NNPHI’s Erin Marziale reflects on the 20th anniversary of Hurricane Katrina and the recovery efforts led by the Louisiana Public Health Institute.

At the 20^th anniversary of Hurricane Katrina, I am a mixture of sadness, joy and gratitude. Hurricane Katrina is the reason I’m passionate about public health institutes and how I ended up at NNPHI. I moved to New Orleans for graduate school at Tulane in August of 2004. By the time Hurricane Katrina arrived on our doorstep, in August 2005, I was on track to graduate with my MPH in International Development, had plans to work in international health and fully fell in love with the city of New Orleans. At the time, I was completely unfamiliar with public health institutes and had never heard of the Louisiana Public Health Institute. The mayor declared the first mandatory evacuation ever in the history of New Orleans on the morning of August 28. The morning of August 29, my friends and I packed for a long weekend and gathered as many pets as we could and sat in traffic for eight hours on our way to Lafayette (normally a three-hour drive). We were the lucky ones.

After an exile of two months, people were slowly returning to the almost total devastation of the city, and the Louisiana Department of Health and Hospitals (LDHH) needed rapid information about the progression of neighborhoods repopulating and their health needs. A professor from Tulane invited students to return to help with the recovery process. We conducted an early survey to determine who was back in which neighborhoods and what their health needs were.  Our early data collection efforts evolved into the Louisiana Health and Population Survey (LHPS), which was designed to provide an objective and timely estimate of population size and demographics in 18 hurricane-affected parishes in southern Louisiana.

At the time of the storm, there were many methods to estimate population size and needs in a post disaster situation, utilizing cluster sampling, wildlife and ecology methods. Most of these methods relied on pre-disaster figures and assumed habitability of most homes. In the case of Hurricane Katrina, using pre-hurricane figures would not represent the demographics and population size in post-hurricane Louisiana. We developed a methodology that adjusted for these factors. At the time, the LHPS was unique in design and implementation. Not only did it report on the proportion of people with certain health and social demographics and needs for assistance, but also it estimated the number of people in these categories. By reporting this information, the LHPS established new population and health indicator baselines for post-hurricane southern Louisiana that otherwise would not have been available to guide the relief and recovery efforts in the region.

Key to the implementation of LHPS was collaboration between the Centers for Disease Control and Prevention, the US Census Bureau, and LDHH. The organization that brought all these partners together was the Louisiana Public Health Institute (LPHI). LPHI, established in 1997, had the administrative infrastructure, staffing and organizational capacity to manage the daily operations of the survey on behalf of LDHH. The city and state health department were devastated by staffing loss, building destruction, funding uncertainty and many other challenges. They did not have the capacity to implement the survey, and we worked closely, step by step, to develop the survey, methodology, analysis and reporting. While LPHI was also deeply affected by the storm, their nimble, nonprofit structure allowed them to quickly pull together the capacity needed to support the project. I was the team leader on the project and experienced how quickly LPHI was able to accept funding from CDC, LDHH and the CDC Foundation as well as rapidly bring on contractors and hire staff to support the survey process. The LPHI project hired mainly Louisiana Census and health department workers who were all struggling with their own recovery processes and knew their neighbors and neighborhoods well.

The survey provided decision-makers with a wide array of key indicators of demographics, health and insurance status, education, income and employment, and migration. By providing accurate population data, the survey helped guide the allocation of resources for critical services like temporary housing, emergency medical care, and public safety. This information was vital for coordinating local, state, and federal recovery efforts. Researchers later used the LHPS to analyze the intrastate and interstate migration of residents and found significant differences in the likelihood of returning to an area. This research uncovered important insights into how displacement and social vulnerabilities impacted recovery. From the LHPS, LPHI’s efforts were instrumental in creating the Louisiana Healthcare Redesign Collaborative which informed the rebuilding plan for health services and secured a major federal grant for the devastated region.

LPHI was a fundamental part of the recovery of New Orleans and has provided that same capacity through new challenges over the years such as the BP oil spill and COVID-19 response. As the LPHS was winding down, I was recruited to join the National Network of Public Health Institutes. Part of my role is developing new public health institutes in states and territories that do not have one so that they too can have the flexible, fast capacity to support public health in disasters and public health crises. The COVID-19 pandemic caused several states to explore the development of an institute and recently I helped to launch institutes in Missouri, Montana and New Jersey so that they can meet the next public health challenges with this unique capacity.

Experiencing Hurricane Katrina was one of the most traumatic and challenging moments of my life. But it was also a gift that taught me many important lessons and launched my public health career. In reflecting on the 20^th anniversary of Hurricane Katrina, I feel tremendous pride in the work we’ve done to advance public health institutes as a critical part of the public health system.