The public health response to disasters in the 21st century: reflections on Hurricane Katrina.

Author:Logue, James N.
 
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Introduction

Ten years have passed since my last update on the public health response to disasters (Logue, 1996). When that article was written, the world was halfway through the International Decade for Natural Disaster Reduction (IDNDR). Despite increased national and international attention to disasters resulting from the IDNDR initiative, unforeseen adverse human health effects continued to occur during that period as a result both of natural and of human-made/technological disasters.

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Even more dramatic events have occurred in this country and throughout the world in the decade following the IDNDR. The September 11, 2001, attacks in the United States represented the worst terrorist events ever experienced on American soil. Four major hurricanes hit the southeast coast of the United States from August to September of 2004, causing major economic losses and many deaths (Shultz, Russell, & Espinel, 2005). The tsunami of December 26, 2004, ravaged large portions of East Africa and South Asia, and a major earthquake struck Pakistan and other areas of Asia in 2005. Both events killed thousands of individuals. Hurricane Katrina struck the Gulf Coast area of the United States during late August 2005 and caused one of the worst natural disasters ever experienced in this country.

Now it is again timely to provide an update on the public health response to disasters and to give more public health attention to this subject. This article comprehensively outlines some of the public health lessons learned as a result of Hurricane Katrina and looks at how public health providers can better prepare to respond to disasters in the future.

Public Health Advances

Many positive advances have occurred since 1996. In 1997, a comprehensive text was published on the topic (Noji, 1997). In 2001, the American Public Health Association published a useful guidebook (Landes-man, 2001) to help public health professionals and others effectively prepare for and respond to the health consequences of disasters. More recently, the 2005 issue of Epidemiologic Reviews gave a thorough review of the public health impacts of disasters. That review updated three earlier reviews (Bromet & Dew, 1995; Lechat, 1990; Logue, Melick, & Hansen, 1981).

Because of the September 11, 2001, terrorist events and other subsequent concerns about terrorism, the roles of public health in disasters and public health preparedness have certainly been recognized and highlighted (Novick, 2005). Although a great deal of the public attention to disasters and public health following September 11 focused on terrorism, the tsunami of December 26, 2004, was a reminder that natural and other human-generated disasters also continue to deserve attention (Lamberg, 2005).

In 1996, very little training was being offered by schools of public health on the public health consequences of disasters. Today, the importance of disasters as a public health problem is widely recognized, and every school of public health in the United States offers some training in this area (Noji, 2005).

Although the topic of disasters was not chosen as a key objective by the U.S. Department of Health and Human Services (DHHS) as part of its Healthy People 2000 initiative (1993), one objective is included in the updated Healthy People 2010 initiative (2000). The overarching goals of Healthy People 2010 are to increase quality and years of healthy life and to eliminate health disparities.

The Centers for Disease Control and Prevention (CDC) have for years provided strong and comprehensive continuing support to others on issues that relate to disasters and public health (Logue, 1996). This support continues today and has strengthened in new areas, such as federal-grant support to states and others related to public health preparedness and the national environmental public health tracking (EPHT) program (McGeehin, Qualters, & Niskar, 2004). CDC grants on preparedness have recently expanded in scope to have a focus on all-hazards preparedness. As part of the EPHT program, both CDC and the Council of State and Territorial Epidemiologists (CSTE) developed a set of public health indicators that provide information about a population's health status with respect to environmental factors (CSTE, 2004). CDC and CSTE also identified 11 indicator topics that serve as broad categories under which indicators are organized. The category of disasters is one of these topics.

Other significant programs have also been developed that have an important impact on all public health preparedness and response actions. These include the National Response Plan, the Emergency Management Assistance Compact, and the National Incident Management System.

The Challenge of Hurricane Katrina

So if America has experienced so many public health advances related to disaster preparedness since 1996, what went wrong with the Hurricane Katrina disaster? Also, what may have gone right with the public health response to this event? Furthermore, what lessons can be learned for the future, given all of these advances?

Lesson 1: Evacuation and Protection of Those Not Evacuating

Public health professionals should have a significant role both before and in the immediate aftermath of any disaster, either natural or human-made (including acts of terrorism). It is critical that, as part of this role, key public health leaders be clearly designated who are responsible for coordinating all necessary public health responses, including public health communications. The author makes this recommendation in light of "10 essential public health services" that are key to understanding the public health activities that should be undertaken in all communities (CDC, 1994). These 10 services are really an...

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