In some parts of the United States, health statistics resemble those in developing countries; New Orleans was one of those places when the storm hit. Louisiana consistently came either 49th or 50th in health rankings of the country, and New Orleans was usually one of its most unhealthy counties. There was a lack of access to care, a lack of health insurance coverage, and a broad unavailability of healthy foods or green spaces. In short, we were set up for failure. We had very few resources, and a high burden of chronic and acute diseases like asthma. A third of the people in New Orleans were uninsured, and many were dependent on one hospital when Katrina hit.
That was ten years ago, so this is a time of reflection for everyone from the city. The hurricane took the lives of over 1,800 people. Roughly a quarter million structures were flooded; the storm took down all the institutions we knew. Everything from 911 to our academic health centers shut down. And so, as we literally sat on the street, surrounded by water and guys with machine guns, wondering how to alleviate the urgent need, we began thinking about how we could build a new, better health care system from scratch. We didn’t want to rebuild it the way that it had been. That is what got us this set of outcomes.
The process that followed is the success story of our city: through a civically-engaged grassroots movement, we built a new framework. And that framework meant that we were going to pay for care differently, that we would make sure that everyone got coverage, and that everyone had a voice and could choose their care. We wanted to build a base of primary care, instead of relying on hospitals. And we wanted to achieve that through health information technology. That would give us the data necessary to take care of people, and do so in a way that was steadily improving. We wanted to set qualitative goals. That meant pinpointing the most complex and terrible things that were scourging our community and tackling them one by one.
With help from the federal government, at various stages, we set out to fulfill that policy agenda. And, except for the financing part, it has largely been achieved. We have gone from having essentially no neighborhood-based care to having a set of 24 different organizations that work cooperatively at about 60 sites across the city. They deliver primary care and mental health support, they work with the hospitals, and they share data with each other. The indices are improving year by year.
