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Hurricane Katrina beat us.1 We lost the ability to communicate, transport by land and air, and provide health care for the population. Louisiana and Mississippi communities sustained a complete collapse of their civil infrastructures, including police, fire, medical and public health, and communication. The storm and its ensuing flooding caused the largest forced migration in US history. Hurricane Katrinas eastward path spared metro New Orleans, Louisiana, from a direct hit. However, the coastal storm surge, combined with surge in a manmade canal (Mississippi River Gulf Outlet) that over 30 years destroyed important protective wetlands, severely strained the levee system.2 The result was 12 feet of flooding in 80% of New Orleans.
The Mississippi River Gulf Outlet project, constructed to provide a shorter route between New Orleans and the Gulf of Mexico, is widely described as a dangerous alteration to the areas ecosystem.2 In addition, state and federal authorities approved construction of a levee system to withstand a Category 3 storm when evidence showed the eventual likelihood ofa Category 5. On average, 70% of New Orleans sits between two and five feet below sea level. The Mississippi River, which divides the city, ranges from 4 to 20 feet above sea level based on seasonal flood stages.
This historical perspective on experiences of the Commander of Joint Task Force-Katrina speaks courageously about policies that, over time, created vulnerabilities to our national safety and security.
KATRINA'S IMPACT
Hurricane Katrina beat us.1 We lost the ability to communicate, transport by land and air, and provide health care for the population. Louisiana and Mississippi communities sustained a complete collapse of their civil infrastructures, including police, fire, medical and public health, and communication. The storm and its ensuing flooding caused the largest forced migration in US history.
Hurricane Katrinas eastward path spared metro New Orleans, Louisiana, from a direct hit. However, the coastal storm surge, combined with surge in a manmade canal (Mississippi River Gulf Outlet) that over 30 years destroyed important protective wetlands, severely strained the levee system.2 The result was 12 feet of flooding in 80% of New Orleans.
The Mississippi River Gulf Outlet project, constructed to provide a shorter route between New Orleans and the Gulf of Mexico, is widely described as a dangerous alteration to the areas ecosystem.2 In addition, state and federal authorities approved construction of a levee system to withstand a Category 3 storm when evidence showed the eventual likelihood ofa Category 5. On average, 70% of New Orleans sits between two and five feet below sea level. The Mississippi River, which divides the city, ranges from 4 to 20 feet above sea level based on seasonal flood stages.
JOINT TASK FORCE-KATRINA
The art of command is to enter a situation and unconfuse people.1 The catastrophic conditions given the collapsed infrastructures and public perception of civic abandonment necessitated establishing order as a critical and immediate role for Joint Task Force-Katrina, in unity of effort with other military partners.
The legal authority for the US Army to deploy troops during disasters and other national emergencies dates to 1865-4 years after the Civil War, when troops assisted with introducing former slaves to daily American life.3 The Department of Defense (US Northern Command in Colorado Springs, Colorado) established Joint Task Force- Katrina on August 30, 2005. The mission was to provide relief and recovery efforts as prioritized by Louisiana, Mississippi, and federal leadership.
Upon arrival of Task Force leadership on August 31, 2005, there was already total failure of all communication and emergency services in both states. As a consequence, Katrina caused an 80-year setback in available technology.1 Against these obstacles, 22 000 active-duty troops, 20 ships, and 200 airplanes and helicopters were quickly put into action in the affected region.1
Response operations began rapidly in collaboration with 46 000 National Guardsmen in both states. The exhaustive span of relief and recovery support included efforts to restore communications; direct search, rescue, and recovery maneuvers; coordinate evacuations; provide medical care; assist with public health disaster surveillance; gather human remains; conduct damage assessments; distribute food and water; open ports; provide food to livestock and pets; and restore civil order.1 The magnitude of deploying active-duty, National Guard, and Reserve forces was the largest since the Civil War.1
SPEAKING TRUTH TO POWER ON INJUSTICES
During disasters, vulnerable populations suffer the most. National safety and security, in fact, are compromised when populations are vulnerable. The social challenges of vulnerability are often created through policies that promote injustices. The military cannot come into a disaster situation and fix in a few days the challenges created through injustices that have festered for centuries, decades, and every day of the year.
When founded in 1718, New Orleans was roughly 10 feet above sea level. Ecosystem changes over three centuries to accommodate flood mitigation, urbanization, and industrialization altered the topography and literally sank the city.4 This created environmental injustices and put generations of people at risk.
Most of the redesign policies to the New Orleans topography, and particularly projects in the 20th century, did not consider impacts on the entire population. Value judgment criteria used to justify some policies excluded analysis of impacts on vulnerable populations who reside in low-lying flood-prone areas because residential development and public policy priorities placed them there. Inadequate levee plans were implemented despite evidence for designs that would endure higher-risk scenarios. Especially alarming were the New Orleans disaster evacuation policies despite recent planning exercises that showed that more than 100 000 residents lacked the socioeconomic status and practical means to leave during disasters. Images of people stranded in floodwaters are heart wrenching, exposing their vulnerabilities to the world.
Unjust policies that create vulnerable populations do not advance positive health benefits for all sectors of the population either. When ranking the population health status across the 50 states, the state of Louisiana ranked 50th in 2004 and 49th in 2018, up from 50th in 2017.5,6 Average life expectancy in Orleans Parish is 75.8 years compared with 79.0 nationally, an indication that unjust policies designed to give one group an advantage over others negatively affects the ability to create healthy communities.7 The statistic showing a low disparity in health status between high-school graduates and those without a high-school diploma among all races and socioeconomic classes across the entire Louisiana population vividly illustrates that point.6 Collectively, these measures of health suggest that many residents across all sectors are likely to be at risk for dying prematurely.
People living in poverty suffer more during and in the aftermath of a disaster. Poverty negatively affects the well-being of adults and children. The rate of New Orleans children living in poverty is 39% compared with the US rate of 18% (https://datacenter. kidscount.org). Workforce programs aligned with state goals to improve credentialed educational attainment as a pathway to better-paying jobs and lifting people out of poverty should be rigorously promoted in New Orleans.
PROFILES IN COURAGE
It takes courage to speak truth to power. Profiles of leaders who courageously promoted improvements across society can be found in Louisiana. Illustrations include Louisiana Governor John Bel Edwards with the expansion of Medicaid; Larry Hollier, MD, chancellor of Louisiana State University Health Sciences Center-New Orleans who, amid highly valid and heartfelt public debate, advocated health system improvement through the construction and opening in 2015 of University Medical Center to replace Charity Hospital built in 1939; Dorothy Mae Taylor, the first African American woman elected to the Louisiana House of Representatives, who fought tirelessly for policies to end segregation and other practices that fostered injustices; and leaders of the Green Army, an alliance of community, civic, and environmental groups successfully advocating environmental reforms in the state of Louisiana.
CALLS TO ACTION
Suggested action to confront injustices, reduce vulnerabilities, and improve preparedness and response capabilities in the future include
* Rapidly implementing preevent unified command and control structures;
* Ensuring a unity of effort among federal, state, and local responders;
* Building secure alternative communication systems that maintain functionality during disasters;
* Requiring disaster planning that must include response planning;
* Creating credentialed educational pathways for advancement into better paying jobs and ending poverty;
* Organizing communities to fight against injustices; and
* Empoweringpeopletovoteas a mechanism to effect needed change.
CONCLUSION
Hurricane Katrina unmasked truths about injustices imposed on society over multiple generations. The unequal negative impacts will continue with every disaster and public health emergency as seen with COVID-19. These revelations should inspire action to mitigate risk and eliminate the injustices. Historical narratives of this horrific event, like those ofprevious deadly storms, will be passed along with intense emotions to future generations-forever.
ACKNOWLEDGMENT
The author is grateful for the contributions to this editorial by Peggy Honore, MHA, DHA, AmeriHealth Caritas-General Russel L. Honore Endowed Professor at Louisiana State University Health Sciences Center-New Orleans School of Public Health and School ofMedicine.
CONFLICTS OF INTEREST
The author has no conflicts of interest.
REFERENCES
1. US Senate Committee on Homeland Security and Governmental Affairs. Hurricane Katrina: the Defense Department's role in the response. February 9, 2006. S. Hrg. 109-813. 2007. Available at: https://www.govinfo.gov/content/pkg/ CHRG-109shrg27028/pdf/CHRG-109shrg27028.pdf. Accessed January 24, 2020.
2. Shrum W. What caused the flood? Controversy and closure in the Hurricane Katrina disaster. Soc Stud Sci. 2014;44(1): 3-33.
3. Wombwell JA. Army support during the Hurricane Katrina. The Long War Series Occasional Paper 29. Fort Leavenworth, KS: US Army Combined Arms Center Combat Studies Institute Press; 2009.
4. Campanella R. How humans sank New Orleans. TheAtlantic.Availableat: https:// www.theatlantic.com/technology/ archive/2018/02/how-humans-sank-new-orleans/552323. Accessed January 13, 2020.
5. America's health: state health rankings-2004 edition. A call to action for people & their communities. Minneapolis, MN: United Health Foundation; 2004.
6. United Health Foundation. America's Health Rankings Annual Report 2019. Available at: https://www. americashealthrankings.org/learn/ reports/2019-annual-report. Accessed January 13, 2020.
7. Healthiest communities rankings. US News & World Report. 2019. Available at: https://www.usnews.com/news/ healthiest-communities/rankings. Accessed March 31, 2020.
Copyright American Public Health Association Oct 2020