Today marks the 10th Anniversary of Hurricane Katrina, which revealed alarming data from an “accidental” 2005 diabetes care study funded by “Mother Nature” in a state that ranked at the time 48th in levels of health insurance, 45th in public health, and 50th in overall health (See: http://www.ncbi.nlm.nih.gov/pubmed/16239669).
This event revealed clear health disparities to the average television viewer. The incidence and co-morbidity of diabetes and/or diabetes complications in the population that stayed behind — the lower income and largely African-American community — overwhelmed the ability of public health agencies to respond in this national emergency (See also: http://www.ncbi.nlm.nih.gov/pubmed/16373918 and http://www.ncbi.nlm.nih.gov/pubmed/16221772 )
Diabetes complications interfered with evacuation, rescue for those who survived, and appropriate resources for evacuees with limited supplies. Some authors liken Katrina to the infamous distributive justice tale of the Titanic, in that there were clearly “not enough lifeboats” for diabetes patients in “steerage class”.
Hurricane Katrina put the health effects of poverty and race in plain view, although the health disparities in the incidence and management of Type 2 diabetes had long been documented at the time of the storm (See: http://www.ncbi.nlm.nih.gov/pubmed/15983347):
- African-Americans are twice as likely as Caucasians to have diabetes.
- African-Americans suffer greater diabetes-related complications.
- Uninsured diabetes patients in 2005 had a 25% greater risk of premature death.
- The percentage of uninsured African-Americans in 2005 was 73% greater than in the Caucasian community.
- African-American diabetes patients in 2005 were less likely to have their A1C measured.
- Usual care for African-American diabetes patients in 2005 failed to meet published diabetes care guidelines.
Hurricane Katrina taught us that chronic disease management is a critical public health need in a disaster — on par with infection control. Stockpiling supplies for diabetes care should now be part of Disaster Planning.
In 2012, diabetes patients with end-stage renal disease caught in Hurricane Sandy were at risk again. (See: http://www.nj.com/healthfit/index.ssf/2015/08/hurricane_sandy_diabetics.html).
How many hurricanes does it take to get disaster diabetes care planning right? We’re not there yet, but we do know that diabetes and poverty always spell disaster for stranded vulnerable populations.