Hurricane Katrina, disaster planning, trust, qualitative research
On August 29th, 2005, Hurricane Katrina made landfall just east of New Orleans, Louisiana. That night and the next day, levees in New Orleans collapsed, resulting in flooding of 80% of the city, with water levels reaching to the rooftops in many areas.1 Despite strong evacuation warnings, followed by a mandatory evacuation order,2 over 100,000 greater New Orleans residents failed to evacuate prior to the hurricane's landfall.3
Distrust of authorities, among numerous other factors,4–5 seems likely to have played a role in New Orleans residents' reactions to evacuation warnings and public health authorities' advice. Prior to the hurricane, 72% of New Orleans residents were of minority race or ethnicity6 and there is a long history of minority groups in the United States distrusting the medical and public health leadership.7–9 Furthermore, distrust of authorities among New Orleans' impoverished residents is rooted in local history. In 1927, The Great Mississippi Flood was threatening to destroy New Orleans, including its crucial downtown regional financial institutions. To avert the threat, and in part to stabilize the financial markets, it was decided to perform a controlled break of the New Orleans levees, thereby selectively flooding poor areas and saving financial institutions.10 This event lives on in the memories and oral history of the residents of the deliberately flooded areas.11
Faced with the knowledge that distrust hampers the success of recommended evacuations and other disaster responses, disaster and public health officials must [End Page 277] learn how to build trust,12–13 a complex and multidimensional phenomenon.14 Research centered in health care settings has identified several components of trust, defined as the expectation that others will act in one's interests, including fiduciary responsibility, honesty, competency, confidentiality, and equity.15 Residents' planning and response to Hurricane Katrina illustrate many elements of trust and distrust as they relate to disaster response and may provide lessons with policy implications.
The salience of trust and distrust was vividly demonstrated in interviews we performed from September 9th through 12th, 2005, days 11 through 14 after Louisiana landfall of Hurricane Katrina. As part of a study of the facilitators and barriers to evacuation,4 we interviewed 58 English-speaking adults who were living in Louisiana prior to landfall of Hurricane Katrina and currently receiving shelter in one of three Houston, Texas, evacuation centers (The Reliant Center, The Astrodome, and The George R. Brown Convention Center). Because our semi-qualitative interviews did not include specific queries about trust and distrust, we were struck by the frequency and depth of distrust reflected in the spontaneous statements of the evacuees we interviewed. This report is intended to describe and contextualize those statements.
Not surprisingly, competency, the belief in another's qualifications to perform a specific act, was the category of distrust that was mentioned most frequently by interviewees. All levels of authority, from the federal and local government officials, to the emergency workers, were the subjects of these statements. The perceived incompetence was summed up in the statement of one participant who said, "They could of did a lot better than what they did." Another said "the whole deal was a total letdown."
Several people went further when discussing their distrust by addressing a second element of trust, perceived equity. The equity component of trust is the belief that one is being treated fairly, without consideration of class, race, gender, or other characteristics.9,16 Seven people told us that they believed that the preparations or response were performed ineffectively or slowly because of the race or socioeconomic composition of their neighborhood. One person stated:
If the President would have stepped in when they give that evacuation just like they were going to send six million dollars to save a whale, send all our men to Iraq, and send food and shelter and money over there, why couldn't he do it for...