Why Haven’t We Learned Hurricane Katrina’s Health Lessons?
Hurricane Katrina, one of the most infamous storms in U.S. history, made landfall on the Gulf Coast 15 years ago. The preventable loss of lives and livelihoods was so severe that “Katrina moment” has become shorthand for grossly inadequate emergency planning, preparation, and response.
Hurricane Katrina was a clarion call to the nation to improve its disaster response and was a stark warning about the future catastrophic consequences of mega-storms fueled by climate change.
Have we learned? Not well enough, when it comes to public health.
Hospital systems have certainly improved their disaster planning and response in the last 15 years. In Texas, for example, regular training exercises and widespread adoption of electronic patient records may have helped save lives during and after Hurricane Harvey in 2017.
What is Public Health?
Public health is focused on improving the health of people and their communities through three basic functions: (1) Assessing community health needs; (2) Assuring access to, and the quality of, health services; and (3) Developing and advocating for evidence-based policies.
Although public health practitioners such as nurses or behavioral therapists provide some of the same basic services found in primary care settings, they’re more focused on prevention of illnesses and injuries rather than treatment after the fact.
Many in the public health community have been slow to recognize their role in tackling racism and other forms of inequity that harm human health and well-being, despite the pioneering work of the environmental and reproductive justice movements to make the link. However, the heavy burden of COVID-19 on communities of color and recent explosion of police brutality against Black people seems to have broken through in a new way. Since June 2020, a flood of U.S. cities, counties, and state have officially declared racism as a public health crisis or emergency.
The public health response to disasters has been slower to improve—through no fault of the many talented and passionate public health professionals across the country.
Rather, this uneven progress reflects the U.S. tendency to prioritize quick-fix medical treatment of individuals over longer-term preventative public health measures. Despite evidence that public health has a high economic and social return on investment, it garners just 1.5 to 2.5 percent of state and federal health spending. The federal contribution to total public health spending is also shrinking, from 35 to 50 percent in the 1970s to 10 to 15 percent now. The result is a patchwork of state commitments to public health, ranging in 2019 from $46 per person in Nevada to $499 per person in the District of Columbia.
The public health workforce is likewise getting smaller, even as the U.S. population grows. Since the 2008 recession, the local health department workforce declined 17 percent, resulting in cuts to basic services such as screening for diabetes and infectious diseases.
Public Health Lessons Remain Unlearned
Hurricanes and pandemics pose different challenges over different time scales. Nevertheless, many of the high-level lessons about the public health response to Hurricane Katrina are eerily relevant to today’s fight against COVID-19.
Significantly, the U.S. Senate Committee on Homeland Security and Governmental Affairs (2006) and researchers from RAND (2007) found that during Katrina:
- There was significant confusion about which organization was responsible for which element of the response and recovery.
- Public health staff had to scramble to fill shortages in medications and other supplies.
- State agencies struggled to identify who needed the most help, and then deliver that help. (Notably, neither of the reports specifically discuss the disproportionate harm this shortfall inflicted on people of color.)
- No one anticipated the overwhelming need for mental health services for both storm survivors and health department staff.
- “No level of government provided adequate safety information to the public.” (Emphasis mine.)
Sound familiar? Our current national response to the pandemic has suffered from each of these challenges and more. And the communication issue is becoming ever more problematic as hundreds of thousands of people across the United States weigh the risks of staying or going when disasters loom.
Of course, the authors of those early reports couldn’t have known just how far-reaching Katrina’s impacts would be. One new study of low-income mothers in New Orleans, most of whom were Black, found that Katrina-related fears for loved ones and lack of medical care were associated with post-traumatic stress 12 years after the storm. This result doesn’t bode well for the long-term mental health of the Black and brown communities hit hardest by COVID-19 today.
The Climate Connection
The Senate Committee’s Katrina report also concluded—in 2006!—that although catastrophes are rare,
“The age of … climate change has ensured that the next occurrence is mainly a question of how and where, not when.”
Our public health system is still wildly unprepared for the climate crisis—as are many other areas of our national safety net. But there have been a couple of signs of progress. For one thing, scientific understanding of the health impacts of climate change has grown by leaps and bounds in the last 15 years. Secondly, state and local public health agencies have been working since at least 2009 to increase the climate resilience of their operations and the people they serve.
This effort, like so many others in public health, is in dire need of more resources. The U.S. Centers for Disease Control and Prevention’s Climate and Health Program is the only direct federal support to state and local agencies for climate and health adaptation planning. Unfortunately, that program only covers 16 states and 2 cities, none of which are in the region currently affected by Hurricane Laura. And even the public health agencies with federal support have found it difficult to make substantial headway in their climate work.
The Impacts of Another Record-setting Hurricane
Hurricane Laura made landfall just east of the Texas border on August 27 as one of the strongest storms to hit Louisiana. It has also tied for the fastest intensifying hurricane on record, complicating preparation efforts.
It’s too early to tell the extent of Laura’s health consequences or how well response and recovery efforts will go. It’s also too early to tell how the dispersal of thousands of evacuees from Louisiana and Texas will affect the regional and national pandemic response.
But one thing is clear: We can’t keep ignoring the lessons of the past as we deal with an increasingly rapid-fire series of disasters fueled by climate change. Our health—and indeed the health of our society and our economy—depends on an agile public health system. We need to prioritize investments in this system, so it is ready to take on multiple challenges at once and actively work to change the racist, ableist, classist, and gendered systems that make and keep people vulnerable.