Why didn't they leave?

The question rang out on TV and talk-radio stations across the U.S. in September. Why did so many people fail to leave New Orleans ahead of Katrina? The mayor's mandate was clear--or was it? Were most of those who stayed homeless? Just plain stubborn? As Congress prepared for hearings on a rescue effort gone wrong, the answer would prove critically important.

Why people stayed is no mystery, thanks to a survey of evacuees in Houston shelters conducted by the Washington Post, the Kaiser Family Foundation, and the Harvard School of Public Health in mid-September. Deep poverty--a simple lack of means--held many back; serious health problems also stood in the way. Communication was yet another hurdle: about one-third of those rescued say they never heard the order to flee.

Of the 61 percent who did not leave before the storm, 38 percent were either too sick or disabled to do so, or were caring for a disabled person, interviewers found. Forty-one percent had a major chronic illness or disability.

Fifty-five percent of respondents had no car or way to leave. Buying a way out was not realistic, the survey found, particularly for 59 percent reporting a household income of less than $20,000 a year.

Learning from mistakes
Working with the Washington Post on the survey's design and analysis was Robert Blendon, HSPH professor of health policy and political analysis in the Department of Health Policy and Management. As director of the Harvard Program on Public Opinion and Health and Social Policy, Blendon uses opinion polls to study attitudes shaping the country's health care agenda. In the absence of data, misinformation prevails, he says. Operating in the dark, decision makers cannot learn from past mistakes.

Giving evacuees a chance to speak out was the aim of the survey, Blendon says. Poor, politically disenfranchised, and 93-percent African American, this constituency would otherwise have no voice in the Congressional hearings, and no impact on officials' handling of future disasters. In the space of 11 days (and with a green light from FEMA and the Red Cross), the survey team met a self-imposed goal: to publish their findings on page one of the Washington Post by September 16, in order to capture the attention of powerbrokers on Capitol Hill before their agenda could shift to the rebuilding of New Orleans.

The survey threw a harsh spotlight on the lack of coordination among local, state, and federal agencies, Blendon notes. "It is striking how many days people went without medicine, food, and water, and without help from any agency of government or volunteer group," he says.

Thirty-nine percent of evacuees got no aid at all from such groups. One-third were trapped in their homes and had to be rescued. Of these, over half waited three or more days for help. Far more people received help from the Coast Guard, National Guard, and military (41 percent) than from local police and fire fighters (14 percent). And public leaders--President Bush, Louisiana Governor Kathleen Babineaux Blanco, New Orleans Mayor Ray Nagin--earned low marks for their handling of rescue operations.

Complications ahead
Going forward, the survey offers a reality check for government planners. Serious health problems will complicate efforts to resettle about 8,000 evacuees, fewer than half of whom plan to return home. One-third reported injuries or health problems resulting from the hurricane; over half had no health insurance. In the longer term, the U.S. has much to learn about disaster management across all levels of government, Blendon says. Among the greatest challenges will be mobilizing populations severely hobbled by poverty and illness--those who most need help.

The most difficult task of all? Narrowing the divide between Americans black and white. Sixty-eight percent of evacuees felt race and income were factors in the government's fumbling response.

All charts in this article courtesy of the Washington Post/Kaiser Family Foundation/Harvard School of Public Health Katrina Evacuee Survey, September, 2005

Karin Kiewra is editor of the Review and associate director of Development Communications at HSPH.

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