization,” says Kuhnert. “Pursuing the use of technologies like TOM takes the concept of the digital human expert from simple task automation to subjective human decision-making support and will expand the idea of a digital expert into something beyond our current capabilities,” Kuhnert says. “I wanted to show that we could digitize very subjective decisions in such areas as ethical and clinical decision-making. In the near future, we will all learn from the wisdom codified in decision-making digital twins. Why not learn from the best? There is a lot of good work to do.” Karl Kuhnert is a Professor in the Practice of Organization & Management and Associate Professor of Psychiatry, School of Medicine and Senior Faculty Fellow of the Emory Ethics Center. If you're looking to connect with Karl to know more - simply click on his icon now to arrange a time to talk today.

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Decoding Hierarchies in Business: When is Having a Boss a Benefit for an Organization?

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12 min

Small Changes Can Save Lives: How a Police Officer’s First Words Can Transform Communities

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This often translates to police officers being encouraged to engage with citizens informally and outside the context of enforcing the law. If police spent more time chatting with people at a public park or at a café, they’d have a better chance to build rapport and foster a collective sense of community caretaking—or so the thinking goes. Such work is often assigned to a particular unit within the police force. This is the fundamental principle behind community-oriented policing: a cop is part of the community, not outside or above it. This approach is not without controversy, as many would argue that the public is better served by police officers interacting with citizens less, not more. In light of the many high-profile instances of police brutality leaving names like Breonna Taylor and George Floyd echoing in the public’s ears, their reticence to support increased police-to-citizen interaction is understandable. “Sometimes when I discuss this research, people say, ‘I just don’t think that officers should approach community members at all, because that’s how things escalate.’ Kyle and I acknowledge that’s a very important debate and has its merits.” As micro-oriented researchers, however, Dittmann and Dobson forgo advocating for or dismissing broad policy. They begin with the environment handed to them and work backward. “The present and immediate reality is that there are officers on the street, and they’re having these interactions every day. So what can we do now to make those interactions go more smoothly? What constitutes a positive interaction with a police officer, and what does it look like in the field?” Good Intentions Gone Awry To find out, they pulled data through a variety of experiments, including live interactions, video studies and online experiments, relying heavily on observation of such police-to-citizen interactions. "What we wanted to do is observe the heterogeneity of police interactions and see if there’s anything that officers are already doing that seems to be working out in the field, and if we can ‘bottle that up’ and turn that into a scalable finding." Andrea Dittmann Dittmann and her colleagues quickly discovered a significant discrepancy between some police officers’ perceived outcome of their interactions with citizens and what those citizens reported to researchers post-interaction. “An officer would come back to us and they’d say it went great. Like, ‘I did what I was supposed to do, I made that really positive connection.’ And then we’d go to the community members, and we’d hear a very different story: ‘Why the heck did that officer just come up to me, I’m just trying to have a picnic in the park with my family, did I do something wrong?’” Community members reported feeling confused, harassed, or—at the worst end of the spectrum—threatened. The vast majority—around 75% of citizens—reported being anxious from the very beginning of the interaction. It’s not hard to imagine how an officer approaching you apropos of nothing may stir anxious thoughts: have I done something wrong? Is there trouble in the area? The situation put the cognitive burden on the citizen to figure out why they were being approached. The Transformational Potential of the “Transparency Statement” And yet, they also observed officers (“super star” police officers, as Dittmann refers to them) who seemed to be especially gifted at cultivating better responses from community members. What made the difference? “They would explain themselves right from the start and say something like, ‘Hey, I’m officer so-and-so. The reason I’m out here today is because I’m part of this new community policing unit. We’re trying to get to know the community and to better understand the issues that you’re facing.’ And that was the lightbulb moment for me and Kyle: the difference here is that some of these officers are explaining themselves very clearly, making their benevolent intention for the interaction known right from the start of the conversation.” Dittmann and her colleagues have coined this phenomenon the “transparency statement.” Using a tool called the Linguistic Inquiry & Word Count software and natural language processing tools, the research team was able to analyze transcripts of the conversations and tease out subconscious cues about the civilians’ emotional state, in addition to collecting surveys from them after the encounter. Some results jumped out quickly, like the fact that those people whose conversation with an officer began with a transparency statement had significantly longer conversations with them. The team also employed ambulatory physiological sensors, or sensors worn on the wrist that measure skin conductivity and, by proxy, sympathetic nervous system arousal. From this data, a pattern quickly emerged: citizens’ skin conductance levels piqued early after a transparency statement (while this can be a sign of stress, in this context researchers determined it to reflect “active engagement” in the conversation) and then recovered to baseline levels faster than in the control group, a pattern indicative of positive social interaction. Timing, too, is of the essence: according to the study, “many patrol officers typically made transparency statements only after trust had been compromised.” Stated simply, the interest police officers showed in them was “perceived as harassment” if context wasn’t provided first. Overall, the effect was profound: citizens who were greeted with the transparency statement were “less than half as likely to report threatened emotions.” In fact, according to the study, “twice as many community members reported feeling inspired by the end of the interaction.” What’s more, they found that civilians of color and those from lower socioeconomic backgrounds —who may reasonably be expected to have a lower baseline level of trust of law enforcement—“may profit more from greater transparency.” Talk, it turns out, is not so cheap after all. Corporate Offices, Clinics, and Classrooms The implications of this research may also extend beyond the particulars of the police force. The sticky dynamics that form between power discrepancies are replicated in many environments: the classroom, between teachers and students; the office, between managers and employees; even the clinic, between medical doctors and patients. In any of these cases, a person with authority—perceived or enforceable—may try to build relationships and ask well-meaning questions that make people anxious if misunderstood. Is my boss checking in on me because she’s disappointed in my performance? Is the doctor being nice because they’re preparing me for bad news? “We believe that, with calibration to the specific dynamics of different work environments, transparency statements could have the potential to ease tense conversations across power disparities in contexts beyond policing,” says Dittmann. More Research, Action, and Optimism What could this mean for policing down the road? Imagine a future where most of the community has a positive relationship with law enforcement and there is mutual trust. "I often heard from family and friends that they’d trust the police more ‘if they were all like you.’ I can hear myself saying, ‘There are lots of police just like me!’ and I truly believe that. I believe that so many officers love people and want to serve their communities—and I believe a lot of them struggle with the same things I do. They want to see our profession do better!" Britt Nestor “When I get a new case and I meet the survivor, and they’re old enough to talk with me, I always explain to them, ‘I work for you. How cool is that?’ And I truly believe this: I work for these kids and their families.” The implications run deep; a citizen may be more likely to reach out to police officers about issues in their community before they become larger problems. An officer who is not on edge may be less likely to react with force. Dittmann is quick to acknowledge that while the results of the transparency statement are very promising, they are just one piece of a very large story with a long and loaded history. Too many communities are under supported and overpoliced; it would be denying the gravity and complexity of the issue to suggest that there is any silver bullet solution, especially one so simple. More must be done to prevent the dynamics that lead to police violence to begin with. “There’s a common narrative in the media these days that it’s too late, there’s nothing that officers can do,” says Dittmann. Yet Dittmann places value on continued research, action and optimism. When a simple act on the intervention side of affairs has such profound implications, and is not expensive or difficult to implement, one can’t help but see potential. “Our next step now is to develop training on transparency statements, potentially for entire agencies,” says Dittmann. “If all the officers in the agency are interacting with transparency statements, then we see this bottom-up approach, with strong potential to scale. If every interaction you have with an officer in your community starts out with that transparency statement, and then goes smoothly, now we’re kind of getting to a place where we can hopefully talk about better relations, more trust in the community, at a higher, more holistic, level.” While the road ahead is long and uncertain, Dittmann’s optimism is boosted by one aspect of her findings: those community members who reported feeling inspired after speaking with police officers who made their benevolent intentions clear. "That was really powerful for me and Kyle. That’s what gets me out of bed in the morning. It’s worth trying to move the needle, even just a little bit." Andrea Dittmann Looking to know more?  Andrea Dittman is available to speak with media about this important research. Simply click on her icon now to arrange an interview today.

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