A Laboratory for Social Change
After being devastated by Hurricane Katrina, New Orleans is creating a more effective, equitable health system and reinvigorating all segments of its community.
New Orleans is on the road to recovery after areas such as the 9th Ward were devastated by Hurricane Katrina in 2005. (Brian Nolan)
Who doesn't love New Orleans? It’s one of those cities whose unique mix of culture and personality carves out a special place in our hearts and minds. From the raucous activity of Bourbon Street to the charm of the French Quarter to the quiet beauty of the Garden District, it is definitely one of a kind.
Because of its leading role in film and literature over the years, even people who have never been there tend to think they know a lot about New Orleans. And most people who are actually familiar with the city will confirm that it’s an easy place to love.
So it’s also easy to understand why most of us still hold vivid memories of when Hurricane Katrina hit in 2005, one of the worst natural disasters to strike this country in recent history.
Practically anyone with the ability to remember back 10 years can recall those days and picture, in excruciating detail, the indelible images of people stranded on rooftops, huddled just above the water line on freeway overpasses and trying to survive in the "shelter" of the city's iconic Superdome. Hurricane Katrina was indeed a defining moment for New Orleans.
In its video submission for City Accelerator, Mayor Mitch Landrieu says, "Hurricane Katrina took away so many things that made up the fabric of our lives," and goes on to describe how his city has made a comeback — especially in terms of health care. The video describes how indigent health care was previously centralized in a single, large hospital (known locally as "Big Charity") prior to Katrina. Since then, efforts have transpired to implement a more geographically distributed strategy that enables the city's poor to have a greater role in providing for their own health needs. It is an interesting and compelling story with implications and applications for other communities — particularly larger urban cities.
New Orleans, like most urban centers, has a large underprivileged population, high poverty rate and rather dramatic income disparity between those at the top and bottom of the economic scale. There seemed to be a distinct dip in the poverty rate after Katrina, but it has now returned to pre-storm levels. A story published in May 2015 by Bruce Alpert, Washington-based correspondent for the New Orleans Times-Picayune, projects even greater troubles ahead: "Poor children growing up in metro New Orleans can expect household income on average to decline by 14.8 percent by the time they reach 26 years old."
In earlier writings for this project, I have described how my own city, Chattanooga, Tenn., is connected to New Orleans by the somewhat odd diagonal Interstate Highway 59 that extends some 500 miles across Mississippi and Alabama. In the days after Katrina, that highway became an escape route for hundreds who sought temporary shelter and refuge while recovery was underway. Prior to Katrina I had been in New Orleans many times, but my more recent experience is limited. Sadly, I must admit that I am probably one of the very few professional city planners who has not had an opportunity to visit New Orleans since the storm, something I plan to correct before this year is out. But one of the rare benefits of Katrina — at least for Chattanooga — is that some of those who came to us for refuge decided to stay and make it their new home. Among such new citizens is a very special couple that now owns and manages an authentic New Orleans-style restaurant in our downtown. To gain first-hand knowledge, I paid them a visit.
Mike and Cherita Adams are New Orleans natives. They lived there most of their lives before Katrina and still have many friends and relatives in that community. Accordingly, they know much more about the situation than I could ever hope to. We spent a good amount of time sitting at a table in their popular restaurant, Blue Orleans, reviewing the New Orleans video and talking about the City Accelerator program.
First of all, we could not help but focus on the Musician's Clinic, a special health facility in New Orleans that’s featured in the video and provides primary health care for anyone in the city's music industry. By taking this unique action, the city is acknowledging that low-cost or no-cost health care is more than simple charity — it is actually an investment in a resource that has real economic value to the entire community. What would New Orleans do without their musicians? That led to discussions about parallels in other areas of the local economy.
"It is my understanding that prior to Katrina there were about 17,000 restaurants and food outlets of all types in New Orleans, but that number is now something like 23,000,” said Mike Adams. “The food industry has actually grown since Katrina." Mike attributes this growth to the influx of Hispanics and citizens of other countries and cultures coming into the local New Orleans food scene and their efforts to put their own spin on things. Of course, food is another industry for which New Orleans is justifiably famous and, like the music industry, it employs a number of individuals in entry-level, traditionally low-wage jobs. Accordingly, something like the Musician's Clinic could serve the growth and development of the local food community well.
Based on her experience with food service workers, Cherita agreed that the model offered by the Musician's Clinic could be applied to other groups and professions — and even other cities. "When you give something the right kind of title, it makes people think 'It's made for me,' and you quickly get over some of the resistance of taking advantage of a free clinic," she said. She suggested branding health facilities so that they are seen as something more than charity and locating them in more neutral places in terms of population segments and neighborhoods — all to make clients feel more at home and comfortable.
Music and food are important industries to New Orleans, but the same efforts to support those employed and seeking to make a career in those fields can also apply to any industry in practically any city. Don't most careers and fields of work begin at a very low subsistence level before blossoming into something much more significant and self-sustaining? Don't all communities have an interest in providing a support mechanism for the human capital factor in these startups?
Both Mike and Cherita described the exciting developments they have witnessed in their former home of New Orleans as areas devastated by Katrina are rebuilt — particularly when it comes to the health facilities. "I've seen some new developments on Canal Street since the storm," said Mike. "They cleared much of a block and replaced it with health facilities that are just fantastic."
In the words of Mayor Landrieu, "Now we're building back New Orleans not as it was but as the city that we always wanted her to be. Today New Orleans is the nation’s leading laboratory for social change. We're testing innovative strategies to improve the lives of our citizens and setting an example that other cities can follow."
Perhaps a more effective and equitable health system, one that supports important and emerging segments of a local economy, will be another surprising benefit that comes from the tragic destruction and disruption of Hurricane Katrina. Perhaps it is something that can provide a higher quality of life for the underprivileged while adding a new dimension to the economic development capabilities of cities across the nation.
New Orleans is making the case: Low-cost or no-cost primary health care is not charity for a few — it's really a benefit for the entire community.