Introduction: Published reports on health impacts from natural disasters causing injuries, poisonings, infectious disease, chronic illness, and NCDs continue to grow exponentially. Simultaneously, calls for the improvement in scientific rigor to improve causal links, strength of association, and efficacy of interventions are increasing. At the heart of this challenge is demonstrating mortality and morbidity risk across a time continuum, where the health effect is not detected for weeks, months, or years after the disaster event. In some circumstances, the presence and acuity of illness are not apparent until after an insidious or cumulative point has been reached. Notwithstanding medical observations or disaster-attributed morality classification matrices being available for 20 years, natural disaster mortality continues to be measured narrowly, on those confirmed dead (acute physical trauma, drowning, poisoning, or missing). There has been little effort to expand mortality assessment beyond this historical lens. For example, it fails to consider suicide in drought and was not redefined when the Indonesian fires caused the highest mortality in 2015. Tens of thousands of lives were lost from smoke exposure. Aim: This study sought to test the progress of two decades of published medical and scientific literature on natural disaster mortality reporting. Methods: A retrospective analysis of natural disaster impact reports for the past ten years was performed on three of the world’s largest disaster databases, including CRED, Sigma, and ADRC. Discussion: WADEM members must commence a strategic process to expand the recognition of health impacts from natural disasters. Global and domestic advocacy is required for building evidence through improved systematic collection of data and especially reporting patient continuum of care as a minimum standard. Without this leadership, disaster health impacts will continue to be underestimated and emergency health program responses and financial resources will fall short in protecting those most at risk.