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Cascade: No. 62, Summer 2006

Disasters, Public Needs, and Public Policy

Typically, after a disaster occurs, serious consideration is given to what it would take to prevent or survive a similar future calamity. This reflection occurs among individuals and within public agencies at all levels of government. The devastation caused by Hurricane Katrina along the Gulf Coast of Louisiana and Mississippi captured our attention and prompted a public debate on our collective ability to deal with a catastrophe of its proportions.

Many aspects of the hurricane and its aftermath have been investigated. Of interest here is the health and other concerns of those affected by Katrina as well as their experiences during and after the storm. The disturbing images in the news media constantly reminded us of the health and other needs of Katrina’s victims. Although the accounts were compelling, many were qualitative rather than quantitative in nature.

A study by Mollyann Brodie, Erin Weltzien, Drew Altman, Robert J. Blendon, and John M. Benson increases our understanding by supplying facts and figures to underscore the health problems and other pressing concerns of Katrina’s victims.1 The authors use the results of a survey of evacuees conducted in Houston-area shelters to provide an extraordinary view of the experiences of those most affected by Katrina, including the evacuees’ views of the efforts to assist them.2 The study seeks to “shed light on how the public health community can promote the recovery of Hurricane Katrina victims and protect people in future disasters.” Given that nearly three-quarters of those surveyed in the study had incomes of $29,999 or less, and that roughly a third had incomes less than $10,000, the results should be of particular interest to those organizations that serve the low- and moderate-income community.

Study Method      

The authors relied on a survey designed jointly by the Washington Post, the Kaiser Family Foundation, and the Harvard School of Public Health. The survey was administered from September 10 to 12, 2005, to “680 randomly selected respondents 18 years or older who were evacuated to Houston from the Gulf Coast after Hurricane Katrina.” The survey sample was composed of “439 respondents from the Houston Reliant Park complex (i.e., the Astrodome and Reliant Center), 152 from the George R. Brown Convention Center, and 12 whose location was not recorded.” The remainder of the sample came from several smaller Red Cross shelters in the Houston area.3,4

The survey, according to the authors, “was intended to cover that population hardest hit by the hurricane: those who did not initially evacuate in time, had to rely on government help to evacuate, and did not have access to housing on their own.”5

Results

Demographics and Health Characteristics

The vast majority of those surveyed were from the New Orleans area.6 The authors found that “compared to New Orleans and Louisiana residents as a whole, disproportionate numbers of evacuees were African American, had low incomes and low rates of home ownership, had no health insurance coverage, and were at low educational levels.” Moreover, 41 percent of the respondents indicated that they had chronic health conditions that included heart disease, hypertension, diabetes, or asthma. Prior to Katrina, the evacuees reported that they relied on the network of hospitals and clinics that comprised the New Orleans public hospital system for the vast majority of their health care. Many depended on Charity Hospital (the city’s flagship institution), which was demolished by the storm.7

The authors discovered an interesting conundrum when it came to the evacuees’ need for health care and their ability to obtain it through a program of government-sponsored care. Roughly half of the evacuees were less than 65 years old and childless, which rendered them ineligible for Medicaid or Medicare. Yet “their health status was nearly identical to that of their peers with children, suggesting similarities between the health care of the two groups but differences in their ability to obtain care.”

Evacuation Orders and Experiences After the Storm

Slightly less than half of those surveyed reported that they had heard the order to evacuate prior to the hurricane and that the instructions were clear on how to leave. This prompted 38 percent to leave before the storm hit. About a third of those who stayed in New Orleans indicated that they did not hear an order to evacuate, while nearly 30 percent had heard the order but thought the evacuation information was unclear. A little over a third said they received clear evacuation information but remained anyway.

For purposes of future planning, it is of interest to know the reasons why some Gulf Coast residents did not evacuate before the storm. The survey revealed that 34 percent reported a lack of transportation, while 28 percent underestimated the magnitude of the storm and its aftermath. Others said they were physically unable to leave or were caring for someone with a disability that prevented their evacuation. Not too surprisingly, economic factors figured prominently in determining those who stayed or left: “39 [percent] of those who said that they could not have found a way to leave reported earning less then $10,000 in the previous year, compared with 29 [percent] of those who said they could have found a way to leave.”8

Equally revealing were the experiences of the respondents in the immediate aftermath of Katrina. Who can forget the wretched conditions in New Orleans’ Superdome and its Convention Center? More than a third of the respondents spent time in the former and 7 percent in the latter. The survey also showed that 40 percent indicated that they had spent at least a day living on the street, while 34 percent were trapped in their homes. Many reported not having sufficient food, fresh water, prescription medicines, or the medical care that they needed.9

Evaluation of the Emergency Response

The evacuees’ views on who provided the most and least help during the storm are well worth noting. The National Guard, Coast Guard, or military were identified as most helpful by 25 percent of the respondents, while 19 percent named private organizations such as the Red Cross.10 However, nearly 40 percent indicated that they did not receive assistance from any of these organizations.

A majority of those surveyed were quite critical of the response to the hurricane by all three levels of government (federal, state, and local). But they reserved their highest disapproval (70 percent) for the federal government. Perhaps even more revealing is that nearly 70 percent believed that the government’s response would have been timelier if the affected areas had a higher percentage of wealthy white residents, instead of a higher proportion of poor black residents.

Implications for Disaster Planners

Among the study’s lessons for those responsible for disaster planning are the need for better emergency communication for urban evacuations, transportation by bus or truck to evacuate lower-income, elderly, or disabled residents, and designated facilities able to house people for long periods of time that have emergency supplies readily available.

Implications for Health Care

Katrina exposed the “health challenges facing poor, largely uninsured populations after massive dislocation.” Brodie and co-authors believe that such circumstances suggest the need to provide short-term public insurance coverage to those in need and access to public hospitals.11 Reflecting on the health-care requirements of Gulf Coast residents, the authors stated that any post-Katrina rebuilding plan requires a safety net system to accommodate the health-care needs of those who are most vulnerable.

  • 1 “Experiences of Hurricane Katrina Evacuees in Houston Shelters: Implications for Future Planning,” American Journal of Public Health, March 29, 2006, online release. Forthcoming in print.
  • 2 In addition, Brodie et al. gleaned valuable information on the demographic and economic makeup of those who suffered the most from the storm and its aftermath.
  • 3 To ensure that the sample reflected the composition of the shelters surveyed, the authors made sure that “interviews were distributed across shelters in proportion to best estimates of the actual shelter populations, which totaled more than 8,000 during the interviewing period. This number represented approximately 30 [percent] of the estimated 27,100 evacuees residing in the main Houston shelters sites at the peak of occupancy.”
  • 4 The authors were unable to survey evacuees in the other shelters in the area. They didn’t think that the responses would be significantly different from those surveyed, but they couldn’t rule that out.
  • 5 The interviews were conducted face-to-face in the most private area possible and lasted approximately 20 to 25 minutes. The interviewers used paper questionnaires to record the responses. Those interviewed were told that their responses would be anonymous; thus no names or other identifying information would be collected. Brodie et al. enjoyed a 90 percent response rate from those selected to be interviewed.
  • 6 See the study’s tables for more detail on the survey.
  • 7 New Orleans’ University Hospital was also used heavily by the evacuees, but it too sustained tremendous damage and is closed.
  • 8 Brodie et al. found “few demographic differences between the Houston shelter residents who said that they evacuated their homes before the storm and those who did not.” But tenure in New Orleans did seem to play a role. The survey revealed that 77 percent of those who did not evacuate before the storm were life-long residents of New Orleans, as compared with 67 percent of residents who left before Katrina hit. 
  • 9 Some even reported having been threatened with violence.
  • 10 Eleven percent of the respondents listed federal agencies such as the Federal Emergency Management Agency or the Department of Homeland Security as being most helpful.
  • 11 This might be accomplished by extending Medicaid benefits to childless adults, whether as a uniform federal response or using state-by-state waivers.

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