Public Health and Hurricane Katrina: Lessons Learned and What We Can Do Now
For several decades, national data have documented that health disparities, specifically related to race and poverty, are real. Subsequent to the terrible devastation of Hurricane Katrina with over 1,000 deaths in New Orleans and the Gulf Coast, and destroyed property, hopes and dreams across the region, the unacceptable levels of morbidity and mortality and disparities in healthcare within certain U.S. communities are now even more a pressing concern. Even prior to Katrina, the need for focused healthcare interventions for poor and African-American communities was clear. For instance, hypertension, the primary cause of office visits in the United States, has dramatically higher rates in African Americans compared to whites. African Americans develop hypertension early in life, have 1.3 times greater rate of nonfatal stroke, 1.8 times greater rate of fatal stroke, 1.5 times greater rate of coronary heart disease mortality and 4.2 times greater rate of end-stage renal disease. It is this excess of hypertension, higher coronary heart disease and heart failure mortality rates, along with diabetes and associated chronic illnesses that primarily explains lower life expectancy for black men and women versus whites. Although the Human Genome Project has convincingly demonstrated, that to a large extent, the concept of race is a poor marker for any specific biologic factor, healthcare disparities reflect the socially and economically disadvantaged status of many black communities.
As it relates to Katrina and its aftermath, many of the areas that were most deeply affected were already underserved and disadvantaged in terms of healthcare. For instance, the Lower Ninth Ward has been essentially destroyed, with its population displaced throughout multiple regions of the United States. This area was approximately 98% black, with 33% living in poverty. The latest data from national surveillance note that mortality from heart disease in 2002 was 310.3/100,000 for blacks in Louisiana as compared to 236.7/100,000 for U.S. whites and 308.4/100,000 for U.S. blacks. For stroke death rates, Louisiana blacks had a rate of 85.5/100,000, which is higher than 76.3/100,000 for U.S. blacks and considerably higher than 54.2/100,000 for U.S. whites. Although located in a large metropolitan area of approximately 1.3 million people, which included two major medical schools (Tulane University School of Medicine and the Louisiana State University School of Medicine), the Lower Ninth Ward resources available were similar to what is more likely found in some rural counties in the United States. The population of >33,000 had no specialty offices or stable primary care providers, with a municipal community health center with limited capabilities. Get smart and save money! Cheap viagra professional online
Researchers have noted that even after controlling for poverty, residents of deteriorated neighborhoods have higher rates of certain infectious diseases, premature death in general, deaths from cardiovascular disease, and homicides. During a natural disaster or other cataclysmic events, disadvantaged communities are more likely to have citizens who will suffer harm and even death beyond the trauma of the disaster itself. Overall, in many large cities, certain neighborhoods continue to exist as healthcare delivery deserts, devoid of well-trained certified specialists or accessible primary care. Community health centers, which were largely supported and flourished during the 1970s and 1980s, now run on conservative budgets with little or no specialty care, radiology services or laboratory testing, and often operate under curtailed hours. The lesson learned from Katrina is that we need a more focused healthcare delivery system, even prior to the next disaster and to accelerate universal healthcare. Make your pharmacy dollar go further and buy levitra canadian pharmacy online
By the beginning of 2006, over four months after the initial landfall of the hurricane, several hundred-thousand citizens remain displaced, abruptly removed from their previous source of care. Poor and working-class patients will thus seek private practitioners and public clinics, not only in Louisiana and the Gulf Coast but throughout the nation. They should be enthusiastically accepted as new patients in the healthcare system. Moreover, the impact of Katrina on private practitioners goes beyond what has happened to the patients themselves. Individual physician practices have been destroyed, and the homes where many physicians lived and raised their families are now uninhabitable. There are few private practitioners who had previously acquired business interruption insurance, and several large national insurance companies have been slow to pay for damages or have not fulfilled their contracts at all. Although there has been no .systematic evaluation of the effects on the private physicians, in the large New Orleans East and Gen-tilly areas, where many physicians lived and practiced, there are essentially no families or active clinics. Furthermore, physicians no longer can practice in these heavily damaged areas because the community has been displaced. In at least one instance, a large medical group has been asked to honor an office lease, although this is no income support. Several states have facilitated temporary licenses in the months after Katrina for doctors who are relocating. Hopefully as physicians return and communities are reconstructed in the Gulf Coast, assistance from the Small Business Administration and other federal funds should be available to help private doctors develop their practices.
What can we do now? First of all, as an immediate issue, clinicians who see displaced Katrina victims should attempt to assist them with locating previous medical records, which unfortunately may be damaged or destroyed. Patients must be healthcare partners which would empower them, even prior to any disaster. Katrina has demonstrated that unexpectedly patients can be removed from the doctor-patient relationship, displaced geographically and disoriented in terms of usual care. One effort, utilizing Sure Scripts and originally formed by the Association of National Community Pharmacists Association and the National Association of Chain Drug Stores, has attempted to improve the ability of patients to refill needed medications with safety, efficiency and quality by searching electronic prescription records. Canadian healthcare cialis
In the future, the most effective way to ensure continuity of care would be through an integrated electronic medical record system in which providers and patients become stakeholders. Federal legislation should continue to support the construction of a national electronic medical system. To ensure patient information is confidential and accessible, regardless of location, medical information can be recorded digitally including the patient’s condition; chronic medications; and recent interventions, both diagnostic and therapeutic. Implementation can be readily accomplished for those patients serviced by Medicaid and Medicare, or some managed care providers who already have a wealth of stored information, utilized in the past with billing and reimbursement. Patients should receive a unique identifier, which will allow only themselves or a designated party to have access to this crucial information. There remains thousands of disaster victims who have no conduit or communication with their healthcare providers and are unable to communicate their medical histories to new clinicians. Patients have been injured or lost their lives, related not only to wind or water damage itself but simply because they could not get access to medications or were unable to recognize arising warning signs. Ensuring health literacy may also help patients to survive storms to come. Health education, therefore, is not only laudable but absolutely necessary.
A Kaiser-Harvard poll suggested that many evacuees must restart their lives with virtually nothing. As many as seven in 10 have no substantial savings, checking accounts or useable credit cards, and as much as 60% had family incomes <$20,000 per year. Homeowner insurance payments to cover losses are often late or nonexistent, and approximately half of evacuees were noted in the poll to have no health insurance. The only functioning adult inpatient hospital within city limits is Touro Infirmary in the uptown area (which has difficulty maintaining nursing and support staff to reach capacity). Within New Orleans, the Medical Center of Louisiana (Charity Hospital), which served the uninsured and underinsured, no longer functions. Additionally, Charity Hospital, along with the University Hospital and run by the Louisiana State University Medical System, has been targeted for demolition. The Charity Hospital was the largest public hospital serving the city and the only level-1 trauma unit for the entire Gulf Coast region, with the closest facilities located over 300 miles away in Birmingham, AL and Houston, TX. The elimination of primary providers, who service low-income populations within the city, and inpatient emergency care, will need attention from the federal government during the reconstruction of the healthcare infrastructure.
Immediate assistance with health insurance coverage is needed. The uninsured and underinsured evacuees need Medicaid availability. Time-limited coverage, such as Disaster Medicaid (available in New York City after September 11, 2001), for those without insurance would assist with acute and chronic illness treatment, canadian prescription drugs and inpatient services. States and other cities that have received evacuees will have a significant financial burden paying their portion of Medicaid funding. The federal government has legislative authority to pay 100% of the cost, short-term, for those evacuees living in other states. Furthermore, specific funds should be allocated for surveillance of the healthcare status of evacuees, since an unknown burden of undiagnosed or undertreated conditions such as diabetes, hypertension, heart failure, infectious diseases and cancers presently exists.
Providers should conduct health impact assessments on evacuees regardless of where they are located. It is important to evaluate blood pressure, glucose and other metabolic conditions, which may rapidly deteriorate in the wake of a natural disaster. This is a link in which medical student volunteers, physicians, nurses and other practitioners can assist with direct patient evaluation, counseling and rewriting needed prescriptions. Efforts by the Association of Black Car diologists and the Hurricane Katrina relief effort known as the HOPE (Health Outreach and Empowerment) Initiative include developing a mobile unit that can be used now and in the future for direct patient care during a disaster. Another laudable present project is being led by the Morehouse School of Medicine with former Surgeon General Dr. David Satcher and funded by the federal government. This plan will attempt to develop and establish strategic responses to a damaged healthcare infrastructure, effective community-based screening and surveillance systems, community health systems and revise primary care practices.
As a long-term solution, to assist underserved communities, medical students should be encouraged by the academic mentors to reclaim the profession as a source of healing and community service versus treating their careers as a means of accumulating personal capital. Federal legislation should be expanded now to cover the educational cost of those students regardless of race or ethnicity who pledge to work in underserved urban communities. In the recent past, the U.S. Public Health Service flourished by contributing to the education of medical students who then returned to public health hospitals and underserved communities as a means of repaying the benevolence they received. This program may help underserved communities in terms of accessible medical care in the future regardless of unexpected disaster.
Part of any solution should include citizens of the affected areas. They should be engaged in planning for rebuilding the Gulf region. In the future, all neighborhoods should be safe environments with adequate housing. We as a society must be energized to remove inequities not only in healthcare but also in substandard housing, poverty, inadequate public transportation, unacceptable high rates of unemployment, and negative economic and labor market conditions that affect our ability to develop and sustain healthy communities. Regardless of the location, the psychological stress and trauma caused by the destruction of personal homes, loss of jobs, separation of families, and general death and devastation continue to affect evacuees. There will be a need for continued mental health services within the affected areas and wherever evacuees have been displaced. Medical literature has demonstrated that even after disasters of a smaller magnitude, there is an increase in divorce rates, suicides, depression and anxiety. Save on your pharmacy bills. Buy levitra plus online
On a personal note, my wife, Daphne P. Ferdinand, PhD, APRN, and I have served our childhood community of the ninth ward and the greater Orleans area for over two decades. Katrina has been a tremendous tragedy for us, reminiscent of the pain and suffering related to Hurricane Betsy in 1965, with a similarbreach of the Industrial Canal levee, flooding the same disadvantaged neighborhood. We should support efforts of nonprofit health associations, including the National Medical Association, the Association of Black Cardiologists and others, who will ensure that donations are targeted appropriately to those in need who may have been overlooked.
“The sun always rises. We cannot hold back the day.” Ahidiana Work/Study Center, New Orleans, LA, 1975.