Kendra Outler, MD, MPH

Founder, Uzima Health & Wellness

In plain Sight

Climate Change and Health Disparity
OCTOBER 2021
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A stroll down Bourbon Street is a feast for your senses.  The sounds of New Orleans jazz, the taste of liquor and the sight of oysters make your stroll easy. But in 2021, this city known as the “Big Easy”, is not having a laissez-faire time. Hurricane Ida, a Category 4 storm, hit Louisiana on the 16th anniversary of when Hurricane Katrina devastated New Orleans.  On August 29th, 2021, the French Quarter shutters began to rock and sway from the forceful winds, not the sounds of music. Given the recent loss of revenue from a yearlong closure due to the pandemic, could this be a fait accompli for the city?


New Orleans once called the New York of the South is mystical in how resilient it is. The people and the buildings seem to weather every battle both man-made and of Mother Nature. In 1862, the Union Army targeted this largest city in the South, strategically located at the mouth of the Mississippi, with a goal to cripple the Confederacy. Its political and commercial importance made the city’s surrender one of the sweetest victories for the Union during the Civil War.  Surrender also saved New Orleans from the destructive Union onslaught other Southern cities experienced.

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 Image Source: BBC News

Walking through the French Quarter for me is a stroll back in time.  Living in the community of Kenner, a day off from work was typically a trip to the Shops on Canal, then over to Café Du Monde and then a trolley ride just for the ease of it.  Then in August 2005, I watched in horror as the water took over the city leaving desperate people looking for escape routes out of the city. The levee system, the flood program built at the turn of the century, failed us. 

 

The environmental policies that helped to create New Orleans’s most vulnerable neighborhoods and the conditions for flooding them started shortly after the Civil War. The city’s coordinated drainage and sewage system began in the 1890s and benefited all the citizens. However, after Jim Crow laws began to seep into housing laws to ensure racial segregation, development for Black housing would be designated to the low-lying areas near the levee system. Hence, heavily dense Black communities like the Ninth Ward were completely destroyed after Hurricane Katrina slammed the Crescent City. “Officially,” the flooding was an act of God and not due to poor flood control programs that allowed homes to be built on low lying areas.  

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Image Source: Shuttershock

Before Hurricane Ida landed, Mayor LaToya Cantrell made a passionate plea for the citizens to evacuate to preserve life. I, like so many others, held my breath in anticipation. Would we see images of distressed Black people wading through flooded streets, grabbing goods for survival, and sitting on rooftops with signs that read “help” as the helicopters flew overhead?  This time there were none of these dramatic scenes and subsequently not much media in New Orleans as of late. Now that the storm has come and gone, the people are suffering from the unbearable heat.  Most deaths after Hurricane Ida are reportedly due to the lack of electricity and an inability to find cool living conditions. The sweltering heat killed nine people after the Category 4 storm landed.  Je ne supporte pas cette chaleur (I find the heat unbearable) is the cry of this previously French territory.

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Image Source: Shuttershock

The proximate cause of death may read heat but the noncontiguous causes are policies that created unfair housing, a longitudinal death trap for many poor Blacks for generations. Emerging from the Great Depression, the New Deal was to help with the shortage of housing. However, there was a raw deal in there for unsuspecting Black citizens, it was called redlining. And it was a racist policy that allowed for discriminatory mortgage appraisals that prevented the Home Owners Loan Corporation (HOLC), created by the federal government, from approving loans for certain developments in or near Black communities.  City maps would have red on them, and the areas had coded grades that created a covert system of structural racism.

As we search for environmental justice, we have uncovered the root of health disparity in communities. It is our environment. The creation of concrete jungles in major cities resulted in what climate scientists call heat islands; areas with a dense population and no tree canopy making the area hotter and for longer periods of time when compared with suburban or rural areas.  The people who live in these areas are often sicker, poor and lack resources like private transportation. On July 23, 1995, Chicago experienced a massive heat wave with temperatures reaching 115 degrees. The scenes of people, especially old and homeless people, being found dead in their homes made the news. The death total in one week was over 700, killing more than Superstorm Sandy and Hurricane Harvey combined. These poor people were trapped on heat islands.

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Image Source: Chicago Tribune - Killer 1995 Heat Wave

Climate change with record-breaking heat is happening, and environmental scientists are speaking up. "In order to save everybody, we have to undo what the government created many years ago," says Richard Rothstein, author of The Color of Law: A Forgotten History of How our Government Segregated America. Environmentalists are taking this conversation of unfair housing and systemic segregation and mapping it out for us. They are helping us see the relationship of climate change and health.

 

Environmental scientists Anthony Nardone and Joan Casey examined the relationship between historical redlining across 102 urban areas and correlated it with the lack of green space for the year of 2010. They found that the neighborhood effects of institutional racism and structural racism outlined by the 1930 HOLC Security Maps appears to still live on, although the practice was outlawed in 1968.  By the time children born in these heat islands enter adulthood the combination of poor infrastructure, lack of public amenities and limited fresh foods and air causes them to already battle preventable diseases such as diabetes, hypertension, obesity and asthma. 

 

The Oschner Health Center from Outcomes and Health Services in New Orleans published a special article seeing to characterize COVID-19 progression and race.  Dr. Price-Haywood and her team found that Black patients came in with more co-morbidities and died from COVID at a higher rate. The study concluded that being of the Black race was not an independent risk factor for death from COVID. In essence they were saying that being Black did not make you die from the virus. The juxtaposition of the high death rates and redlining which created planned segregation of Black people by city planners that built freeways through neighborhoods, choked off access to clean air, destroyed green space, and created heat islands, race is paramount.  In the search for environmental justice, the evidence is in plain sight.