Natural Disasters and Public Health: Hurricanes Katrina, Rita and Wilma (review)

Natural Disasters and Public Health: Hurricanes Katrina, Rita and Wilma is an excellent book that brings together 26 essays showcasing the theory and practice of providing medical care in challenging situations during and after disasters. This book should be required reading for medical professionals and emergency responders who may be called upon to respond in disasters. It is also ideal for health and graduate students, researchers and policy makers.

The book covers key issues for health care providers from evacuation procedures to emergency care to dealing with chronic illness amongst evacuees. It also looks at post-disaster issues connected to mental health and addiction. Each chapter is clearly written, with a minimal of technical jargon making it highly accessible. Many of the essays come from practitioners who were provided immediate and post-disaster relief during one or all of the storms. This first-hand experience plus photographs that show the makeshift nature of emergency response bring a needed practicality to the issue.

At the same time, scholarly research adds a dimension of quantitative and qualitative research through evaluations of public health issues. Concerns of race, class, social capital, ethnicity and age are all addressed throughout the book.

One key component of the book is the way in which it examines issues of environmental justice and racism prior to, during and after the storm. The impact of poverty, the uninsured chronically ill, and evacuation plans that didn't address the most marginalized compounded the challenges for public health and medical officials. As Bailus Walker and Rueben Warren say in Chapter 2, "Plainly, many of the determinants of the health consequences and conditions of Katrina were part of a broad, economic, social, and political construct, and thus, beyond the direct control of health service professionals in either the public or the private sector" (p. 29).

In the final chapter, Jennifer Seidenberg compares recovery in Lakeview (an upper-middle class community), the Lower Ninth ward (a low-income neighborhood) and St. Bernard's Parish (a White working class community to the east of New Orleans). She notes various factors that challenged lower-income Blacks in the Lower 9th ward to return whereas Lakeview and St. Bernard, while still not back to normal, have made quicker recoveries. She says ". . . FEMA and the rest of the federal government took an arms-length approach that exacerbated rather than mitigated the effect of race and class on Katrina survivors' recovery from the disaster" (p. 289).

The essays in this volume don't shy away from making public policy recommendations be they about health care, disaster response, or recovery issues. They include:

• • Considering the possibility more thoroughly of advance evacuation of medical facilities during a disaster warning. (p. 80)

• • The importance of electronic and web-based medical charts to improve access and understanding of patient records. (p. 179)

• • Distribution of practical and possible preparedness plans in minority communities that are also culturally appropriate. (p. 248)

• • Increasing the role of charitable and religious groups in disaster response given their greater connections with the local communities than federal organizations such as FEMA. (p. 293)

Overall, Natural Disasters and Public Health is an excellent book that, if heeded, will improve disaster response and emergency preparedness in any kind of disaster.