Survey details New Orleans residents experiences three years after Hurricane Katrina

Aug 10 2008

A comprehensive new Kaiser Family Foundation survey of the experiences of New Orleans residents - the second since Hurricane Katrina - reveals a still-struggling population that gives very mixed reviews in key areas of the recovery efforts. Most residents feel forgotten by the nation and its leaders, yet are still optimistic about their city's future.

In two critical areas, housing (72 percent) and crime (71 percent), the vast majority of city residents see little or no progress. In other key areas - medical facilities, public schools, jobs, and rebuilding neighborhoods - reviews are more mixed, but with majorities seeing little or no progress. Only in one area, levee repair, does a majority (60 percent) see progress.

"Residents are not satisfied with the pace of the recovery effort, but they do see it moving in the right direction," Foundation President and CEO Drew Altman said.

The survey also finds that an increasing number of residents say they face mental health challenges as the recovery drags on. In addition, the results show some easing of racial tensions, though many residents still see a city divided between haves and have-nots.

Designed and analyzed by Foundation researchers, the survey was fielded house to house and by telephone in the spring among 1,294 residents of Orleans Parish, the area with the most residents affected by the storm's aftermath. It finds about four in 10 (41 percent) residents who lived through the storm report that their lives are still very or somewhat disrupted - only marginally better than the 46 percent who reported this level of disruption in Kaiser's first survey in Fall 2006. Similarly, residents' assessment of their overall quality of life is low - with only 25 percent saying they would rate their lives as very satisfying, unchanged from 2006. (In 2006, 65 percent reported that their lives had been very satisfying before Katrina.)

As in 2006, a majority of New Orleans residents (56 percent) say that the rebuilding and recovery process is going in the right direction. But at the same time, fully half of those living in the city say they are either dissatisfied (41 percent) or angry (11 percent) with the amount of progress that has been made. And 22 percent say they are thinking about leaving, up from 12 percent in 2006.

Overall, residents give a gloomy report about opportunities available in the city. Nearly two in three (64 percent) say that "good jobs are difficult to find" and 61 percent rate job opportunities as not so good or poor. These sentiments were specific to the city, but may also reflect the wave of economic unease sweeping the nation this year.

Overall, six in 10 New Orleans residents say they do not think the rebuilding of New Orleans is a priority for Congress and the president, and even more (65 percent) say they think "most Americans have forgotten about the challenges facing New Orleans." Three in four say the federal government has not provided enough money and other support to the city. Most residents (86 percent) also say that the city has at least a somewhat serious problem with political corruption.

Nevertheless, the survey finds widespread hope that things will improve. Three in four (74 percent) say they are optimistic about the city's future, a level of confidence that has hardly wavered since 2006.

Divisions Remain, But Improvement In Racial Tensions

Looking at life in New Orleans three years after the storm, the new survey finds a large majority of residents (70 percent) see the city as "mainly divided by things like race and income," and that most of this group see the divide as a problem. However, significantly more of the population says it is the divide between rich and poor that is the problem (33 percent) than say it is the racial divide (15 percent). Roughly a fifth sees both as causing divisions. It is unclear how much of this perceived divide is new and how much of it predated the disaster. The focus on income may be particularly relevant in a city where four in 10 adults say they live in low-income families (making less than $42,400 for a family of four).

The survey does suggest that race relations in the city may be improving. In the latest survey, 28 percent say race relations are "worse [than] they were before Hurricane Katrina," down 9 percentage points from the results of the 2006 survey. Three in four residents (74 percent) say that the diversity of racial and ethnic groups in the city is good for New Orleans, and a majority (58 percent) says that the growing number of immigrant workers in the city is a good thing.

In addition, the percentage of African Americans who feel the recovery process is racially biased against them has declined from 2006, dropping from a majority of 55 percent to the current 46 percent. African Americans are nearly twice as likely as whites to report than their lives still remain at least somewhat disrupted by the disaster nearly three years later (50 percent versus 26 percent).

Growing Reports of Stress and Mental Health Problems, While Access to Care Improves

The challenges facing New Orleans are compounded by a fairly high-needs population whose problems are not easily solved. The new survey finds 84 percent of adults living in New Orleans facing ongoing health challenges in at least one of four critical areas: a physical or mental health challenge, a problem with health care coverage or access, or a health problem facing a child.

The survey finds a substantial deterioration in residents' self-reported mental health status. Currently, 15 percent of residents say they have been diagnosed with a serious mental illness such as depression, up from 5 percent in 2006. Similarly, the proportion who report taking a prescription medicine for problems with their mental health rose from 8 percent to 17 percent.

The survey also finds a higher proportion of residents reporting a physical health challenge. Overall, 65 percent report either having some sort of chronic condition or disability or being in "fair" or "poor" health, up from 45 percent in 2006. Three in ten (31 percent) of those with a child under 19 at home say that at least one of their children suffers from a chronic condition or disability, up from 21 percent in 2006.

It's unclear what has caused these shifts over the past 18 months. It's possible that, having survived the disaster and the immediate aftermath, the slow recovery is taking a toll on the population. But it's also possible that the increased rates of reported health problems are the result of a different factor: Now that the health system is at least partially up and functioning again, residents have a better opportunity to be diagnosed and treated for any mental or physical health issues.

More residents report having health insurance coverage (with 18 percent saying they are uninsured, down from 26 percent in 2006), and fewer say that they do not have a usual source of health care or primarily depend on a hospital emergency room (25 percent, down from 34 percent).

At the same time, the affordability of care appears to be a bigger issue, perhaps partly due to the difficult economic climate gripping Louisiana and the rest of the nation this year and possibly due to the impact of medical costs on family budgets as care becomes more available. Overall, fully one in four (25 percent) say they had a problem paying for medical bills in the past six months, up dramatically from 9 percent in 2006. At least twice as many as in 2006 report that they recently skipped or postponed needed care (18 percent vs. 9 percent) or skipped needed doses of medication in the same time period (15 percent vs. 6 percent), bringing these experiences more in line with the current national average.

The survey is the second of at least three that the Foundation will conduct to track residents' experiences and views as the city rebuilds after Hurricane Katrina and the subsequent levee breaches that devastated huge sections in August 2005. The first survey around the first anniversary of Katrina quantified the many ways in which the disaster impacted people's lives financially, emotionally, and personally. The next will take place in about 18 months. By providing an over-time assessment of residents' experiences, priorities, goals, and concerns, the Foundation hopes to give people a continuing chance to report on how the recovery effort is affecting them, to inform leaders of the public's priorities, and to maintain national attention on the efforts to rebuild New Orleans.

Methodology

New Orleans Three Years after the Storm: The Second Kaiser Post-Katrina Survey, 2008 was designed and analyzed by researchers at the Kaiser Family Foundation including: the survey research team led by Kaiser Vice President and Director for Public Opinion and Survey Research Mollyann Brodie along with Claudia Deane and including Liz Hamel, Sasha Buscho, and Pam Murnane; the health policy team led by Kaiser Executive Vice President Diane Rowland and including Adele Shartzer, Samantha Artiga, and David Rousseau; and Kaiser President and CEO Drew Altman. Dr. Brodie had overall responsibility for the project. The survey was conducted from March 5 to April 28, 2008, among 1,294 randomly selected adults ages 18 and older residing in Orleans Parish. The sample design was a multi-stage stratified area probability sample starting with 275 randomly selected segments based on Census Block Groups distributed proportionate to expected population in each of fourteen Census tract defined neighborhoods in Orleans Parish and then selecting a random sample of addresses from those areas using the U.S. Postal Service's Delivery Sequence File. To ensure coverage of all residents, interviewing was conducted using a mixed-mode design including by telephone (669 interviews), web (178), and face-to-face (447). Interviews were completed in English and Spanish. The margin of sampling error for the full sample is plus or minus 3 percentage points. For results based on other subsets of respondents the margin of sampling error may be higher. The 2006 Kaiser survey referenced was conducted in a four parish area, but for reasons of comparability the 2006 results are based only on Orleans Parish residents. ICR/International Communications Research collaborated with Kaiser researchers on sample design and weighting, and supervised the fieldwork.

The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to producing and communicating the best possible information and policy analysis on health issues.