IN THE STATES: Stress and Health Problems Still Plague New Orleans Three Years After Storm

The Kaiser Family Foundation has done its part to track the post-Katrina progress of New Orleans and the Gulf Coast, to make the rest of us remember what the people of New Orleans can't forget. Kaiser released its latest survey this weekend, and it's a moving testimony about resilience, about how people can somehow live simultaneously with both enduring hope and increasing pessimism. The Kaiser survey went beyond health care to look at how residents of Orleans parish feel about crime, housing, schools, the job market, and other aspects of post-storm life and you can see the whole report here. But we're going to focus mostly on health in a city where health infrastructure took a heavy hit.

The city is about half the size it was three years ago, and almost all the residents are those who chose to stay or return to rebuild, hoping perhaps to create a "new" New Orleans free of the social problems that had plagued it long before the levees broke. The survey provides ample data that those high hopes haven't been matched by the facts on the ground, but most people living in New Orleans continue to believe that their city will slowly come back, even if many are dissatisfied by the pace of progress in crime control, housing, fixing the schools and access to health care. The most visible area of improvement was levee-rebuilding and flood control. But how much more time they are willing to wait to see progress elsewhere is an open question. In a 2006 Kaiser survey marking the first anniversary after the storm, 12 percent said they were "currently planning or seriously considering moving" away. As the third anniversary of Katrina approaches, that number has nearly doubled, to 22 percent.

As anyone who has visited New Orleans and had a chance to explore its damaged health care system can attest, the battered mental health system is ill-equipped to deal with the battered population. (When I visited on a Kaiser-sponsored trip in March 2007, the city's police mental health crisis coordinator Cecile Tebo told us about how she broke down and wouldn't get out of bed after her kids' pediatrician hanged himself. Another writer on that trip, Maryn McKenna later wrote a magazine profile of Tebo.) The Kaiser survey found that more than half reported that their "general level of stress" was worse than before the storm, 40 percent described their mental and emotional health as worse, and one in four of those with children in their home said their children's mental or emotional health had deteriorated.

The survey finds a marked increase in the proportion of residents who say they have been diagnosed by a doctor with a serious mental illness, such as depression, from five percent in the 2006 survey to 15 percent now. There is also an uptick in the proportion who report they have recently been taking a prescription medicine for problems with their mental health (17 percent now compared to eight percent in 2006) Not surprisingly, self-reports of feeling in "fair" or "poor" mental health have also doubled over the time period, from 10 percent to 20 percent now....Though the survey cannot directly tie these reported increases in mental health problems to Katrina-related after effects, this is certainly high on the list of plausible culprits. It's possible that, having survived the disaster and the immediate aftermath, the slow recovery is taking a toll on the population, somewhat like the shift from an acute to a chronic illness. But it's equally possible that the increased rates of reported mental health problems are an indication that the health system is at least partially up and functioning again. Residents may have a better opportunity to be diagnosed and treated for any mental health issues, an opportunity that was not as widespread at the time of our 2006 survey.

Physical health is also a challenge as it was even before the storm in a city with a diverse population that was sicker and poorer than most of the nation. Overall 65 percent report either having some sort of chronic condition or disability or being in "fair" or "poor" health, up from 45 percent in 2006. Hypertension was the most frequently cited, by 37 percent of adults, although asthma rates have roughly doubled to 17 percent from nine percent in 2006. About a third reported that their child or teenager has a chronic condition or disability, up from 21 percent. And although the health care infrastructure is more robust than in the first year after the storm, coverage and access are problematic. More people have health insurance, probably because jobs have returned to the city (18 percent of all adults and 22 percent of non-elderly adults are uninsured, compared to 16 and 20 percent nationally) The number reporting that they have no regular source of care other than an emergency room has dropped from a third to a fourth—which is still high. But many cited affordability as an issue, saying they can't pay their bills or they are skimping on care or drugs. Of course, New Orleans is not unique in that regard, and the rest of the country can't even blame its health insurance problems on a natural disaster.