The 21st Century climate challenge

Box 2.3Hurricane Katrina—the social demographics of a disasterWhen Hurricane Katrina breached the levees of New Orleans itcaused human suffering and physical damage on a vast scale. Asthe fl ood waters receded, they revealed the acute vulnerabilitiesassociated with high levels of pre-existing social inequality. Flooddamage was superimposed on a divided city, just as climate changedamage will be superimposed on a divided world. Two years afterthe tragedy, inequalities continue to hamper recovery.Located on the Gulf Coast of the United States, New Orleansis in one of the world’s high-risk hurricane zones. In August 2005the fl ood defences mitigating that risk were overwhelmed, withtragic consequences. Hurricane Katrina claimed over 1,500 lives,displaced 780,000 people, destroyed or damaged 200,000 homes,crippled the city’s infrastructure and traumatized its population.The hurricane impacted on the lives of some of the poorestand most vulnerable people in the world’s richest nation.Pre-Katrina child poverty rates in New Orleans were among thehighest in the United States, with one in three living below thepoverty line. Health provision was limited, with some 750,000people lacking insurance coverage.Hurricane Katrina selected its victims overwhelmingly from themost disadvantaged areas of the city. Poorer districts dominatedby black communities bore the brunt. Flood damage interacted withdeep racial inequalities (poverty rates among blacks three timeshigher than for whites). An estimated 75 percent of the populationliving in flooded neighbourhoods was black. The Lower Ninth Wardand the Desire/Florida communities, two of the poorest and mostvulnerable in the city, were both totally devastated by Katrina.Images of the human suffering in New Orleans were beamedaround the world as the city became a magnet for internationalmedia attention. Yet as people sought to rebuild their lives afterthe cameras had departed, pre-hurricane inequalities emerged asa barrier to recovery.The health sector provides a striking example. Many of thehealth facilities in the safety net system serving the poor weredamaged by Hurricane Katrina, with the Charity Hospital, whichprovided most of the medical care for this group—emergency,acute and basic—still closed. While a special Medicaid waiver wasintroduced to provide temporary coverage for uninsured evacuees,eligibility rules limited entitlements for low-income householdswithout children, leading to a large number of rejected claims. Ittook Congress and the Administration 6 months to authorize a US$2billion provision for Medicaid to cover uninsured health costs.Research conducted by the Kaiser Family Foundation 6 monthsafter the storm revealed that many people had been unable tomaintain pre-existing treatment or to access the care needed todeal with new conditions. In household interviews, over 88 percentof respondents identifi ed the need for expanded and improvedhealth provision as a vital challenge for the city. Two years on, thatchallenge remains.Of the many factors blocking the social and economic recoveryof New Orleans, the health care system may be the most important.Only one of the city’s seven general hospitals is operating at itspre-hurricane level; two more are partially open, and four remainclosed. The number of hospital beds in New Orleans has droppedby two-thirds. There are now 16,800 fewer medical jobs than beforethe storm, down 27 percent, in part because nurses and otherworkers are in short supply.Two important lessons emerge from Hurricane Katrina thathave a wider bearing on climate change strategies. The fi rst isthat high levels of poverty, marginalization and inequality createa predisposition for risk to convert into mass vulnerability. Thesecond is that public policy matters. Policies that provide peoplewith entitlements to health and housing provision can facilitate earlyrecovery, while weak entitlements can have the opposite effect.Poverty in New OrleansPeople living in poverty, 2000 (%) New Orleans United StatesTotal population 28 12Children 18 years and younger 38 18Whites 12 9African–Americans 35 25Source: Perry et al. 2006.2Climate shocks: risk and vulnerability in an unequal worldSource: Perry et al. 2006; Rowland 2007; Turner and Zedlewski 2006; Urban Institute 2005.protection during periods of sickness orunemployment, assist child developmentand protect basic nutrition. Countries varywidely in their support for social insurance(figure 2.4). Rich countries spend a greatershare of their far higher average incomes onsocial insurance. In terms of global climatechange risk management this means thatthere is an inverse relationship betweenvulnerability (which is concentrated inpoor countries) and insurance (which isconcentrated in rich countries).Gender inequalities intersect with climaterisks and vulnerabilities. Women’s historicdisadvantages—their limited access to resources,restricted rights, and a muted voice in shapingdecisions—make them highly vulnerable toclimate change. The nature of that vulnerabilityvaries widely, cautioning against generalization.But climate change is likely to magnify existingHUMAN DEVELOPMENT REPORT 2007/2008 81