Environmental Public Health Impacts of Disasters: Hurricane Katrina: Workshop Summary (2007)

The Tulane/Xavier Center for Bioenvironmental Research is an interdisciplinary research center in which environmental engineers, environmental health scientists, philosophers, and other groups work together. To be able to understand the next steps in environmental impact research following Hurricane Katrina, the center is mapping and modeling the post-Katrina area, said John McLachlan, Professor and Director of the center. In the short term, the center is contributing to recovery by capitalizing on its existing resources, situation, and locale to create a laboratory without walls. In addition, because the center involves both a major research-intensive university and a historically black university, it is integrating issues of cultural awareness and sensitivity. It has received a small grant from the National Science Foundation to fund exploratory research to launch the Katrina Environmental Research and Restoration Network (KERRN). It will also attempt to ensure maximum benefit by avoiding duplication of effort. The project will be a network of researchers who share data and ideas, crossing disciplinary, geographic, and institutional lines and providing models for how to respond to major environmental disasters. The central premise will focus on coordination and collaboration to gathering time-sensitive data, noted McLachlan. Because data are already being collected and distributed to different places, depending on what organization provides funding, this effort will provide a central repository to advance the science.

One of the functions of KERRN is to aid people in finding the information they need, whether they are researchers or the public. KERRN will provide a centralized information source for research plans and offer virtual brainstorm-

ing. In addition, it could serve as a clearinghouse, matching skills and interests to research needs. By becoming a nucleating center or coordination node, both regional and international investigators can find out the status of current research. KERRN could facilitate communication between investigators via the web as well as through face-to-face meetings.

According to McLachlan, KERRN is going to be a “bottom-up” effort, meaning a community-based effort that reaches out not only to the scientific community but also to other kinds of community efforts. This network is designed to be transparent and nimble because issues in the area are evolving and any research effort needs to be flexible to address this, noted McLachlan.

The network has three goals: intellectual capacity, preparing for future disasters, and approaching environmental health in the region in a systematic way. First, a network in which the scientific community engages in working on problems may help to rebuild the intellectual capacity in the region, noted McLachlan. Second, KERRN can become a central data source for research plans and findings. Through analyzing these data, the center can pass on lessons learned for the next disaster. Third, it is hoped the network will help create a new model for environmental health research. Taking a systems approach, connectedness, and the realization that environmental health is the ultimate transdisciplinary subject will contribute to creating a new model for environmental health research.

Scientists need to break the habit of basing research approaches on who provides the money or who has the ideas, noted McLachlan. Post-Katrina issues are interconnected, and what we can learn from the disaster is to how break down the silos and take an interdisciplinary approach to research.

Hurricane Katrina affected not only cities, including Baton Rouge and New Orleans, but also small towns and rural communities, said Sandral Hullett, CEO and Medical Director of the Jefferson (Alabama) Health System. Most of the affected rural areas are in the “black belt” that includes counties across Alabama, Mississippi, Louisiana, and Arkansas. The black belt was named because of the rich soil that historically produced most of the cotton in the country. Today, the

majority of the population consists of people of color who are economically disadvantaged (Figure 6-1).

Alabama’s black belt reflects the area’s poverty. The state’s 10 most rural counties rank among the poorest counties in the country. Approximately 37 percent of black belt families with related children under the age of 18 live below the poverty level, compared with 21.5 percent for Alabama as a whole, and 18.2 percent nationwide, (Figure 6-2) (Black Belt Action Commission, 2004). In the black belt, 61.7 percent of single mothers with related children under the age of 18 live below the poverty level compared with 36.6 percent nationwide. The unemployment rate is 10.9 percent (5.6 percent nationwide), and median household income is $22,301 for a family of four ($41,994 nationwide). In addition to losing their boats and homes, some rural communities near the Gulf Coast lost their sources of income as well, because the oyster beds were closed and they are not allowed to farm them for at least a year. This has had a large impact on a region that was very poor to begin with, noted Hullett. Without income, it will be impossible for these communities to replace their lost homes.

People in rural areas generally have poor health as well as perceived poor health, said Hullett. The infrastructure in these areas is also inadequate. Such health issues as hypertension, diabetes mellitus, renal failure, stroke, arthritis,

FIGURE 6-1 Alabama’s black belt is one of the rural areas most affected by Hurricane Katrina. The area is called “black belt” because of the soil, not because of the people who live there, although the majority are of people of color.

SOURCE: Black Belt Action Commission (2004).

FIGURE 6-2 Families with related children under age 18 who live below the poverty level.

SOURCE: Black Belt Action Commission (2004).

cancer, and obesity contribute to mortality and morbidity in these areas and need to be addressed.

The major environmental issues in these rural areas are septic system leakage (some places still have raw sewage coming from them), solid waste disposal landfills, and chemical waste sites. Not only are chemical waste sites a public health concern, but they also create environmental justice issues because of their locations, noted Hullett. Other areas of concern in the community are groundwater contamination, soil contamination, and solid waste facilities that attract rodents and mosquitoes which can carry West Nile virus, create unpleasant odors, and decrease property values. Most people in rural areas get their drinking water from deep wells that were affected by Hurricane Katrina, making the water not potable. There are possible post-Katrina chemical waste leakages in the area. Although there is no evidence of it at this time, some people are concerned about hepatitis A virus, noted Hullett.

According to Hullett, leadership is the greatest problem in the most affected areas. As conditions were constantly changing, several support agencies, including the Federal Emergency Management Agency, the Red Cross, and local agencies, were involved, but none of them was in a leadership role. Most communities already have some leaders whom they trust—these are often their local medical providers, said Hullett—and they consider people not born in the area as outsiders. When these outsider agencies, as well as the county and state officials, come into communities and try to tell people what to do, it creates distrust in the local community. Thus, agencies and researchers should not underestimate community leadership involvement in post-Katrina areas.

To truly affect health, researchers and practitioners must address social and economic factors by working with the community. Hullett paraphrased Eugene Fidell, president of the National Institute of Military Justice, saying, “If the problem exists in the community, the solution can be found in the community.” That means that sometimes we in the health professions and sciences need to ask the communities what they want. The knowledge, expertise, and resources of the involved communities are often vital to successful research.

Three primary features of participatory research include collaboration, mutual education, and acting on results developed from research questions that are relevant to the community. Participatory research is based on mutually respectful partnerships between researchers and communities. The community needs to feel that it is a part of the process, that it is not being used or taken advantage of because of its hardships. Partnerships can be strengthened by joint developments of research agreements regarding the design, implementation, analysis, and dissemination of the results. That may be a lot to ask, noted Hullett, although, if one is committed to making it work, it will. Finally, one of the most important things is disseminating the results of participating research, thus letting the community know that it is part of the process. The results of participatory research both have local applicability and are transferable to other communities with similar characteristics.

In conclusion, Hullett noted that when people from groups with a common cause are involved in investigation of their situations and decision making, they are transformed. They lose fear and gain self-confidence, self-esteem, and new direction to move forward.

Advocates for Environmental Human Rights is a nonprofit public interest law firm whose mission is to advance and defend the human right to a healthy and safe environment. This organization conducts litigation on behalf of communities. According to Monique Harden of Advocates for Environmental Human Rights, in many communities the environmental regulatory system has failed. Hurricane Katrina has exposed many of those failings, not just from an environmental regulatory standpoint, but also in social, economic, and racial issues.

Social justice advocates are concerned about how displaced people’s right of return will be handled in the aftermath of Hurricane Katrina. The right to return has its roots in human rights. It is recognized in the Universal Declaration of Human Rights (Article 13) and often has been invoked in cases resolving the humanitarian issue of populations displaced during natural disasters and armed conflicts, noted Harden. Ensuring that displaced communities have opportunities and the ability to return to their homeland is one of the declaration’s missions. The right to return is a major issue among the diaspora of New Orleans residents

who have been displaced by Hurricane Katrina, many of whom face significant obstacles to coming back to their communities.

Before displaced residents can return to their communities and start to rebuild and reestablish themselves, certain sets of conditions have to be met involving economic opportunities, housing, social conditions, and environmental health and public health. Today there are several known toxic threats in New Orleans, including biological pathogens in the remaining floodwaters and soil, semivolatile chemical compounds, heavy metals, the potential intrusion of contaminants in the drinking water system, and toxic mold in houses and buildings, noted Harden. All of these problems get in the way of the right of return, thus making public health important in allowing displaced residents to exercise their basic human right. According to Harden, these public health needs include the following:

Respectful engagement of communities: Communities need to be at the table and setting priorities in the rebuilding of hurricane-affected neighborhoods, in health precautions, and in environmental remediation. Harden noted that it is currently not happening but needs to happen.

Public accessibility to environmental monitoring data: According to Harden, the current information on environmental monitoring is not publicly accessible because it is not presented in a clear and easy-to-understand way. It does not give an assessment of the remaining risks, especially for people of color and low-income populations. Some of these vulnerable populations lived in neighborhoods where there were toxic issues prior to Hurricane Katrina. For example, the Agriculture Street neighborhood in New Orleans was built on a toxic landfill. When it was built during the late 1960s, the contaminants from the toxic landfill were not properly secured, and several years later, after people moved there—the majority of whom are African Americans—they began noticing an unusually high incidence of breast cancer and other types of cancers among themselves, their family members, and neighbors (Caesar et al., 1997). In 1994 the Environmental Protection Agency (EPA) designated the area as a Superfund site because of its findings of more than 150 toxic chemicals and heavy metals, some of which were as deep as 17 feet below ground (Rules and Regulations, 1994). This subdivision is one of many in the area that have potential for toxic exposures post-Katrina, cautioned Harden.

Safe removal and disposal of hurricane-related waste: Initially, it was proposed to manage the mounds of hurricane debris by burning them. The EPA Science Advisory Board has criticized the plan because combustion creates toxic

chemicals in the air, which is a public health threat. Compliance with environmental justice guidelines requires the involvement of the affected community in the safe removal and disposal of waste.

Compliance with environmental and public health laws: Rigorous compliance with all existing environmental public health laws and standards, including the federal executive order concerning environmental justice, is still needed in New Orleans and throughout the Gulf Coast, noted Harden.

To protect public health and the public’s right to return, EPA needs to convene monthly public meetings with communities in coordination with community-based organizations and relevant agencies to monitor, assess the risk, and remediate public health threats in hurricane-affected areas.

What is needed now is the development of policies that strengthen the capacities of local, state, and federal health providers to respond effectively to toxic exposures and prioritize publicly accessible environmental health monitoring, assessment, and remediation by EPA and local agencies in times of disaster, concluded Harden. To begin to address this, she suggested that additional work was needed in several areas:

• Develop environmentally sustainable initiatives and policies for safe distances between residential communities and toxic waste sites.

• Construct hurricane-resistant green buildings.

• Investigate flood protection infrastructure.

• Preserve and restore wetlands and coastal areas that can mitigate the impacts of future hurricane damage.

• Diversify energy sources to thwart the impacts of climate change and more intense hurricanes.

• Replace harmful industrial manufacturing with safe alternative materials and processes.