Ten years ago Risa Lavizzo-Mourey visited Gulfport, Mississippi, and witnessed firsthand the devastation and ruin wrought by Hurricane Katrina. “We may not be able to fix the broken levees, restore ruined cities, house the homeless, or feed the hungry,” she wrote soon after. “That's not our job. But we most certainly can apply Katrina's lessons to the wide range of good work that we support...”
On the 10th anniversary of Hurricane Katrina, we must reflect on valuable lessons learned from this cataclysmic event, the complexity of recovery, and the disastrous health outcomes that can result from a fundamental distrust between residents and government agencies. Katrina's devastation and the Gulf's uneven recovery also have served as an opportunity for studying resiliency—the capacity of communities to prepare for, respond to, and recover from adversity whether in the form of a natural disaster, economic downturn, or a pandemic.
This emphasis on community resilience represents a paradigm shift in emergency preparedness, which has traditionally focused on shoring up infrastructure (reinforcing buildings, roads, and levees), improving detection of new hazards to human health, and being able to mount an immediate response to disasters. Katrina and subsequent threats such as Hurricane Sandy, the Florida panhandle oil spill and the H1N1 epidemic have taught us that to be truly prepared for the long-term impact of adversity communities must also develop a different set of assets: those that build strength through promoting well-being and community engagement.
This means forming strong social networks and developing sustainable programs with community-based organizations, faith-based organizations, and other neighborhood-level groups that can participate in a prompt response and recovery effort. Building resiliency involves fostering neighbor-to-neighbor ties, improving risk communication, and encouraging multi-sector partnerships between government, business, and community organizations. Finally, community resilience also depends on incorporating equity and social justice considerations into preparedness planning—making sure health and other support services are accessible to everyone, in particular the most marginalized residents.
In New Orleans and throughout the Gulf, work is continuing on rebuilding sustainable communities that will be more resilient in the face of future disasters. In 2013, New Orleans was among the inaugural winners of the Robert Wood Johnson Foundation (RWJF) Culture of Health Prize. This is not to say that their work is done but that their effort to transform and rebuild by working across sectors, in partnership with residents themselves, is a model for other communities on the journey to better health. Across the board, these types of efforts also have real-time benefits for promoting general health and well-being in these communities—especially for the region's most vulnerable populations. For example, activities that boost preparedness by fostering community engagement—such a campaign to strengthen neighborhood social ties, a volunteer effort to visit elderly residents, and improved methods of communication—can also be a platform for addressing neighborhood public safety concerns. Collaborative activities like these simultaneously strengthen community social ties and improve dialogue and trust with public agencies.
This notion that building resiliency into communities can have dual benefits was the spark for the first ever large-scale demonstration project to build and measure resilience. In 2013, we led this project in Los Angeles County. The county, which spans 4,000 square miles from coast to desert, is home to an economically, ethnically, and racially diverse population of 10 million people. Roughly 80,000 of its residents are homeless and approximately one in six live below the poverty level. L.A. County is at risk for earthquakes, fires or other natural disasters, but many of its communities also face chronic stressors such as violence, segregation, poverty, and homelessness. We took lessons learned from the impact of Katrina and applied them to a framework for building resiliency in 16 L.A. County communities. The hope was that a focus on strengthening social networks and multi-sectorial engagement in public health broadly would not only bolster emergency preparedness but also help these communities address the chronic stressors they face.
The community resilience framework we developed for the Los Angeles County Department of Public Health was designed to both augment public health preparedness and reinforce longer standing public health approaches to improving community health and well-being (including social, emotional, physical, and economic factors). The emphasis was on neighborhood connectedness: Residents were encouraged to meet other local residents and to prepare both individual and community disaster plans; they were provided online resources to improve appropriate responses to emergencies. We developed a resilience toolkit for community organizations (PDF) to build coalitions and coordinate neighborhood strategies to increase community preparedness and specific mitigation and adaptation skills. Finally, we identified metrics to help measure and evaluate how well certain interventions promote resiliency.
This work in Los Angeles continues with support from RWJF. It also contributes to the Foundation's larger commitment to building a Culture of Health in communities throughout the nation. All of the assets, systems, and dynamic partnerships that help make a community resilient to a range of challenges—natural disasters, infectious disease outbreaks, terrorism, and chronic stressors—are essential elements in our long-term strategy for ensuring that all people have the chance to live long, healthy lives. These include such key action areas as making health a shared value and fostering cross-sector collaborations to improve well-being.
There is much work to be done in figuring out the specific actions that can make communities more resilient. As we've seen in New Orleans, in Joplin, MO (the scene of 2011's powerful and deadly tornado), and in the communities that make up Los Angeles County, one size does not fit all when it comes to strengthening the social connections and multi-sector engagement efforts that build resiliency and emergency preparedness. RWJF will continue to fund research and design programs in these areas. If you are working to make your community stronger and more resilient, we invite you to learn more about what RWJF funds, and subscribe to our funding opportunity alerts.
The Foundation is taking the commitment to resiliency even further. Last year, we assumed support and operation of the National Health Security Preparedness Index in a transition from the Centers for Disease Control and Prevention. The Index ranks each state on six different parameters, including health security surveillance, community planning and engagement and healthcare delivery. Several of the NHSPI parameters deal specifically with community resilience. We expect that the index will be a catalyst for broader cross-sector collaboration and community engagement in preparedness.
Hurricane Katrina left a path of destruction, death, and suffering in its wake. Its recovery, halting and incomplete as it has been, has taught us valuable lessons about resiliency. It would be a tragedy if all this happened and we had learned nothing.
Alonzo Plough is vice president, Research-Evaluation-Learning and chief science officer for the Robert Wood Johnson Foundation. Anita Chandra is a senior policy researcher and director of RAND Justice, Infrastructure, and Environment at the RAND Corporation. She is also on the faculty of the Pardee RAND Graduate School.
This commentary originally appeared on Robert Wood Johnson Foundation's Culture of Health blog on August 27, 2015. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.