Among the primary reasons for the workshop was not only to convey compassion for the people of New Orleans and the Gulf Coast region, but also to ensure their safety and well-being as they reinhabit their homes. In addition, this workshop is the beginning of a scientific dialogue to understand the impacts of Hurricane Katrina on people’s health. Third, the workshop discussed how the public health community can use the dialogue to gain knowledge for preparation for future events. This workshop did not consist of lessons learned during the response, but rather was an examination of the science needed to inform the ongoing response during disasters of this magnitude.
ENSURING ENVIRONMENTAL SAFETY AND WELL-BEING
One of the first steps in the response was to ensure environmental safety and well-being as the requirements for safe homes and neighborhoods. In any city, the public needs a strong environmental infrastructure, which includes safe drinking water, sanitation, and removal of trash and waste at the street, neighborhood, and regional levels. One of the central concerns is the amount of pollution that went into Lake Pontchartrain, the Mississippi River, and the Gulf of Mexico. Because of the importance of the waterways to the way of life in the region, this pollution will impact recovery. It may ultimately have economic impacts on the fishing industry because of contamination of the shellfish beds.
Infrastructure rebuilding will be a critical component. One of the greatest challenges in the Gulf Coast initially was to reconstitute the drinking water supplies and waste treatment, and rebuilding also needs to include transit and schools. The rebuilding also provides an opportunity for improving on these key infrastructure needs. During the rebuilding process, there will be opportunities to innovate if people are willing to take a step back to assess the situation to build
smarter. One shouldn’t presume that just what was there will be repaired and rebuilt; it may not have been adequate in the first place.
IMPACTS ON THE HEALTH OF COMMUNITIES AND THEIR RESIDENTS
In the long term, there will be a need for reconstituting the communities in the region—knitting back together communities that provide social support to people. This will require commitment to schools and services and the preservation of cultural, racial, and socioeconomic diversity. From a practical aspect, the question remains how people will be able to remediate their homes and where they will be able to obtain the financing for such endeavors.
The public health community has learned from 9/11 about posttraumatic stress disorder and depression in the aftermath of the terrorist attacks. It is well known that stress can be a risk factor for many diseases, and for the post-Katrina residents and evacuees, the cleanup and recovery continue to be stressful. Many individuals were flown out of their communities without knowing where they were going and without any belongings—one example of a stressful situation.
Neighborhood stability provides social stability to its residents. Previous research suggests that the loss of social networks in communities that have become fragmented has impacted health through increased drug abuse, alcohol abuse, and HIV infection. For New Orleans and the Gulf Coast region, there is unprecedented disruption to this stability, which will probably never be regained. In New Orleans, closely knit communities that provided stability to each other by being part of a social network are now scattered. This leaves the community more vulnerable and more fragile in many respects.
THEMES FROM THE WORKSHOP
During the workshop a number of major themes were discussed that cut across scientific disciplines. Many of these themes warrant future discussion, including the need for research, scientific leadership, and environmental management.
Health Studies and Scientific Leadership
There is a need for health studies, whether they are cross-sectional, case-controlled, or longitudinal. Public health needs to look at disasters systematically to ensure that the affected communities are involved and can fully participate in the recovery. Under normal (nondisaster) situations, many public health scientists have done these studies, and they can be challenging. For Hurricane Katrina and other Katrina-like events, the fact that people are dispersed around the country makes recruiting and conducting these experiments even more difficult. A further complication is that the local scientific leadership was displaced. Thus, there is a
need for rebuilding the leadership in the scientific community to conduct public health tracking or exposure investigation. Because of their connections with the community, it is essential to use the local scientists to ensure credibility.
Global Warming and Environmental Management
During the workshop, global warming was only briefly discussed. The National Aeronautics and Space Administration (NASA) released data that showed a decrease in the minimum coverage of sea ice in the Arctic from 1979 to 2005 (NASA, 2005). The receding ice shelf has led to a rise in the sea level and, consequently, a change in the temperature of such water bodies as the Gulf of Mexico. Although scientists cannot say that this trend results in hurricanes, it does not help the situation in New Orleans, where parts of the city are below sea level.
At the same time that there are changes on a global scale, there have been regional problems in environmental management. The Louisiana coast has lost wetlands from lack of sediment flow, human activities, and rises in sea level. This loss of wetlands is important because the wetlands are part of the protective barriers against hurricanes. Although the levees need to be rebuilt, they need to be rebuilt to address the rising sea level, and they need to be rebuilt sustainably by working with the natural barriers. Any plans moving forward should merge regional planning with an outlook to building a system integrated with nature. It is the only way to return the city to habitability in the near future, and it needs to be done in a way that makes the city more resilient to future events.
STRATEGIES FOR THE FUTURE
From a public health viewpoint, we need to look at shelters and evacuation routes. The roads designated for evacuation were flooded, freeways fell apart, and shelters such as the Superdome could not sustain the winds. One way to prepare for disaster is to use Bill Hadden’s 10 basic strategies for injury prevention. Six of them were considered:
Do not create the amount of the hazard. This is not possible for hurricanes.
Reduce the amount of the hazard. Although society may be able to mitigate the frequency of hurricanes, affecting climate change is a very long-range process, and any changes made today would be very beneficial to our children and their children.
Prevent the release of the agent. Although this is not an option for hurricanes, we can think about modifying the release of the agent. For example, scientists and engineers need to think about ways to control storm surges and flooding by effectively using wetlands and floodgates in their management strategy.
Move people away from the hazard. This would imply separation by means of a physical barrier, such as tidal gates or levees, and building homes and other structures on stilts. However, there is a need to stop building in vulnerable places.
Modify surfaces and basic structures. During the storm dramatic pictures were shown of flying debris that could cause injury to residents. Although this is of concern to the public health community, the solution will require the help of other disciplines to build more resilient materials.
Provide first aid in emergency response. The first response needs to be better prepared. There were documented critical gaps in the evacuation of people in hospitals and in providing for the needs of individuals in acute care and rehabilitation centers.
These six points are areas for further research as well as action as the public health community prepares for future disasters. This is important because across the globe there are approximately 6 billion people, and a high percentage of them live in coastal areas very similar to the Gulf Coast. Combined with the individuals who reside in highly earthquake-vulnerable regions, what we face, as public health and other professionals across the disciplines, are challenges to ensuring people’s protection and well-being.