In the New Orleans Metro area, there is a 25-year difference in life expectancy between ZIP codes 70124 and 70112. These two areas are fewer than five miles apart and within the same city – so why is there such a large difference in health? The difference is that the first is home to mostly Caucasians with only three percent Black residents, while the other hosts 75 percent Black residents.
In 2018, The Data Center released a report titled “Advancing Health Equity in New Orleans: Building on Positive Change in Health,” exploring the history and ongoing fight against health inequity across the city.
The History of Fighting Health Inequity in New Orleans
In 1931, Flint-Goodridge Hospital was built to address longstanding inequities and racist institutions that were, at the time, rampant in New Orleans governed healthcare. Until 1983, it served mainly Black patients and was the only place where Black nurses could receive professional training. It was also the only private hospital during the Jim Crow era that allowed Black doctors to receive staff privileges. The Louisiana Department of Health and Human Services didn’t desegregate state hospitals until 1965 – though it took several more years to fully integrate, in spite of that order.
According to The Data Center’s report, even following the legal order to desegregate, data shows that fewer than 10 percent of Louisiana hospitals compliant with federal integration guidelines. Even into the 1970s, many of the hospitals that did integrate only did so because of a new federal government policy that stated hospitals that failed to meet guidelines could not receive Medicaid funds.
Though access to medical care did improve, health inequity remained a widespread issue throughout the city into the 1980s, 1990s, and 2000s. This was mainly due to disproportionate exposure to environmental toxins – something that remains a problem today. For example, the majority Black subdivisions of Press Park and Gordon Plaza, as well as Moton Elementary School, were developed on top of the Agriculture Street Landfill – an area that was later declared to be a toxic Superfund site in need of hazardous waste cleanup. While several class-action suits have been filed as a result, there remain residents who feel “stuck” living in toxic homes in the area.
In 2005, Charity Hospital closed permanently after sustaining significant damage from Hurricane Katrina. This was a serious blow to health equity in New Orleans, as the hospital served 80 to 90 percent of New Orleans’ low-income residents. This effectively eliminated the city’s health safety net, leaving most of the city’s most vulnerable residents without access to health care.
Current Health Inequities in New Orleans
In order to explore health inequity in New Orleans, it’s important to look at the factors known to affect health. For example, as shown above, 71 percent of Black households in New Orleans earned less than $45,000 in 2016 (a living wage in the city for a single adult with one child in New Orleans at that time was $47,611) while only 31 percent of non-Hispanic white families fell into the same category. As a result, 47 percent of the city’s Black residents experienced child poverty in 2015, while only nine percent of non-Hispanic white children faced the same challenge.
The effects of that privilege become clear when looking at public health outcomes by population.
As shown in the graph above, Black residents experience worse outcomes in infant mortality, low birth weight, preterm birth, hypertension/high blood pressure, and asthma or other breathing problems, and diabetes.
What the City Got Right after Katrina
According to The Data Center’s report, the decentralized, community-based healthcare system implemented after Hurricane Katrina was successful in improving access to primary care and prevention services to uninsured and poor New Orleans residents. Though in 2015, 64 percent of New Orleans residents reported that they didn’t believe there were enough healthcare services available to the city’s low-income and uninsured population, that was a vast improvement over the 93 percent of residents who felt that way just one year after the storm.
The Medicaid expansion enacted by Gov. John Bel Edwards in 2016 also had a positive effect on healthcare access across New Orleans. The proportion of uninsured residents in the city fell from 22 percent in 2013 to 13 percent after the expansion was enacted. Many of these residents were those who fell into the “coverage gap” in the Patient Protection and Affordable Care Act (more commonly known as “Obamacare”).
However, in order to build on these gains, it is important that state and local governments enact policies that address issues beyond the healthcare system. Access to quality education, affordable housing, and employment paying a decent wage all fall outside of the public health system, yet they directly impact the health and safety of the city’s residents – particularly the underserved and more vulnerable communities.
What Policymakers Can Do Now
The report outlines several measures that researchers from the Institute of Women and Ethnic Studies as well as the Tulane School of Public Health and Tropical Medicine believe can create better health equity across the city, such as:
- Addressing factors underlying persistent health disparities in New Orleans by institutionalizing equity through staff training, quality improvement, and deep engagement with community members.
- Effectively communicating the services, programs, and health resources provided by the New Orleans Health Department and the City of New Orleans
- Continuing to conduct equity-focused health impact assessments and act accordingly on the data found in those assessments.
- Pursue a people-driven and community-centered approach in the healthcare system by building relationships with community leaders, community-based organizations, and community members.
- Focus on community partnerships, culturally-relevant responses to community issues, and integrating local expertise with scientific evidence into health equity initiatives.
- Increase access to high-quality, population-based health data by increasing the state, federal, and philanthropic commitment to funding community-level data collection and dissemination efforts.
For more information on this issue, you can read the full Data Center report here.
Jenn Bentley is a freelance journalist and editor currently serving as Editor-in-Chief of Big Easy Magazine. Her work has also been featured in publications such as Wander N.O. More, The High Tech Society, FansShare, Yahoo News, Examiner.com, and others. Follow her on Twitter: @JennBentley_