Federal health policy response to Hurricane Katrina: what it was and what it could have been.

ONE YEAR AGO, THE UNITED STATES EXPERIENCED one of the worst natural disasters in its history. Hurricane Katr ina caused wel l documented, widespread death and destruction, reducing hospital capacity by 80% and safety-net clinics by 75% in New Orleans alone. The hurricane also created a diaspora of more than a million evacuees to every state in the nation. This disaster could be viewed as an isolated event. Indeed, the hurricane destroyed infrastructure in states with low income and particularly high health care needs. Yet similar crises could occur in different and, unfortunately, likely circumstances. A major earthquake, avian flu epidemic, or bioterrorism attack could diminish health care capacity, cause displacement, and take a great toll on the nation’s health. Thus, the federal health policy response to Hurricane Katrina is not just history but a test of the system’s effectiveness. In this commentary, we review the activities of federal officials, critique their performance, and suggest what should be done in the aftermath of disasters, natural or manmade. We focus on the federal government because, in the US democracy, it has the ultimate authority to respond to serious threats or crises. Disasters also call for state and local responses (eg, rapidly assessing need, planning for rebuilding infrastructure). While assessing this response is beyond the scope of this article, its performance contributed to the outcomes described. Special attention is paid to Hurricane Katrina and Louisiana given their size and impact. Our perspective is that of former officials in the federal government who are familiar with both its limitations and its powers.