Describe an issue that impacts distance-education learning. The selected issue can be a faculty issue, student issue, or administrative issue. Examine the issue and its significance to distance education.

Describe an issue that impacts distance-education learning. The selected issue can be a faculty issue, student issue, or administrative issue. Examine the issue and its significance to distance education..

Describe an issue that impacts distance-education learning. The selected issue can be a faculty issue, student issue, or administrative issue. Examine the issue and its significance to distance education.

Description
Describe an issue that impacts distance-education learning. The selected issue can be a faculty issue, student issue, or administrative issue. Examine the issue and its significance to distance education.

Assume that you are in a leadership position for the development of either nursing or patient education. Propose strategies on how your organization can meet challenges posed by the issue you selected in order to continue providing quality distance-education learning. Support your proposal by incorporating evidence-based literature and relevant professional standards.

ESSAY MUST INCLUDE THESE POINTS:
Describes a faculty, student, or administrative issue that impacts distance-education learning clearly and comprehensively. The submission additionally incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.
Examines the issue and its significance to distance education clearly and comprehensively. The submission additionally incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.
Proposes strategies to meet challenges posed by the selected issue as assumed from a position of a nursing or patient educator, inclusive of relevant professional standards clearly and comprehensively. The submission additionally incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

1.APA-formatted paper (1,000-1,250 words)

In addition to the course materials, you are required to use a minimum of three current scholarly, evidence-based, peer-reviewed resources (less than 5 years old).

APA format is required for essays only. Solid academic writing is always expected. For all assignment delivery options, documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.


 

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The post Describe an issue that impacts distance-education learning. The selected issue can be a faculty issue, student issue, or administrative issue. Examine the issue and its significance to distance education. appeared first on THE NURSING PROFESSIONALS.

Describe an issue that impacts distance-education learning. The selected issue can be a faculty issue, student issue, or administrative issue. Examine the issue and its significance to distance education.

Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008).

Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008)..

Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008).

Health Complications among Drug and Substance Abusers
Over the years, substance abuse treatment approaches been focusing on eliminating or reducing the use of psychoactive materials, a trend that has ignored the adverse health issues. Disregarding the impacts of substance abuse and focusing on underlying issues has resulted in an ever-growing burden of drug-related deaths and blood-borne diseases. Epidemiologists have established a significant association between use of psychoactive materials and new patterns of viral infections such as Hepatitis B and C, and HIV/AIDS (Guarino, Marsch, Deren, Straussner, & Teper, 2015). The growing concern of drug abuse has also influenced the incidence of diseases such as wound botulism and tetanus. The adverse health impacts have informed a number of solutions. Some of the popular evidenced-based approaches include matrix model, family behavior therapy, motivational enhancement therapy, cognitive-behavioral therapy, contingency management interventions, and 12-step facilitation therapy. While the efficacy of the approaches has been confirmed by the current stock of knowledge, they have not addressed the health needs of drug abusers, with many scholars suggesting that the plans are rigid in their approach, whereas the substance abuse trends are highly evolving. The supposition is supported by the contemporary effects of drug addiction, where they continue to have a significant toll on individual health and social functions in spite of massive public health spending (Degenhardt et al., 2013).
The prevalence of substance abuse has remained persistently high. The trend is explained by Alhyas et al. (2015) in their suggestion that the current generation is using psychoactive materials for the desired outcome, unlike the 20th-century abusers who did not understand the effects of indulging in drugs. The 21st-century youths are abusing substances as part of the exploratory behavior, even when they have full knowledge of the side effects. The trend has resulted in legislative measures where some states are legalizing previously outlawed substances such as Marijuana (Huddleston, 2016). However, the strategies only address the socioeconomic implications and not drug-usage complications and deaths. Against this backdrop, practitioners are starting to embrace harm reduction strategies to offset both socioeconomic and adverse health effects at both individual and community level. Harm limiting strategies are evidence-based approaches of keeping up with the dynamics of drug abuse. With the traditional methods having failed to address relative risks linked with substance abuse, focusing on offsetting the adverse effects and complications does not only offer a promising future, but also reduced mortality, negative behaviors, and morbidity rates (Toumbourou et al., 2007).
The problem-oriented approach is congruent with the principles of evidence-based practice where the focus should not only be embracing proven policies and interventions, but also adopting methods and procedures that are linked to the dynamism of the problem. Its focus is informed by trends in substance abuse, where many people continue to use drugs with full knowledge of its negative implications for the physical and psychosocial functioning (Sederer, 2016). The behavioral trend has led to a scholarly conclusion that drug will remain part of the humanity, where users will keep furthering their experiments to exploit perceived benefits such as enhancing pleasure and easing discomfort (Coon & Mitterer, 2013). The surmise is supported by recent trends, where the rate of use of opioids for non-medical purposes has been on the rise (Longo, Compton, Jones, & Baldwin, 2016). Although the impact of the misuse is a well-understood subject, individuals continue to use opioids. The trend is against the natural responses when human beings avoid harmful substances. Schatz (2016) associates the trend to Hollywood culture, where drug-related phenomenon such as sexual prowess, curiosity, enjoyment, boldness, confidences, and sound sleep are praised. With the concept of global village scenario having been realized through advanced transport and communication system, Manza (2016) suggest that the number of drug users will keep increasing as advanced technologies have resolved inaccessibility. The trend necessitates the need for a change in focus from limiting the use of substance abuse to harm minimizing strategies (van Amsterdam & van den Brink, 2013).
Harm Minimization Strategies as Evidence-Based Interventions for Drug and Substance Abusers
One of the evidence-based approaches to addressing adverse health effects and social dysfunction associated with drug abuse is harm minimization strategies. The interventions focus on empowering substance users and cushioning them against complications and the risk of contracting illnesses (Ruan et al., 2013). Harm minimization procedures entail neutralizing risks in drug taking as well as addressing elements that can affect the quality of life. The evidence-based practices are effective in addressing unprecedented effects of substance abuse such as blood-borne viruses, overdose, unintentional injury, premature drug-related death, septicemia, and dental health among others (Hickman, De Angelis, Vickerman, Hutchinson, & Martin, 2015). The issues calls for revisiting drug policies, where harm minimizing approaches should be integrated into comprehensive care plans for drug abuse treatments (van Amsterdam & van den Brink, 2013).
Harm reduction approaches entail embracing practical ideas and strategies to offset the risk and negative health impacts arising from drug use. Like other patient-centered public health and psychosocial interventions, harm minimizing strategies adopts a non-judgmental approach with drug users and the community being active participants in shaping procedures and programs around substance abuse (Harmreduction.org, 2016). The evidence-based and cost-conscious practices do not only focus on drug use control but also improving the quality of life of involved parties. The harm minimization model is informed by a widely explored supposition that substance abuse is a behavior that is influenced by a myriad of factors. The underlying elements are utilized in the execution of the activities such as peer education, counseling, overdose prevention, need and syringe programs, voluntary HIV testing, wound care, enlisting in substance abuse treatment programs, pharmacotherapy for addiction cases, and primary health care including treatment for STIs and viral diseases.
The rationale for the set of interventions is informed by Roizen’s 4-L model, where harm minimization action plans are structured to address livelihood aspects, health effects, legal issues, and relationship issues emanating from substance abuse (Hussein, 2008). Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008). Based on the two theoretical frameworks, harm minimization approaches focus on the three behavioral levels of 1) substance acquisition, 2) usage, and 3) withdrawal stage. At the acquisition level, harm minimization approaches focus on addressing violence and criminality associated with accessing psychoactive materials from the market.
Intervening at the drug abuse stage entails offsetting complications that are related to drug use. A key area of focus at the usage level is dosage and route of administration. The centrality of the two aspects is evidence-based, where the current body of literature reveals that most of the complications are contributed by the dosage as well as the route of administration. For instance, intravenous injections have been classified as the riskiest strategy as it compromises the integrity of the skin as a primary line of defense, exposing victims to opportunistic pathogens. It also leads to open wounds, vein problems, and abscesses (Del Giudice, 2004). The stage is linked to viral infections such as Hepatitis B and C and HIV/AIDs, making awareness campaigns and health education a critical cog. The health promotion methods create awareness on disease transmission and ways of effective prevention and educate users on safety procedures such as disposal of sterile and well as non-sterile materials. Uses of injectable are discouraged to offset the spread of blood-borne infections.
Harm minimization at the withdrawal level seeks to address physical symptoms as well as psychosocial aspects associated with quitting drugs. The stage focuses on establishing supportive tools and environment where professional, families and drug users interact to modify behaviors. To prevent withdrawal complications and setbacks, the intervention provides alternatives such as pharmacological antagonist drugs (Farr?, Galindo, & Torrens, 2014). The drug-substitution approach does not only reduce address usage-related risks but also initiates the road to recovery.
Identification of Measurement Outcomes for Identified Interventions
The rationale of the health promotion is ingrained in the Ron Roizen?s model, where effects of psychoactive substances are abbreviated as 4Ls (Liver, Lover, Livelihood, and Law). The four categories will be the parameters of monitoring and evaluation procedures to assess the level of efficacy of the health promotion intervention. The four categories are informed by the WHO definition of health, where it?s a state of holistic mental, physical, and social well-being and not the absence of disease or infirmity. Evaluating the four pillars is thus critical in assessing the effectiveness of the intervention in attaining complete wellbeing.
The liver category captures all aspects of personal health. The primary measurement areas are physical parameters such as engagement in activities of daily living, diet and nutrition, sleep patterns, and temperament. Visual aspects such as bodily injuries and hygiene are also important in assessing the impacts of the intervention on the health of the victims.
Lover and livelihood focus on psychosocial effects of substance abuse. A critical issue is interactional behaviors between the victim and friends, intimate partners, and family members. Another livelihood measurement outcome is engagement in activities of daily living, including professional practices and non-professional aspects. The legal issues explore observable behavioral trends such as violence.
Utilization of epidemiology principles and terminology
a) Prevalence has been used to describe the extensiveness of drug abuse as well as effects such as drug-related deaths and blood-borne diseases.
b) Incidence has been adopted to highlight new patterns of viral diseases such as Hepatitis C, Hepatitis B, HIV/AIDS, wound botulism, and tetanus infections. The terminology is used to highlight the risk of contracting the disease when one is a drug abuser.
c) Risk has been used to describe the potential of substance abuse in increasing susceptibility to bloodborne diseases
d) The rate has used to predict a downward change in frequency of the current mortality, negative behaviors, and morbidity cases if harm minimization strategies are fully embraced.
e) Mortality rate has been used to describe deaths emanating from drug abuse and associated complications
Implications of the project for the APN clinical practice
The health promotion project offers a valuable learning experience on sociomedical realities. The elements explored challenges the traditional perspective of disease causation, where only pathogens were considered in the etiopathophysiology of infections. The project offers valuable lessons on the expansiveness of the public health, where history, social, and political issues are also determinants of health. The contribution of social issues in therapeutic area challenges advanced practice nurses to adopt a broad perspective of caregiving, where history and culture should be the epicenter of nursing research and interventions to empower the community to take control over their lives. The realization that holistic functioning can be affected by an array of issues informs area of future engagement to assess impacts of sociomedical subjects such as sexuality, homelessness, immigration, and aging in the public health.
The project has also offered invaluable lessons on the importance of inter-professional collaborations in public health. While the health promotion intervention focuses on adverse health outcomes of drugs abuse, the models and proposition adopted to inform the arguments of the project are informed by anthropological, psychological, and well as sociological postulations.

References
Alhyas, L., Al Ozaibi, N., Elarabi, H., El-Kashef, A., Wanigaratne, S., & Almarzouqi, A. et al. (2015). Adolescents’ perception of substance use and factors influencing its use: a qualitative study in Abu Dhabi. JRSM Open, 6(2). http://dx.doi.org/10.1177/2054270414567167
Coon, D. & Mitterer, J. (2013). Psychology (p. 210). Boston: Cengage Learning.
Degenhardt, L., Whiteford, H., Ferrari, A., Baxter, A., Charlson, F., & Hall, W. et al. (2013). Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010. The Lancet, 382(9904), 1564-1574. http://dx.doi.org/10.1016/s0140-6736(13)61530-5
Del Giudice, P. (2004). Cutaneous complications of intravenous drug abuse. Br J Dermatol, 150(1), 1-10. http://dx.doi.org/10.1111/j.1365-2133.2004.05607.x
Farr?, M., Galindo, L., & Torrens, M. (2014). Addiction to Hallucinogens, Dissociatives, Designer Drugs and ?Legal Highs?. Textbook Of Addiction Treatment: International Perspectives, 567-596. http://dx.doi.org/10.1007/978-88-470-5322-9_27
Guarino, H., Marsch, L., Deren, S., Straussner, S., & Teper, A. (2015). Opioid Use Trajectories, Injection Drug Use, and Hepatitis C Virus Risk Among Young Adult Immigrants from the Former Soviet Union Living in New York City. Journal Of Addictive Diseases, 34(2-3), 162-177. http://dx.doi.org/10.1080/10550887.2015.1059711
Hickman, M., De Angelis, D., Vickerman, P., Hutchinson, S., & Martin, N. (2015). Hepatitis C virus treatment as prevention in people who inject drugs. Current Opinion In Infectious Diseases, 28(6), 576-582. http://dx.doi.org/10.1097/qco.0000000000000216
Huddleston, J. (2016). This Map Shows How Legalized Marijuana Is Sweeping the U.S.. Fortune. Retrieved 4 October 2016, from http://fortune.com/2016/06/29/legal-marijuana-states-map/
Hussein, R. (2008). Alcohol and Drug Misuse ; A handbook for students and health professionals. Routledge.
Longo, D., Compton, W., Jones, C., & Baldwin, G. (2016). Relationship between Nonmedical Prescription-Opioid Use and Heroin Use. New England Journal Of Medicine, 374(2), 154-163. http://dx.doi.org/10.1056/nejmra1508490
Manza, J. (2016). Marijuana: a gateway drug that keeps growing stronger. Eehealth.org. Retrieved 4 October 2016, from https://www.eehealth.org/blog/2016/09/marijuana-addiction-teens
Principles of Harm Reduction – Harm Reduction Coalition. (2016). Harmreduction.org. Retrieved 4 October 2016, from http://harmreduction.org/about-us/principles-of-harm-reduction/
Ruan, Y., Liang, S., Zhu, J., Li, X., Pan, S., & Liu, Q. et al. (2013). Evaluation of Harm Reduction Programs on Seroincidence of HIV, Hepatitis B and C, and Syphilis Among Intravenous Drug Users in Southwest China. Sexually Transmitted Diseases, 40(4), 323-328. http://dx.doi.org/10.1097/olq.0b013e31827fd4d4
Schatz, J. (2016). Hollywood culture perpetuates drug abuse (February 6, 2014 issue) « Collegian. Clubs.lasalle.edu. Retrieved 4 October 2016, from http://clubs.lasalle.edu/collegian/2014/02/06/hollywood-culture-perpetuates-drug-abuse-february-6-2014-issue/
Sederer, L. (2016). Ask Dr. Lloyd | Why Are Psychoactive Drugs So Popular?. Askdrlloyd.com. Retrieved 4 October 2016, from http://www.askdrlloyd.com/blog/view/addictions,%20drugs,%20substance%20abuse
Toumbourou, J., Stockwell, T., Neighbors, C., Marlatt, G., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use. The Lancet, 369(9570), 1391-1401. http://dx.doi.org/10.1016/s0140-6736(07)60369-9
Van Amsterdam, J. & van den Brink, W. (2013). The high harm score of alcohol. Time for drug policy to be revisited?. Journal Of Psychopharmacology, 27(3), 248-255. http://dx.doi.org/10.1177/0269881112472559


 

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The post Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008). appeared first on THE NURSING PROFESSIONALS.

Similarly, the proposition of Thorley’s model on patterns of use and drug-related complications finds huge applicability in limiting the impacts of drug addiction at both individual and community level (Hussein, 2008).

Prepare a proposal in the form of a two-page paper which describes a detailed plan for the project.

Prepare a proposal in the form of a two-page paper which describes a detailed plan for the project..

Prepare a proposal in the form of a two-page paper which describes a detailed plan for the project.

Description
The purpose of this assignment is to provide the student an opportunity to design a health promotion proposal specific to your role specialization.

There are multiple sections to the project. These include:
1. Identification of a specific health promotion topic, along with a well-defined target population. This will be due in Week 1.
Choosing Your Topic
The first step in the project is to identify a topic appropriate for a health promotion project. There are multiple areas to look for acceptable projects, such as the Health People 2020 site, The Institute of Medicine, Centers for Disease Control (CDC), National Institute of Nursing Research (NINR), Agency for Health Care Research and Quality (AHRQ), and current literature in the South University library. You may also want to look at the websites for professional nursing organizations who may also have listings of health promotion priorities.

Week 1 Project Task:
Prepare a proposal in the form of a two-page paper which describes a detailed plan for the project.
Assignment 3 Grading Criteria
Maximum Points
Identified an appropriate goal for health promotion.
10
Developed or proposed a specific, narrow, and focused intervention to address the goal.
10
Provided an explanation of the importance of the project relative to the students? future advanced practice role.
10
Developed a plan to identify the needed data and information for creation of the project.
10
Followed APA Guidelines
10
Total:
50


 

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The post Prepare a proposal in the form of a two-page paper which describes a detailed plan for the project. appeared first on THE NURSING PROFESSIONALS.

Prepare a proposal in the form of a two-page paper which describes a detailed plan for the project.

Introducing that includes background of guideline, such as why the guideline exists and how it is relevant to nursing practice?

Introducing that includes background of guideline, such as why the guideline exists and how it is relevant to nursing practice?.

Introducing that includes background of guideline, such as why the guideline exists and how it is relevant to nursing practice?

Order Description

This is the last part of the assignment with the subject Pneumonia.

GRADING CRITERIA FOR EVALUATION OF PAPER: EVALUATION A GUIDELINE
This paper is expected to be 10 ? 12 pages in length.
I. Research Focused Literature Review (50 points)
A. Introducing that includes background of guideline, such as why the guideline exists and how it is relevant to nursing practice?

B. Literature review discusses a major theory /framework as a basis for the review.

C. Evidence of literature search: Discuss the literature search. Include main search topics, databases used, and year range for articles. Discuss at least 6 research studies that are relevant to the guideline /guideline (s). Summarize and critically evaluate each study. Group like studies together under subheading that reflect major concepts.

D. Identify level of evidence for each of the studies

E. Based on the results of the study discuss how the study relates to your guideline(s). Does the study support or oppose the current recommendations?

F. Literature review is focused and organized.

II. Development of Recommendations (25 points)

A. Recommendations relevant to the guideline are given.

B. Recommendations are grounded in the literature reviewed for the guideline.

C. Conclusion is succinct and appropriate.

D. Areas for future research are identified.

III. Presentation of paper (50 points)

A. APA format

B. Grammar, spelling, and writing guidelines

C. Writing style

Total points: 150 points


 

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The post Introducing that includes background of guideline, such as why the guideline exists and how it is relevant to nursing practice? appeared first on THE NURSING PROFESSIONALS.

Introducing that includes background of guideline, such as why the guideline exists and how it is relevant to nursing practice?

Write a nursing report about Mr. Jones as if you were completing it in his notes after he has been discharged. The information should convey to the reader what you have specifically discussed/explained/planned for Mr. Jones and his family in relation to their discharge planning requirements.

Write a nursing report about Mr. Jones as if you were completing it in his notes after he has been discharged. The information should convey to the reader what you have specifically discussed/explained/planned for Mr. Jones and his family in relation to their discharge planning requirements..

Write a nursing report about Mr. Jones as if you were completing it in his notes after he has been discharged. The information should convey to the reader what you have specifically discussed/explained/planned for Mr. Jones and his family in relation to their discharge planning requirements.

Assessment item 2

Task

This task requires you to compile responses that suggest cares and rationales to a set of 4 questions regarding the care of the post-operative patient. It is suggested that you limit these responses to 200 words. This assessment also requires an introduction and conclusion.

Patient information

Mr. Malcolm Jones is a 32 year old male, who has presented to the Extended Day Surgery Unit (EDSU) you are working in, in the capacity of a Registered Nurse. Mr. Jones is scheduled for a repair of an inguinal hernia and is being admitted on the day of his surgery. Mr. Jones has been allocated to you for care, therefore you will need to ensure all relevant information is collected.

Following an admission and pre-operative interview you have gathered the following information:
Mr. Malcolm Jones, DOB: 6.5.1984. Medical History
? Gastro Oesophageal Reflux Disease (GORD) for 6 years
? Medications: Omeprazole 40mg, Nocte PO
? Allergies: Penicillin, causes all over body rash and mild airway occlusion
Other relevant
? Non-smoker, nil special dietary requirements, nil alcohol
? Nil dentures, nil sensory deficits, skin integrity intact
? Ambulant without assistance

Social history
? Lives with wife Meredith and two children, works as delivery driver for a furniture warehouse
? Plays indoor cricket each Thursday night

Family History
? Nil significant, parents still alive and healthy

Cultural History
? Practicing Jehovah Witness

Pre-operative preparation:

At 0730 hrs. you collected and charted a baseline set of vital observations, including height, weight, BGL & U/A. You have also completed a pre op check list, ensured the Mr. Jones has not had anything to eat or drink since midnight last night, has identifying name and allergy bands insitu and has been advised to change into a theatre gown and remain in bed now until he is transferred to theatre.
Malcolm?s next of kin (his wife, Meredith) accompanied him for this admission and knows where she is able to wait for Mr. Jones until he returns from theatre. The operation consent was completed at a pre-operative appointment by Dr. Williams (the surgeon) prior to Mr. Jones? admission and this is now with the admission paperwork.

Intra-operative Period:

Mr. Jones was transferred to theatre at 1100hrs, the procedure was attended with nil adverse events, remained in recovery for one (1) hour and returned to the surgical ward at 1530hrs.

Post-operative orders:

Patient can eat and drink as desired, ambulate as able and analgesia is ordered. Mr. Jones can be discharged home in the morning after review by surgical team. Mr. Jones has an appointment made for two weeks? time for a wound check with Dr. Williams and a medical certificate has been organised to cover sick leave from work for two weeks. Mr. Jones has been advised that he is not to do any heavy lifting (over 15 kg) for 6 weeks post operatively.

Questions

1. Post- operative pain assessment
During your most recent post-operative assessment of Mr. Jones, he tells you he has pain in his abdomen. Identify one (1) method of pain assessment used in the adult post operative setting and provide a rationale to support its use.

This discussion should be supported by a minimum of two (2) evidenced based resources.

2. Pain management

On checking Mr. Jones? medication chart, you find a valid order for the following: Paracetamol tablets 500mg to 1000mg orally every 6 hours.
You decide to administer 1000 mgs of Paracetamol. In the drug cupboard is a stock of 500 mg tablets.

In your answer, provide the working out of the dose you would administer and discuss two (2) medication safety issues and two (2) legal nursing precautions you should consider prior to the

administration of this drug.

This discussion should be supported by a minimum of two (2) evidenced based references

3. Discharge Planning
Discharge planning often involves extensive patient education in relation to the post-operative recovery period. Complete the discharge template that has been provided and attach this to your submitted paper, as an appendix. You are then required to discuss the rationale for the instructions you have given Mr. Jones and his family which address his post-operative management goals. Aspects to consider could be, ambulation, return to work, pain relief, medical follow up as well as any other issues that maybe relevant to Mr. Jones, his needs and his family?s needs.

Note: The discharge planning template can be located in the assessment section on the interact2 NRS122 site.

This discussion should be supported by a minimum of two (2) evidenced based references

4. Nursing Documentation
Write a nursing report about Mr. Jones as if you were completing it in his notes after he has been discharged. The information should convey to the reader what you have specifically discussed/explained/planned for Mr. Jones and his family in relation to their discharge planning requirements.

Rationale

This assessment will allow you to apply the theoretical and clinical underpinnings of nursing care of the patient during the perioperative period. It will also show appreciation of using research to support your fundamental understanding of clinical decision making.
? This assessment item addresses all of the subject learning outcomes.

Marking criteria

Criterion High Distinction Distinction Credit Pass Fail Mark
Introduction A clear and concise introduction of the paper that covers all required aspects and is well structured. A clear and concise introduction that covers most of the required aspects and is well structured. A clear introduction that covers most of the required aspects and is well structured. An introduction that may miss some of the required aspects.
The structure could be better organised. No introduction.
Or an introduction that does not cover the required or important aspects.

There are major errors in the structure.

/5
Pain assessment tool Clear and concise exploration of a pain assessment method and rationale for its use

This discussion in this section has been supported by two (2) or more current and credible evidence based references. Concise exploration of a pain assessment method and rationale for its use

This discussion in this section has been supported by two (2) current and credible evidence based references. Clear explanation of a pain assessment method and a rationale for its use

This discussion in this section has been supported by two (2) credible evidence based references. Brief explanation of a pain assessment method and a rationale for its use.

The discussion in this section has been supported by two
(2) evidence based reference. No or limited discussion of a pain assessment method and/or minimal evidence of a rationale for its use

The discussion in this section has been not been supported by less than two
(2) evidence based references.

/16
Pain Demonstrates satisfactory Demonstrates satisfactory Demonstrates satisfactory Demonstrates satisfactory Demonstrates
management drug calculation skills. drug calculation skills. drug calculation skills. drug calculation skills. unsatisfactory drug
calculation skills.
A comprehensive discussion A concise discussion of two A clear discussion of two (2) A brief discussion of a
surrounding three (3) legal (2) – three (3) safety and two safety and two (2) legal minimum of two (2) legal and Minimal discussion of one
and three (3) safety aspects (2) – three (3) legal aspects of aspects of administering two (2) safety aspects of (1) legal and one (1) safety
of administering Paracetamol administering Paracetamol Paracetamol are provided. administering Paracetamol aspect.
are provided. are provided.
The discussion in this are provided. Or omission of discussion any safety and legal /16
The discussion in this section The discussion in this section section has been supported The discussion in this section aspects of administering
has been supported by two has been supported by two by two (2) and credible has been supported by two Paracetamol.
(2) or more current and (2) current and credible evidence based references. (2) evidence based references
credible evidence based evidence based references. The discussion in this
references. section has not been
supported by evidence
based references.
Discharge Planning Discharge template has been fully completed and is Discharge template has been fully completed and is Discharge template has been fully completed and is Discharge template has been fully completed. Discharge template has not been fully completed or is

accurate and reflects patient accurate and informative accurate. not included.
education. Limited identification and
Clear and concise brief discussion of four (4) Discharge advice not
identification and discussion aspects identified in the identified and/or
Comprehensive identification of six (6) ? seven (7) aspects discharge planning template discussed.
and discussion of seven (7) identified in the discharge Clear identification and that will help the patient and Or advice identified and
or more aspects identified in planning template that offers discussion of five (5) ? six family be informed about discussed that will not
the discharge planning the patient and family (6) aspects identified in the some post-operative help the patient and family
template that offers the information about most discharge planning template management goals and be informed about basic
patient and family concise management goals and that offers the patient and ongoing care needs. management goals or
information about ongoing care needs. family information about ongoing care needs.
management goals and
ongoing care needs.
Demonstrates an many management goals and
ongoing care needs Limited integration of holistic
care. Or discharge advice given that is not related to the /16
understanding of holistic patient.
Demonstrates an excellent care. Integrates some aspects of The discussion in this section
understanding of holistic holistic care. has been supported by two No integration of holistic
care. The discussion in this section (2) evidence based care.
has been supported by two The discussion in this references.
The discussion in this section (2) current and credible section has been supported The discussion in this
has been supported by two evidence based references. by two (2) credible evidence section has not been
(2) or more current and based references. A copy of the completed supported by any evidence
credible evidence based discharge template is attached based references.
references. as an appendix
A copy of the completed A copy of the completed
A copy of the completed discharge template is A copy of the completed discharge template is not
discharge template is attached as an appendix discharge template is attached as an appendix.
attached as an apendix attached as an appendix
Documentation Comprehensive report which discusses all aspects of discharge planning discussed with patient and family.

The report is correctly composed with two (2) forms of patient identification, designation and signature of author, date and time written included.

The report is free of ambiguous abbreviations and compliments the Concise report which discusses all aspects of discharge planning discussed with patient and family.

The report is correctly composed with two (2) forms of patient identification, designation and signature of author, date and time written included.

The report is free of ambiguous abbreviations and supports the management A sound report which discuses most aspects of the discharge planning with the patient and family.

The report is correctly composed with two (2) forms of patient identification designation and signature of author, date and time written included.

The report has one (1) ? two
(2) abbreviations which may be ambiguous however do A satisfactory report which discusses some aspects relevant to safe discharge planning for the patient and their family.

The report is correctly composed with two (2) forms of patient identification, designation and signature of author, date and time written included.

The report contains abbreviations that may be The report does not identify any aspects involved in the discharge of the patient.
Or
The patient report is absent.

The report is incorrectly composed with errors in all of the following: two
(2) forms of patient identification, designation and signature of author, date and time not included.


 

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The post Write a nursing report about Mr. Jones as if you were completing it in his notes after he has been discharged. The information should convey to the reader what you have specifically discussed/explained/planned for Mr. Jones and his family in relation to their discharge planning requirements. appeared first on THE NURSING PROFESSIONALS.

Write a nursing report about Mr. Jones as if you were completing it in his notes after he has been discharged. The information should convey to the reader what you have specifically discussed/explained/planned for Mr. Jones and his family in relation to their discharge planning requirements.

What is new in the HSSP? The Health Sector Strategic Plan 2011-2016 is different from the Program of Work (PoW) 2004-2010 because it: ?

What is new in the HSSP? The Health Sector Strategic Plan 2011-2016 is different from the Program of Work (PoW) 2004-2010 because it: ?.

What is new in the HSSP? The Health Sector Strategic Plan 2011-2016 is different from the Program of Work (PoW) 2004-2010 because it: ?

A written report for a plan review
Assignment 1 has a word limit of 3300 words and it is worth 50%. For submission date, please refer to the unit outline.

As an international consultant in Health Planning, you have been assignment by the Government of Australia to review the Health Sector Strategic Plan (HSSP) for the year 2011-2016 for the country of Muteu or (Theu). The Government of Australia has agreed to provide technical and financial support for developing a new Health sector Plan for the country of Muteu. Before the Ministry of Health in Muteu can develop the new strategic plan, The Australian Government in collaboration with Government of Muteu would like the current HSSP to be reviewed and evaluated as a basis for the next HSSP.

The first part of your assignment in this role, is to critically analyse the current HSSP (see the document as provided) and identify areas that need to be improved in the next planning process and the final plan document. You are asked to write a report of this plan review which should address the following areas;

Using frameworks for population’s health approach to health planning; strategic planning and health services planning;

? Using a SWOTT and PEST analysis tools, analyse the planning context and identify three major health system capacity concerns for developing and implementing the next HSSP. Discuss their potential implication on the next HSSP and provide suggestions of how these might be addressed
? Does the current plan address the core principles of health planning? Justify your position.
? What should be the three key priority health issues to be addressed in the next plan? Provide evidence and rationale for your recommendations in this regard
? What should be the main goals and objectives for the next plan based on the three main priority health issues as recommended?
? Using a decision tree, identify strategies which are most likely to help the Ministry of Health in Theu to reach its goals and objectives for the key priority areas?
? Present a stakeholder analysis matrix of the key stakeholders that the Ministry of Muteu needs to engage with and involve in the next planning process and discuss why

Note: Please, completely ignore implementation, budget implications and evaluation for now. When you get to read the provided health sector plan, you will realise that I have cut the sections that cover budgets, implementation, monitoring and evaluation as well as the preamble stuff (preface, table of contents, and list of abbreviations). I have left the sections on the context, situation analysis, mission, goals, objectives and strategies intact for you to appreciate the messiness of the real world. Be warned that the provided health sector plan is a big document (close to 38 pages with lots of tables and some empty pages), start getting to understand its context and main issues as soon as you can, do not wait until the last minute! At the same time, do not be overwhelmed with the size of the document, for purposes of the assignment, you will only get to read bits and pieces of information and not the whole document

The trick to getting this assignment right is to have a good grip of the ideal health planning which we are learning in this Unit. Only then, you can be able to see the flaws in the provided health sector plan and think of ways of how it can be improved.

All the best!

Your report should at least include the following information and headings:

Cover page
Title for the report, information about the author, to whom the report is being submitted

Introduction
? Briefly describe the basis or background of this report
? Present and explain the framework which you are using for analysing Theu’s HSSP
? Provide the structure of your report

The body
Present and discuss your key findings using subtitles that reflect the requested areas to be addressed in the report.

Conclusion
Provide summary of your key findings and recommendations

References
? Include a list of references cited in the report e.g. for the Rationale or Program Activities.
Reference any existing resources that will be used to implement the program.

Marking Guide-Essay
OBJECTIVE 0% 20% 50% 70% 100% Weight Mark Awarded
Introduction: clearly defines the topic and purpose No introduction provided Poor formation of introduction. Poor academic language or use of casual language Topic discussed or aims stated. Good language used Topic discussed or aims stated. Good language used Topic & purpose clearly defined. Aims outlined. Clear academic language used 2
The introduction identifies the framework and structure (these can be informed by guidelines for the assignment or relevant theories for the topic being considered No framework for framing the plan
No structure outlined Framework and structure outlined in the introduction but;
1. do not relate with the main discussion and arguments or
2. are not used for framing the main discussion/body Framework and structure outlined in the introduction and are related with the main discussion but do not frame the structure of the discussion or vice versa Framework and structure outlined in the introduction; are related with the main discussion and used for framing the structure of the discussion Uses creativity in framing and structuring of the essay i.e. use of a work based scenarios as examples and conceptual frameworks 7
The student demonstrates a clear understanding of the topic area, context and issues being analyzed
No evidence of knowledge of the topic and context Minimal evidence of knowledge of the topic area and context of issues being analyzed Considerable evidence of knowledge of the topic and context of issues being analyzed Significant evidence of knowledge of the topic and context of issues being analyzed Demonstrates an outstanding level of knowledge for the topic area and context of issues being analyzed 10
Appropriate and clear use of relevant concepts and theories
relevant theory and concepts are explained clearly and applied critically in analysis of an experience in a specific context No theoretical concepts used Theoretical concepts mentioned but not explained or used Theoretical concepts clearly explained but not used appropriately Theoretical concepts and conceptual frameworks explained and used appropriately Theoretical concepts and conceptual frameworks explained and used appropriately
Exceptional application of theories in the analysis with clear examples 20
Argument development: Idea development is logical and orderly, presenting a cohesive argument The argument is not clear and not presented in a logical order Has provided limited argument development with significant sections which are incoherent The argument is clear/coherent but not in logical order Has addressed the purpose of the assignment coherently and with some attempt to demonstrate imagination Has addressed the purpose of the assignment comprehensively and imaginatively in an academic manner 20
There is evidence of critical thinking, indicating an ability in analysis and interpretation Critical Thought Either no evidence of literature being consulted or irrelevant to the assignment set Literature is presented uncritically, in a purely descriptive way and indicates limitations of understanding Clear evidence and application of readings relevant to the subject; uses indicative texts identified Able to critically appraise the literature and theory gained from variety of sources, developing own ideas in the process Has developed and justified using own ideas based on a wide range of sources which have been thoroughly analyzed, applied and discussed 15
Academic Writing Meaning unclear and/or grammar and/or spelling contain frequent errors Meaning apparent, but language not always fluent (i.e. casual). Grammar and/or spelling contain errors Language mainly fluent Grammar and spelling mainly accurate Language fluent. Grammar and spelling accurate High academic writing style appropriate to document. Grammar and spelling accurate. 10
Conclusion: A rational conclusion is offered and supported. Unsubstantiated/invalid conclusions based on anecdote and generalization only, or no conclusions at all Limited evidence of findings and conclusions supported by theory/literature Evidence of findings and conclusions grounded in theory/literature Good development shown in summary of arguments based in theory/literature Analytical and clear conclusions well-grounded in theory and literature showing development of new concept 5
In text referencing ? all text and diagrams are correctly referenced using appropriate referencing style. Problems with more than 4 citation requirements Problems with 3-4 citation requirement. Problems with 2 citation requirement. Problems with 1 citation requirement. All citation requirements met 2
Reference List ? current references (no more than 5 yrs old unless justified). Referenced using an appropriate referencing style. Problems with more than 4 referencing requirements Problems with 3-4 referencing requirement
Problems with 2 referencing requirement. Problems with 1 referencing requirement
All referencing requirements met 2
The presentation of the paper is of an appropriate academic standard Problems with more than 4 formatting requirements Problems with 3-4 formatting requirement
Problems with 2 formatting requirement. Problems with 1 formatting requirement
All formatting requirements met 2
Total
100
Out of 30%
30%

Note: A mark over 50% does not automatically mean that you have passed the paper if you have plagiarised

FORMATTING REQUIREMENTS:
? Cover page as per Guide to Assignment Presentation (GAP) (Appendix A) including student declaration
? Clearly stated title on cover page
? Contents page as per GAP (with correct footer, as per Appendix B of GAP)
? All pages numbered correctly (starting with page 1 on Introduction page)
? Appropriate footer (Group Number, due date & page number)
? Short, appropriate headings and subheadings, correctly numbered and formatted

CITATION REQUIREMENTS:
? Correct citation style has been consistently used, use APA 6th Edition as the recommended referencing style. Visit the Curtin Library homepage for guidelines on referencing
? All facts that are not original thought have a citation provided
? All components of citation are present
? All components are in the correct order
? Capitals are correct
? Punctuation is correct
? All direct quotes contain page number
? All tables and graphs correctly cited
? All citations are referenced in the reference list

REFERENCING REQUIREMENTS:
? Correct citation style has been consistently used
? References appropriate age and where more than 5 years old are justified
? Credible sources of information used
? All components of references are present (inc electronic source & access date)
? All components are in the correct order
? Punctuation is correct
? Capitals & italics are correct
? Alphabetical order & hanging indent is correct
? All references are cited in the report

2011- 2016
Government of Muteu
Ministry of Health
Muteu Health Sector Strategic Plan 2011 – 2016
Moving towards equity and quality
Ministry of Health PO Box 3077 Lirome 3 Muteu

Th
Executive summary Muteu Health Sector Strategic Plan (HSSP) (2011-2016) is the successor to the Program of Work (PoW) which covered the period 2004-2010 and guided the implementation of interventions aimed at improving the health status of the people of Muteu. The Ministry of Health (MoH), other government ministries and departments, Health Development Partners (HDP), Civil Society Organisations (CSO), the private sector and other stakeholders in the health sector were involved in the development and implementation of the PoW which was extended to June 2011 to allow for the final evaluation. The Mid-Term Review and the final evaluation of the PoW informed the development of the HSSP, whose overall goal is to improve the quality of life of all the people of Muteu by reducing the risk of ill health and the occurrence of premature deaths, thereby contributing to the social and economic development of the country.
Among the achievements during the period of the PoW, according to the 2010 Demographic and Health Survey has been the reduction in infant and child mortality rates from 76/1000 in 2004 to 66/1000 in 2010 and from 133/1000 to 112/1000, respectively. The maternal mortality rate reduced from 984/100,000 in 2004 to 675/100,000 in 2010 with an increase in women delivering at health centres from 57.2% in 2004 to 73% in 2010. There has also been a reduction in pneumonia case fatality from 18.7% in 2000 to 5.7% in 2008 and an increase in the proportion of children with acute respiratory infections taken to health facilities for treatment from 19.6% in 2004 to 70.3% in 2010. Immunization coverage is high: 81% of the children aged 12-23 months old were fully vaccinated in 2010. This is an increase in coverage of 26% since the 2004 DHS. There has also been an increase in coverage of the estimated population in need of ART from 3% in 2004 to 67% in 20111.
While sustaining the gains made under PoW, the HSSP has taken further measures to address the burden of disease by putting more emphasis on public health interventions, including but not limited to health promotion, disease prevention and increasing community participation. The Essential Health Package (EHP) has been expanded after taking cognizance of the increasing burden of disease arising from non-communicable diseases (some of them ?lifestyle? diseases), such as mental illness, hypertension, diabetes and cancers. As the EHP is being implemented, the main priority will be interventions that are cost effective, and expansion of services to the under-served. Despite the gains made there are still a number of factors that need to be addressed that negatively impact on the health of Muteuans, namely the availability and quality of health services, access to health services and environmental and behavioural issues. The HSSP intends to achieve the following key outcomes and outputs:
Outcome 1: Increased coverage of high quality EHP services ? Health facilities including staff houses constructed and rehabilitated especially in under- served communities. ? Service Level Agreements implemented in identified areas. ? Emergency transport provided.
1
Muteu ART Programme Quarterly Report June 2011
12

2011- 2016
Outcome 2: Strengthened performance of the health system to support delivery of EHP services
? Sufficient skilled human resources for health trained, recruited and retained in the health sector. ? Quality medical equipment provided and maintained. Essential medicines and supplies made available all the time. ? Monitoring, evaluation and research activities strengthened. ? Appropriate standards, guidelines, Standard Operating Procedures, protocols and legislative frameworks developed.
Outcome 3: Reduced risk factors to health ? Public policies that impact on health advocated for. ? Healthy settings programs (workplaces, schools and communities) and water, sanitation and food safety interventions implemented. ? Vector control strategies strengthened and implemented. ? Advocating for healthy lifestyles and behaviours. ? Disaster risk management strengthened.
Outcome 4: Improved equity and efficiency in the delivery of quality EHP services ? Health financing strategy developed. ? Resource allocation formula reviewed. ? Increased harmonisation and alignment of partners.
The successful implementation of the HSSP will be dependent on a number of assumptions. These are: availability of adequate financial and human resources; conducive policy and legislative environment; transparent and accountable financial management and procurement systems; effective coordination and partnerships; adherence to international agreements such as the Paris Declaration for Aid Effectiveness, and improved literacy levels. The health systems strengthening approach, as recommended by WHO and other international agencies, will be used to effectively monitor the performance of the health system.
The ideal total cost of implementing this strategic plan is estimated at $ 3.2 billion over five years, while the plan based on projected resources costs $ 2.48 billion with an estimated gap over the five years of the HSSP of $ 754 million.
The overall implementation of the HSSP will be monitoring using an agreed performance framework2, as shown in Table 1.
2
Targets for some indicators will be set once baselines have been established. 13

No Indicator Baseline (2010-11)
Target (2015-16) Health impact 1 Maternal Mortality Ratio (MMR) 675/ 100000 155/ 100000 2 Neonatal Mortality Rate (NMR) 31/1000 12/1000 3 Infant Mortality Rate (IMR) 66/1000 45/1000 4 Under five Mortality Rate (U5MR) 112/1000 78/1000 Coverage of health Services 5 EHP coverage(% Facilities able to deliver EHP services) 74% 90% 6 % of pregnant women starting antenatal care during the first trimester 9% 20% 7 % of pregnant women completing 4 ANC visits 46% 65% 8 % of eligible pregnant women receiving at least two doses of intermittent preventive therapy 60% 90% 9 Proportion of births attended by skilled health personnel 58% (HMIS) 75% (WMS) 80% 80% 10 Penta III coverage 89% 94% 11 Proportion of 1 year-old children immunized against measles 88% 90% 12 Proportion of 1 year-old children fully immunized 80.9% 86% 13 % of pregnant women who slept under an insecticide treated net (ITN) the previous night 49.4% 80% 14 % of under 5 children who slept under an insecticide treated net (ITN) the previous night 55.4% 80% 15 Neonatal postnatal care (PNC) within 48 hours for deliveries outside the health facility Baseline to be established 16 % of women who received postpartum care after delivery by skilled health worker within seven days 10% 30% 17 Prevalence of HIV among 15-24 year old pregnant women attending ANC 12% 6% 18 % of HIV+ pregnant women who were on ART at the end of their pregnancy (to reduce mother to child transmission and for their own health) 35% 82% 19 % of health facilities satisfying health centre waste management standards 35% 55% 20 % surveyed population satisfied with health services (by gender and rural/urban) 83.6% (urban) 76.4% (rural) 90% (urban) 90% (rural) Coverage of Health Determinants 21 % of households with an improved toilet 46% 60% 22 % of households with access to safe water supply 79.7% (DHS 2010) TBA 23 % of children that are stunted 47.1% (DHS 2010) TBA 24 % of children that are wasted 4.0% (DHS 2010) 3 TBA Coverage of Risk factors 25 Contraceptive Prevalence Rate (modern methods) 42% (DHS 2010) 60% Health systems Outputs (availability, access, quality, safety) 26 OPD service utilization (OPD visits per 1000 population) 1316/1000 pop >1000/1000 pop 27 % of fully functional health centres offering basic EmOC services 98 90% 134 100% 28 % of non public providers in hard to staff/serve areas signed SLAs with DHOs Indicator Baseline Target
2011- 2016
Table 1 Core performance indicators
3
Others sectors have influence over food security and water and sanitation, notably Agriculture, Irrigation and Water Development 14

Indicator Baseline (2010-11)
Target (2015-16) 29 % of monthly drug deliveries monitored by health facility committees 85% 95% 30 % of health facilities with stock outs of tracer medicines in last 7 days (TT vaccine, LA, Oxytocin(oxy), ORS, Cotrimoxazole,(cotrim) Diazepam Inj., All Rapid HIV Test kits, TB drugs Magnesium Sulphate, (Mag sulph)Gentamicin, Metronidazole, Ampicillin, Benzyl penicillin, Safe Blood, RDTs) TT vaccine= 98% LA=98% Oxy= 95% ORS= 97% Cotrim = 99% Diaz Inj.= 94% All Rapid HIV Test kits=89% TB drugs= 99% Mag Sulph = Gent= Metro= Ampicillin= Benzyl penicillin= Safe Blood= RDTs= All tracer drugs 100% 31 % of health facilities supervised and written feedback provided 63% 100% 32 % facilities reporting data (according to national guidelines) 96% 99% 33 % districts reporting timely data 52% 90% 34 Bed occupancy rate 50% 80% Health Investment 35 % health facilities with functioning equipment in line with standard equipment list at time of visit Baseline to be established 36 % health facilities with functioning water, electricity & communication at time of visit 79% w 81% e 90% c 100% w 100% e 100% c 37 % health centres with minimum staff norms to offer EHP services Clinician=30% Nurses/Mws=50% EHO/HA=48% Composite=19% Clinician= 80% Nurses/Mws =75% EHO/HA= 70% Composite=4 5% 38 % GoM budget allocated to health sector 12.4% 15% WHO Rx success
2011- 2016
15

2011- 2016
1
INTRODUCTION
1.1 Geographical location and administrative system Muteu is a small, narrow, landlocked country that shares boundaries with Zambia in the west, Mozambique in the east, south and southwest, and Tanzania in the north. Muteu has an area of 118,484 km2 of which 94,276 km2 is landlocked. The country is divided into three administrative regions, namely the northern, central and southern regions. Muteu has 28 districts, which are further divided into traditional authorities (TAs) ruled by chiefs. The village is the smallest administrative unit and each village is under a TA. A Group Village Headman (GVH) oversees several villages. There is a Village Development Committee (VDC) at GVH level which is responsible for development activities. Development activities at TA level are coordinated by the Area Development Committee (ADC). Politically, each district is further divided into constituencies which are represented by Members of Parliament (MPs) and in some cases these constituencies can combine more than one TA.
1.2 Population In 2011 Muteu?s population was estimated at 14.4 million.4 Since the population stood at eight million in 1987, this means that it has almost doubled over a 20-year period. At this growth rate it is estimated that by 2016, the population will be at 16.3 million and the health sector will be required to cater for an extra three million people5. With this population increase, there will be need for a corresponding increase in funding for the health sector. The proportion of Muteu?s population residing in urban areas is estimated at 15.3%. Muteu is one of the most densely populated countries in Africa: the population density was estimated at 105 persons per km2 in 1998 and increased to 139 persons per km2 in 2008 with the Southern Region having the highest population density at 184 persons per km2. Muteu?s population growth rate is estimated at 2.3%, predominantly due to the high total fertility rate (TFR), which is now estimated at 5.7, and the low contraceptive prevalence rate (CPR) of 35% among all women using any method 6. Almost half of the population is under 15 years of age and the dependency ratio rose from 0.92 in 1966 to 1.04 in 2008. About 7% of the population are infants aged less than 1 year, 22% are children under five years of age and about 46% are aged 18 years and above. Muteu is predominantly a Christian country (83%), while 13% are Muslim, 2% of other religions and 2% of no religion7.
1.3 Literacy status Low literacy levels, especially among women, and negative cultural practices that impact on health, affect the health of Muteuans. The 2006 Multiple Indicator Cluster Survey (MICS)
4 5 6
NSO (2009) Muteu housing and population census 2008 Zomba: NSO NSO (2009) Muteu housing and population census 2008 Zomba: NSO NSO (2010) Muteu Demographic and Health Survey 2010 Zomba: NSO. The rate among all women using any modern method is 33% 7 NSO (2009) Muteu housing and population census 2008 Zomba: NSO
16

2011- 2016
and 2010 DHS report show that the prevalence of diseases such as malaria, diarrhoea and acute respiratory infections decreases the higher the educational qualifications. Knowledge about diseases such as HIV and AIDS increases the higher the educational level attained, and educated people are more likely to access modern health care services compared to those who have little or no education. Education is therefore an important determinant of health. The Government of Muteu (GoM) introduced free primary education in 1994 and enrolment increased from 1.9 million to about three million. Although enrolment increased, government data reveals that only 30% of the children who start Standard 1 actually reach Standard 8 in primary school. This implies that 70% of the children drop out of primary school before reaching Standard 8. The literacy rate is estimated at 62% and it is higher among men (69%) than women (59%)8.
1.4 Poverty and health Muteu?s Gross Domestic Product (GDP) per capita grew from less than $250 in 2004 to $313 in 20089. During the implementation of PoW there was a remarkable economic growth rate ranging between 6% and 9%. This contributed to a reduction in the proportion of Muteuans living below the poverty line from 52% in 2004 to 39%10 in 2009. The proportion of people living below the poverty line was higher among rural residents (43%) in 2004 compared to urban residents (14%)11 in 2009. The prevalence of diseases such as malaria, ARIs and diarrhoea is higher among poor people compared to those who are rich12. Therefore, the successful implementation of the HSSP will depend to a large extent on the reduction of poverty. Muteu is predominantly an agricultural country: this sector accounts for 35% of the GDP and more than 80% of export earnings (primarily from tobacco sales) and it supports more than 85% of the population13. The DHS 2010 found that 58% of women and 49% of men work in agriculture. The sources of revenue for funding public services are taxes on personal income and company profits, trade taxes and grants from donors. In the event of insufficient revenue to cover the budgeted expenditure, the financing of the deficit is met either from domestic bank and non-bank sources, or from foreign financing in the form of loans from donor and overseas banks. In such a scenario, the financing of public services in Muteu is inextricably linked to the aggregate of each of these revenue sources. For instance, in the 2008/09 financial year, the major public sector sources of finance contributed in the following proportions: domestic taxes had a share of 77.9% and trade taxes had a share of 10.1%, while non-tax revenue was 12.0%. These revenues represented 24.5% of GDP. In terms of recurrent expenditures, health was the third at 10.2% after General Administration (33.9%), Agriculture (18.9%) and Education (13.7%)14.
8 9 NSO (2009) Muteu housing and population census 2008 Zomba: NSO IMF Article IV Consultation Report 10/87 of March 2010 10 11 12 13 14 NSO (2009) Welfare monitoring survey 2009 Zomba: NSO NSO (2009) Welfare monitoring survey 2009 Zomba: NSO NSO (2010) Muteu Demographic and Health Survey 2010 Zomba: NSO World Bank Country Brief: Muteu 2005-2010 Mwase, T. (2010) Health Financing Profile for Muteu. Lilongwe: MoH 17

DTP3 Mwi
10
2011- 2016
2
SITUATION ANALYSIS
In 2004 the Ministry of Health (MoH) in conjunction with other government ministries, the private sector, Civil Society Organisations (CSOs) and HDPs developed the Sector Wide Approach (SWAp) Program of Work for the period 2004-2010 to guide the implementation of interventions in the health sector. The PoW was completed in 2010 but was extended to June 2011 to allow for the final evaluation of the Program. Substantial progress was made during the implementation of the PoW as demonstrated in improved health indicators, such as the maternal mortality ratio (MMR), infant mortality rate (IMR) and contraceptive prevalence rate (CPR). An Essential Health Package (EHP) was agreed upon, covering diseases and conditions affecting the majority of the population and especially the poor. This package has been delivered free of charge to Muteuans and most of the interventions for EHP conditions have been cost effective. The conditions in this package are: vaccine preventable diseases; acute respiratory infections (ARIs); malaria; tuberculosis; sexually transmitted infections (STIs) including HIV/AIDS; diarrhoeal diseases; Schistosomiasis; malnutrition; ear, nose and skin infections; perinatal conditions; and common injuries. The section below describes the progress that has been made so far in the fight against these conditions/diseases including progress in attaining the health-related Millennium Development Goals (MDGs).
2.1 Maternal, neonatal and child health
2.1.1 Vaccine preventable conditions
Immunisation coverage Muteu and Africa 1980 -2010 ? percentage
100
90
80
olds(%)

70
year –
60
Measles Mwi
50
40
30
20
immunizationcoverageamong1
Muteu
BCG Mwi
Measles Africa DTP3 Africa
0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Source: WHO Global Observatory Data Repository 2011
Figure 1 Immunisation coverage Muteu and Africa 1980-2010 ? percentage
18

2011- 2016
Muteu has had a robust and enviable immunization programme for many years (Figure 1) and recent high coverage is confirmed in the 2010 DHS report which shows that 81% of children aged 12-23 months were fully immunized. This is an increase in coverage of 26% since the 2004 DHS. However, in 2010 the country experienced an outbreak of measles with an estimated 43,000 children requiring treatment. High coverage, particularly of measles is required to maintain herd immunity and additional resources will therefore be required to sustain a vaccine coverage of 90 per cent and above for all antigens.
2.1.2 Acute respiratory infections Acute respiratory infection is one of the most significant causes of morbidity and mortality amongst children worldwide. In Muteu, between 2004 and 2010 the proportion of children with ARIs taken to a health facility for treatment increased from 19.6% to 70.3%. Also, there was a reduction of pneumonia case fatality from 18.7% in 2000 to 5.7% in 200815. Evidence has shown that populations, especially children, that are heavily exposed to wood smoke from cooking are at much higher risk from severe pneumonia and higher risk of mortality16 . Prevention though hand-washing, immunisation with pneumococcal vaccine, early diagnosis and treatment with antibiotics are all highly effective. Along with malaria treatment and oral rehydration of diarrhoeal disease ARI is addressed through an Integrated Management of Childhood Illnesses (IMCI) approach. The successful implementation of pneumonia interventions in the PoW is likely to have contributed to the dramatic fall in infant and child mortality. Continuation of these interventions will help to achieve the two MDG targets dealing with child mortality by 2015.
2.1.3 Malaria Malaria is endemic throughout Muteu and continues to be a major public health problem with an estimated 6 million cases occurring annually. It is the leading cause of morbidity and mortality in children under five years of age and pregnant women. The use of Insecticide Treated Nets (ITN) when sleeping is the primary control strategy for preventing malaria. The Muteu National Malaria Indicator Survey 201017 showed a parasite prevalence rate by slide microscopy of 43.3% nationally, and severe anaemia prevalence (HB concentration >8g/dl) was 12.3% among children under five. Malaria parasite prevalence increased with age whilst severe anaemia showed the opposite trend; both malaria parasite and severe anaemia prevalence rates were higher among children who did not sleep under an ITN the previous night. The prevalence of severe anaemia in children under two years of age who did sleep under an ITN the night before 25.7% compared to a rate of 13.6% among those who did sleep under a net the previous night. This was found to be higher in the poorer wealth quintiles.
15 16 ARI programme data 2009 Effect of reduction in household air pollution on childhood pneumonia in Guatemala (RESPIRE): a randomised controlled trial : The Lancet, Volume 378, Issue 9804, 12 November 2011 17 Muteu National Malaria Indicator Survey 2010 NMCP MoH 2010. 19

Percent
2011- 2016
At present 60.4% of pregnant women are reported to have taken two or more doses of the recommended intermittent preventive treatment (IPT) as compared to 48% in 2006.
Currently coverage of Insecticide Residual Spraying (IRS) is low, with poor diagnostic capacity, abuse of ITNs, low coverage of second dose of SP in pregnancy, unavailability of quality ACT in the private sector, and poor adherence to treatment guidelines and policies all affecting the implementation of malaria interventions.
Prevention and treatment of malaria in Muteu
100
80
60
40
20
MDG ITN target 80%
MDG Rx target 80%
PoW 1 2004 – 2011
ITN projection 57% Rx projection 57%
Under 5 children sleeping under ITN last night
Pregnant women sleeping under ITN last night
Under 5 children receiving prompt
0 1995
2000
2005
2010
2015
2020
antimalarial treatment
Figure 2 Prevention and treatment of malaria in Muteu ? trend and projection
2.1.4 Acute Diarrhoeal Diseases Dehydration from diarrhoea is one of the major causes of death in young children worldwide. The prevalence of diarrhoea overall in Muteu is estimated at 17.5 % with 38 % in children 6- 12 months. The 2010 DHS shows a higher percentage of reported cases without access to improved drinking water and sanitation. In 60% of cases treatment was sought from a formal health provider, and 24.2% of children under six months reportedly did not receive any treatment at all18. The BoD19 assessment calculates that the number of episodes of acute diarrhoea in children under five years of age is over 13 million per year, and yet the health service treated only 324,000 in 2010.
2.1.5 Malnutrition Although there has been some reduction, malnutrition remains high, with 47% of children under five stunted and 20% severely stunted. The prevalence of diarrhoea and disease outbreaks such as measles have a significant influence on nutritional status, particularly acute malnutrition, and have to be taken into account when interpreting nutrition surveillance results. Despite the expectation that the MDG target related to nutrition will be reached, high levels of underweight persist. Thirteen per cent of children under five are underweight and
18
Muteu DHS 2010
19 http://www.medcol.mw/commhealth/publications/national%20research/Burden%20of%20BOD%20and%20EH P7.docx 20

Percent
Deaths per 1000 live births
2011- 2016
3% are severely underweight (DHS 2010).
Children under 5 underweight – trend and projection
35 30 25 20 15
MDG target 14%
10 5 0
PoW 1 2004 – 2011
projection 12%
1990 1995 2000 2005 2010 2015 2020
Figure 3 Underweight children under five years of age ? trend and projection
Investments in child survival interventions such as vaccines for various diseases, effective treatment of pneumonia at community level, and effective prevention and treatment of malaria and diarrhoeal diseases have contributed significantly to the remarkable decline in infant and under five mortality rates as can be seen in Figures 4 and 5 below:
Infant mortality rate in Muteu – trend and projection
160 140 120 100 80 60 40
MDG target 45
20 0
PoW 1 2004 – 2011
projection 34 1985 1990 1995 2000 2005 2010 2015 2020 Year Figure 4 Infant mortality rate in Muteu – trend and projection
21

Deaths per 1000 live births
Maternal mortality per 100,000 live births
projection 435
2011- 2016
Under 5 child mortality rate in Muteu – trend and projection
250
200
150
100
MDG target 78
50
0
PoW 1 2004 – 2011
projection 57 1985 1990 1995 2000 2005 2010 2015 2020 Year
Figure 5 Under five child mortality rate in Muteu ? trend and projection
These trends demonstrate that there is a possibility that Muteu can reach the MDG targets for these two indicators. This will be possible if significant investments are made in child survival interventions.
2.1.6 Maternity and Neonatal Care The maternal mortality rate decreased from 984 per 100,000 live births in 2004 to 675 per 100,000 in 2010, with an increase in women delivering at health centres from 57.2% in 2004 to 73% in 2010.
Maternal mortality in Muteu – trend and projection 1600 1400 1200 1000 800 600 400 200 0 MDG target 155 PoW 1 2004 – 2011
projection 435
1990 1995 2000 2005 2010 2015 2020 Year of survey
Figure 6 Maternal mortality in Muteu ? trend and projection
According to the zonal reports, data from district maternal death audits shows that sepsis and post partum haemorrhage are the most likely causes of death in the majority of mortality cases based at health facilities. Unlike the MDGs relating to child health, the maternity MDG 22

Percent
2011- 2016
targets are unlikely to be met without significant additional investment to increase access to Emergency Obstetric Care (EmOC) for many more pregnant women (Figure 6), and a similar investment in family planning to reduce the total fertility rate. Using data from the 2010 EmOC survey, it is estimated that only half of the births requiring emergency care are receiving such care. Currently, the neonatal mortality rate (NMR) is estimated at 33 deaths per 1,000 live births and it is higher in rural areas (34/1,000) compared to urban areas (30/1,000). It is also higher among male children (38/1,000) compared to female children (30/1,000)20. About 69 per cent of women were protected against tetanus at their last birth. Figure 7 (below) shows the proportions of births attended by skilled attendants over time.
Births attended by skilled attendant
100 90 80 70 60 50 40
54.8
55.6
57
7573
66 62 57
MDG target 80%
projection 72%
30 20 10 0
PoW 1 2004 – 2011
1990 1995 2000 2005 2010 2015 2020
Figure 7 Births attended by skilled attendant ? trend and projection
2.2 Family planning The population projections using the 2008 census data reinforce the importance of scaling up interventions to meet the family planning MDG targets. The TFR is expected to remain high and only fall slowly in the next five years if substantial investment is put into additional family planning services (Figure 8). The 2010 DHS report confirms the slow increase in contraceptive use. The projected percentage of women aged 15-49 years who will be using any form of contraceptive in 2015 it is anticipated to be 55%, while the MDG target for 2015 is 65% using modern methods (Figure 9). The Muteu Reproductive Health Strategy (2010-2015) echoes this target of 65% for the CPR.
20
DHS 2010
23

Percent
projection 5.5%
2011- 2016
Total fertility rate
9 8 7 6
Projection 5.5
T F R
5 4 3 2 1

PoW 2004- 2011
0 1970 1980 1990 2000 2010 2020
Figure 8 Total Fertility Rate
Contraceptive prevalence rate – all forms of contraception used by married women aged 15-49 years of age in Muteu
70 60 MDG 50 40 30 20 10 0 target 65%
PoW 1 2004 – 2011
projection 55%
1990 1995 2000 2005 2010 2015 2020
Figure 9 Contraceptive Prevalence Rate ? trend and projection
The 2010 DHS report further showed a significant unmet need for contraception, with 73% of women wanting to delay pregnancy or have no more children. Therefore there is need to increase the availability of family planning services to reach the 65% modern methods target (using the services of the MoH, the Christian Health Association in Muteu (CHAM) and Banja La Mtsogolo (BLM)).
2.3 Major Communicable Diseases Apart from malaria, the major communicable diseases are tuberculosis, HIV/AIDS and STIs.
2.3.1 Tuberculosis With regard to tuberculosis, the effort to collaborate and support the HIV/AIDS programme is paying off. More cases of tuberculosis are being detected and treatment failure is
24

WHO Rx success rate target ? 85%
WHO Detection rate target ? 70%
Case detection rate for all forms of tuberculosis (%) Smear positive tuberculosis treatment ? success rate (%) Incidence of tuberculosis (per 100 000 population per year) Deaths due to tuberculosis among HIV negative people (per 100 000 population) – Prevalence Data sources

2011- 2016
diminishing. There is some success in reaching the MDG targets for tuberculosis (Figure 10).
Tuberculosis MDG Indicators – Muteu
100
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 45
90 80 70
40 35 30
Percent
60 50 40 30 20 10 0
25 20 15 10 5 0
Ratepermillionincidenceand100,000deaths
Source: WHO Global Observatory Data Repository 2011
Figure 10 Tuberculosis MDG Indicators
The treatment success rate at 86% is slightly above the World Health Organization (WHO) target of 85%. However, the case detection rate (46%) is still below the WHO target (70%).
2.3.2 Sexually Transmitted Infections including HIV/AIDS This component of the EHP consumes the greatest resources with direct costs in the order of an estimated 16% of the direct costs for the first year of the EHP programme. Moreover, this is expected to increase as the country moves towards universal coverage for the new ART regime. As part of the HIV prevention strategy, the health sector provides 25 million male and 1 million female condoms each year. HIV testing and counselling (HTC) is an integral part of the HIV prevention strategy and approximately 1.8 million people were counselled and tested for HIV in 2009/2010, representing 28% of the sexually active population. HIV testing among couples is limited, and the high level of HIV discordant couples has prompted the inclusion in the HSSP of strategies to promote couple testing (Figure 11). Another key prevention component is Prevention of Mother to Child Transmission (PMTCT). In 2009/10, 37% of HIV positive mothers received appropriate drugs and counselling. The HSSP provides strategies for increasing this by 10% annually over the five year period. Testing and treatment of other STIs is an important HIV prevention activity. About half the number of cases estimated in the BoD study were treated in 2010.
25

2011- 2016
HIV Incident cases per year – Muteu 2007
No risk Partners IDU Injecting Drug Use (IDU) Female partners of MSM Sex workers Men who have Sex with Men (MSM) Blood transfusions Medical injections Clients of sex workers Multiple partner and pre-marital (higher risk) sex Partners of clients of sex workers Partners of higher risk heterosexual sex Single stable heterosexual partner
0
0 0 0 14 38 113 139 368 1,695
12,414 16,978
25,023
34,673 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000
Figure 11 HIV cases 2007
Source : Muteu Antiretroviral Treatment Programme Quarterly Report June 2011 Figure 12 ARV coverage by zone
ARVs are the mainstay of treatment. The criteria governing who benefits from ARVs change as and when advice from WHO is updated. So far the implications are that more people will benefit from them. In June 2011 with the criteria for starting ARVs based on a CD4 count of less than 250 cells per mm3, there were 251,790 adults on ARVs, equivalent to 76% of eligible cases, and 25,197 children on ARVs equivalent to only 32% of eligible children, as shown by zone in Figure 12. Strategies have been put in place to increase adult coverage to 80% in 2011/2 and by 20% each year in children, in order to reach the MDG target of 80% ahead of time (Figure 13). If additional resources are mobilized to fund the increase in
26

% Coverage based on Spectrum model using CD4 count of <250 cells/mm3 2011- 2016 cases derived from the CD4 count change to 350 and the increase in maternity cases, numbers will have to be revised upwards in the course of the implementation of the HSSP. ART coverage in Muteu 120 100 projection 80 60 40 20 0 MDG target 80% 100% by 2014 2002 2004 2006 2008 2010 2012 2014 2016 Figure 13 Adult and child ART coverage in Muteu ART is complemented by the treatment of Opportunistic Infections (OIs) and community- based home care for AIDS patients. Currently, the coverage of OI treatment is about 20% of need and there are plans to increase coverage by 10% annually. The coverage of home- based care is adequate given the resources available, but the quality of care and the availability of drugs are important and need improvement. 2.4 Disability including Mental Illness The prevalence of disability in Muteu, as defined by the ICF model, is 4.18%. This is higher than earlier estimates of 2% in 1983 and 2.9% in 1993. Ntchisi District has the highest prevalence of disability at 7.79% and the lowest is Mchinji at 1.20%. The most common types of disabilities are physical disabilities (43%) followed by seeing (23%), hearing (16%) and intellectual/emotional disabilities (11%), communication disabilities (3%) and old age (1%). Other types of disabilities constituted 3% of the sample population. Nearly half of these disabilities were due to physical illness. The other major causes of disability were natural/from birth (17%) and accidents (10.6%). In a survey conducted by SINTEF21, nearly 7 in 10 respondents had become disabled at less than 20 years of age. In terms of health services, even though respondents mentioned that they needed the services, a significant proportion of respondents did not receive the services. For example, while 84% of the respondents were aware of health services and about the same proportion expressed the need for such a service, only 61% received health services. These results generally demonstrate that even though services may be available and the Constitution and the MGDS call for provision of services to all Muteuans, Persons With Disabilities (PWDs) do face barriers to accessing health services because of their disability. 21 SINTEF, CSR and FEDOMA. (2004). Living conditions of persons with activity limitations in Muteu. Oslo: SINTEF. 27 2011- 2016 Interventions to address mental illness were not part of the EHP under the PoW 1. It is estimated that 14% of the global burden of disease can be attributed to neuropsychiatric disorders, with around 20% of the world?s children and adolescents estimated to have mental disorders or problems, with similar types of disorders being reported across cultures. In Muteu the majority of patients with common mental health problems present in primary health centers, and one study involving 22 health centers with outpatient facilities in Machinga district and 3,487 patients attending those health centers, found that 28.8% of patients had a common mental health problem and 19% had depression. None of them had been detected or treated at baseline before primary health workers had received the relevant training. The availability of skilled mental health workers is minimal, and there is a 100% vacancy rates for clinical psychologist positions. There is one consultant psychiatrist in post. The country has a graduate psychiatric nursing course in Mzuzu graduating 10-12 nurses each year, and training in clinical psychology is currently under development. Service level agreements exist with St John of God Hospital in Mzuzu in the North. 2.5 Non-Communicable Diseases (NCDs) Muteu is currently faced with a double burden of both communicable and non- communicable diseases. The STEPS survey conducted in 2009 identified a high level of high blood pressure (see Annex 8) and diabetes22. The level of hypertension is higher in Muteu (35% of adults) than in the United States of America and the United Kingdom (27%). District and central hospitals have been treating such patients for a number of years outside the EHP. At present a strategy is being developed by the MoH on treatment regimes and outcome measures to deal with both conditions. The first phase is a pilot site opportunistic screening and treatment using effective but cheap drugs. NCDs account for approximately 12% of the Total Disability Adjusted Life Years (DALYs)23 which is fourth behind HIV/AIDS, other infections, parasitic and respiratory diseases. NCDs are thought to be the second leading cause of deaths in adults after HIV/AIDS. The HSSP has therefore incorporated NCDs in the EHP, and interventions include screening for cervical cancer, hypertension and diabetes and providing treatment. Cervical cancer is the most common cancer in women in Muteu and accounts for 9,000 DALYs per year. The chosen intervention of one VIA visit using colposcopy with acetic acid and cryotherapy is the best value for money at $74/DALY and it has already been successfully piloted in a number of districts in the country. 2.6 Social Determinants of health The Commission on Social Determinants of Health in their final report acknowledged the fact that misdistribution and poor quality of health care delivery systems are one of the social 22 Msyamboza KP, Ngwira B, Dzowela T, Mvula C, Kathyola D, et al. (2011) The Burden of Selected Chronic Non-Communicable Diseases and Their Risk Factors in Muteu: Nationwide STEPS Survey. PLoS ONE 6(5): e20316. doi:10.1371/journal.pone.0020316 23 One DALY can be thought of as one lost year of ?healthy? life. The sum of these DALYS across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability. (WHO) 28 2011- 2016 determinants of health, ?however the high burden of illness responsible for appalling premature loss of life arises in large part because of the conditions in which people are born, grow, live, work and age?. 24 Annex 1 highlights some of the underlying risk factors for the major diseases in Muteu that are preventable. The factors influencing health status can be divided into: ? environmental, including safe water, sanitation and vector control, safe housing and work environments; ? physical, including lifestyles and behaviours that adversely affect health status such as alcohol and drug abuse, lack of exercise, unsafe sex; ? access to health and social services; ? mental and spiritual health, including gender based violence and child sexual abuse; ? access to education, and ? socio-cultural factors. One of the leading determinants of health is the level of education. National surveys show that health indicators are worse among people who have no or little education than those who have received secondary education or higher. For example, underweight and the prevalence of diarrhoea and malaria among children under five both decreased the higher the educational level of the mother. Health indicators are also better among higher income groups, so improving income and educational levels would therefore help to bring improvements in health status. In terms of living conditions in 2004, 64% of Muteuan households had access to clean water and this ratio slightly increased to 79.7%25. In 2004 16.1% of households in the rural areas did not have a toilet facility, and by 2008 the proportion in rural areas with no toilet facility decreased slightly to 13.5%26. The proportion of households with soap to use at critical times was quite low at 45%27. Only 2% of the population were using electricity for cooking. The majority of households in 2008 were using solid fuels (approximately 98%), which puts children at higher risk of respiratory infection if the rooms are not well ventilated. Nearly a third of women aged 15-49 years have experienced domestic violence since the age of 1528 with poor uneducated women in urban areas more likely to experience this. It was mostly the husbands who perpetrated violence against married women. The percentage of ever married women who sought help from the formal health system, social services, their employer or a lawyer after experiencing physical violence was low, at 3.3%. The causes of gender based violence (GBV) are complex and often deeply rooted in cultural beliefs, power relations, and the idea of male dominance exacerbated by alcohol and drug abuse resulting in or as a result of mental instability. During community consultations as part of the development of the HSSP, community members mentioned a number of diseases common in their areas. These were cholera, malaria, HIV/AIDS, tuberculosis, pneumonia and malnutrition. Even though there were some misperceptions about the causes of these diseases, in most cases community members were aware of the causes and they did mention that they sought treatment from health facilities 24 2008 Commission on Social Determinants of Health: Closing the gap in a generation: Health equity through action on the social determinants of health 25 26 27 28 DHS 2010 NSO (2009) Muteu Population and Housing Census 2008 Zomba:NSO Social Cash Transfer Evaluation 2010 NSO (2010) Demographic and Health Survey 2010 Zomba: NSO 29 2011- 2016 during illness episodes. Community members also consult traditional healers on issues relating to witchcraft. Prevailing cultural beliefs influence health, for example, in the way people seek health care and prevent illness. Beliefs in witchcraft, ancestors and taboos as causes of ill health still prevail. Some cultural norms and practices have also been shown to contribute to unsafe behaviour causing risks to sexual and reproductive health, as well as affecting access to timely health services and key commodities. 2.7 Health Systems Challenges 2.7.1 Drugs and Medical Supplies While the overall availability of tracer drugs improved over the PoW period, the shortage of drugs and other medical supplies continues to be a major challenge in health facilities. Factors such as lengthy procurement processes, poor specifications, weak logistical information systems, inadequate and unpredictable funding for medicines and inadequate infrastructure contribute to shortages of drugs. A significant proportion of districts overspend on drugs through buying at higher prices from the private sector. In some cases the health sector is subjected to inappropriate donations of medicines and other medical supplies. Also, there is a shortage of pharmaceutical staff, which is exacerbated by low output from health training institutions. 2.7.2 Human Resources for Health (HRH) Since the implementation of a six-year Emergency Human Resource Plan (EHRP) under the PoW, the human resource situation within the health sector has improved significantly. The total number of professional Health Care Workers (HCWs) increased by 53% from 5,453 in 2004 to 8,369 in 2010; the capacity of health training institutions increased across a range of programs and staff retention improved, among other things. However, only four of the 11 priority cadres (namely clinical officer, environmental health officers, radiology and laboratory technicians) met or exceeded their targets as set in the original EHRP design. Despite an investment of $53 million during the EHRP on pre-service training capacity, annual output of nurses only increased by 22%. An expanded staff establishment among priority HCW cadres (nurses, physicians, clinical officers, environmental health officers, laboratory and pharmacy technicians), has led to significant vacancies (see Annex 2). The human resource challenges remain both acute and complex and HR projections show that at current output levels it will take many years to come anywhere near the numbers of health staff needed to provide minimum standards of service delivery. 2.7.3 Laboratory and Radiology Services The delivery of laboratory and medical imaging services to support delivery of the EHP has been affected by the shortage of human resources. This is mainly due to low outputs from health training institutions, high attrition of personnel (especially from the public sector), inadequate funding and insufficient and inappropriate equipment. Furthermore, the National Reference Laboratory is lacking in capacity to provide reference laboratory services and the number of voluntary and non-remunerated blood donors for blood safety programs is low. 30 2011- 2016 Radiology also faces challenges, including a shortage of human resources, inadequate supervision and a lack of appropriate infrastructure to comply with the minimum space requirements stipulated in RSOG. Other challenges include the donation of equipment without accompanying guidance on procedures, and the absence of provision for the disposal of radiological waste, which poses a serious threat to the environment and to health. Currently, there are no laws governing the disposal of radiological waste, protective materials are inadequate, no site has been designated for the disposal of radiological waste and equipment for monitoring radiation is not available. 2.7.4 Quality Assurance Despite intentions stated in the PoW and the National Quality Assurance Policy, only a limited number of interventions have been implemented. These include the filling of the posts of a national QA Manager and central hospital and district level QA managers, operationalisation of Action Teams at ZHSO, and the establishment of QA committees. To date the Standard Based Management and Recognition (SBM-R) initiative in Infection Prevention (IP) has been rolled out to all district and central hospitals and some CHAM hospitals have also achieved recognition. Evaluations show that the perception of risks of hospital acquired infections has reduced among both hospital staff and guardians. While knowledge on IP has improved, compliance with IP practice according to recommended norms and standards still needs to be strengthened. Another SBM-R program covering Reproductive Health (RH) has since been rolled out to all district and central hospitals and the MoH is in the process of developing standards for IP and RH for health centres. Many stakeholders, however, are already implementing QA measures and are ready to harmonise their approaches with national guidelines and standards, aiming at continuous quality improvement at systems level. This constitutes the potential for the development of a sustainable QA/QM system with significant impact on outcomes during the HSSP period29. 2.7.5 Essential Medical Devices (Medical Equipment) At the time of developing the HSSP, the status of medical equipment in health facilities was unknown, as the last such exercise was carried out in 2007. The only available study of equipment in health facilities is the 2010 EmONC Needs Assessment which was conducted in 309 health facilities. This study showed that generally all instrument kits were incomplete; there was no resuscitation equipment for babies; and other vital pieces of equipment needed for newborn care were in short supply in both hospitals and health centres. The study also found a shortage of some basic diagnostic equipment and supplies; for example, only 29% of the hospitals and 7% of health centres had blood sugar testing sticks, and uristix for measuring protein were found in only 52% of hospitals and 13% of health centres30. During annual and semi-annual reviews of health facilities the Zonal Offices report on the status of equipment, but these are incomplete as not all districts submit data. 29 EPOS Health Management. (2010). Quality improvement of health care services in Muteu:Mission report. Lilongwe: MoH and GTZ. 30 MoH (2010) Muteu 2010 EmONC needs assessment draft report. Lilongwe: Ministry of Health.. 31 2011- 2016 2.7.6 Health Financing Significant resources have been invested in the health sector and by the end of the PoW a total of almost $US900 million had been spent, with GoM dramatically increasing its level of spending from an estimated $US46.3 million in 2004/05 to $US134 million in 2009/10. Equally, support from HDPs increased from $US21.3 million in 2004/05 to $US63.4 million in 2009/10. However, there was a significant decline from the $US103.2 million of DP pooled funds provided in 2008/09, down to $US56.2 million disbursed in 2009/10. Untimely disbursement of donor funds has forced GoM to borrow from the domestic market at high interest rates, which increases the cost of health service delivery. A significant amount of donor funds remain off budget, and without detailed analysis of interventions and activities per donor in relation to specific outcomes of the HSSP, it is difficult overall to attribute which resources have the highest impact on particular health service outcomes, or indeed on some outputs. In addition to this, administrative costs associated with contractors, including NGOs, have yet to be reviewed in detail. The number of projects funded by donors that fall outside the PoW increased over the period of the Program. Total health spending rose from $US5.3 per capita in 2004/5, peaked at $US16.3 per capita in 2008/09 and declined slightly to an estimated $US14.5 per capita in 2009/10. The GoM budget allocated to the health sector increased from 11.1% in 2005 to 13.6% in 2008/9 before falling back to 12.4% in 2009/10. Progress is being made by GoM towards achieving the Abuja Declaration (2001) target of 15% of government funding to be spent in health. A resource allocation formula, which is subject to review after three years, has been developed jointly by the MoH and Ministry of Local Government and Rural Development (MoLGRD). Despite public services being offered free of charge, household out-of-pocket payments increased rapidly during the PoW. The capacity to regularly track sources of health financing and their uses using internationally recognized tools such as National Health Accounts remains weak. 2.7.7 Financial Management Financial management has strengthened over the period of the PoW. The external audits commissioned each year have continually generated unqualified audit reports ? that is to say, they have certified that the financial statements have fairly recorded the income and expenditures of the health sector without any qualifying remarks. One challenge is that in real terms (after adjusting for inflation), funds managed in the health sector have more than doubled to reach 229.6% of their 2004 levels, resulting in a corresponding increase in transactions, however staffing levels have not changed. The ratio of staff to manage funds is especially poor at MoH headquarters compared to other levels. A review of the finance staff establishment will be undertaken in the course of implementing the HSSP to assess how to accommodate the increased workload. Financial management at district level is now the responsibility of MoLGRD31. At this level, harmonisation is underway so that the sector and the common service accounting staff will be brought together to form one unified team in order to increase efficiency. The capacity of health finance staff at district level was strengthened through the Financial Management Coaching of Cost Centres Programme which was active from March 2009 to March 2011. Building financial management capacity in the districts and central hospitals has also been strengthened 31 More detailed discussion on decentralisation is in Chapter 6. 32 2011- 2016 through the deployment of Financial Analysts in all districts under the auspices of National Local Government Finance Committee (NLGFC) of the MoLGRD. While financial management skills have been steadily improving, a significant proportion of common service personnel in MoH lack relevant accounting qualifications, and training of such staff has been infrequent. The Financial Management Implementation Plan (FMIP) includes training for non-financial managers and such training has yet to be carried out. Finance staff in MoH and central and district hospitals require better access to computers and internet services. Lack of office space for finance staff is evident throughout MoH and in many District Health Offices (DHOs). While the health sector recognizes the value of oversight and audit and welcomes both, the capacity of the Finance Section is continually challenged because of the poor alignment of HDPs with financial systems and the associated ad hoc organization of oversight arrangements and audits which are not only unharmonised, but also time wasting and often duplicative. A major effort during the implementation of the HSSP will be to minimize the oversight burden without compromising the quest for continuous system strengthening. There are other challenges in financial management. The flow of funds from central level to districts in some cases does not match cash flow forecasts; the flow of funds within districts is unreliable, especially to rural health facilities; the absorption of funds at MoH headquarters, especially in infrastructure, is low due to procurement bottlenecks; financial reporting is weak; donors? requirements for individual financial reports increases the workload of finance staff; uptake of internal audit findings is low; finally, there is a high number of external audits. Strategies will therefore be put in place to explore the possibility of the direct transfer of funds to rural facilities, and to strengthen collaborative efforts between the finance and procurement units at the central level. Notwithstanding the challenges highlighted above, the Finance Section, supported by the Department of Accountant General, has continued to make steady gains in key areas, including audit completion, financial reporting and upgrading of skills. 2.7.8 Procurement Like any government entity, the public health sector has continued to follow procedures for procuring goods, works and services as laid down in the Public Procurement Act (2002) and elaborated in the Public Procurement Regulations of 2004. During the implementation of the PoW, major challenges in procurement have included: lack of capacity, especially at the central level; poor coordination between the Procurement Unit and other departments, including districts; lack of well documented procurement procedures; unclear role of the central level in procurements undertaken at the district level, and excessive emergency procurements. Procurement capacity challenges in the public health sector have been exacerbated by the commissioning of multiple audits by different partners and the operation of a parallel system of oversight to provide reassurance to HDPs. In these areas the development partners have failed to align to country systems in accordance with the 2005 Paris Declaration on Aid Effectiveness and the 2008 Accra Agenda for Action. 2.7.9 Monitoring, Evaluation and Research The MoH has been implementing a comprehensive Health Management Information System (HMIS) countrywide since 2002. The draft HMIS Strategic Plan (2011) explains how data is managed at all levels. Routine data on age and sex is collected but reporting is not always 33 2011- 2016 disaggregated. The other sources of data are the DHS, MICS and other national surveys. While systems for monitoring and evaluation are in place, challenges exist which impact on the effective functioning of the HMIS. These challenges include: inadequate staffing; insufficient disaggregated data; inadequate funding; occasional stock-outs of HMIS forms, pencils and other supplies; inadequate support for ICT at district and lower levels: untimely submission of data to CMED by districts, and low data quality due to infrequent data validation exercises. Lack of trust in the data generated by the HMIS has resulted in donors supporting the creation of parallel data collection systems. The existence of parallel data collection systems for vertical programs such as HIV/AIDS and malaria puts a strain on already scarce HRH. Civil statistics are vital, yet Muteu still lacks a coherent system for registering births and deaths, although it would be possible for HSAs to collect such data effectively. The MoH has recruited Statistical Data Entry Clerks and 65% of them have already reported for duties, and will attend Training of Trainers courses at zonal level. The National Commission on Science and Technology (NCST) regulates the conduct of research in Muteu by the various institutions involved. Challenges are as follows: the absence of legal and policy frameworks to regulate research; weak coordination and monitoring of research being carried out within the country; limited multidisciplinary research, largely due to the lack of highly qualified and experienced indigenous researchers; and poor utilization of research findings for practice and policy formulation, due to limited interactions between researchers and those to whom the research findings may be of use. As a way of addressing some of the problems being faced in the area of research, the NCST is implementing a five-year Health Research Capacity Strengthening Initiative (HRCSI) with support from the Wellcome Trust, the Department for International Development (DFID) and the International Development Research Centre (IDRC). The HRCS initiative offers an opportunity for Muteu to improve the capacity of Muteuan researchers to conduct high- quality research. 2.7.10 Universal access The MoH is committed to ensuring that services in the EHP are available with universal coverage for all Muteuans. The signing of Service Level Agreements (SLAs) with CHAM facilities for the delivery of Maternal and Neonatal Health (MNH) services is one way of ensuring that the services are accessed by everyone regardless of their socio-economic status. Evidence shows that the removal of user fees in CHAM facilities has resulted in an increase in the number of patients seeking care in these facilities. Universal coverage also includes geographical coverage. An analysis of the proportion of Muteu?s population living within an 8km radius of a health facility (Annex 3) shows that there are certain districts that are better served than others. On Likoma Island, where there is no government facility, none of the population is served, and this district is followed by Chitipa where 51% of the population live more than 8km from a health facility, Kasungu (38%), Balaka (32%), Chikwawa and Mangochi (27%). On the other hand, in Chiradzulu, Blantyre, Mulanje and Zomba Districts less than 5% of the population reside more than 8km from a health facility. In some rural places, the health infrastructure is absent or dysfunctional. In others, the challenge is to provide health support to widely dispersed populations. In high density urban areas, health services can be physically within reach of the poor and other vulnerable populations, but provided by unregulated private providers who do not deliver EHP services. 34 2011- 2016 Annex 4 compares the number of health facilities in Muteu in 2003 and 2010: about half of the facilities in both 2003 and 2010 belonged to the MoH. Between 2003 and 2010 the number of health facilities in Muteu increased overall from 575 to 606, largely due to an increase in the number of health centres (from 219 to 258). The significant increase in MoH health centres is attributed to some public facilities, mainly maternity units and health posts, being upgraded to health centres in line with the aims of the Program of Work for the Health Sector (PoW) 2004-2006. While new health facilities have been constructed and some existing health facilities have been renovated or upgraded, challenges still exist. The construction of Umoyo Houses32 has not been completed and staff accommodation remains a challenge, especially in hard to staff/serve areas. Rehabilitation of infrastructure is rarely done, hence the need for refurbishment. Other challenges relating to infrastructure include the lack of ICT in most health facilities, inadequate staff in the Infrastructure Unit at MoH headquarters, and inadequate funding for construction and maintenance of infrastructure and equipment. 2.8 Policy Context 2.8.1 National Policy Context The Constitution of the Republic of Muteu states that the State is obliged ?to provide adequate health care, commensurate with the health needs of Muteuan society and international standards of health care?33. The Constitution therefore guarantees that all Muteuans will be provided with free health care and other social services of the highest quality within the limited resources available. It also guarantees equality to all people in access to health services. The Muteu Growth and Development Strategy (MGDS II) is an overall development plan for Muteu and aims at creating wealth through sustainable economic growth and infrastructure development as a means of achieving poverty reduction. The MGDS recognizes that a healthy and educated population is necessary if the country is to achieve sustainable economic growth, and achieve and sustain MDGs. The long-term goal of the MGDS with regard to health is to improve the health of the people of Muteu regardless of their socio-economic status, at all levels of care and in a sustainable manner with increased focus on public health and health promotion. The National Health Policy is in its final draft and the National Public Health Act is in the process of being reviewed. The HIV Bill is in draft form and is expected to be passed during the period of the HSSP. The development of the Health Sector Strategic Plan took into consideration this and other existing legislation, namely the Prevention of Domestic Violence Act, the Wills and Inheritance Act and the Child (Care, Protection and Justice) Act. Other pieces of legislation, such as the Divorce, Marriage and Family Relations Bill and the Deceased Estates Bill (to replace the Wills and Inheritance Act) are being reviewed. In 1999 the GoM defined the MoH?s strategic vision for health care in Muteu into the 21st century under the title ?To the year 2020: A vision for the Health Sector in Muteu?, outlining the broad policy direction for the health sector at all levels. The document acknowledged that financial resources for health in Muteu are inadequate to address the increasing population, the disease burden and the awareness of rights for Muteuans. It was in this document that 32 33 Staff housing programme designed to improve availability of staff houses in remote, hard to reach areas Section 13 (c) of the Constitution of the Republic of Muteu 35 2011- 2016 GoM first defined the EHP for Muteu which would be made available to every Muteuan at his or her first contact with the formal health care system34. This EHP was revisited in 2004 during the development of the PoW and then again in 2010 during the development of the HSSP. It is the policy of GoM that the EHP should be provided free of charge to all Muteuans and hence contribute to reducing poverty, as it addresses the damaging social and environmental conditions that most poor people endure. The HSSP has also been informed by the draft National Health Policy (NHP) whose overall goal is to improve the health status of all the people of Muteu by reducing the risk of ill health and the occurrence of premature deaths. This overall goal will be achieved by implementing strategies and interventions that address critical areas in health services delivery, such as management, hospital reforms, quality assurance, Public and Private Partnerships (PPPs), HRH, Essential Medicines and Supplies (EMS), blood safety, infrastructure and health financing. The NHP also redefines the EHP based on the Burden of Disease assessment and the STEPS survey, and it lays emphasis on the need for an effective monitoring, evaluation and research system that will address the data needs of the sector. The HSSP takes on board all these issues. Highlighting the inadequate resources available for the health sector, the National Health Policy also defines the EHP, confirming that it will be available to all Muteuans free of charge. The provision of health services has been decentralised, so that the responsibility for service delivery has passed from MoH headquarters to the MoLGRD in accordance with the Decentralisation Policy and Decentralisation Act. Thus, districts have been given greater responsibility for managing health services at district and lower levels. 2.8.2 International and Regional Policies Muteu is a signatory to a number of international conventions, of which the most important is the 2000 Millennium Declaration with its eight Millennium Development Goals or MDGs, four of them relating directly to health. These are: Reduce extreme poverty and hunger (malnutrition – MDG 1), Reduce child mortality (MDG 4), Improve maternal health (MDG 5) and Combat AIDS, malaria and other diseases (MDG 6). The country is on course to achieving MDG 4, however, MDG 5 may be difficult to achieve before 2015, due to a number of factors. Therefore the HSSP has included strategies and interventions aimed at accelerating progress towards achieving the MDG targets by 2015. As a member state of the WHO, Muteu is also a signatory to the Ouagadougou Declaration on Primary Health Care (PHC) and Health Systems in Africa: Achieving better Health for Africa in the New Millennium in which African countries reaffirmed their commitment to PHC as a strategy for delivering health services, and as an approach to accelerate the achievement of the MDGs as advocated by the World Health Report of 2008. Other important international declarations to which Muteu is a signatory are: 1. The Abuja Declaration which calls on African Governments to increase their budgetary allocation to health to at least 15% 34 MoH (1999) To the year 2020: a vision for the health sector in Muteu. Lilongwe: MoH and Population 36 2011- 2016 2. The Paris Declaration on Aid Effectiveness, the Accra Agenda for Action and the Busan Partnership for Effective Development Cooperation35, which call for harmonization and alignment of aid in all sectors 3. The Africa Health Strategy 2007-2015 4. The 1986 Ottawa Charter on Health Promotion 5. Libreville Declaration on Environment and Health 6. AU Maputo Plan of Action on Sexual and Reproductive Health and Rights. Muteu is committed to these declarations and strategies but challenges still remain. For example, as mentioned above (2.7.6), the country has yet to achieve the target of 15% budgetary allocation for the health sector as detailed in the Abuja Declaration. This long-term goal is expected to be achieved, but within the context of the overall budgetary balance, recognizing other developmental priorities including education, water and sanitation, agricultural development, and infrastructure. Such areas of spending have their own developmental merits, while also contributing significantly to health outcomes. 2.9 Summary of the analysis As this chapter has demonstrated, the PoW (2004-2010) has registered overall progress in many spheres of the health sector. For example, there has been a decline in the maternal mortality rate (MMR); staffing levels have improved, although this has been offset by an expanded staff establishment, which has created more vacancies; there has been a general improvement in the availability of drugs and other medical supplies, and there have been many other successes. Annex 5 details the strengths, weaknesses, opportunities and threats that may affect the implementation of the HSSP. Some key risks might hinder the MoH and its stakeholders in the implementation of the Plan, and so Annex 6 provides a risk analysis outlining key risks and how they may be mitigated. 35 Fourth High Level Forum on Aid Effectiveness (HLF-4, 29 November ? 1 December 2011) 37 2011- 2016 3 INTRODUCING THE HEALTH SECTOR STRATEGIC PLAN 3.1 Development of the HSSP: Rationale and Process The HSSP (2011-2016) has been developed following the expiry of Sector Wide Approach (SWAp) Program of Work, a fore-runner strategic document for the health sector in Muteu which covered the period 2004-2010 and guided the implementation of interventions aimed at improving the health status of the nation. The MoH, HDPs and other stakeholders in the health sector collaborated in the development and implementation of the PoW. Progress towards achieving the targets set in 2004 was measured using program monitoring and evaluation (M&E) data routinely collected using the Health Management Information System (HMIS), and the PoW also provided for Joint Annual Reviews (JARs) for the health sector, a Mid-Term Review (MTR) and a final evaluation.. Although the PoW expired in June 2010, it was extended for one year partly to allow for the final evaluation. The results from both the MTR and the final evaluation therefore informed the development of the HSSP. The development of the HSSP also coincides with the development of the MGDS, the overall development agenda of the Government of Muteu. In mid-2010 the MoH formed a Core Group (CG) to coordinate the development of the HSSP. In order to ensure that the process was participatory the CG drew membership from all departments in the MoH, health workers? training institutions, the private sector, Civil Society Organizations (CSOs) and HDPs. The CG was chaired by the Director of the SWAp Secretariat in the MoH and members met regularly to discuss the progress made in the drafting of the HSSP as well as other emerging issues. Technical Working Groups (TWGs) were given the responsibility of contributing towards the development of the situation analysis for their thematic area, identifying objectives, strategies and key interventions and key indicators and also looking at implementation arrangements. The following TWGs participated in the development of the HSSP: Finance and Procurement, Hospital Reform, Human Resources (HR), Health Promotion, Public Private Partnerships (PPP), Health Infrastructure, Essential Medicines and Supplies (EMS), Laboratories, Essential Health Package, Quality Assurance and Monitoring, Evaluation and Research. Consultations were conducted with individual departments and disease programs. The development of the HSSP also benefited from technical assistance provided by both local and international experts and supported by HDPs, namely DFID, WHO, GTZ, FICA, USAID and UNFPA. A number of agreements were made during the 2010/2011 JAR meeting in October 2010 including: ? Revision of the Essential Health Package (EHP) based on the Burden of Disease (BoD) study conducted by the College of Medicine (CoM) and the STEPS study on NCDs conducted by the MoH and WHO. ? Discussion of some critical issues that should be addressed in the HSSP for example alternatives for sustainably financing the non-EHP conditions. Traditional authorities, religious leaders and MPs, among other interest groups, participated in this JAR workshop. As part of the development of the HSSP, literature was also reviewed including the Muteu MDG reports, the MGDS and specific disease strategic plans. The 38 2011- 2016 development of the HSSP also benefited from existing or draft strategic plans namely Malaria; Pharmaceuticals; Tuberculosis; Environmental Health; Nutrition and Food Security Policy and Strategic Plan; the Extended National AIDS Action Framework; Health Information Systems (HIS); the comprehensive Multi-year EPI Plan; and the Sexual and Reproductive Health and Rights Strategic Plan. The HSSP was also informed by the draft National Health Policy and the draft Health Bill. Focus Group Discussions (FGDs) were conducted with community members in six districts, two from each region, to get their inputs into the HSSP. The major outcome of this consultation was that community members also identified as important the diseases that have currently been included in the EHP. Thereafter, a national consultative workshop with participants from the Zonal Health Support Offices (ZHSOs), MoH headquarters, DHOs, chiefs, CSOs, HDPs and other government Ministries and Departments was held at Crossroads Hotel in Lilongwe on 2nd December 2010 to review the first draft of the HSSP. This workshop was also attended by Traditional Authorities, religious leaders and MPs. Comments were then incorporated into the document and a consultant was hired to cost the HSSP. As part of developing the HSSP two internal JANS36 assessments were done by the CG and stakeholders. The comments from these assessments were incorporated into the HSSP. In April-May an external team was invited to conduct the JANS with support from the HDPs. A further internal JANS was conducted at the end of June 2011. The comments from the external JANS were used to finalize the HSSP document. Annex 7 shows the roadmap for development of the HSSP and stakeholders who were involved, external JANS reports and response by MOH to the JANS. 3.2 Priorities for the HSSP 3.2.1 Major recommendations from evaluation of the PoW 1 The following are the major recommendations from the evaluation of the Program of Work: 1. Both MoH and HDPs are experiencing high staff turnover with great loss of institutional memory. Over the period of the HSSP mechanisms need to be put in place in order to retain staff as well as to address the critical staff shortages at all levels. 2. Monitoring and evaluation in the health sector focuses on the measurement of impact and outcomes, and so there is need to ensure that hospital statistics are added to the routine HMIS and made available. The M&E system needs be extended to monitor quality of care, and data should be disaggregated by gender, age and place of residence. The use of a broad baseline survey linked to impact evaluation is recommended to complement the DHS, and this survey should be carried out and the role of research should be made clear. 3. The EHP was defined in 2004 and disease patterns have changed since then. The evaluation recommended that the EHP should be revised to take into consideration the introduction of new technologies, changing disease patterns and available resources. There should also be gradual expansion of the EHP (e.g. by including cost-effective interventions for non-communicable diseases such as cardiovascular disease and 36 Joint Assessment of National Strategic Plans 39 2011- 2016 diabetes, mental health interventions, and a package of highly cost-effective surgical procedures to be provided in rural and district hospitals). 4. The drug supply system needs to be strengthened and dependence on emergency tenders has to be reduced. The logistics management information system needs to be improved to generate accurate data at facility level and departments have to provide accurate and complete specifications. There is also a need to recapitalise Central Medical Stores (CMS). 5. The HSSP should address issues of equity, including gender and geographical location. Preventive and curative health care should target hard to serve and vulnerable groups, e.g. adolescents seeking sexual and reproductive health care and antiretroviral treatment, orphans and other vulnerable children, women and girls seeking post- abortion care, the disabled, rural and traditional communities, and border and migrant populations. 6. Quality assurance approaches need to be strengthened and become systematic, as over the years QA has been implemented on a piecemeal basis. The implementation of interventions at district level should be based on need and public health priorities. 7. The HSSP should address issues of HRH management, coordination and oversight at all levels of implementation. 8. DIP guidelines should be revised to allow for better alignment of PoW planning and budgeting formats with those of MoLGRD/MoF. These recommendations have been taken into consideration during the development of this plan. 3.2.2 Burden of Disease (BoD) for Muteu In 2006 the College of Medicine (CoM) conducted a BoD study looking at the incidence and prevalence of all major diseases and disease-specific death rates, ranking the top ten conditions according to these rates. This study shows the top ten risk factors and diseases causing deaths in Muteu, as shown in Annex 8. HIV/AIDS is the major cause of mortality, followed by Lower Respiratory Infection (LRI), malaria, diarrhoeal diseases and conditions arising from perinatal conditions. The ranking of the top diseases and conditions was useful as it enabled an assessment of priority diseases for inclusion in EHP. Cost-effective interventions are available for most of these diseases and conditions. As has been mentioned earlier on, the STEPS survey clearly demonstrates that NCDs are also a significant public health problem, as can be seen in Table 2 below and this has led the MoH to establish an NCD Unit at headquarters. 40 – Prevalence Data sources Hypertension 32.9% NCD STEPS survey 2009 Cardiovascular diseases (using cholesterol as a marker) 8.9% NCD STEPS survey 2009 (N=3910, age 25-64 years) Injuries other than RTA 8.5% 37 WHS Muteu 2003 (N=5297, age >=18years)
Diabetes 5.6% NCD STEPS survey 2009 Asthma 5.1% WHS Muteu 2003 (N=5297, age >=18years)
Road Traffic Accidents (RTA) 3.5% WHS Muteu 2003 (N=5297, age >=18years)
2011- 2016
Table 2 Prevalence of Non- Communicable Diseases (NCDs) in Muteu
Since the diseases and conditions identified by the BoD study and the STEPS survey contribute to high levels of morbidity and mortality in Muteu, the national Technical Working Group on the EHP used the studies in identifying the 13 conditions to be prioritized within the EHP. After wide consultations, the original EHP as contained in the PoW 2004-2010 was modified to include new interventions, while maintaining the original set of interventions. The full list of conditions is as follows (with new ones marked with an asterisk): 1. 2. 3. 4. 5. HIV/AIDS ARI Malaria Diarrhoeal diseases Perinatal conditions 6. * NCDs including trauma 7. 8. Tuberculosis Malnutrition 9. * Cancers 10. Vaccine preventable diseases 11. * Mental illness and epilepsy 12. * Neglected Tropical Diseases (NTDs) 13. Eye, ear and skin infections During the FGD with community members, participants agreed with research findings, giving HIV/AIDS, ARIs, tuberculosis, malaria and diarrhoea as the most common diseases in their communities. The evidence used to assess each intervention is derived from core datasets comprising a revised Burden of Disease assessment for 201138, an assessment of the cost- effectiveness of past and potential interventions, the preliminary report of the Demographic Health Survey of 2010 (DHS 2010), ad hoc epidemiological surveys (such as the Malaria and EMOC surveys of 2010), projections of Millennium Development goals (MDGs) and published research evidence. The EHP TWG used the following criteria for prioritising interventions for inclusion and the setting of targets in the EHP:
37 38 World Health Survey Muteu (2006) http://www.who.int/healthinfo/survey/whsmwi-Muteu.pdf Burden of Disease estimates for 2011, College of Medicine 2011, at http://www.Muteu- mph.co.uk/data/bod%202011/Burden%20of%20BOD%20and%20EHP1.doc
41

2011- 2016
4 6

2011- 2016
3.2.3 What is new in the HSSP? The Health Sector Strategic Plan 2011-2016 is different from the Program of Work (PoW) 2004-2010 because it: ? Places emphasis on health promotion and disease prevention, as the majority of the diseases affecting Muteuans are preventable;
? Focuses on community participation, in line with the Ouagadougou Declaration; ? Promotes integration of EHP services delivery at all levels; ? Redefines the EHP based on the Burden of Disease study and the STEPS survey, and as a result mental health and NCDs will constitute part of the new EHP;
? Promotes the expansion of SLAs; ? Defines EHP by level of service delivery; ? Encourages exploration and implementation of alternative sources of financing; ? Places emphasis on the reform of central hospitals; ? Promotes the implementation of quality assurance interventions; ? Promotes increased coordination and alignment, and the reduction of transaction costs.
47

2011- 2016
4
VISION, MISSION, GUIDING PRINCIPLES, GOAL AND BROAD OBJECTIVES OF THE PLAN
4.1 Vision and mission The Vision of the health sector is to achieve a state of health for all the people of Muteu that would enable them to lead a quality and productive life. The Mission of the health sector is to provide strategic leadership by the Ministry of Health for the delivery of a comprehensive range of quality, equitable and efficient health services to all people in Muteu by creating an enabling environment for health promoting activities.
4.2 Guiding principles The guiding principles for the HSSP are inspired by the primary health care approach contained in the international aid effectivness agreements signed in Paris, Accra and Busan. The principles are: 1.
2.
3.
4.
5.
6.
7.
National ownership and government leadership: In the interest of national development and self-reliance, all partners in the health sector will respect national ownership of this HSSP, and the extent to which this principle is reinforced will be measured.
Human rights based approach and equity: All the people of Muteu shall have access to health services without distinction by ethnicity, gender, disability, religion, political belief, economic and social condition or geographical location. The rights of health care users and their families, providers and support staff shall be respected and protected.
Gender sensitivity: Gender issues shall be mainstreamed in the planning and implementation of all health programs and tracked for impact.
Ethical considerations: The ethical requirement of confidentiality, safety and efficacy in both the provision of health care and health care research shall be adhered to.
Efficiency: All stakeholders shall use available health care resources efficiently to maximize health gains. Opportunities shall be identified to facilitate the integration of health service delivery where appropriate to address client needs efficiently and effectively.
Accountability: All stakeholders shall discharge their respective mandates in a manner that takes full responsibility for the decisions made in the course of providing health care. All health workers at all levels and all DPs shall be accountable to the people of Muteu.
Inter-sectoral collaboration: In addition to the MoH there are also other Government Ministries and Departments and CSOs that play an important role especially in
48

2011- 2016
addressing social determinants of health; hence inter-sectoral collaboration shall be promoted.
8.
9.
Community Participation: Community participation shall be encouraged in the planning, management and delivery of health services.
Evidence-based decision making: Interventions shall be based on proven and cost- effective national and international best practices.
10. Partnership: Public Private Partnership (PPP) shall be encouraged and strengthened to address the determinants of health, improve service provision, create resources (e.g. training of human resources) and share technologies among others.
11. Decentralization: Health services management and provision shall be in line with the Local Government Act of 1998 which entails devolving health service delivery to Local Assemblies.
12. Appropriate technology: All health care providers shall use health care technologies that are appropriate, relevant and cost effective.
4.3 Goal The Goal of the Health Sector Strategic Plan is to improve the quality of life of all the people of Muteu by reducing the risk of ill health and the occurrence of premature deaths, thereby contributing to the social and economic development of the country.
4.4 Objectives of the HSSP The broad objectives of the HSSP are: 1.
2.
3.
4.
Increase coverage of the Essential Health Package interventions, paying attention to impact and quality.
Strengthen the performance of the health system to support delivery of EHP services.
Reduce risk factors to health.
Improve equity and efficiency in the delivery of quality EHP services.
49


 

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What is new in the HSSP? The Health Sector Strategic Plan 2011-2016 is different from the Program of Work (PoW) 2004-2010 because it: ?

Discuss some of the factors that increased the vulnerability of African-American residents (Henkel article)

Discuss some of the factors that increased the vulnerability of African-American residents (Henkel article).

Discuss some of the factors that increased the vulnerability of African-American residents (Henkel article)

After reading either of the two articles ?Institutional Discrimination, Individual Racism, and Hurricane
Katrina? by Henkel, et al. or ?In the Eye of the Storm: How the Government and Private Response to
Hurricane Katrina Failed Latinos? by Mu?iz, write a short essay that responds to the following:
Discuss some of the factors that increased the vulnerability of African-American residents (Henkel article)
or Latino residents (Mu?iz article) of New Orleans before, during, and after Hurricane Katrina, including
their ability to anticipate and prepare for the storm, cope with the impacts, and eventually recover.
Your essay should be roughly 1-2 pages in length (single spacing). All essays should be clear, concise,
and well-organized, and demonstrate a solid understanding of the reading. All essays should be
proofread thoroughly for spelling and grammatical errors. Direct quotes (if used) should include page
numbers in the citation.
Submit your essay via the ?Submit Short Essay 6 Here? link, found under the ?Short Essays? tab on
Blackboard no later than 1:30PM (the start of class) on Thursday 9/29. NO late essays will be accepted.

Analyses of Social Issues and Public Policy, Vol. 6, No. 1, 2006, pp. 99–124
Institutional Discrimination, Individual Racism,
and Hurricane Katrina
Kristin E. Henkel*
University of Connecticut
John F. Dovidio
University of Connecticut
Samuel L. Gaertner
University of Delaware
Since Hurricane Katrina made landfall, there have been accusations of blatant
racism in the government?s response, on the one hand, and adamant denials that
race played any role at all, on the other. We propose that both perspectives reflect
oversimplifications of the processes involved, and the resulting debate may obscure
a deeper understanding of the dynamics of the situation. Specifically, we discuss
the potential roles of institutional discrimination, subtle contemporary biases,
and racial mistrust. The operation of these processes is illustrated with events
associated with Hurricane Katrina. In addition, drawing on these principles, we
offer suggestions for present and future recovery efforts.
You?d have to go back to slavery, or the burning of Black towns, to find a comparable event
that has affected Black people this way.
?Darnell M. Hunt, a sociologist and head of the
African American Studies Department at UCLA
I think all of those remarks were disgusting, to be perfectly frank because, of course,
President Bush cares about everyone in our country, and I know that.
?Laura Bush, First Lady
*Correspondence concerning this article should be addressed to Kristin E. Henkel, Department
of Psychology, 406 Babbidge Road, Unit 1020, University of Connecticut, Storrs, CT 06269-1020
[e-mail: Kristin.Henkel@gmail.com].
99
C 2006 The Society for the Psychological Study of Social Issues
100 Henkel, Dovidio, and Gaertner
In the aftermath of Hurricane Katrina, which devastated New Orleans and
had particular impact on its Black community in August of 2005, accusations
pertaining to the lack of preparation for the storm and for the plight of its victims
were heatedly exchanged. Racism was one focus of the debate. On one side, it
was asserted that the inadequate response to the storm and the flooding was due
to obvious racism. This sentiment is evident in a statement by Kanye West, a
prominent rap artist, who said, ?George Bush doesn?t care about Black people?
(Broder, Wilgoren, & Alford, 2005). In response and in contrast, others such as
Secretary of State Condoleeza Rice adamantly denied that race had anything to
do with Hurricane Katrina or the government?s response to it. She claimed that
?nobody, especially the President, would have left people unattended on the basis
of race? (Broder et al., 2005).
From a social psychological perspective, both sides appeared to oversimplify
the situation, and polemics obscured the potential roles of historical factors, institutional
discrimination, and contemporary subtle forms of individual racism,
all of which likely played parts in the impact of Hurricane Katrina and the government?s
response to it. This article examines some events and decisions related
to Hurricane Katrina, and explores how historical and contemporary orientations
toward Blacks in the United States likely shaped responses in a way that produced
particularly tragic consequences for Black residents of New Orleans without overt
antipathy or intention of decision makers. We emphasize the importance of how
the past shapes contemporary race relations. In the next section, we provide a brief
overview of the forces that contribute to racism in the United States. We then apply
these psychological insights into the dynamics of racism to understand the events
and decisions that produced uniquely devastating outcomes for Blacks in New
Orleans. We conclude by exploring the implications of this analysis for specific
interventions in New Orleans and for policy more generally.
It is impossible to know whether the processes we propose were operating
among the protagonists; we can only point out that the immenseness of the devastation
created tremendous confusion and communication problems and, further,
show that these are precisely the conditions most conducive to the activation of
these processes. We have prepared this article in the interests of helping people
sort through the different perspectives on these tragic events and to sensitize policy
makers, officials, and future rescuers to how racial factors can play a role during
such catastrophes.
Understanding Racism
Although discussions and accusations of racism in the popular media typically
portray racism in its most obvious and blatant form, within psychology it
is considered to be much more complex and multifaceted. Individual bias is just
one aspect, but one that involves several components: prejudice, stereotypes, and
Racism and Katrina 101
discrimination (Dovidio, Brigham, Johnson, & Gaertner, 1996). Prejudice is commonly
defined as an unfair negative attitude toward a social group or a person
perceived to be a member of that group. A stereotype is a generalization of beliefs
about a group or its members that is unjustified because it reflects faulty
thought processes or overgeneralization, factual incorrectness, inordinate rigidity,
an inappropriate pattern of attribution, or a rationalization for a prejudiced attitude
or discriminatory behavior. Discrimination is defined as a selectively unjustified
negative behavior toward members of the target group that involves denying ?individuals
or groups of people equality of treatment which they may wish? (Allport,
1954, p. 51).
Even though racism relates directly to the coordinated interaction of stereotypes,
prejudice, and discrimination, it involves more than individual biases. Racism
reflects institutional, social, and cultural influences, as well. According to Jones
(1997), at its very essence racism involves not only negative attitudes and beliefs,
but also the social power that translates them into disparate outcomes that disadvantage
other races or offer unique advantages to one?s own race at the expense of
others. As Feagin and Vera (1995) explain, ?Racism is more than a matter of individual
scattered episodes of discrimination,? it represents a widely accepted racist
ideology and the power to deny other racial groups the ?dignity, opportunities, freedoms,
and rewards that are available to one?s group through a socially organized set
of ideas, attitudes, and practices? (p. 7). Thus, while the study of prejudice and discrimination
focuses on the roles of individuals and interpersonal processes, racism
encompasses institutional, social, and cultural processes that serve as an influential
backdrop to individual-level perspectives. Institutional racism, for example,
refers to the intentional or unintentional manipulation or toleration of institutional
policies (e.g., poll taxes, admissions criteria) that unfairly restrict the opportunities
of particular groups of people, and cultural racism involves beliefs about the superiority
of one?s racial cultural heritage over that of other races and the expression
of this belief in individual actions or institutional policies (Jones, 1997).
Moreover, both contemporary personal and institutional racism often operate
without Whites? intention to harm members of minority groups or even awareness
by Whites of their personal role in disadvantaging Blacks. For instance, applying
policies that seem just and egalitarian based on immediate principles of fairness
in a narrow sense may systematically disadvantage groups that for historical reasons
have fewer contemporary resources (e.g., wealth or education) that would
allow them to benefit fully from these policies and procedures (Dovidio, Mann, &
Gaertner, 1989). Thus, Whites? historical discrimination against Blacks produces
a legacy of disparity that may be perpetuated even by well-intentioned people
who endorse and exercise current policies that have disparate consequences for
Whites and Blacks. Furthermore, cultural racism gives priority to the values of
the majority group, which are embedded in widely accepted cultural ideologies
(Sidanius & Pratto, 1999). Policies, laws, and procedures that reflect these values
102 Henkel, Dovidio, and Gaertner
may be subtly distorted in ways that enhance the disadvantage of minority groups
and the advantage of the majority group. Thus, when a racial group and its members
have been historically disadvantaged, the consequences are broad and severe,
reproducing themselves across time (Jones, 1997).
Consistent with this perspective, statistics show that racial disparities in several
key quality-of-life areas have stubbornly persisted over the years. For example,
the median family income for Blacks is less than two-thirds that of Whites, a
differential that has widened over the past two decades (Blank, 2001). Also, on
several basic measures of health and well-being, the racial gap either has been
maintained or in some cases (e.g., infant mortality) has widened substantially over
the past 50 years (Jenkins, 2001). Furthermore, recent studies suggest that over
their lifespans, Black and White patients receive unequal treatment from medical
practitioners, resulting in less favorable health-related outcomes for Blacks (see
Smedley, Stith, & Nelson, 2003). Steady trends toward residential integration that
were observed from 1950 to 1970 have slowed in the South and stagnated in the
North (Massey, 2001). Massey (2001) observed, ?Either in absolute terms or in
comparison to other groups, Blacks remain a very residentially segregated and
spatially isolated people? (p. 403). Both cultural racism and institutional racism
are subtle, difficult-to-detect processes that are at least partially responsible for
these outcomes.
Like institutional and cultural racism, individual prejudice is also commonly
manifested subtly, often without conscious awareness or intention. Many contemporary
approaches to individual racism acknowledge the persistence of overt,
intentional forms of racism but also consider the role of automatic or unconscious
processes and indirect expressions of bias (McConahay, 1986; Sears, Henry, &
Kosterman, 2000). We have explored the nature of Whites? racial attitudes to
understand the duality between the generally expressed nonprejudicial views of
Whites in contemporary U.S. society and the persistence of significant racial disparity
and discrimination. Our work built upon the conceptual framework of Kovel
(1970), who distinguished between dominative and aversive racism. Dominative
racism is the ?old-fashioned,? blatant form. According to Kovel, the dominative
racist is the ?type who acts out bigoted beliefs?he represents the open flame of
racial hatred? (p. 54). Aversive racists, in comparison, sympathize with victims
of past injustice, support the principle of racial equality, and regard themselves as
nonprejudiced, but, at the same time, possess negative feelings and beliefs about
Blacks, which may be unconscious. Aversive racism is hypothesized to be qualitatively
different than blatant, ?old-fashioned,? racism, is more indirect and subtle,
and is presumed to characterize the racial attitudes of most well-educated and
liberal Whites in the United States. Nevertheless, the consequences of aversive
racism (e.g., the restriction of economic opportunity) are as significant and pernicious
as those of the traditional, overt form (Dovidio & Gaertner, 2004; Gaertner
& Dovidio, 1986).
Racism and Katrina 103
A critical aspect of the aversive racism framework is the conflict between
Whites? denial of personal prejudice and underlying unconscious negative feelings
toward, and beliefs about, Blacks. Because of current cultural values, most Whites
have strong convictions concerning fairness, justice, and racial equality. However,
because of a range of normal cognitive, motivational, and sociocultural processes
that promote intergroup biases, most Whites also develop some negative feelings
toward or beliefs about Blacks, of which they are unaware or from which they try
to dissociate their nonprejudiced self-images. These negative feelings that aversive
racists have toward Blacks do not reflect open hostility or hatred. Instead, aversive
racists? reactions may involve discomfort, uneasiness, disgust, and sometimes fear.
That is, they find Blacks ?aversive,? while at the same time finding any suggestion
that they might be prejudiced ?aversive? as well. Thus, aversive racism may involve
more positive reactions to Whites than to Blacks, reflecting a pro-ingroup rather
than an anti-outgroup orientation, thereby avoiding the stigma of overt bigotry
while protecting a nonprejudiced self-image.
The negative feelings and beliefs that underlie aversive racism are hypothesized
to be rooted in normal, often adaptive, psychological processes. These processes
fundamentally involve the consequences of social categorization. People
inherently categorize others into groups, typically in ways that delineate the ?we?s
from the ?they?s? (Hamilton & Trolier, 1986). The mere categorization of people
into groups, even on the basis of arbitrary assignment, is sufficient to initiate (often
spontaneously, according to Otten & Moskowitz, 2000) an overall evaluative bias,
in which people categorized as members of one?s own group are evaluated more
favorably than are those perceived as members of another group (Brewer, 1979;
Tajfel, 1970).
The aversive racism framework also helps to identify when discrimination
against Blacks and other minority groups will or will not occur. Whereas oldfashioned
racists exhibit a direct and overt pattern of discrimination, aversive
racists? actions may appear more variable and inconsistent. Sometimes they discriminate
(manifesting their negative feelings), and sometimes they do not
(reflecting their egalitarian beliefs). Our research has provided a framework for
understanding this pattern of discrimination.
Because aversive racists consciously recognize and endorse egalitarian values
and because they truly aspire to be nonprejudiced, they will not discriminate in
situations with strong social norms when discrimination would be obvious to others
and to themselves. Specifically, when people are presented with a situation in which
the normatively appropriate response is clear, in which right and wrong are clearly
defined, aversive racists will not discriminate against Blacks. In these contexts,
aversive racists will be especially motivated to avoid feelings, beliefs, and behaviors
that could be associated with racist intent. Wrongdoing, which would directly
threaten their nonprejudiced self-image, would be too costly. However, because
aversive racists still possess feelings of uneasiness, these feelings will eventually
104 Henkel, Dovidio, and Gaertner
be expressed, but they will be expressed in subtle, indirect, and rationalizable ways.
For instance, discrimination will occur in situations in which normative structure
is weak, when the guidelines for appropriate behavior are vague, or when the basis
for judgment is ambiguous or confusing. In addition, discrimination will occur
when an aversive racist can justify or rationalize a negative response or a failure
to respond favorably on the basis of some factor other than race. Under these
circumstances, Whites unintentionally may engage in behaviors that ultimately
harm Blacks but that allow Whites to maintain their self-image as nonprejudiced
and that insulate them from recognizing that their behavior is not color blind.
Frequently, this discrimination does not manifest itself in purposeful harm or
injury, but rather in Whites? failure to help Blacks either in situations in which
the failure to help can be attributed to factors other than race (e.g., the belief
that someone else will intervene; Gaertner & Dovidio, 1977; Saucier, Miller, &
Doucet, 2005), or in the expression of particular positive responses to Whites
without overtly negative actions toward Blacks (Gaertner et al., 1996). Indeed, one
of the fundamental conclusions of the Report of the National Advisory Commission
on Civil Disorders (1968) over 35 years ago was that the disadvantaged status of
Blacks was due, in part, to insufficient efforts of Whites to help Blacks, not to their
efforts to harm them. This principle could likely be relevant to the inadequacy of
the official responses to Hurricane Katrina in 2005.
The subtlety of the contemporary expressions of institutional racism and individual
biases may contribute in significant ways to the racial mistrust, particularly
the distrust of Blacks for Whites that characterizes race relations within the United
States (Dovidio, Gaertner, Kawakami, & Hodson, 2002; Feagin & Sikes, 1994).
Blacks have a pervasive distrust for Whites that is reflected in high levels of perceived
discrimination and orientations toward basic social institutions (Dovidio
et al., 2002). Blacks report distrust of government leaders (Earl & Penney, 2001;
Shavers-Hornaday, Lynch, Burmeister, & Torner, 1997) and medical practitioners
and researchers (Armstrong, Crum, Reiger, Bennett, & Edwards, 1999; Davis &
Reid, 1999), as well as for authorities and policies in the areas of business and
education (Phelps, Taylor, & Gerard, 2001). They also tend to perceive conspiracies
by the government and Whites generally to harm Blacks (Crocker, Luhtanen,
Broadnax, & Blaine, 1999), reflected for example in the belief that AIDS was
purposefully created to infect Blacks.
At the same time, because of the absence of intention and awareness involved
in much of contemporary institutional and individual racism, Whites may be not
be sensitive to the extent of racial bias in the United States and particularly to
their own expressions of bias (Dovidio et al., 2002). As a consequence, Whites
and Blacks often express divergent views about their race relations. For instance,
in a Gallup Poll (Gallup, 2002) over three-quarters (79%) of Whites reported that
Blacks ?have as good a chance as Whites? to ?get any kind of job,? but less than
half (46%) of Blacks shared that view. Whereas the vast majority (69%) of Whites
Racism and Katrina 105
perceived that Blacks were treated ?the same as Whites,? the majority of Blacks
(59%) reported that Blacks were treated worse than Whites.
In the next section we illustrate the role of three of the basic processes in
contemporary racism?institutional racism, aversive racism, and racial mistrust?
in the context of Hurricane Katrina. We acknowledge that old-fashioned, blatant
racism still exists among Whites and that it continues to affect the lives and wellbeing
of Black Americans. It may even have played a role in the consequences
of Hurricane Katrina on Blacks in New Orleans. Nevertheless, we emphasize that
understanding the subtle dynamics of race relations, rather than being preoccupied
with assigning blame for intentional harm, may not only provide valuable insight
into the events and responses associated with Hurricane Katrina but also help guide
the development of new policies that can assist the residents of New Orleans and
prevent disparate harm to Blacks more generally in the future.
Understanding Responses to Hurricane Katrina
What happened during and after Hurricane Katrina was determined not only
by the present circumstances on the Gulf Coast but also by a history of discriminatory
policies and practices, particularly in the New Orleans area, that created
socioeconomic and consequent housing disparities along racial lines. In addition,
although the actions of decision makers during Hurricane Katrina and its aftermath
may have appeared ?colorblind,? without particular sensitivity to the unique vulnerabilities
of the Black population these actions were subtly biased and produced
racially disparate consequences. Also, historical discrimination and contemporary
institutional racism eroded the trust of Blacks in New Orleans for the government,
which adversely influenced the effectiveness of interventions in the aftermath of
Hurricane Katrina. In this section we therefore examine the influences of (a) historical
discrimination and contemporary institutional racism, (b) subtle bias at the
individual level, and (c) interracial distrust.
Historical Discrimination, Contemporary Institutional Racism,
and Hurricane Katrina
The impact by Hurricane Katrina was catastrophic by all measures. Besides
billions of dollars of damage and a premier city in the United States left largely
in ruins, between 1,100 and 1,700 people died and thousands more are still unaccounted
for (Burchfiel, 2006). In addition, Hurricane Katrina was particularly
devastating for Blacks. The flooding caused by the hurricane was particularly damaging
to Black neighborhoods, communities that were relatively uninsured against
floods. Thus, many of the Blacks in New Orleans who survived but were displaced
by Hurricane Katrina will not be able to afford to return to the city and to the areas
where they once lived.
106 Henkel, Dovidio, and Gaertner
To understand what happened during Katrina and why it had such a disproportionate
negative impact on Blacks, it is important to appreciate the local and
national historical context that surrounded the disaster. One of the most significant
legacies of slavery and historical discrimination in the United States is the
pervasive racial disparity in wealth (Blank, 2001). The median family income for
Whites in 1994 was $33,600 but was only $20,508 for Blacks. Blacks? incomes
were only 62% of Whites? incomes. Moreover, when net worth is considered,
weighing family financial assets and debts, the gap is even greater. In 1994, the
median net worth for Whites was $52,944 as compared to $6,723 for Blacks. That
is, Blacks? net worth was only 12% of Whites? net worth (Oliver & Shapiro, 2001).
Contemporary biases further contribute to racial disparities in income. Minority
groups have disproportionate difficulty finding jobs as compared to majority
groups: based on job audits across several countries, minority-group members
have a 23.7 percent chance of being discriminated against when applying for any
given job (Sidanius & Pratto, 1999). Even when Blacks find jobs, they are overrepresented
in jobs with poor working conditions, such as shift work, long hours,
repetitive tasks, physical dangers, and accident rates. They also have disproportionately
low mobility out of such low-end jobs (Sidanius & Pratto, 1999). Institutional
discrimination in the labor market only serves to increase discrepancies between
minority group and majority group members. Discrepancies in the labor market
lead to a disproportionate number of Blacks in positions of lower socioeconomic
status.
Race and racial disparities are particularly relevant for understanding the impact
of Hurricane Katrina in New Orleans. For example, in the context of Hurricane
Katrina, fewer available resources meant that it may not have been as easy for
Blacks, who were less likely to own cars, to leave the city. In addition, socioeconomic
differences influenced the vulnerability of Blacks, relative to Whites,
to the devastating consequences of Hurricane Katrina. Approximately one-third
of the population in the New Orleans metropolitan area is Black, ranking it 11th
in terms of percentage of Black population among over 300 major metropolitan
areas in the United States (CensusScope, 2006). The largest proportion of Blacks
is concentrated within the city limits, representing 68% of the population, many
of whom lived in the most low-lying areas?those most vulnerable to Hurricane
Katrina. In addition, New Orleans historically has been one of the cities with the
largest racial disparities in income and wealth. It showed the fourth largest increase
in racial disparity in income in recent years (Madden, 2000). The poverty rate in
New Orleans has been almost twice the national rate, and a third of Blacks and
half of the Black children in the city live below the poverty level (Hancock, 2005).
This racial gap in income and wealth contributed significantly to the particular
vulnerability of Blacks in New Orleans to Hurricane Katrina.
One consequence of racial disparities in wealth and income, which is exacerbated
by contemporary housing discrimination, is the residential segregation of
Racism and Katrina 107
Blacks. In general, more affluent residential areas in the United States are predominantly,
if not virtually exclusively, White. Thus, access to housing in these
areas requires either pre-existing wealth or access to substantial housing loans. As
we noted earlier, the racial gap in wealth is even greater than the sizable income
disparity (Blank, 2001; Madden, 2000). Moreover, in part due to their lower wealth
and available assets, Blacks have more difficulty obtaining housing loans than do
Whites. In 2001, 36% of Black applicants, compared to 16% of White applicants,
were denied conventional home mortgage loans. However, even when controlling
for financial status, Blacks are denied home loans at rates much greater than
Whites. Among applicants who had incomes less than 50% of the income for the
local area, Blacks were denied loans 42.7% of the time, whereas Whites were
denied 29.6% of the time. Among the applicants who made more than 120% of
the median income, Blacks were denied 19.6% of the time, whereas Whites were
denied only 6.8% of the time (Federal Financial Institutions Examination Council,
2002).
Institutional policies, past and present, have further contributed to residential
segregation of Blacks and Whites. According to Seitles (1996), federal and state
governments have had large roles in creating and maintaining residential racial
segregation. For example, the Federal Housing Administration (FHA) employed
practices that disadvantaged Blacks since it began in 1937. It used a practice
called ?red-lining? to determine risks associated with loans made to borrowers in
specific neighborhoods. ?Red-lining? involved rating neighborhoods such that the
neighborhoods in the top two categories were White, stable, and in demand. The
?high risk? categories involved Blacks. The third category was made up of working
class neighborhoods near Black residences, and the fourth category was Black
neighborhoods. As a result of this policy, most mortgages and home loans went to
middle class White families, promoting the racial segregation of neighborhoods,
particularly in urban areas. Further, the federal government used interstate highway
and urban renewal programs to increase segregation (Seitles, 1996).
In addition to institutional discrimination rooted in historical practices, contemporary
biases conspire to contribute further to residential segregation. Fischer
and Massey (2004) found that callers identifiable as Black were systematically
discriminated against relative to those identifiable as White in housing
inquiries, controlling for the socioeconomic status of the caller. The primary
exception to this effect was for Black neighborhoods. Blacks were more
likely than Whites to gain access to areas that already had high concentrations
of Blacks. Thus, institutional discrimination, along with individual discrimination,
tends to deny Blacks access to the more affluent neighborhoods, which are
much more readily available to Whites. Due to past and present institutional discrimination
in housing and mortgage processes, neighborhoods are segregated
and mortgages go to largely White neighborhoods, which only perpetuates the
problem.
108 Henkel, Dovidio, and Gaertner
The history of racial disparities in income and wealth and the influence of
institutional discrimination have had a significant influence on housing patterns
in New Orleans. New Orleans currently ranks 29th out of 318 metropolitan areas
examined in terms of the extent of neighborhood racial segregation (CensusScope,
2006), and the highest concentrations of Blacks have been in poorer areas. In addition,
as Laura Bush observed, in New Orleans poor Black neighborhoods were
on lower, undesirable, cheaper land that was particularly vulnerable to flooding.
As a function of where they lived, when Hurricane Katrina hit, many Black people
in New Orleans were already in a position to be disproportionately affected by
the disaster. For example, HUD-funded public housing units above Feret Street
West, which were occupied largely by Blacks, and New Orleans East were also
on lower ground more vulnerable to flooding than higher, more desirable neighborhoods.
Even areas that Blacks considered attractive locations within the city,
such as New Orleans East and the Lower Ninth Ward, were at environmental risk.
New Orleans East is home to middle income Blacks who left the urban center of
New Orleans in the 1960s and 1970s to build affordable homes in this area. The
homes were affordable because they were built on slabs and were located 2.5 to
4.0 feet below sea level. The Lower Ninth Ward is a neighborhood of primarily
modest houses, often the location of choice of musicians and multi-generational
Black families of the metropolitan area. It is situated in close proximity to an
industrial canal, which posed particular health risks during the flood. This neighborhood
was devastated by Hurricanes Betsy and Rita, as well as by Hurricane
Katrina.
In summary, the result of the institutional discrimination in New Orleans as
outlined here is multifaceted. Because of discriminatory housing and mortgage
policies and practices, Blacks tended to live in more environmentally vulnerable
areas of the city. The discrepancies in socioeconomic status were exacerbated by
discrimination in the labor market, which on the whole prevented Blacks from
gaining jobs, specifically ones of higher status, and prevented acquisition of material
resources, such as personal cars, that would have enabled them to evacuate
New Orleans for safer areas as Hurricane Katrina approached. When evacuation
orders were announced, a disproportionate number of Blacks in the areas most
at-risk lacked the resources to leave the city. ?Many of them were people without
automobiles,? explained Marc Morial, former mayor of New Orleans and now the
president and chief executive officer of the National Urban League. They were
?people who couldn?t afford a hotel room, who may have had no choice but to
remain. And that means that the people who remain in New Orleans are disproportionately
poor people, disproportionately African-American? (Ross, 2005). Past
and recent institutional discrimination on the basis of race thus contributed to the
particular vulnerability of the Black population of New Orleans to a disaster like
Hurricane Katrina.
Racism and Katrina 109
Subtle Bias and Response to Hurricane Katrina
The pattern of decision making, or lack of immediate responsiveness that characterized
the official response in the aftermath of Katrina, also reflects the kinds of
subtle biases associated with aversive racism. Given that Blacks were disproportionately
affected by the storm and flooding, any sluggishness and disorganization
on the part of government officials also disproportionately affected Black victims
of the disaster. Michael Brown, then the head of the Federal Emergency
Management Agency (FEMA), learned about the starving crowds at the New
Orleans Convention Center from news media, rather than through official means
(CNN, 2005). In addition, no large-scale deliveries of supplies arrived at the
Convention Center until midday on September 2nd, four days after Katrina hit
(Callebs, Gupta, Lavendera, Lawrence, & Starr, 2005). In another example of
poor government response, housing for evacuees was held up because of a notably
slow bureaucratic process. Two weeks after Katrina, the Department of
Veteran Affairs offered up 7,000 single-family homes owned by the government
for the use of evacuees. The houses then went unused for three months
because of paperwork problems in FEMA (ABC News, 2006). Such unhurried
relief work on the part of the government disproportionately affected Blacks,
because the victims of Katrina were disproportionately Black in the first place.
This is an instance of institutional discrimination, since it disadvantaged a racial
group, even if there was no race conscious intentionality on the part of the
government.
In addition to the slow government response to the immediate needs of evacuees,
the recovery process continues to be remarkably slow. Whole areas of New
Orleans (particularly the poorer areas) have still not been made habitable. Demolition
in the Lower Ninth Ward to remove houses that were uninhabitable since
the hurricane did not begin until four months after the hurricane hit New Orleans
(Nossiter, 2006). At the time, there was still no power or running water in these
areas, which were primarily Black neighborhoods.
It was the responsibility of the individuals who made up the Department of
Homeland Security and FEMA to respond and to make decisions in times of crisis
such as that of Hurricane Katrina. As previously noted, one of the most common
forms that individual discrimination takes is a failure to help or intervene
rather than committing an intentional act of harm. In Hurricane Katrina, a swift,
well-organized, large response was critically important but did not occur. Michael
Chertoff, head of the Department of Homeland Security, acknowledged that FEMA
was overwhelmed by Hurricane Katrina and responded poorly (Hau, 2005). Ultimately,
the responsibility for such a response falls on the shoulders of individuals
rather than institutions. Knowing this, Chertoff oversaw the resignation of Michael
Brown due to FEMA?s response.
110 Henkel, Dovidio, and Gaertner
It cannot be stressed enough that it would be unfair, given the evidence, to say
that race was a conscious motivator in the government response. It is unreasonable
to assert that individuals knowingly made decisions based on race, but research
has shown that lack of empathy and perspective-taking may be the unintentional
factors operating behind a failure to help, especially across group membership.
One of our early experiments (Gaertner & Dovidio, 1977) demonstrated how
subtle racism could have operated unintentionally amidst the initial confusion, both
regarding the magnitude of the storm?s impact and who had primary responsibility
to respond among local, state, and national government agencies. As we indicated
earlier, this confusion and ambiguity are precisely the circumstances that are most
conducive to the influence of subtle biases. The scenario for the experiment was
inspired by an incident in the mid-1960s in which 38 people witnessed the stabbing
of a woman, Kitty Genovese, without a single bystander intervening to help. What
accounted for this behavior? Feelings of responsibility play a key role (see Darley
& Latan?e, 1968). If a person witnesses an emergency knowing that he or she is
the only bystander, that person bears all of the responsibility for helping and,
consequently, the likelihood of helping is high. In contrast, if a person witnesses
an emergency but believes that there are several other potential helpers, then the
responsibility for helping is shared. Moreover, if the person believes that someone
else either will help or has already helped, the likelihood of that bystander taking
action is significantly reduced.
We created a situation in the laboratory in which White participants witnessed
a staged emergency involving a Black or White victim. We led some of our participants
to believe that they would be the only witness to this emergency, while we led
others to believe that there would be two other White people who also witnessed
the emergency. These potential bystanders were isolated from one another in their
own cubicles and thus they could not easily communicate with each other. We
predicted that, because aversive racists do not act in overtly bigoted ways, Whites
would not discriminate when they were the only witness and the responsibility for
helping was clearly focused on them. However, we anticipated that Whites would
be much less helpful and would respond slower to Black than to White victims
when they had a justifiable excuse not to get involved, such as the belief that one
of the other witnesses would take responsibility for helping.
The results supported these predictions. When White participants believed
that they were the only witness, they helped both White and Black victims very
frequently (over 85% of the time) and equally quickly. There was no evidence of
blatant racism. In contrast, when they thought there were other witnesses and they
could rationalize not helping rapidly on the basis of some factor other than race
(e.g., the presence of other bystanders), they helped Black victims more slowly
and only half as often as White victims (37.5% vs. 75%).
Another feature of this study that is also revealing of what may have happened
during the aftermath of Hurricane Katrina involved the monitoring of our
Racism and Katrina 111
participants? heart rates just prior to and following the emergency. Within the first
10 seconds after the emergency, participants who witnessed the emergency alone
showed equivalent patterns of heart-rate escalation for both the Black and the
White victims. Those who witnessed the emergency believing other bystanders
were present showed heart-rate escalation in response to the emergency involving
the White victim. In contrast, when the victim was Black and participants believed
other bystanders were present, participants? heart rates decelerated within
the initial 10-second period following the emergency.
However, the differing pattern of heart-rate responsiveness following the emergency
does not necessarily reflect differential concern for the well-being of the
Black and White victims in the presence of other bystanders. Rather, heart-rate
escalation has been linked to a preparation for action, whereas deceleration is
associated with the intake of information from the environment (Lacey & Lacey,
1974). Thus, amidst the confusion during the aftermath of the emergency, the initial
orientation of our participants was to take action when the victim was White. For
Black victims, however, the initial orientation was take in and process information
about what needs to be done?rather than rapidly doing something to alleviate the
problem.
Recently, Saucier et al. (2005) performed a meta-analysis of 31 experiments
conducted over the past 40 years that examined race and Whites? helping behavior,
specifically testing implications of the aversive racism framework. Across these
studies, they found ?that less help was offered to Blacks relative to Whites when
helpers had more attributional cues available for rationalizing the failure to help
with reasons having nothing to do with race? (p. 10). Moreover, the pattern of
discrimination against Blacks remained stable over time; the effect for year of
study was nonsignificant. Saucier et al. summarized, ?The results of this metaanalysis
generally supported the predictions for aversive racism theory? (p. 13),
and concluded, ?Is racism still a problem in our society? …Racism and expression
of discrimination against Blacks can and will exist as long as individuals harbor
negativity toward Blacks at the implicit level? (p. 14).
During an emergency such as that presented by Hurricane Katrina, this differential
pattern of initial, visceral responsiveness as well as the observed pattern of
actual intervention for Black and White victims in our experiment suggest some
unintentional processes by which local, state, and national authorities may well
have responded quite differently than they did in the aftermath of the storm?had
New Orleans been inhabited by White rather than by Black citizens.
The Select Bipartisan Committee to Investigate the Preparation for and Response
to Hurricane Katrina (2006) identified several junctures where a lack of
decisiveness to intervene had tragic consequences, particularly for Blacks, in
New Orleans. The reports states, ?The failure of local, state, and federal governments
to respond more effectively to Katrina?which had been predicted for
many years, and forecast with startling accuracy for 5 days?demonstrates that
112 Henkel, Dovidio, and Gaertner
whatever improvements have been made to our capacity to respond to natural or
man-made disasters, four and half years after 9/11, we are still not fully prepared?
(p. 1). Despite adequate warning 56 hours before landfall, orders for mandatory
evacuation of the most vulnerable areas?those inhabited disproportionately by
Blacks?were delayed until 19 hours before landfall. The report concluded, ?The
failure to order timely mandatory evacuation led to deaths, thousands of dangerous
rescues, and horrible conditions for those who remained? (p. 2). In addition,
investigation found that subsequent decisions at the highest levels of government,
which showed a lack of responsiveness to the events as they transpired, had substantial
consequences: ?The White House failed to de-conflict varying damage
assessments and discounted information that ultimately proved accurate? (p. 3).
It is under conditions such as conflicting information and ambiguity (Dovidio
& Gaertner, 2000; Hodson, Dovidio, & Gaertner, 2002) that aversive racism influences
decision making in ways that ultimately disadvantage Blacks. Further,
consistent with the aversive racism framework, the report of the Bipartisan Committee
contrasted the response of decision makers at more remote sites with those
in positions of immediate responsibility. The report observed, ?The Select Committee
identified failures at all levels of government that significantly undermined
and detracted from the heroic efforts of first-responders… those who didn?t flinch,
who took matters into their own hands when bureaucratic inertia was causing death,
injury, and suffering? (p. 1).
Racial Distrust and Consequences for Hurricane Katrina
We have discussed the mistrust that Blacks generally feel for Whites and the
government (Crocker et al., 1999; Dovidio et al., 2002) and the inconsistencies
in how Blacks and Whites see race relations in the United States (Gallup, 2002).
Racial tensions in New Orleans were particularly high before Hurricane Katrina
hit and continue to be high in the aftermath. New Orleans? history of racial tension
was reflected in Blacks? more negative attitudes than Whites? toward the police,
particularly among those for whom their race was a more important part of their
identity (Howell, Perry, & Vile, 2004). Hancock (2005) reported, ?The tensions of
race have always defined the best and worst of this city … many residents say that
their future hinges on bridging race and class divisions that many say had gotten
deeper, uglier, and angrier in the months before the storm.? At the beginning of
2005, three White bouncers of a nightclub suffocated a young Black man to death
during a New Year?s celebration. This event escalated Black anger, distrust, and
guardedness. Glanton (2005) described the racial tensions in New Orleans in the
months before Katrina hit. In an interview with Glanton, Rev. Norwood Thompson,
president of the New Orleans chapter of the Southern Christian Leadership
Conference, remarked, ?New Orleans is still part of the deep South, and what happened
that night was pure racism. Even though we have a Black mayor and a Black
Racism and Katrina 113
police chief, racism has been very flagrant. African-Americans have been asleep,
but now we are in an uproar.? A month later a Black teenager was killed ?in a hail
of more than 100 bullets? fired by Jefferson County police officers (Treadway,
2005).
One possible consequence of this racial divide in New Orleans is the lack of coordination
and responsiveness that characterized evacuation efforts for Hurricane
Katrina. The Select Bipartisan Committee to Investigate the Preparation for and
Response to Hurricane Katrina (2006) noted, ?Two of Louisiana?s most populous
localities, New Orleans and Jefferson Parish, declared mandatory evacuations late
or not at all? (p. 103). These areas have particularly large Black populations.
Although over a million Louisiana residents evacuated their homes in private vehicles,
the Select Bipartisan Committee also found ?that thousands of residents,
particularly in New Orleans, did not evacuate or seek shelter, but remained in their
homes? (p. 64). It is likely that Blacks? distrust of government contributed to their
decisions not to heed the warnings to evacuate. Moreover, the government?s decision
not to make evacuation mandatory in some of the most vulnerable areas,
which had substantial Black populations, permitted this hesitancy to have disastrous
consequences. By the time the severity of the crisis became clear to many of
the Black residents of New Orleans, they were unable to evacuate the areas successfully
because they did not own cars and public transportation and volunteer
transportation were too limited at the time.
The history of racial discrimination and disparity in New Orleans went hand
and hand with deep racial distrust. Indeed, in New Orleans there has been a strong
history of a connection between racism and flooding. One of the most common
oversights in the dispute over Katrina is this history of racism in New Orleans.
It is crucial to understand how history led New Orleans to its precedent of racial
mistrust that existed long before the hurricane and the flooding. In 1927, with
floodwaters all along the Mississippi River rising, the government dynamited a
levee south of New Orleans to relieve pressure on the city proper, flooding land
owned by rural and poor farmers. Most of those affected were never compensated,
despite government promises (Leopold, 2005). In 1965, when Hurricane
Betsy hit New Orleans, Black communities were once again flooded and there
were rumors that again, the levee had been breached intentionally (Ross, 2005).
These historical factors are too important to be overlooked or underestimated.
With a precedent of the government intentionally breaching levees followed by
rumors that it had happened again in 1965, there were strong and deeply rooted
feelings of mistrust among the Black community in New Orleans. When mass
destruction and flooding occurred in New Orleans again in 2005, many in the
Black community questioned the government?s willingness to respond. Racial
mistrust is only compounded by the other historical factors and discrimination
that have led to racial discrepancies in housing, labor, socioeconomic status, and
education.
114 Henkel, Dovidio, and Gaertner
In addition, actions during the crisis caused by Hurricane Katrina have fueled
racial suspicions and exacerbated racial mistrust. For instance, on September 1,
2005, 3 days after Hurricane Katrina struck, thousands of evacuees who were
fleeing the wretched conditions of the city and the Convention Center marched
toward a bridge that would take them to safety. They were met at the bridge by
the Gretna Police, who brandished rifles. The evacuees recount hearing gunshots
(Hamilton, 2006) as the police prevented them from crossing the bridge and turned
them back to the city. Two visitors trying to escape New Orleans wrote about their
experiences: ?We questioned why we couldn?t cross the bridge anyway, especially
as there was little traffic on the 6-lane highway. They responded that the West
Bank was not going to become New Orleans and there would be no Superdome
in their city? (Bradshaw & Slonsky, 2005). The police chief explained that ?his
town … feared for its safety from a tide of evacuees? (Sharokman, 2005). As
Sharokman (2005) observed, ?And because most of the evacuees were Black and
most of Gretna is White, the episode has stirred charges of racism? (p. 1A). This
incident remains a symbol of racism and the fundamental racial divide in New
Orleans. Six months after the incident, Rev. Jesse Jackson, who organized the
protest, led a demonstration by ?a celebrity-studded, almost exclusively AfricanAmerican
crowd of thousands who marched across the bridge, which they consider
a symbol of injustice in post-Katrina New Orleans? (Donze & Filosa, 2006, Metro,
p. 1).
Given a national context in which Blacks distrust Whites and the government
(e.g., Earl & Penny, 2001), in combination with clearly differential outcomes
for majority and minority group members (e.g., Sidanius & Pratto, 1999), and
a history of racism and flooding specifically in New Orleans, it is not surprising
that racial distrust played a role in response to Hurricane Katrina and the
recovery process. Hancock (2005) described the deepened distrust of Blacks in
the aftermath of Katrina. He found that many Blacks felt the events were ?too
coincidental,? and wrote, ?There are other, more sinister conspiracy theories.
Many Black residents believe that the Ninth Ward and other Black neighborhoods
were deliberately flooded in order to save the tourist areas and White business
areas.?
This distrust has been fueled by questions about the recovery and rebuilding
efforts. Efforts to return Blacks to their communities have appeared to be particularly
slow. Three months after Hurricane Katrina hit landfall, only 16% of the
trailers and other forms of temporary housing requested, which would have primarily
benefited those originally from low-income housing areas, had been delivered
(Hancock, 2005). Despite similar damage, residents of Lakeview, a predominantly
White community, were allowed to ?look and leave,? a key step in the recovery
process, in which residents are allowed to return temporarily to their homes during
the day, long before residents in the primarily Black area of the Lower Ninth Ward
were given this opportunity, ostensibly because the neighborhood was still flooded
Racism and Katrina 115
(Scott, 2005). In fact, bulldozing of the Lower Ninth Ward was commissioned prior
to informing residents, and it took the action of local activists to stop the bulldozing
plan.
Government actions in the rebuilding process have further fueled Blacks?
perceptions of conspiracies against them. Hancock (2005) observed, ?In Katrina?s
aftermath, rumors circulated that the area [the Ninth Ward] would be bulldozed and
returned to swampland or handed to rich, White developers.? The Mayor?s Bring
New Orleans Back Commission explicitly proposed ?greenspaces? in New Orleans
East, which would displace residents in this traditionally Black neighborhood, and
recommended turning over historically Black neighborhoods and public housing
areas not substantially damaged by Hurricane Katrina to White urban developers.
Professor John Logan, a sociologist who studied the impact of Hurricane Katrina,
concluded that New Orleans could lose up to 80% of its Black population if people
displaced by the storm are not allowed to return to live in their neighborhoods
(Smith, 2006). It is not surprising that three-quarters of Blacks reported feeling
anger in the aftermath of Hurricane Katrina (Saad, 2005).
Policy Implications
Although much of the public debate about the devastating consequences of
Hurricane Katrina, particularly for Blacks in New Orleans, has focused on whether
racism was involved, we have attempted to show that a focus on old-fashioned,
overt racism likely misrepresents the dynamics in the situation. Overt racism might
have played a role, but subtle and unintentional biases seemed to be a much more
significant influence. Moreover, the actions of Whites and Blacks both contributed
to varying degrees and in various ways to the lack of responsiveness that characterized
the preparation for the hurricane and the response in its aftermath. Specifically,
three key processes that we identified are institutional racism, subtle contemporary
prejudice, and racial distrust. We further propose that understanding how these
forces shaped the way both Whites and Blacks responded to the threat and damage
of Hurricane Katrina can help to guide policies that can facilitate effective recovery
and enhance emergency efforts in the future.
One of the most basic implications of our analysis is that the circumstances
of Blacks in New Orleans at the time Hurricane Katrina made landfall, which
made them especially vulnerable to flooding and which contributed to racial distrust,
were the result of historical discrimination and institutional racism. Because
race was central to these circumstances, interventions to address the consequences
of Hurricane Katrina and policies for future emergency situations cannot be colorblind.
Effective interventions and policies should consider the importance of
historical and contemporary racial disparities to the susceptibility of different
communities to harm, how racial biases may unintentionally influence the actions
of decision makers, and how race relations might influence the responses
116 Henkel, Dovidio, and Gaertner
of vulnerable groups to efforts to help. That is, the processes related to how New
Orleans got to this point need to be considered in a plan to reverse the devastating
consequences of these processes. We illustrate the application of these principles
with a recovery strategy that could meet these requirements.
It is important to establish trust for the recovery effort. Given Blacks? mistrust
for the government (Dovidio et al., 2002), some other more-trusted agency should
be chosen to work directly with citizens of New Orleans, with government sponsorship.
That is, while the government may provide financial and logistical support,
other organizations may be employed to deliver the assistance. For example, neighborhood
coalitions could be formed to meet this need and other organizations that
are already trusted in the community can provide additional assistance. To facilitate
the development of interracial trust and improve race relations, as outlined in
the Contact Hypothesis (Allport, 1954; Pettigrew, 1998), these coalitions should
include members of both Black and White communities. The efforts of Blacks and
Whites should involve personal interactions in which they are equal-status partners
in cooperative ventures with the support of both communities and the government
(Dovidio, Gaertner, & Kawakami, 2003).
In addition, the community coalitions with government support would then
be responsible for meeting the needs of storm victims not simply by giving money,
which could foster the dependency of residents on outside assistance, but by encouraging
the autonomy and agency of the storm victims themselves. For instance,
rebuilding programs might recruit members of the community as apprentices who
could acquire skills that would enable them to help others in the community in the
future. By addressing specific problems that are common among storm victims, it
would be possible to get the community members back on their feet more quickly
and effectively.
These skills that are acquired can provide either material assistance, such
as carpentry, or psychological help, such as social support, and information for
appropriate referrals. Besides the extensive damage to property, Hurricane Katrina
will have long-term adverse effects on victims? mental and physical health. A
recent report (Dewan, 2006) found that among storm victims, more than 50% of
female caregivers scored ?very low? on mental health screening exams, showing
signs of anxiety and depression in particular. Children are exhibiting symptoms of
behavioral and anxiety problems as well. Among children, 34% have asthma as
compared to 25% of the rest of the population and many of these children have gone
without prescription medication at some point since Katrina. Among adult victims,
50% have some kind of chronic condition like diabetes, high blood pressure, or
cancer. Given these statistics, it is critical to provide access to medical and mental
health clinics. However, a 2001 Surgeon General?s report has shown that mistrust
of such clinics is prevalent among Black communities. We suggest establishing
a community council to help run the clinics and educate the communities about
services being offered to bolster trust.
Racism and Katrina 117
Other problems that need to be addressed are those of jobs and housing. Many
Katrina evacuees are currently fighting eviction from landlords who want to renovate
and raise prices (Kunzelman, 2006). In addition, evacuees may not have the
skills that they need to get jobs. Therefore, we propose that the recovery effort
involve job training, job placement, and housing placement programs. To counteract
the past segregation and discrimination that Blacks experienced, it would be
important for such programs to work to integrate job environments and facilitate
voluntary integration of neighborhoods. Because of the community organizations,
such intentional integration would be possible, since members of both Black and
White communities would both be responsible for training and placement.
Another problem that many evacuees have faced is that their children have
missed significant amounts of school (Dewan, 2006). Missing school only
exacerbates the effects of educational discrimination that many children of color
face, so it is critical for the children to catch up in school. This can be accomplished
through individual support, such as tutoring, or more general efforts, such
as extending the school year and expanding day care programs. Children can go
to day care while their parents are at work and receive tutoring if they have missed
significant school time. Members of the community can volunteer to provide day
care and to tutor. Since the program would be run through the community, parents
would not have the added stress of worrying about their children while they are at
work, and children would have the opportunity to continue with their schoolwork.
Although it will involve added community expense, extending the school year
will help students compensate for time and opportunities lost while schools were
closed, emphasize the priority of education, and reduce the cost of supervision of
school-age children in the summer for parents directly.
Programs addressing needs such as health care, job training and placement,
housing, and childcare are critical in the recovery process, but the process may be
overwhelming for many individuals who are trying to reestablish themselves. To
address this, we propose a mentorship or a sponsorship program where people who
are in the early stages of recovery are paired up with members of the community
who have been through the process already and can provide support and advice.
As people move through the process, they can then be in a position to mentor
others. Thus, efforts for recovery need to consider explicitly the particular needs
of victims, recognizing the historical legacy of racial biases and the potential for
contemporary subtle racial bias, and addressing these needs with race-sensitive
policies.
To some extent, neighborhood associations and charitable community organizations
are already carrying out many of the same strategies that we suggest. For
example, Association of Community Organizations for Reform Now (ACORN) is
helping residents recover financially from Hurricane Katrina and return to their
neighborhoods by cleaning out and gutting homes in low income neighborhoods
to reduce costs for homeowners. ACORN also holds regular housing workshops
118 Henkel, Dovidio, and Gaertner
to provide assistance with buying or building a home, getting rehabilitation loans,
applying for state aid, carrying out FEMA appeals, removing lead contamination,
and dealing with displacement from public housing (ACORN, 2006). Another
nonprofit group, Cityworks, is cataloguing the efforts of individual neighborhood
associations in an attempt to assess what has been done and what resources
these neighborhood associations still need. Cityworks, along with New Orleans
neighborhood associations and other nonprofit and governmental groups, recently
organized a ?Festival of Neighborhoods,? which was aimed at helping people rebuilding
from Katrina. Many of these organizations set up booths with information,
resources, and helpful items like fly and mice strips (Bazile, 2006).
In summary, the events in New Orleans related to Hurricane Katrina and its
aftermath illustrate the importance of understanding how historical race relations
and subtle and institutional racial bias can significantly influence what types of
efforts and policies can be effective for providing people the assistance they need.
Without a foundation of trust, formal government assistance programs may be met
with suspicion and resistance, compromising their effectiveness. As Nadler (2002;
see also Nadler & Halabi, 2006) noted, low power groups may resist offers of help,
even if it provides valuable material benefit, if it is perceived as reinforcing the control
of the high power group. Thus, volunteer groups and other nongovernmental
agencies are particularly important in the rebuilding of New Orleans.
Conclusions
Even if overt discrimination may not have played a role in the government?s
response to Hurricane Katrina, the fact that Blacks in New Orleans were disproportionately
affected by the disaster suggests that other, more subtle processes
were at work. These processes included contemporary personal prejudice, past
and present institutional discrimination, and cultural racism. In addition, these
processes combined to create a climate of racial distrust that served as a backdrop
for Katrina?s landfall. Although it is impossible to go back and change the
way Hurricane Katrina was handled initially, it is crucial that researchers, government
agencies, and people in positions of power learn from what happened there
and improve the recovery still in process as well as future disaster and recovery
efforts.
It is also critical to recognize that institutional and subtle forms of racism, and
even blatant racism, are not simply historical events but are also contemporary influences.
Racial biases are a formidable challenge in the rebuilding of New Orleans.
Institutional racism can take new forms, with apparently egalitarian policies having
adverse impact on race relations and opportunities for Blacks in the city. For example,
the government has further damaged its relationship with the Black community
in New Orleans by planning to tear down 5,000 apartments in public housing and
to replace them with mixed-income housing (Quigley, 2006). Although support
Racism and Katrina 119
for this likely more integrated housing seems to be a well-meaning and positive
step toward racial harmony, it would drastically reduce the amount of low-income
housing in New Orleans and displace a large number of Black residents from their
homes and, ultimately, from the city. Many of these apartments are part of buildings
that are repairable, like the Lafitte complex near the Faubourg Treme (Elie, 2006).
Displaced residents have filed a lawsuit against local and federal housing agencies,
saying that the agencies are keeping low-income Black families from returning to
their homes, which violates their civil rights (Filosa, 2006b). In this case, what
government officials may have thought was a positive step toward integration may
actually push or keep Blacks out of New Orleans.
The recovery of public education in New Orleans has also been controversial.
All but four of the city?s 128 public schools have been converted to charter
schools or taken over by state agencies. Although some residents find the charter
school system progressive, others are unhappy. For example, Louella Givens, New
Orleans? representative to the state?s Board of Elementary and Secondary Education,
has expressed concern about the amount of input communities will be able to
have on how their schools are run. Other residents believe that the charter school
system will result in more inequality (Filosa, 2006a). Thus, the reconstruction
of New Orleans illustrates the ways that apparently well-intentioned efforts and
government policies can alienate Blacks, limit their opportunities for housing, and
mute their voice in key institutions such as their schools. Without full consideration
of the long-term consequences of these actions, these efforts can enable
others with blatant racial motivations to exclude Blacks physically, politically, and
psychologically from the future of New Orleans.
Hurricane Katrina could have been and still can be a means for positive change
in New Orleans. It has created a turning point, where either racism can be eradicated
or an unfair history can be repeated. To this point, there have been mixed results
in New Orleans. Since Katrina, there has been a wave of activism in the city,
indicating that there is hope for a positive change (Bazile, 2006). Nevertheless,
problems in housing and education have further damaged the government?s image
(e.g., Elie, 2006).
More generally, after almost 250 years of racial inequality in the United States,
the aftermath of Hurricane Katrina, which disproportionately affected the lives of
Black citizens, could serve as a catalyst for leaders and policy makers in the United
States to commit themselves fully to addressing institutional and individual forms
of racism that continue to harm and restrict opportunities for millions of citizens.
If the United States is serious about eradicating racism and its consequences, it is
important to learn more about the dynamics of racial attitudes and their underlying
cognitive, emotional, and developmental processes. Moreover, it is important that
policy makers be made aware of these advances and incorporate them directly into
policy formulations. Thus, in addition to providing the financial support that is
necessary to address the immediate needs of victims of Hurricane Katrina, it is
120 Henkel, Dovidio, and Gaertner
also important to invest substantially, in terms of enhanced research funding, to
make the elimination of racism a national priority. Long-term national investments
to understand the basic processes of racism and discrimination and to facilitate
partnerships between scholars and policy makers can be critical in combating
racism, which can bring racial groups in the United States closer together rather
than pushing them further apart.
References
ABC News. (2006, January 13). Available housing for Katrina evacuees caught in federal red tape:
VA offered FEMA thousands of single-family homes; deal formalized four months after storm
hit. Retrieved January 13, 2006, from http://abcnews.go.com/WNT/HurricaneKatrina/story?id=
1503846.
Association of Community Organizations for Reform Now (ACORN). Retrieved July 7, 2006 from
http://www.acorn.org/index.php?id=10223.
Allport, G. W. (1954). The nature of prejudice. Cambridge, MA: Addison-Wesley.
Armstrong, T. D., Crum, L. D., Reiger, R. H., Bennett, T. A., & Edwards, L. J. (1999). Attitudes of
Africa Americans toward participation medical research. Journal of Applied Social Psychology,
29, 553?574.
Bazile, K. T. (2006, June 25). Celebrating teamwork: Residents and neighborhood groups share information
on rebuilding efforts?and have a little fun. The Times-Picayune. Retrieved June
29, 2006 from http://www.nola.com/search/index.ssf?/base/news-15/1151219042101580.xml?
NZNPMT&coll=1.
Blank, R. M. (2001). An overview of trends in social and economic well-being, by race. In N. J.
Smelser, W. J. Wilson, & F. Mitchell, F. (Eds.), Racial trends and their consequences (Vol. 1,
pp. 21?39). Washington, DC: National Academy Press.
Bradshaw, L., & Slonsky, L. B. (2005, September 5). Hurricane Katrina-Our Experiences. Retrieved
July 7, 2006 from http://sfsocialists.livejournal.com/3687.html.
Brewer, M. B. (1979). Ingroup bias in the minimal intergroup situation: A cognitive-motivational
analysis. Psychological Bulletin, 86, 307?324.
Broder, J. M., Wilgoren, J., & Alford, J. (2005, September 5). Storm and crisis: Racial tension; amid
criticism of federal efforts, charges of racism are lodged. New York Times, p. A9.
Burchfiel, N. (2006, January 13). Update: Statistics confirm earlier report on Katrina deaths.CNS News.
Retrieved May 7, 2006 from http://www.cnsnews.com/Nation/Archive/200601/NAT20060113a.
html.
Callebs, C., Gupta, S., Lavendera, E., Lawrence, C., & Starr, B. (2005, September 2). Convoys bring
relief to New Orleans: Refugees cheer envoys, Bush signs $10.5 billion aid package. CNN.
Retrieved April 25, 2006, from http://us.cnn.com/2005/US/09/02/katrina.impact/index.html.
CensusScope. (2006). University of Michigan, Social Science Data Analysis Network, (2000: Segregation:
Dissimilarity Indices. Retrieved May 7, 2006, from the CensusScope website: http://www.
censusscope.org/us/rank dissimilarity white black.html.
CNN. (2005, September 2). The big disconnect on New Orleans: The official version; then there?s the
in-the-trenches version. Retrieved April 19, 2006, from http://www.cnn.com/2005/US/09/02/
katrina.response/index.html.
Crocker, J., Luhtanen, R., Broadnax, S., & Blaine, B. E. (1999). Belief in U.S. government conspiracies
against Blacks among Black and White college students: Powerlessness or system blame?
Personality and Social Psychology Bulletin, 25, 941?953.
Darley, J. M., & Latan?e, B. (1968). Bystander intervention in emergencies: Diffusion of responsibility.
Journal of Personality and Social Psychology, 8, 377?383.
Davis, S. M., & Reid, R. (1999). Practicing participatory research in American Indian communities.
American Journal of Clinical Nutrition, 69S, 4, 755S?759S.
Racism and Katrina 121
Dewan, S. (2006, April 18). Evacuee study finds declining health. New York Times. Retrieved April 18,
2006 from http://www.nytimes.com/2006/04/18/us/nationalspecial/18health.html?ex=
1147320000&en=1c18f8a508471e51&ei=5070.
Donze, F., & Filosa, G. (2006, April 2). Bridge march hails justice, voter rights; Thousands join
Jesse Jackson in crossing river. The Times-Picayune, Metro, p. 1. Retrieved July 8, 2006 from
http:/ /web.lexis-nexis.com/universe/document? m=7e65e5db04cc42b210fbf69a1664dae1&
docnum=11&wchp=dGLbVtz-zSkVA& md5=baa1fcee5aa80ffba404c2ecb4fc5904.
Dovidio, J. F., Brigham, J., Johnson, B. T., & Gaertner, S. L. (1996). Stereotyping, prejudice, and
discrimination: Another look. In N. Macrae, C. Stangor, & M. Hewstone (Eds.), Stereotypes
and stereotyping (pp. 276?319). New York: Guilford.
Dovidio, J. F., & Gaertner, S. L. (2000). Aversive racism and selection decisions: 1989 and 1999.
Psychological Science, 11, 319?323.
Dovidio, J. F., & Gaertner, S. L. (2004). Aversive racism. In M. P. Zanna (Ed.), Advances in experimental
social psychology (Vol. 36, pp. 1?51). San Diego, CA: Academic Press.
Dovidio, J. F., Gaertner, S. L., & Kawakami, K. (2003). The contact hypothesis: The past, present, and
the future. Group Processes and Intergroup Relations, 6, 5?21.
Dovidio, J. F., Gaertner, S. L., Kawakami, K., & Hodson, G. (2002). Why can?t we just get along?
Interpersonal biases and interracial distrust. Cultural Diversity & Ethnic Minority Psychology,
8, 88?102.
Dovidio, J. F., Mann, J., & Gaertner, S. L. (1989). Resistance to affirmative action: The implications
of aversive racism. In F. A. Blanchard & F. J. Crosby (Eds.), Affirmative action in perspective
(pp. 83?103). New York: Springer-Verlag.
Earl, C. E., & Penney, P. J. (2001). The significance of trust in the research consent process with
African Americans. Western Journal of Nursing Research, 23, 753?762.
Elie, L. (2006, June 16). HUD builds Katrina hall of shame. The Times-Picayune. Retrieved June 29,
2006 from http://www.nola.com/news/t-p/frontpage/index.ssf?/base/news-15/1150440448324
60.xml&coll=1.
Feagin, J. R., & Sikes, M. P. (1994). Living with racism: The Black middle-class experience. Boston,
MA: Beacon Press.
Feagin, F. R., & Vera, H. (1995). White racism: The basics. New York: Routledge.
Federal Financial Institutions Examination Council. (2002). Nationwide summary statistics for the 2001
HMDA data fact sheet. Retrieved May 7, 2006 from http://www.ffiec.gov/hmcrpr/hm fs01.htm.
Filosa, G. (2006a, June 25). School leaders assail move to charters: Many at summit see it as invasion by
state. The Times-Picayune. Retrieved June 29, 2006 from http://www.nola.com/search/index.
ssf?/base/news-2/1151219470101580.xml?NSBED&coll=1.
Filosa, G. (2006b, June 28). Displaced residents file suit: Local, federal housing agencies face civil rights
allegations. The Times-Picayune. Retrieved June 29, 2006 from http://www.nola.com/search/
index.ssf?/base/news-15/1151476788163220.xml?NZNPMT&coll=1.
Fischer, M. J., & Massey, D. S. (2004). The ecology of racial discrimination. City and Community,
3(3), 221?241.
Gaertner, S. L., & Dovidio, J. F. (1977). The subtlety of White racism, arousal, and helping behavior.
Journal of Personality and Social Psychology, 35, 691?707.
Gaertner, S. L., & Dovidio, J. F. (1986). The aversive form of racism. In J. F. Dovidio & S. L. Gaertner
(Eds.), Prejudice, discrimination, and racism (pp. 61?89). Orlando, FL: Academic Press.
Gaertner, S. L., Rust, M. C., Dovidio, J. F., Bachman, B. A., & Anastasio, P. A. (1996). The Contact
hypothesis: The role of a common ingroup identity on reducing intergroup bias among majority
and minority group members. In J. L. Nye & A. M. Brower (Eds.), What?s social about social
cognition? (pp. 230?360). Newbury Park, CA: Sage.
Gallup. (2002). Poll topics & trends: Race relations. Washington, DC: The Gallup Organization.
http:/www.gallup.com/poll/topics/race.asp.
Glanton, D. (2005, February 21). Death stokes racial tension in Big Easy.Chicago Tribune. Retrieved on
May 11, 2006, from http://web.lexis.nexis.com/universe/document? m=1084a6ceec5bb908ac
28e0f8e0c56741& docnum=1&wchp=dGLbVtb-zSkVA& md5=d9c9c411cd47dceaf1d3e679
ef2f073d.
122 Henkel, Dovidio, and Gaertner
Hamilton, B. (2006, February 26). Evacuees recount gunfire at bridge blockade; Gretna, Jeff officials
defend Katrina action. The Times-Picayune, National, p. 1. Retrieved July 8, 2006 from
http:/ /web.lexis-nexis.com/universe/document? m=7e65e5db04cc42b210fbf69a1664dae1&
docnum=17&wchp=dGLbVtz-zSkVA& md5=a2c52b77050a0db353ec86dbeb30f2cf.
Hamilton, D. L., & Trolier, T. K. (1986). Stereotypes and stereotyping: An overview of the cognitive
approach. In J. F. Dovidio & S. L. Gaertner (Eds.), Prejudice, discrimination, and racism (pp.
127?163). Orlando, FL: Academic Press.
Hancock, L. (2005, December 7). In a city split and sinking before the storm, racial issues boil. The
Dallas Morning News. Retrieved on May 11, 2006, from http://web.lexis.nexis.com/universe/
document? m=949ad005ce157e5c25025cfedb3eea6f& docnum=1&wchp=dGLbVtb-zSkVA
& md5=ce9f19e57614fd49ea8dedc44a952643.
Hau, S. S. (2005, October 20). Chertoff vows to ?re-engineer? preparedness: Secretary recognizes flaws
in hurricane response but defends department. Washington Post, p. A2.
Hodson, G., Dovidio, J. F., & Gaertner, S. L. (2002). Processes in racial discrimination: Differential
weighting of conflicting information. Personality and Social Psychology Bulletin, 28, 460?471.
Howell, S. E., Perry, H. L., & Vile, M. (2004). Black/White cities: Evaluating the police. Political
Behavior, 26, 45?68.
Jenkins, R. R. (2001). The health of minority children in the year 2000: The role of government
programs in improving the health status of America?s children. In N. J. Smelser, W. J. Wilson,
& F. Mitchell, F. (Eds.),Racial trends and their consequences(Vol. 2, pp. 351?370). Washington,
DC: National Academy Press.
Jones, J. M. (1997). Prejudice and racism (2nd ed.). New York: McGraw-Hill.
Kovel, J. (1970). White racism: A psychohistory. New York: Pantheon.
Kunzelman, M. (2006, April 18). After Katrina, poor tenants fight eviction. Guardian Unlimited.
Retrieved April 18, 2006 from http://www.guardian.co.uk/uslatest/story/0,,-5763810,00.html.
Lacey, B. C., & Lacey, J. I. (1974). Studies of heart rate and other bodily processes in sensorimotor
behavior. In P. A. Obrist, A. H. Black, J. Brenner, & L. V. DiCara (Eds.), Caridiovascular
psychophysiology (pp. 538?564). Chicago: Aldine.
Leopold, T. (2005, September 1). ?Louisiana 1927?: A song and a tragedy. CNN. Retrieved December
19, 2005, from http://www.cnn.com/2005/SHOWBIZ/08/31/eye.ent.louisiana/.
Madden, J. F. (2000). Changes in Income Inequality within U.S. Metropolitan Areas. Kalamazoo, MI:
Upjohn Institute for Employment Research.
Massey, D. S. (2001). Residential segregation and neighborhood conditions in U.S. metropolitan areas.
In N. J. Smelser, W. J. Wilson, & F. Mitchell, F. (Eds.), Racial trends and their consequences
(Vol. 1, pp. 391?434). Washington, DC: National Academy Press.
McConahay, J. B. (1986). Modern racism, ambivalence, and the modern racism scale. In J. F. Dovidio
& S. L. Gaertner (Eds.), Prejudice, discrimination, and racism (pp. 91?125). Orlando, FL:
Academic Press.
Nadler, A. (2002). Inter-group helping relations as power relations: Helping relations as affirming or
challenging inter-group hierarchy. Journal of Social Issues, 58, 487?502.
Nadler, A., & Halabi, S. (2006). Intergroup helping as status relations: Effects of status stability ingroup
identification and type of help on receptivity to help from high status group. Journal of
Personality and Social Psychology, 91, 97-110.
Nossiter, A. (2006, March 7). Demolition of homes begins in sections of New Orleans. New York Times,
p. A12.
Oliver, M. L., & Shapiro, T. M. (2001). Wealth and racial stratification. In N. J. Smelser, W. J. Wilson, &
F. Mitchell, F. (Eds.), Racial trends and their consequences (Vol. 2, pp. 222?251). Washington,
DC: National Academy Press.
Otten, S., & Moskowitz, G. B. (2000). Evidence for implicit evaluative in-group bias: Affect-based
spontaneous trait inference in a minimal group paradigm. Journal of Experimental Social
Psychology, 36, 77?89.
Pettigrew, T. F. (1998). Intergroup Contact Theory. Annual Review of Psychology, 49, 65?85.
Phelps, R. E., Taylor, J. D., & Gerard, P. A. (2001). Cultural mistrust, ethnic identity, racial identity and
self-esteem among ethnically diverse black students. Journal of Counseling & Development,
79, 209?216.
Racism and Katrina 123
Quigley, B. (2006, June 23). No place like home. The Times-Picayune. Retrieved June 29, 2006 from
http:/ /www.nola.com/news/t-p/otheropinions/index.ssf?/base/news-0/115104297973020.xml
&coll=1.
Report of the National Advisory Commission on Civil Disorders. (1968). Washington, DC: Washington
Government Printing Office.
Ross, B. (2005, September 2). Katrina after math raises questions of race: Largely poor, Black survivors
deal with charges of lawlessness, loaded history. ABC News. Retrieved December 19, 2005,
from http://abcnews.go.com/Primetime/HurricaneKatrina/story?id=1089382&page=1.
Saad, L. (2005, September 14). Blacks bash Bush for Katrina response. Gallup Poll News Service. Retrieved
May 11, 2006, from http://web.lexis.nexis.com/universe/document? m=64eb31361594
5542f8e79163963b457b& docnum=1&wchp=dGLbVtb-zSkVA& md5=bdaa8c7fa7043bf8c4
79c3ac46ae08d0.
Saucier, D. A., Miller, C. T., & Doucet, N. (2005). Differences in helping Whites and Blacks: A
meta-analysis. Personality and Social Psychology Review, 9, 2?16.
Scott, R. T. (2005, September 28). Nagin says some residents can return Friday. The Times-Picayune.
Retrieved July 7, 2006 from http://www.nola.com/newslogs/breakingtp/index.ssf?/mtlogs/
nola Times-Picayune/archives/2005 09 28.html.
Sears, D. O., Henry, P. J., & Kosterman, R. (2000). Egalitarian values and contemporary racial politics.
In D. O. Sears, J. Sidanius, & L. Bobo (Eds.), Racialized politics: The debate about racism in
America (pp. 75?117). Chicago, IL: University of Chicago Press.
Seitles, M. (1996). The perpetuation of residential racial segregation in America: Historical discrimination,
modern forms of exclusion, and inclusionary remedies. Journal of Land Use and
Environmental Law, 14(1), 1?30.
Select Bipartisan Committee toInvestigate the Preparation for andResponse to Hurricane Katrina.
(2006). A Failure of Initiative: The Final Report of the Select Bipartisan Committee to Investigate
the Preparation for and Response to Hurricane Katrina. Retrieved May 7, 2006, from
http://katrina.house.gov/full katrina report.htm.
Sharockman, A. (2005, September 17). Neighboring town denied evacuees. St. Petersburg Times, National,
p. 1A. Retrieved July 8, 2006 from http://web.lexis-nexis.com/universe/document? m=
ab7637d9749a572f7de2a64d85077bd8& docnum=60&wchp=dGLbVtz-zSkVA& md5=2a6c
8b08704ae5bbf00fb128f03382ed.
Shavers-Hornaday, V. L., Lynch, C. F., Burmeister, L. F., & Torner, J. C. (1997). Why are African
Americans underrepresented in medical research studies? Impediments to participation. Ethnicity
and Health, 2, 31?45.
Sidanius, J., & Pratto, F. (1999). Social dominance: An intergroup theory of social hierarchy and
oppression. New York: Cambridge University Press.
Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.) (2003). Unequal treatment: Confronting racial
and ethnic disparities in health care. Washington, DC: National Academy Press.
Smith, M. R. (2006, January 27). Study cites racial makeup of New Orleans. Associated Press Online.
Retrieved May 11, 2006, from http://web.lexis.nexis.com/universe/document? m=4bd229970d
2824f5c1f0be58a630e484& docnum=1&wchp=dGLbVtb-zSkVA& md5=9a553b535847095
6f7d1b62c5e315b4e.
Tajfel, H. (1970). Experiments in intergroup discrimination. Scientific American, 223, 96?102.
Treadway, J. (2005, June 27). Groups tackle recent racial tensions; Local organizations strive for harmony.
Times-Picayune (New Orleans). Retrieved on May 11, 2006, from http://web.lexis.nexis.
com/universe/document? m=f4b5ac9ab314380e42b64997ec7cc73e& docnum=1&wchp=dG
LbVtb-zSkVA& md5=47314d18311364c9c615747803f5fbea.
KRISTIN E. HENKEL is pursuing her Ph.D. in social psychology at the University
of Connecticut. Her current research interests are in stereotyping, prejudice, and
discrimination. She is a National Institute of Mental Health Fellow in the Social
Processes of AIDS Training Program supported by grant T32 MH074387.
124 Henkel, Dovidio, and Gaertner
JOHN F. DOVIDIO is professor of Psychology at the University of Connecticut.
His research interests in social psychology are in stereotyping, prejudice, and discrimination;
social power and nonverbal communication; and altruism and helping.
He is the editor of the Journal of Personality and Social Psychology?Interpersonal
Relations and Group Processes.
SAMUEL L. GAERTNER is professor of Psychology at the University of Delaware.
His research interests involve intergroup relations, with a primary focus on reducing
prejudice, discrimination and racism. He has served on the Council of the
Society for the Psychological Study of Social Issues (SPSSI) and on the editorial
boards of the Journal of Personality and Social Psychology, Personality and Social
Psychology Bulletin, and Group Processes and Intergroup Relations. He and John
Dovidio shared SPSSI?s Gordon Allport Intergroup Relations Prize in 1985 and in
1998 and the Kurt Lewin Award in 2004.

After reading either of the two articles ?Institutional Discrimination, Individual Racism, and Hurricane
Katrina? by Henkel, et al. or ?In the Eye of the Storm: How the Government and Private Response to
Hurricane Katrina Failed Latinos? by Mu?iz, write a short essay that responds to the following:
Discuss some of the factors that increased the vulnerability of African-American residents (Henkel article)
or Latino residents (Mu?iz article) of New Orleans before, during, and after Hurricane Katrina, including
their ability to anticipate and prepare for the storm, cope with the impacts, and eventually recover.
Your essay should be roughly 1-2 pages in length (single spacing). All essays should be clear, concise,
and well-organized, and demonstrate a solid understanding of the reading. All essays should be
proofread thoroughly for spelling and grammatical errors. Direct quotes (if used) should include page
numbers in the citation.
Submit your essay via the ?Submit Short Essay 6 Here? link, found under the ?Short Essays? tab on
Blackboard no later than 1:30PM (the start of class) on Thursday 9/29. NO late essays will be accepted.

Analyses of Social Issues and Public Policy, Vol. 6, No. 1, 2006, pp. 99–124
Institutional Discrimination, Individual Racism,
and Hurricane Katrina
Kristin E. Henkel*
University of Connecticut
John F. Dovidio
University of Connecticut
Samuel L. Gaertner
University of Delaware
Since Hurricane Katrina made landfall, there have been accusations of blatant
racism in the government?s response, on the one hand, and adamant denials that
race played any role at all, on the other. We propose that both perspectives reflect
oversimplifications of the processes involved, and the resulting debate may obscure
a deeper understanding of the dynamics of the situation. Specifically, we discuss
the potential roles of institutional discrimination, subtle contemporary biases,
and racial mistrust. The operation of these processes is illustrated with events
associated with Hurricane Katrina. In addition, drawing on these principles, we
offer suggestions for present and future recovery efforts.
You?d have to go back to slavery, or the burning of Black towns, to find a comparable event
that has affected Black people this way.
?Darnell M. Hunt, a sociologist and head of the
African American Studies Department at UCLA
I think all of those remarks were disgusting, to be perfectly frank because, of course,
President Bush cares about everyone in our country, and I know that.
?Laura Bush, First Lady
*Correspondence concerning this article should be addressed to Kristin E. Henkel, Department
of Psychology, 406 Babbidge Road, Unit 1020, University of Connecticut, Storrs, CT 06269-1020
[e-mail: Kristin.Henkel@gmail.com].
99
C 2006 The Society for the Psychological Study of Social Issues
100 Henkel, Dovidio, and Gaertner
In the aftermath of Hurricane Katrina, which devastated New Orleans and
had particular impact on its Black community in August of 2005, accusations
pertaining to the lack of preparation for the storm and for the plight of its victims
were heatedly exchanged. Racism was one focus of the debate. On one side, it
was asserted that the inadequate response to the storm and the flooding was due
to obvious racism. This sentiment is evident in a statement by Kanye West, a
prominent rap artist, who said, ?George Bush doesn?t care about Black people?
(Broder, Wilgoren, & Alford, 2005). In response and in contrast, others such as
Secretary of State Condoleeza Rice adamantly denied that race had anything to
do with Hurricane Katrina or the government?s response to it. She claimed that
?nobody, especially the President, would have left people unattended on the basis
of race? (Broder et al., 2005).
From a social psychological perspective, both sides appeared to oversimplify
the situation, and polemics obscured the potential roles of historical factors, institutional
discrimination, and contemporary subtle forms of individual racism,
all of which likely played parts in the impact of Hurricane Katrina and the government?s
response to it. This article examines some events and decisions related
to Hurricane Katrina, and explores how historical and contemporary orientations
toward Blacks in the United States likely shaped responses in a way that produced
particularly tragic consequences for Black residents of New Orleans without overt
antipathy or intention of decision makers. We emphasize the importance of how
the past shapes contemporary race relations. In the next section, we provide a brief
overview of the forces that contribute to racism in the United States. We then apply
these psychological insights into the dynamics of racism to understand the events
and decisions that produced uniquely devastating outcomes for Blacks in New
Orleans. We conclude by exploring the implications of this analysis for specific
interventions in New Orleans and for policy more generally.
It is impossible to know whether the processes we propose were operating
among the protagonists; we can only point out that the immenseness of the devastation
created tremendous confusion and communication problems and, further,
show that these are precisely the conditions most conducive to the activation of
these processes. We have prepared this article in the interests of helping people
sort through the different perspectives on these tragic events and to sensitize policy
makers, officials, and future rescuers to how racial factors can play a role during
such catastrophes.
Understanding Racism
Although discussions and accusations of racism in the popular media typically
portray racism in its most obvious and blatant form, within psychology it
is considered to be much more complex and multifaceted. Individual bias is just
one aspect, but one that involves several components: prejudice, stereotypes, and
Racism and Katrina 101
discrimination (Dovidio, Brigham, Johnson, & Gaertner, 1996). Prejudice is commonly
defined as an unfair negative attitude toward a social group or a person
perceived to be a member of that group. A stereotype is a generalization of beliefs
about a group or its members that is unjustified because it reflects faulty
thought processes or overgeneralization, factual incorrectness, inordinate rigidity,
an inappropriate pattern of attribution, or a rationalization for a prejudiced attitude
or discriminatory behavior. Discrimination is defined as a selectively unjustified
negative behavior toward members of the target group that involves denying ?individuals
or groups of people equality of treatment which they may wish? (Allport,
1954, p. 51).
Even though racism relates directly to the coordinated interaction of stereotypes,
prejudice, and discrimination, it involves more than individual biases. Racism
reflects institutional, social, and cultural influences, as well. According to Jones
(1997), at its very essence racism involves not only negative attitudes and beliefs,
but also the social power that translates them into disparate outcomes that disadvantage
other races or offer unique advantages to one?s own race at the expense of
others. As Feagin and Vera (1995) explain, ?Racism is more than a matter of individual
scattered episodes of discrimination,? it represents a widely accepted racist
ideology and the power to deny other racial groups the ?dignity, opportunities, freedoms,
and rewards that are available to one?s group through a socially organized set
of ideas, attitudes, and practices? (p. 7). Thus, while the study of prejudice and discrimination
focuses on the roles of individuals and interpersonal processes, racism
encompasses institutional, social, and cultural processes that serve as an influential
backdrop to individual-level perspectives. Institutional racism, for example,
refers to the intentional or unintentional manipulation or toleration of institutional
policies (e.g., poll taxes, admissions criteria) that unfairly restrict the opportunities
of particular groups of people, and cultural racism involves beliefs about the superiority
of one?s racial cultural heritage over that of other races and the expression
of this belief in individual actions or institutional policies (Jones, 1997).
Moreover, both contemporary personal and institutional racism often operate
without Whites? intention to harm members of minority groups or even awareness
by Whites of their personal role in disadvantaging Blacks. For instance, applying
policies that seem just and egalitarian based on immediate principles of fairness
in a narrow sense may systematically disadvantage groups that for historical reasons
have fewer contemporary resources (e.g., wealth or education) that would
allow them to benefit fully from these policies and procedures (Dovidio, Mann, &
Gaertner, 1989). Thus, Whites? historical discrimination against Blacks produces
a legacy of disparity that may be perpetuated even by well-intentioned people
who endorse and exercise current policies that have disparate consequences for
Whites and Blacks. Furthermore, cultural racism gives priority to the values of
the majority group, which are embedded in widely accepted cultural ideologies
(Sidanius & Pratto, 1999). Policies, laws, and procedures that reflect these values
102 Henkel, Dovidio, and Gaertner
may be subtly distorted in ways that enhance the disadvantage of minority groups
and the advantage of the majority group. Thus, when a racial group and its members
have been historically disadvantaged, the consequences are broad and severe,
reproducing themselves across time (Jones, 1997).
Consistent with this perspective, statistics show that racial disparities in several
key quality-of-life areas have stubbornly persisted over the years. For example,
the median family income for Blacks is less than two-thirds that of Whites, a
differential that has widened over the past two decades (Blank, 2001). Also, on
several basic measures of health and well-being, the racial gap either has been
maintained or in some cases (e.g., infant mortality) has widened substantially over
the past 50 years (Jenkins, 2001). Furthermore, recent studies suggest that over
their lifespans, Black and White patients receive unequal treatment from medical
practitioners, resulting in less favorable health-related outcomes for Blacks (see
Smedley, Stith, & Nelson, 2003). Steady trends toward residential integration that
were observed from 1950 to 1970 have slowed in the South and stagnated in the
North (Massey, 2001). Massey (2001) observed, ?Either in absolute terms or in
comparison to other groups, Blacks remain a very residentially segregated and
spatially isolated people? (p. 403). Both cultural racism and institutional racism
are subtle, difficult-to-detect processes that are at least partially responsible for
these outcomes.
Like institutional and cultural racism, individual prejudice is also commonly
manifested subtly, often without conscious awareness or intention. Many contemporary
approaches to individual racism acknowledge the persistence of overt,
intentional forms of racism but also consider the role of automatic or unconscious
processes and indirect expressions of bias (McConahay, 1986; Sears, Henry, &
Kosterman, 2000). We have explored the nature of Whites? racial attitudes to
understand the duality between the generally expressed nonprejudicial views of
Whites in contemporary U.S. society and the persistence of significant racial disparity
and discrimination. Our work built upon the conceptual framework of Kovel
(1970), who distinguished between dominative and aversive racism. Dominative
racism is the ?old-fashioned,? blatant form. According to Kovel, the dominative
racist is the ?type who acts out bigoted beliefs?he represents the open flame of
racial hatred? (p. 54). Aversive racists, in comparison, sympathize with victims
of past injustice, support the principle of racial equality, and regard themselves as
nonprejudiced, but, at the same time, possess negative feelings and beliefs about
Blacks, which may be unconscious. Aversive racism is hypothesized to be qualitatively
different than blatant, ?old-fashioned,? racism, is more indirect and subtle,
and is presumed to characterize the racial attitudes of most well-educated and
liberal Whites in the United States. Nevertheless, the consequences of aversive
racism (e.g., the restriction of economic opportunity) are as significant and pernicious
as those of the traditional, overt form (Dovidio & Gaertner, 2004; Gaertner
& Dovidio, 1986).
Racism and Katrina 103
A critical aspect of the aversive racism framework is the conflict between
Whites? denial of personal prejudice and underlying unconscious negative feelings
toward, and beliefs about, Blacks. Because of current cultural values, most Whites
have strong convictions concerning fairness, justice, and racial equality. However,
because of a range of normal cognitive, motivational, and sociocultural processes
that promote intergroup biases, most Whites also develop some negative feelings
toward or beliefs about Blacks, of which they are unaware or from which they try
to dissociate their nonprejudiced self-images. These negative feelings that aversive
racists have toward Blacks do not reflect open hostility or hatred. Instead, aversive
racists? reactions may involve discomfort, uneasiness, disgust, and sometimes fear.
That is, they find Blacks ?aversive,? while at the same time finding any suggestion
that they might be prejudiced ?aversive? as well. Thus, aversive racism may involve
more positive reactions to Whites than to Blacks, reflecting a pro-ingroup rather
than an anti-outgroup orientation, thereby avoiding the stigma of overt bigotry
while protecting a nonprejudiced self-image.
The negative feelings and beliefs that underlie aversive racism are hypothesized
to be rooted in normal, often adaptive, psychological processes. These processes
fundamentally involve the consequences of social categorization. People
inherently categorize others into groups, typically in ways that delineate the ?we?s
from the ?they?s? (Hamilton & Trolier, 1986). The mere categorization of people
into groups, even on the basis of arbitrary assignment, is sufficient to initiate (often
spontaneously, according to Otten & Moskowitz, 2000) an overall evaluative bias,
in which people categorized as members of one?s own group are evaluated more
favorably than are those perceived as members of another group (Brewer, 1979;
Tajfel, 1970).
The aversive racism framework also helps to identify when discrimination
against Blacks and other minority groups will or will not occur. Whereas oldfashioned
racists exhibit a direct and overt pattern of discrimination, aversive
racists? actions may appear more variable and inconsistent. Sometimes they discriminate
(manifesting their negative feelings), and sometimes they do not
(reflecting their egalitarian beliefs). Our research has provided a framework for
understanding this pattern of discrimination.
Because aversive racists consciously recognize and endorse egalitarian values
and because they truly aspire to be nonprejudiced, they will not discriminate in
situations with strong social norms when discrimination would be obvious to others
and to themselves. Specifically, when people are presented with a situation in which
the normatively appropriate response is clear, in which right and wrong are clearly
defined, aversive racists will not discriminate against Blacks. In these contexts,
aversive racists will be especially motivated to avoid feelings, beliefs, and behaviors
that could be associated with racist intent. Wrongdoing, which would directly
threaten their nonprejudiced self-image, would be too costly. However, because
aversive racists still possess feelings of uneasiness, these feelings will eventually
104 Henkel, Dovidio, and Gaertner
be expressed, but they will be expressed in subtle, indirect, and rationalizable ways.
For instance, discrimination will occur in situations in which normative structure
is weak, when the guidelines for appropriate behavior are vague, or when the basis
for judgment is ambiguous or confusing. In addition, discrimination will occur
when an aversive racist can justify or rationalize a negative response or a failure
to respond favorably on the basis of some factor other than race. Under these
circumstances, Whites unintentionally may engage in behaviors that ultimately
harm Blacks but that allow Whites to maintain their self-image as nonprejudiced
and that insulate them from recognizing that their behavior is not color blind.
Frequently, this discrimination does not manifest itself in purposeful harm or
injury, but rather in Whites? failure to help Blacks either in situations in which
the failure to help can be attributed to factors other than race (e.g., the belief
that someone else will intervene; Gaertner & Dovidio, 1977; Saucier, Miller, &
Doucet, 2005), or in the expression of particular positive responses to Whites
without overtly negative actions toward Blacks (Gaertner et al., 1996). Indeed, one
of the fundamental conclusions of the Report of the National Advisory Commission
on Civil Disorders (1968) over 35 years ago was that the disadvantaged status of
Blacks was due, in part, to insufficient efforts of Whites to help Blacks, not to their
efforts to harm them. This principle could likely be relevant to the inadequacy of
the official responses to Hurricane Katrina in 2005.
The subtlety of the contemporary expressions of institutional racism and individual
biases may contribute in significant ways to the racial mistrust, particularly
the distrust of Blacks for Whites that characterizes race relations within the United
States (Dovidio, Gaertner, Kawakami, & Hodson, 2002; Feagin & Sikes, 1994).
Blacks have a pervasive distrust for Whites that is reflected in high levels of perceived
discrimination and orientations toward basic social institutions (Dovidio
et al., 2002). Blacks report distrust of government leaders (Earl & Penney, 2001;
Shavers-Hornaday, Lynch, Burmeister, & Torner, 1997) and medical practitioners
and researchers (Armstrong, Crum, Reiger, Bennett, & Edwards, 1999; Davis &
Reid, 1999), as well as for authorities and policies in the areas of business and
education (Phelps, Taylor, & Gerard, 2001). They also tend to perceive conspiracies
by the government and Whites generally to harm Blacks (Crocker, Luhtanen,
Broadnax, & Blaine, 1999), reflected for example in the belief that AIDS was
purposefully created to infect Blacks.
At the same time, because of the absence of intention and awareness involved
in much of contemporary institutional and individual racism, Whites may be not
be sensitive to the extent of racial bias in the United States and particularly to
their own expressions of bias (Dovidio et al., 2002). As a consequence, Whites
and Blacks often express divergent views about their race relations. For instance,
in a Gallup Poll (Gallup, 2002) over three-quarters (79%) of Whites reported that
Blacks ?have as good a chance as Whites? to ?get any kind of job,? but less than
half (46%) of Blacks shared that view. Whereas the vast majority (69%) of Whites
Racism and Katrina 105
perceived that Blacks were treated ?the same as Whites,? the majority of Blacks
(59%) reported that Blacks were treated worse than Whites.
In the next section we illustrate the role of three of the basic processes in
contemporary racism?institutional racism, aversive racism, and racial mistrust?
in the context of Hurricane Katrina. We acknowledge that old-fashioned, blatant
racism still exists among Whites and that it continues to affect the lives and wellbeing
of Black Americans. It may even have played a role in the consequences
of Hurricane Katrina on Blacks in New Orleans. Nevertheless, we emphasize that
understanding the subtle dynamics of race relations, rather than being preoccupied
with assigning blame for intentional harm, may not only provide valuable insight
into the events and responses associated with Hurricane Katrina but also help guide
the development of new policies that can assist the residents of New Orleans and
prevent disparate harm to Blacks more generally in the future.
Understanding Responses to Hurricane Katrina
What happened during and after Hurricane Katrina was determined not only
by the present circumstances on the Gulf Coast but also by a history of discriminatory
policies and practices, particularly in the New Orleans area, that created
socioeconomic and consequent housing disparities along racial lines. In addition,
although the actions of decision makers during Hurricane Katrina and its aftermath
may have appeared ?colorblind,? without particular sensitivity to the unique vulnerabilities
of the Black population these actions were subtly biased and produced
racially disparate consequences. Also, historical discrimination and contemporary
institutional racism eroded the trust of Blacks in New Orleans for the government,
which adversely influenced the effectiveness of interventions in the aftermath of
Hurricane Katrina. In this section we therefore examine the influences of (a) historical
discrimination and contemporary institutional racism, (b) subtle bias at the
individual level, and (c) interracial distrust.
Historical Discrimination, Contemporary Institutional Racism,
and Hurricane Katrina
The impact by Hurricane Katrina was catastrophic by all measures. Besides
billions of dollars of damage and a premier city in the United States left largely
in ruins, between 1,100 and 1,700 people died and thousands more are still unaccounted
for (Burchfiel, 2006). In addition, Hurricane Katrina was particularly
devastating for Blacks. The flooding caused by the hurricane was particularly damaging
to Black neighborhoods, communities that were relatively uninsured against
floods. Thus, many of the Blacks in New Orleans who survived but were displaced
by Hurricane Katrina will not be able to afford to return to the city and to the areas
where they once lived.
106 Henkel, Dovidio, and Gaertner
To understand what happened during Katrina and why it had such a disproportionate
negative impact on Blacks, it is important to appreciate the local and
national historical context that surrounded the disaster. One of the most significant
legacies of slavery and historical discrimination in the United States is the
pervasive racial disparity in wealth (Blank, 2001). The median family income for
Whites in 1994 was $33,600 but was only $20,508 for Blacks. Blacks? incomes
were only 62% of Whites? incomes. Moreover, when net worth is considered,
weighing family financial assets and debts, the gap is even greater. In 1994, the
median net worth for Whites was $52,944 as compared to $6,723 for Blacks. That
is, Blacks? net worth was only 12% of Whites? net worth (Oliver & Shapiro, 2001).
Contemporary biases further contribute to racial disparities in income. Minority
groups have disproportionate difficulty finding jobs as compared to majority
groups: based on job audits across several countries, minority-group members
have a 23.7 percent chance of being discriminated against when applying for any
given job (Sidanius & Pratto, 1999). Even when Blacks find jobs, they are overrepresented
in jobs with poor working conditions, such as shift work, long hours,
repetitive tasks, physical dangers, and accident rates. They also have disproportionately
low mobility out of such low-end jobs (Sidanius & Pratto, 1999). Institutional
discrimination in the labor market only serves to increase discrepancies between
minority group and majority group members. Discrepancies in the labor market
lead to a disproportionate number of Blacks in positions of lower socioeconomic
status.
Race and racial disparities are particularly relevant for understanding the impact
of Hurricane Katrina in New Orleans. For example, in the context of Hurricane
Katrina, fewer available resources meant that it may not have been as easy for
Blacks, who were less likely to own cars, to leave the city. In addition, socioeconomic
differences influenced the vulnerability of Blacks, relative to Whites,
to the devastating consequences of Hurricane Katrina. Approximately one-third
of the population in the New Orleans metropolitan area is Black, ranking it 11th
in terms of percentage of Black population among over 300 major metropolitan
areas in the United States (CensusScope, 2006). The largest proportion of Blacks
is concentrated within the city limits, representing 68% of the population, many
of whom lived in the most low-lying areas?those most vulnerable to Hurricane
Katrina. In addition, New Orleans historically has been one of the cities with the
largest racial disparities in income and wealth. It showed the fourth largest increase
in racial disparity in income in recent years (Madden, 2000). The poverty rate in
New Orleans has been almost twice the national rate, and a third of Blacks and
half of the Black children in the city live below the poverty level (Hancock, 2005).
This racial gap in income and wealth contributed significantly to the particular
vulnerability of Blacks in New Orleans to Hurricane Katrina.
One consequence of racial disparities in wealth and income, which is exacerbated
by contemporary housing discrimination, is the residential segregation of
Racism and Katrina 107
Blacks. In general, more affluent residential areas in the United States are predominantly,
if not virtually exclusively, White. Thus, access to housing in these
areas requires either pre-existing wealth or access to substantial housing loans. As
we noted earlier, the racial gap in wealth is even greater than the sizable income
disparity (Blank, 2001; Madden, 2000). Moreover, in part due to their lower wealth
and available assets, Blacks have more difficulty obtaining housing loans than do
Whites. In 2001, 36% of Black applicants, compared to 16% of White applicants,
were denied conventional home mortgage loans. However, even when controlling
for financial status, Blacks are denied home loans at rates much greater than
Whites. Among applicants who had incomes less than 50% of the income for the
local area, Blacks were denied loans 42.7% of the time, whereas Whites were
denied 29.6% of the time. Among the applicants who made more than 120% of
the median income, Blacks were denied 19.6% of the time, whereas Whites were
denied only 6.8% of the time (Federal Financial Institutions Examination Council,
2002).
Institutional policies, past and present, have further contributed to residential
segregation of Blacks and Whites. According to Seitles (1996), federal and state
governments have had large roles in creating and maintaining residential racial
segregation. For example, the Federal Housing Administration (FHA) employed
practices that disadvantaged Blacks since it began in 1937. It used a practice
called ?red-lining? to determine risks associated with loans made to borrowers in
specific neighborhoods. ?Red-lining? involved rating neighborhoods such that the
neighborhoods in the top two categories were White, stable, and in demand. The
?high risk? categories involved Blacks. The third category was made up of working
class neighborhoods near Black residences, and the fourth category was Black
neighborhoods. As a result of this policy, most mortgages and home loans went to
middle class White families, promoting the racial segregation of neighborhoods,
particularly in urban areas. Further, the federal government used interstate highway
and urban renewal programs to increase segregation (Seitles, 1996).
In addition to institutional discrimination rooted in historical practices, contemporary
biases conspire to contribute further to residential segregation. Fischer
and Massey (2004) found that callers identifiable as Black were systematically
discriminated against relative to those identifiable as White in housing
inquiries, controlling for the socioeconomic status of the caller. The primary
exception to this effect was for Black neighborhoods. Blacks were more
likely than Whites to gain access to areas that already had high concentrations
of Blacks. Thus, institutional discrimination, along with individual discrimination,
tends to deny Blacks access to the more affluent neighborhoods, which are
much more readily available to Whites. Due to past and present institutional discrimination
in housing and mortgage processes, neighborhoods are segregated
and mortgages go to largely White neighborhoods, which only perpetuates the
problem.
108 Henkel, Dovidio, and Gaertner
The history of racial disparities in income and wealth and the influence of
institutional discrimination have had a significant influence on housing patterns
in New Orleans. New Orleans currently ranks 29th out of 318 metropolitan areas
examined in terms of the extent of neighborhood racial segregation (CensusScope,
2006), and the highest concentrations of Blacks have been in poorer areas. In addition,
as Laura Bush observed, in New Orleans poor Black neighborhoods were
on lower, undesirable, cheaper land that was particularly vulnerable to flooding.
As a function of where they lived, when Hurricane Katrina hit, many Black people
in New Orleans were already in a position to be disproportionately affected by
the disaster. For example, HUD-funded public housing units above Feret Street
West, which were occupied largely by Blacks, and New Orleans East were also
on lower ground more vulnerable to flooding than higher, more desirable neighborhoods.
Even areas that Blacks considered attractive locations within the city,
such as New Orleans East and the Lower Ninth Ward, were at environmental risk.
New Orleans East is home to middle income Blacks who left the urban center of
New Orleans in the 1960s and 1970s to build affordable homes in this area. The
homes were affordable because they were built on slabs and were located 2.5 to
4.0 feet below sea level. The Lower Ninth Ward is a neighborhood of primarily
modest houses, often the location of choice of musicians and multi-generational
Black families of the metropolitan area. It is situated in close proximity to an
industrial canal, which posed particular health risks during the flood. This neighborhood
was devastated by Hurricanes Betsy and Rita, as well as by Hurricane
Katrina.
In summary, the result of the institutional discrimination in New Orleans as
outlined here is multifaceted. Because of discriminatory housing and mortgage
policies and practices, Blacks tended to live in more environmentally vulnerable
areas of the city. The discrepancies in socioeconomic status were exacerbated by
discrimination in the labor market, which on the whole prevented Blacks from
gaining jobs, specifically ones of higher status, and prevented acquisition of material
resources, such as personal cars, that would have enabled them to evacuate
New Orleans for safer areas as Hurricane Katrina approached. When evacuation
orders were announced, a disproportionate number of Blacks in the areas most
at-risk lacked the resources to leave the city. ?Many of them were people without
automobiles,? explained Marc Morial, former mayor of New Orleans and now the
president and chief executive officer of the National Urban League. They were
?people who couldn?t afford a hotel room, who may have had no choice but to
remain. And that means that the people who remain in New Orleans are disproportionately
poor people, disproportionately African-American? (Ross, 2005). Past
and recent institutional discrimination on the basis of race thus contributed to the
particular vulnerability of the Black population of New Orleans to a disaster like
Hurricane Katrina.
Racism and Katrina 109
Subtle Bias and Response to Hurricane Katrina
The pattern of decision making, or lack of immediate responsiveness that characterized
the official response in the aftermath of Katrina, also reflects the kinds of
subtle biases associated with aversive racism. Given that Blacks were disproportionately
affected by the storm and flooding, any sluggishness and disorganization
on the part of government officials also disproportionately affected Black victims
of the disaster. Michael Brown, then the head of the Federal Emergency
Management Agency (FEMA), learned about the starving crowds at the New
Orleans Convention Center from news media, rather than through official means
(CNN, 2005). In addition, no large-scale deliveries of supplies arrived at the
Convention Center until midday on September 2nd, four days after Katrina hit
(Callebs, Gupta, Lavendera, Lawrence, & Starr, 2005). In another example of
poor government response, housing for evacuees was held up because of a notably
slow bureaucratic process. Two weeks after Katrina, the Department of
Veteran Affairs offered up 7,000 single-family homes owned by the government
for the use of evacuees. The houses then went unused for three months
because of paperwork problems in FEMA (ABC News, 2006). Such unhurried
relief work on the part of the government disproportionately affected Blacks,
because the victims of Katrina were disproportionately Black in the first place.
This is an instance of institutional discrimination, since it disadvantaged a racial
group, even if there was no race conscious intentionality on the part of the
government.
In addition to the slow government response to the immediate needs of evacuees,
the recovery process continues to be remarkably slow. Whole areas of New
Orleans (particularly the poorer areas) have still not been made habitable. Demolition
in the Lower Ninth Ward to remove houses that were uninhabitable since
the hurricane did not begin until four months after the hurricane hit New Orleans
(Nossiter, 2006). At the time, there was still no power or running water in these
areas, which were primarily Black neighborhoods.
It was the responsibility of the individuals who made up the Department of
Homeland Security and FEMA to respond and to make decisions in times of crisis
such as that of Hurricane Katrina. As previously noted, one of the most common
forms that individual discrimination takes is a failure to help or intervene
rather than committing an intentional act of harm. In Hurricane Katrina, a swift,
well-organized, large response was critically important but did not occur. Michael
Chertoff, head of the Department of Homeland Security, acknowledged that FEMA
was overwhelmed by Hurricane Katrina and responded poorly (Hau, 2005). Ultimately,
the responsibility for such a response falls on the shoulders of individuals
rather than institutions. Knowing this, Chertoff oversaw the resignation of Michael
Brown due to FEMA?s response.
110 Henkel, Dovidio, and Gaertner
It cannot be stressed enough that it would be unfair, given the evidence, to say
that race was a conscious motivator in the government response. It is unreasonable
to assert that individuals knowingly made decisions based on race, but research
has shown that lack of empathy and perspective-taking may be the unintentional
factors operating behind a failure to help, especially across group membership.
One of our early experiments (Gaertner & Dovidio, 1977) demonstrated how
subtle racism could have operated unintentionally amidst the initial confusion, both
regarding the magnitude of the storm?s impact and who had primary responsibility
to respond among local, state, and national government agencies. As we indicated
earlier, this confusion and ambiguity are precisely the circumstances that are most
conducive to the influence of subtle biases. The scenario for the experiment was
inspired by an incident in the mid-1960s in which 38 people witnessed the stabbing
of a woman, Kitty Genovese, without a single bystander intervening to help. What
accounted for this behavior? Feelings of responsibility play a key role (see Darley
& Latan?e, 1968). If a person witnesses an emergency knowing that he or she is
the only bystander, that person bears all of the responsibility for helping and,
consequently, the likelihood of helping is high. In contrast, if a person witnesses
an emergency but believes that there are several other potential helpers, then the
responsibility for helping is shared. Moreover, if the person believes that someone
else either will help or has already helped, the likelihood of that bystander taking
action is significantly reduced.
We created a situation in the laboratory in which White participants witnessed
a staged emergency involving a Black or White victim. We led some of our participants
to believe that they would be the only witness to this emergency, while we led
others to believe that there would be two other White people who also witnessed
the emergency. These potential bystanders were isolated from one another in their
own cubicles and thus they could not easily communicate with each other. We
predicted that, because aversive racists do not act in overtly bigoted ways, Whites
would not discriminate when they were the only witness and the responsibility for
helping was clearly focused on them. However, we anticipated that Whites would
be much less helpful and would respond slower to Black than to White victims
when they had a justifiable excuse not to get involved, such as the belief that one
of the other witnesses would take responsibility for helping.
The results supported these predictions. When White participants believed
that they were the only witness, they helped both White and Black victims very
frequently (over 85% of the time) and equally quickly. There was no evidence of
blatant racism. In contrast, when they thought there were other witnesses and they
could rationalize not helping rapidly on the basis of some factor other than race
(e.g., the presence of other bystanders), they helped Black victims more slowly
and only half as often as White victims (37.5% vs. 75%).
Another feature of this study that is also revealing of what may have happened
during the aftermath of Hurricane Katrina involved the monitoring of our
Racism and Katrina 111
participants? heart rates just prior to and following the emergency. Within the first
10 seconds after the emergency, participants who witnessed the emergency alone
showed equivalent patterns of heart-rate escalation for both the Black and the
White victims. Those who witnessed the emergency believing other bystanders
were present showed heart-rate escalation in response to the emergency involving
the White victim. In contrast, when the victim was Black and participants believed
other bystanders were present, participants? heart rates decelerated within
the initial 10-second period following the emergency.
However, the differing pattern of heart-rate responsiveness following the emergency
does not necessarily reflect differential concern for the well-being of the
Black and White victims in the presence of other bystanders. Rather, heart-rate
escalation has been linked to a preparation for action, whereas deceleration is
associated with the intake of information from the environment (Lacey & Lacey,
1974). Thus, amidst the confusion during the aftermath of the emergency, the initial
orientation of our participants was to take action when the victim was White. For
Black victims, however, the initial orientation was take in and process information
about what needs to be done?rather than rapidly doing something to alleviate the
problem.
Recently, Saucier et al. (2005) performed a meta-analysis of 31 experiments
conducted over the past 40 years that examined race and Whites? helping behavior,
specifically testing implications of the aversive racism framework. Across these
studies, they found ?that less help was offered to Blacks relative to Whites when
helpers had more attributional cues available for rationalizing the failure to help
with reasons having nothing to do with race? (p. 10). Moreover, the pattern of
discrimination against Blacks remained stable over time; the effect for year of
study was nonsignificant. Saucier et al. summarized, ?The results of this metaanalysis
generally supported the predictions for aversive racism theory? (p. 13),
and concluded, ?Is racism still a problem in our society? …Racism and expression
of discrimination against Blacks can and will exist as long as individuals harbor
negativity toward Blacks at the implicit level? (p. 14).
During an emergency such as that presented by Hurricane Katrina, this differential
pattern of initial, visceral responsiveness as well as the observed pattern of
actual intervention for Black and White victims in our experiment suggest some
unintentional processes by which local, state, and national authorities may well
have responded quite differently than they did in the aftermath of the storm?had
New Orleans been inhabited by White rather than by Black citizens.
The Select Bipartisan Committee to Investigate the Preparation for and Response
to Hurricane Katrina (2006) identified several junctures where a lack of
decisiveness to intervene had tragic consequences, particularly for Blacks, in
New Orleans. The reports states, ?The failure of local, state, and federal governments
to respond more effectively to Katrina?which had been predicted for
many years, and forecast with startling accuracy for 5 days?demonstrates that
112 Henkel, Dovidio, and Gaertner
whatever improvements have been made to our capacity to respond to natural or
man-made disasters, four and half years after 9/11, we are still not fully prepared?
(p. 1). Despite adequate warning 56 hours before landfall, orders for mandatory
evacuation of the most vulnerable areas?those inhabited disproportionately by
Blacks?were delayed until 19 hours before landfall. The report concluded, ?The
failure to order timely mandatory evacuation led to deaths, thousands of dangerous
rescues, and horrible conditions for those who remained? (p. 2). In addition,
investigation found that subsequent decisions at the highest levels of government,
which showed a lack of responsiveness to the events as they transpired, had substantial
consequences: ?The White House failed to de-conflict varying damage
assessments and discounted information that ultimately proved accurate? (p. 3).
It is under conditions such as conflicting information and ambiguity (Dovidio
& Gaertner, 2000; Hodson, Dovidio, & Gaertner, 2002) that aversive racism influences
decision making in ways that ultimately disadvantage Blacks. Further,
consistent with the aversive racism framework, the report of the Bipartisan Committee
contrasted the response of decision makers at more remote sites with those
in positions of immediate responsibility. The report observed, ?The Select Committee
identified failures at all levels of government that significantly undermined
and detracted from the heroic efforts of first-responders… those who didn?t flinch,
who took matters into their own hands when bureaucratic inertia was causing death,
injury, and suffering? (p. 1).
Racial Distrust and Consequences for Hurricane Katrina
We have discussed the mistrust that Blacks generally feel for Whites and the
government (Crocker et al., 1999; Dovidio et al., 2002) and the inconsistencies
in how Blacks and Whites see race relations in the United States (Gallup, 2002).
Racial tensions in New Orleans were particularly high before Hurricane Katrina
hit and continue to be high in the aftermath. New Orleans? history of racial tension
was reflected in Blacks? more negative attitudes than Whites? toward the police,
particularly among those for whom their race was a more important part of their
identity (Howell, Perry, & Vile, 2004). Hancock (2005) reported, ?The tensions of
race have always defined the best and worst of this city … many residents say that
their future hinges on bridging race and class divisions that many say had gotten
deeper, uglier, and angrier in the months before the storm.? At the beginning of
2005, three White bouncers of a nightclub suffocated a young Black man to death
during a New Year?s celebration. This event escalated Black anger, distrust, and
guardedness. Glanton (2005) described the racial tensions in New Orleans in the
months before Katrina hit. In an interview with Glanton, Rev. Norwood Thompson,
president of the New Orleans chapter of the Southern Christian Leadership
Conference, remarked, ?New Orleans is still part of the deep South, and what happened
that night was pure racism. Even though we have a Black mayor and a Black
Racism and Katrina 113
police chief, racism has been very flagrant. African-Americans have been asleep,
but now we are in an uproar.? A month later a Black teenager was killed ?in a hail
of more than 100 bullets? fired by Jefferson County police officers (Treadway,
2005).
One possible consequence of this racial divide in New Orleans is the lack of coordination
and responsiveness that characterized evacuation efforts for Hurricane
Katrina. The Select Bipartisan Committee to Investigate the Preparation for and
Response to Hurricane Katrina (2006) noted, ?Two of Louisiana?s most populous
localities, New Orleans and Jefferson Parish, declared mandatory evacuations late
or not at all? (p. 103). These areas have particularly large Black populations.
Although over a million Louisiana residents evacuated their homes in private vehicles,
the Select Bipartisan Committee also found ?that thousands of residents,
particularly in New Orleans, did not evacuate or seek shelter, but remained in their
homes? (p. 64). It is likely that Blacks? distrust of government contributed to their
decisions not to heed the warnings to evacuate. Moreover, the government?s decision
not to make evacuation mandatory in some of the most vulnerable areas,
which had substantial Black populations, permitted this hesitancy to have disastrous
consequences. By the time the severity of the crisis became clear to many of
the Black residents of New Orleans, they were unable to evacuate the areas successfully
because they did not own cars and public transportation and volunteer
transportation were too limited at the time.
The history of racial discrimination and disparity in New Orleans went hand
and hand with deep racial distrust. Indeed, in New Orleans there has been a strong
history of a connection between racism and flooding. One of the most common
oversights in the dispute over Katrina is this history of racism in New Orleans.
It is crucial to understand how history led New Orleans to its precedent of racial
mistrust that existed long before the hurricane and the flooding. In 1927, with
floodwaters all along the Mississippi River rising, the government dynamited a
levee south of New Orleans to relieve pressure on the city proper, flooding land
owned by rural and poor farmers. Most of those affected were never compensated,
despite government promises (Leopold, 2005). In 1965, when Hurricane
Betsy hit New Orleans, Black communities were once again flooded and there
were rumors that again, the levee had been breached intentionally (Ross, 2005).
These historical factors are too important to be overlooked or underestimated.
With a precedent of the government intentionally breaching levees followed by
rumors that it had happened again in 1965, there were strong and deeply rooted
feelings of mistrust among the Black community in New Orleans. When mass
destruction and flooding occurred in New Orleans again in 2005, many in the
Black community questioned the government?s willingness to respond. Racial
mistrust is only compounded by the other historical factors and discrimination
that have led to racial discrepancies in housing, labor, socioeconomic status, and
education.
114 Henkel, Dovidio, and Gaertner
In addition, actions during the crisis caused by Hurricane Katrina have fueled
racial suspicions and exacerbated racial mistrust. For instance, on September 1,
2005, 3 days after Hurricane Katrina struck, thousands of evacuees who were
fleeing the wretched conditions of the city and the Convention Center marched
toward a bridge that would take them to safety. They were met at the bridge by
the Gretna Police, who brandished rifles. The evacuees recount hearing gunshots
(Hamilton, 2006) as the police prevented them from crossing the bridge and turned
them back to the city. Two visitors trying to escape New Orleans wrote about their
experiences: ?We questioned why we couldn?t cross the bridge anyway, especially
as there was little traffic on the 6-lane highway. They responded that the West
Bank was not going to become New Orleans and there would be no Superdome
in their city? (Bradshaw & Slonsky, 2005). The police chief explained that ?his
town … feared for its safety from a tide of evacuees? (Sharokman, 2005). As
Sharokman (2005) observed, ?And because most of the evacuees were Black and
most of Gretna is White, the episode has stirred charges of racism? (p. 1A). This
incident remains a symbol of racism and the fundamental racial divide in New
Orleans. Six months after the incident, Rev. Jesse Jackson, who organized the
protest, led a demonstration by ?a celebrity-studded, almost exclusively AfricanAmerican
crowd of thousands who marched across the bridge, which they consider
a symbol of injustice in post-Katrina New Orleans? (Donze & Filosa, 2006, Metro,
p. 1).
Given a national context in which Blacks distrust Whites and the government
(e.g., Earl & Penny, 2001), in combination with clearly differential outcomes
for majority and minority group members (e.g., Sidanius & Pratto, 1999), and
a history of racism and flooding specifically in New Orleans, it is not surprising
that racial distrust played a role in response to Hurricane Katrina and the
recovery process. Hancock (2005) described the deepened distrust of Blacks in
the aftermath of Katrina. He found that many Blacks felt the events were ?too
coincidental,? and wrote, ?There are other, more sinister conspiracy theories.
Many Black residents believe that the Ninth Ward and other Black neighborhoods
were deliberately flooded in order to save the tourist areas and White business
areas.?
This distrust has been fueled by questions about the recovery and rebuilding
efforts. Efforts to return Blacks to their communities have appeared to be particularly
slow. Three months after Hurricane Katrina hit landfall, only 16% of the
trailers and other forms of temporary housing requested, which would have primarily
benefited those originally from low-income housing areas, had been delivered
(Hancock, 2005). Despite similar damage, residents of Lakeview, a predominantly
White community, were allowed to ?look and leave,? a key step in the recovery
process, in which residents are allowed to return temporarily to their homes during
the day, long before residents in the primarily Black area of the Lower Ninth Ward
were given this opportunity, ostensibly because the neighborhood was still flooded
Racism and Katrina 115
(Scott, 2005). In fact, bulldozing of the Lower Ninth Ward was commissioned prior
to informing residents, and it took the action of local activists to stop the bulldozing
plan.
Government actions in the rebuilding process have further fueled Blacks?
perceptions of conspiracies against them. Hancock (2005) observed, ?In Katrina?s
aftermath, rumors circulated that the area [the Ninth Ward] would be bulldozed and
returned to swampland or handed to rich, White developers.? The Mayor?s Bring
New Orleans Back Commission explicitly proposed ?greenspaces? in New Orleans
East, which would displace residents in this traditionally Black neighborhood, and
recommended turning over historically Black neighborhoods and public housing
areas not substantially damaged by Hurricane Katrina to White urban developers.
Professor John Logan, a sociologist who studied the impact of Hurricane Katrina,
concluded that New Orleans could lose up to 80% of its Black population if people
displaced by the storm are not allowed to return to live in their neighborhoods
(Smith, 2006). It is not surprising that three-quarters of Blacks reported feeling
anger in the aftermath of Hurricane Katrina (Saad, 2005).
Policy Implications
Although much of the public debate about the devastating consequences of
Hurricane Katrina, particularly for Blacks in New Orleans, has focused on whether
racism was involved, we have attempted to show that a focus on old-fashioned,
overt racism likely misrepresents the dynamics in the situation. Overt racism might
have played a role, but subtle and unintentional biases seemed to be a much more
significant influence. Moreover, the actions of Whites and Blacks both contributed
to varying degrees and in various ways to the lack of responsiveness that characterized
the preparation for the hurricane and the response in its aftermath. Specifically,
three key processes that we identified are institutional racism, subtle contemporary
prejudice, and racial distrust. We further propose that understanding how these
forces shaped the way both Whites and Blacks responded to the threat and damage
of Hurricane Katrina can help to guide policies that can facilitate effective recovery
and enhance emergency efforts in the future.
One of the most basic implications of our analysis is that the circumstances
of Blacks in New Orleans at the time Hurricane Katrina made landfall, which
made them especially vulnerable to flooding and which contributed to racial distrust,
were the result of historical discrimination and institutional racism. Because
race was central to these circumstances, interventions to address the consequences
of Hurricane Katrina and policies for future emergency situations cannot be colorblind.
Effective interventions and policies should consider the importance of
historical and contemporary racial disparities to the susceptibility of different
communities to harm, how racial biases may unintentionally influence the actions
of decision makers, and how race relations might influence the responses
116 Henkel, Dovidio, and Gaertner
of vulnerable groups to efforts to help. That is, the processes related to how New
Orleans got to this point need to be considered in a plan to reverse the devastating
consequences of these processes. We illustrate the application of these principles
with a recovery strategy that could meet these requirements.
It is important to establish trust for the recovery effort. Given Blacks? mistrust
for the government (Dovidio et al., 2002), some other more-trusted agency should
be chosen to work directly with citizens of New Orleans, with government sponsorship.
That is, while the government may provide financial and logistical support,
other organizations may be employed to deliver the assistance. For example, neighborhood
coalitions could be formed to meet this need and other organizations that
are already trusted in the community can provide additional assistance. To facilitate
the development of interracial trust and improve race relations, as outlined in
the Contact Hypothesis (Allport, 1954; Pettigrew, 1998), these coalitions should
include members of both Black and White communities. The efforts of Blacks and
Whites should involve personal interactions in which they are equal-status partners
in cooperative ventures with the support of both communities and the government
(Dovidio, Gaertner, & Kawakami, 2003).
In addition, the community coalitions with government support would then
be responsible for meeting the needs of storm victims not simply by giving money,
which could foster the dependency of residents on outside assistance, but by encouraging
the autonomy and agency of the storm victims themselves. For instance,
rebuilding programs might recruit members of the community as apprentices who
could acquire skills that would enable them to help others in the community in the
future. By addressing specific problems that are common among storm victims, it
would be possible to get the community members back on their feet more quickly
and effectively.
These skills that are acquired can provide either material assistance, such
as carpentry, or psychological help, such as social support, and information for
appropriate referrals. Besides the extensive damage to property, Hurricane Katrina
will have long-term adverse effects on victims? mental and physical health. A
recent report (Dewan, 2006) found that among storm victims, more than 50% of
female caregivers scored ?very low? on mental health screening exams, showing
signs of anxiety and depression in particular. Children are exhibiting symptoms of
behavioral and anxiety problems as well. Among children, 34% have asthma as
compared to 25% of the rest of the population and many of these children have gone
without prescription medication at some point since Katrina. Among adult victims,
50% have some kind of chronic condition like diabetes, high blood pressure, or
cancer. Given these statistics, it is critical to provide access to medical and mental
health clinics. However, a 2001 Surgeon General?s report has shown that mistrust
of such clinics is prevalent among Black communities. We suggest establishing
a community council to help run the clinics and educate the communities about
services being offered to bolster trust.
Racism and Katrina 117
Other problems that need to be addressed are those of jobs and housing. Many
Katrina evacuees are currently fighting eviction from landlords who want to renovate
and raise prices (Kunzelman, 2006). In addition, evacuees may not have the
skills that they need to get jobs. Therefore, we propose that the recovery effort
involve job training, job placement, and housing placement programs. To counteract
the past segregation and discrimination that Blacks experienced, it would be
important for such programs to work to integrate job environments and facilitate
voluntary integration of neighborhoods. Because of the community organizations,
such intentional integration would be possible, since members of both Black and
White communities would both be responsible for training and placement.
Another problem that many evacuees have faced is that their children have
missed significant amounts of school (Dewan, 2006). Missing school only
exacerbates the effects of educational discrimination that many children of color
face, so it is critical for the children to catch up in school. This can be accomplished
through individual support, such as tutoring, or more general efforts, such
as extending the school year and expanding day care programs. Children can go
to day care while their parents are at work and receive tutoring if they have missed
significant school time. Members of the community can volunteer to provide day
care and to tutor. Since the program would be run through the community, parents
would not have the added stress of worrying about their children while they are at
work, and children would have the opportunity to continue with their schoolwork.
Although it will involve added community expense, extending the school year
will help students compensate for time and opportunities lost while schools were
closed, emphasize the priority of education, and reduce the cost of supervision of
school-age children in the summer for parents directly.
Programs addressing needs such as health care, job training and placement,
housing, and childcare are critical in the recovery process, but the process may be
overwhelming for many individuals who are trying to reestablish themselves. To
address this, we propose a mentorship or a sponsorship program where people who
are in the early stages of recovery are paired up with members of the community
who have been through the process already and can provide support and advice.
As people move through the process, they can then be in a position to mentor
others. Thus, efforts for recovery need to consider explicitly the particular needs
of victims, recognizing the historical legacy of racial biases and the potential for
contemporary subtle racial bias, and addressing these needs with race-sensitive
policies.
To some extent, neighborhood associations and charitable community organizations
are already carrying out many of the same strategies that we suggest. For
example, Association of Community Organizations for Reform Now (ACORN) is
helping residents recover financially from Hurricane Katrina and return to their
neighborhoods by cleaning out and gutting homes in low income neighborhoods
to reduce costs for homeowners. ACORN also holds regular housing workshops
118 Henkel, Dovidio, and Gaertner
to provide assistance with buying or building a home, getting rehabilitation loans,
applying for state aid, carrying out FEMA appeals, removing lead contamination,
and dealing with displacement from public housing (ACORN, 2006). Another
nonprofit group, Cityworks, is cataloguing the efforts of individual neighborhood
associations in an attempt to assess what has been done and what resources
these neighborhood associations still need. Cityworks, along with New Orleans
neighborhood associations and other nonprofit and governmental groups, recently
organized a ?Festival of Neighborhoods,? which was aimed at helping people rebuilding
from Katrina. Many of these organizations set up booths with information,
resources, and helpful items like fly and mice strips (Bazile, 2006).
In summary, the events in New Orleans related to Hurricane Katrina and its
aftermath illustrate the importance of understanding how historical race relations
and subtle and institutional racial bias can significantly influence what types of
efforts and policies can be effective for providing people the assistance they need.
Without a foundation of trust, formal government assistance programs may be met
with suspicion and resistance, compromising their effectiveness. As Nadler (2002;
see also Nadler & Halabi, 2006) noted, low power groups may resist offers of help,
even if it provides valuable material benefit, if it is perceived as reinforcing the control
of the high power group. Thus, volunteer groups and other nongovernmental
agencies are particularly important in the rebuilding of New Orleans.
Conclusions
Even if overt discrimination may not have played a role in the government?s
response to Hurricane Katrina, the fact that Blacks in New Orleans were disproportionately
affected by the disaster suggests that other, more subtle processes
were at work. These processes included contemporary personal prejudice, past
and present institutional discrimination, and cultural racism. In addition, these
processes combined to create a climate of racial distrust that served as a backdrop
for Katrina?s landfall. Although it is impossible to go back and change the
way Hurricane Katrina was handled initially, it is crucial that researchers, government
agencies, and people in positions of power learn from what happened there
and improve the recovery still in process as well as future disaster and recovery
efforts.
It is also critical to recognize that institutional and subtle forms of racism, and
even blatant racism, are not simply historical events but are also contemporary influences.
Racial biases are a formidable challenge in the rebuilding of New Orleans.
Institutional racism can take new forms, with apparently egalitarian policies having
adverse impact on race relations and opportunities for Blacks in the city. For example,
the government has further damaged its relationship with the Black community
in New Orleans by planning to tear down 5,000 apartments in public housing and
to replace them with mixed-income housing (Quigley, 2006). Although support
Racism and Katrina 119
for this likely more integrated housing seems to be a well-meaning and positive
step toward racial harmony, it would drastically reduce the amount of low-income
housing in New Orleans and displace a large number of Black residents from their
homes and, ultimately, from the city. Many of these apartments are part of buildings
that are repairable, like the Lafitte complex near the Faubourg Treme (Elie, 2006).
Displaced residents have filed a lawsuit against local and federal housing agencies,
saying that the agencies are keeping low-income Black families from returning to
their homes, which violates their civil rights (Filosa, 2006b). In this case, what
government officials may have thought was a positive step toward integration may
actually push or keep Blacks out of New Orleans.
The recovery of public education in New Orleans has also been controversial.
All but four of the city?s 128 public schools have been converted to charter
schools or taken over by state agencies. Although some residents find the charter
school system progressive, others are unhappy. For example, Louella Givens, New
Orleans? representative to the state?s Board of Elementary and Secondary Education,
has expressed concern about the amount of input communities will be able to
have on how their schools are run. Other residents believe that the charter school
system will result in more inequality (Filosa, 2006a). Thus, the reconstruction
of New Orleans illustrates the ways that apparently well-intentioned efforts and
government policies can alienate Blacks, limit their opportunities for housing, and
mute their voice in key institutions such as their schools. Without full consideration
of the long-term consequences of these actions, these efforts can enable
others with blatant racial motivations to exclude Blacks physically, politically, and
psychologically from the future of New Orleans.
Hurricane Katrina could have been and still can be a means for positive change
in New Orleans. It has created a turning point, where either racism can be eradicated
or an unfair history can be repeated. To this point, there have been mixed results
in New Orleans. Since Katrina, there has been a wave of activism in the city,
indicating that there is hope for a positive change (Bazile, 2006). Nevertheless,
problems in housing and education have further damaged the government?s image
(e.g., Elie, 2006).
More generally, after almost 250 years of racial inequality in the United States,
the aftermath of Hurricane Katrina, which disproportionately affected the lives of
Black citizens, could serve as a catalyst for leaders and policy makers in the United
States to commit themselves fully to addressing institutional and individual forms
of racism that continue to harm and restrict opportunities for millions of citizens.
If the United States is serious about eradicating racism and its consequences, it is
important to learn more about the dynamics of racial attitudes and their underlying
cognitive, emotional, and developmental processes. Moreover, it is important that
policy makers be made aware of these advances and incorporate them directly into
policy formulations. Thus, in addition to providing the financial support that is
necessary to address the immediate needs of victims of Hurricane Katrina, it is
120 Henkel, Dovidio, and Gaertner
also important to invest substantially, in terms of enhanced research funding, to
make the elimination of racism a national priority. Long-term national investments
to understand the basic processes of racism and discrimination and to facilitate
partnerships between scholars and policy makers can be critical in combating
racism, which can bring racial groups in the United States closer together rather
than pushing them further apart.
References
ABC News. (2006, January 13). Available housing for Katrina evacuees caught in federal red tape:
VA offered FEMA thousands of single-family homes; deal formalized four months after storm
hit. Retrieved January 13, 2006, from http://abcnews.go.com/WNT/HurricaneKatrina/story?id=
1503846.
Association of Community Organizations for Reform Now (ACORN). Retrieved July 7, 2006 from
http://www.acorn.org/index.php?id=10223.
Allport, G. W. (1954). The nature of prejudice. Cambridge, MA: Addison-Wesley.
Armstrong, T. D., Crum, L. D., Reiger, R. H., Bennett, T. A., & Edwards, L. J. (1999). Attitudes of
Africa Americans toward participation medical research. Journal of Applied Social Psychology,
29, 553?574.
Bazile, K. T. (2006, June 25). Celebrating teamwork: Residents and neighborhood groups share information
on rebuilding efforts?and have a little fun. The Times-Picayune. Retrieved June
29, 2006 from http://www.nola.com/search/index.ssf?/base/news-15/1151219042101580.xml?
NZNPMT&coll=1.
Blank, R. M. (2001). An overview of trends in social and economic well-being, by race. In N. J.
Smelser, W. J. Wilson, & F. Mitchell, F. (Eds.), Racial trends and their consequences (Vol. 1,
pp. 21?39). Washington, DC: National Academy Press.
Bradshaw, L., & Slonsky, L. B. (2005, September 5). Hurricane Katrina-Our Experiences. Retrieved
July 7, 2006 from http://sfsocialists.livejournal.com/3687.html.
Brewer, M. B. (1979). Ingroup bias in the minimal intergroup situation: A cognitive-motivational
analysis. Psychological Bulletin, 86, 307?324.
Broder, J. M., Wilgoren, J., & Alford, J. (2005, September 5). Storm and crisis: Racial tension; amid
criticism of federal efforts, charges of racism are lodged. New York Times, p. A9.
Burchfiel, N. (2006, January 13). Update: Statistics confirm earlier report on Katrina deaths.CNS News.
Retrieved May 7, 2006 from http://www.cnsnews.com/Nation/Archive/200601/NAT20060113a.
html.
Callebs, C., Gupta, S., Lavendera, E., Lawrence, C., & Starr, B. (2005, September 2). Convoys bring
relief to New Orleans: Refugees cheer envoys, Bush signs $10.5 billion aid package. CNN.
Retrieved April 25, 2006, from http://us.cnn.com/2005/US/09/02/katrina.impact/index.html.
CensusScope. (2006). University of Michigan, Social Science Data Analysis Network, (2000: Segregation:
Dissimilarity Indices. Retrieved May 7, 2006, from the CensusScope website: http://www.
censusscope.org/us/rank dissimilarity white black.html.
CNN. (2005, September 2). The big disconnect on New Orleans: The official version; then there?s the
in-the-trenches version. Retrieved April 19, 2006, from http://www.cnn.com/2005/US/09/02/
katrina.response/index.html.
Crocker, J., Luhtanen, R., Broadnax, S., & Blaine, B. E. (1999). Belief in U.S. government conspiracies
against Blacks among Black and White college students: Powerlessness or system blame?
Personality and Social Psychology Bulletin, 25, 941?953.
Darley, J. M., & Latan?e, B. (1968). Bystander intervention in emergencies: Diffusion of responsibility.
Journal of Personality and Social Psychology, 8, 377?383.
Davis, S. M., & Reid, R. (1999). Practicing participatory research in American Indian communities.
American Journal of Clinical Nutrition, 69S, 4, 755S?759S.
Racism and Katrina 121
Dewan, S. (2006, April 18). Evacuee study finds declining health. New York Times. Retrieved April 18,
2006 from http://www.nytimes.com/2006/04/18/us/nationalspecial/18health.html?ex=
1147320000&en=1c18f8a508471e51&ei=5070.
Donze, F., & Filosa, G. (2006, April 2). Bridge march hails justice, voter rights; Thousands join
Jesse Jackson in crossing river. The Times-Picayune, Metro, p. 1. Retrieved July 8, 2006 from
http:/ /web.lexis-nexis.com/universe/document? m=7e65e5db04cc42b210fbf69a1664dae1&
docnum=11&wchp=dGLbVtz-zSkVA& md5=baa1fcee5aa80ffba404c2ecb4fc5904.
Dovidio, J. F., Brigham, J., Johnson, B. T., & Gaertner, S. L. (1996). Stereotyping, prejudice, and
discrimination: Another look. In N. Macrae, C. Stangor, & M. Hewstone (Eds.), Stereotypes
and stereotyping (pp. 276?319). New York: Guilford.
Dovidio, J. F., & Gaertner, S. L. (2000). Aversive racism and selection decisions: 1989 and 1999.
Psychological Science, 11, 319?323.
Dovidio, J. F., & Gaertner, S. L. (2004). Aversive racism. In M. P. Zanna (Ed.), Advances in experimental
social psychology (Vol. 36, pp. 1?51). San Diego, CA: Academic Press.
Dovidio, J. F., Gaertner, S. L., & Kawakami, K. (2003). The contact hypothesis: The past, present, and
the future. Group Processes and Intergroup Relations, 6, 5?21.
Dovidio, J. F., Gaertner, S. L., Kawakami, K., & Hodson, G. (2002). Why can?t we just get along?
Interpersonal biases and interracial distrust. Cultural Diversity & Ethnic Minority Psychology,
8, 88?102.
Dovidio, J. F., Mann, J., & Gaertner, S. L. (1989). Resistance to affirmative action: The implications
of aversive racism. In F. A. Blanchard & F. J. Crosby (Eds.), Affirmative action in perspective
(pp. 83?103). New York: Springer-Verlag.
Earl, C. E., & Penney, P. J. (2001). The significance of trust in the research consent process with
African Americans. Western Journal of Nursing Research, 23, 753?762.
Elie, L. (2006, June 16). HUD builds Katrina hall of shame. The Times-Picayune. Retrieved June 29,
2006 from http://www.nola.com/news/t-p/frontpage/index.ssf?/base/news-15/1150440448324
60.xml&coll=1.
Feagin, J. R., & Sikes, M. P. (1994). Living with racism: The Black middle-class experience. Boston,
MA: Beacon Press.
Feagin, F. R., & Vera, H. (1995). White racism: The basics. New York: Routledge.
Federal Financial Institutions Examination Council. (2002). Nationwide summary statistics for the 2001
HMDA data fact sheet. Retrieved May 7, 2006 from http://www.ffiec.gov/hmcrpr/hm fs01.htm.
Filosa, G. (2006a, June 25). School leaders assail move to charters: Many at summit see it as invasion by
state. The Times-Picayune. Retrieved June 29, 2006 from http://www.nola.com/search/index.
ssf?/base/news-2/1151219470101580.xml?NSBED&coll=1.
Filosa, G. (2006b, June 28). Displaced residents file suit: Local, federal housing agencies face civil rights
allegations. The Times-Picayune. Retrieved June 29, 2006 from http://www.nola.com/search/
index.ssf?/base/news-15/1151476788163220.xml?NZNPMT&coll=1.
Fischer, M. J., & Massey, D. S. (2004). The ecology of racial discrimination. City and Community,
3(3), 221?241.
Gaertner, S. L., & Dovidio, J. F. (1977). The subtlety of White racism, arousal, and helping behavior.
Journal of Personality and Social Psychology, 35, 691?707.
Gaertner, S. L., & Dovidio, J. F. (1986). The aversive form of racism. In J. F. Dovidio & S. L. Gaertner
(Eds.), Prejudice, discrimination, and racism (pp. 61?89). Orlando, FL: Academic Press.
Gaertner, S. L., Rust, M. C., Dovidio, J. F., Bachman, B. A., & Anastasio, P. A. (1996). The Contact
hypothesis: The role of a common ingroup identity on reducing intergroup bias among majority
and minority group members. In J. L. Nye & A. M. Brower (Eds.), What?s social about social
cognition? (pp. 230?360). Newbury Park, CA: Sage.
Gallup. (2002). Poll topics & trends: Race relations. Washington, DC: The Gallup Organization.
http:/www.gallup.com/poll/topics/race.asp.
Glanton, D. (2005, February 21). Death stokes racial tension in Big Easy.Chicago Tribune. Retrieved on
May 11, 2006, from http://web.lexis.nexis.com/universe/document? m=1084a6ceec5bb908ac
28e0f8e0c56741& docnum=1&wchp=dGLbVtb-zSkVA& md5=d9c9c411cd47dceaf1d3e679
ef2f073d.
122 Henkel, Dovidio, and Gaertner
Hamilton, B. (2006, February 26). Evacuees recount gunfire at bridge blockade; Gretna, Jeff officials
defend Katrina action. The Times-Picayune, National, p. 1. Retrieved July 8, 2006 from
http:/ /web.lexis-nexis.com/universe/document? m=7e65e5db04cc42b210fbf69a1664dae1&
docnum=17&wchp=dGLbVtz-zSkVA& md5=a2c52b77050a0db353ec86dbeb30f2cf.
Hamilton, D. L., & Trolier, T. K. (1986). Stereotypes and stereotyping: An overview of the cognitive
approach. In J. F. Dovidio & S. L. Gaertner (Eds.), Prejudice, discrimination, and racism (pp.
127?163). Orlando, FL: Academic Press.
Hancock, L. (2005, December 7). In a city split and sinking before the storm, racial issues boil. The
Dallas Morning News. Retrieved on May 11, 2006, from http://web.lexis.nexis.com/universe/
document? m=949ad005ce157e5c25025cfedb3eea6f& docnum=1&wchp=dGLbVtb-zSkVA
& md5=ce9f19e57614fd49ea8dedc44a952643.
Hau, S. S. (2005, October 20). Chertoff vows to ?re-engineer? preparedness: Secretary recognizes flaws
in hurricane response but defends department. Washington Post, p. A2.
Hodson, G., Dovidio, J. F., & Gaertner, S. L. (2002). Processes in racial discrimination: Differential
weighting of conflicting information. Personality and Social Psychology Bulletin, 28, 460?471.
Howell, S. E., Perry, H. L., & Vile, M. (2004). Black/White cities: Evaluating the police. Political
Behavior, 26, 45?68.
Jenkins, R. R. (2001). The health of minority children in the year 2000: The role of government
programs in improving the health status of America?s children. In N. J. Smelser, W. J. Wilson,
& F. Mitchell, F. (Eds.),Racial trends and their consequences(Vol. 2, pp. 351?370). Washington,
DC: National Academy Press.
Jones, J. M. (1997). Prejudice and racism (2nd ed.). New York: McGraw-Hill.
Kovel, J. (1970). White racism: A psychohistory. New York: Pantheon.
Kunzelman, M. (2006, April 18). After Katrina, poor tenants fight eviction. Guardian Unlimited.
Retrieved April 18, 2006 from http://www.guardian.co.uk/uslatest/story/0,,-5763810,00.html.
Lacey, B. C., & Lacey, J. I. (1974). Studies of heart rate and other bodily processes in sensorimotor
behavior. In P. A. Obrist, A. H. Black, J. Brenner, & L. V. DiCara (Eds.), Caridiovascular
psychophysiology (pp. 538?564). Chicago: Aldine.
Leopold, T. (2005, September 1). ?Louisiana 1927?: A song and a tragedy. CNN. Retrieved December
19, 2005, from http://www.cnn.com/2005/SHOWBIZ/08/31/eye.ent.louisiana/.
Madden, J. F. (2000). Changes in Income Inequality within U.S. Metropolitan Areas. Kalamazoo, MI:
Upjohn Institute for Employment Research.
Massey, D. S. (2001). Residential segregation and neighborhood conditions in U.S. metropolitan areas.
In N. J. Smelser, W. J. Wilson, & F. Mitchell, F. (Eds.), Racial trends and their consequences
(Vol. 1, pp. 391?434). Washington, DC: National Academy Press.
McConahay, J. B. (1986). Modern racism, ambivalence, and the modern racism scale. In J. F. Dovidio
& S. L. Gaertner (Eds.), Prejudice, discrimination, and racism (pp. 91?125). Orlando, FL:
Academic Press.
Nadler, A. (2002). Inter-group helping relations as power relations: Helping relations as affirming or
challenging inter-group hierarchy. Journal of Social Issues, 58, 487?502.
Nadler, A., & Halabi, S. (2006). Intergroup helping as status relations: Effects of status stability ingroup
identification and type of help on receptivity to help from high status group. Journal of
Personality and Social Psychology, 91, 97-110.
Nossiter, A. (2006, March 7). Demolition of homes begins in sections of New Orleans. New York Times,
p. A12.
Oliver, M. L., & Shapiro, T. M. (2001). Wealth and racial stratification. In N. J. Smelser, W. J. Wilson, &
F. Mitchell, F. (Eds.), Racial trends and their consequences (Vol. 2, pp. 222?251). Washington,
DC: National Academy Press.
Otten, S., & Moskowitz, G. B. (2000). Evidence for implicit evaluative in-group bias: Affect-based
spontaneous trait inference in a minimal group paradigm. Journal of Experimental Social
Psychology, 36, 77?89.
Pettigrew, T. F. (1998). Intergroup Contact Theory. Annual Review of Psychology, 49, 65?85.
Phelps, R. E., Taylor, J. D., & Gerard, P. A. (2001). Cultural mistrust, ethnic identity, racial identity and
self-esteem among ethnically diverse black students. Journal of Counseling & Development,
79, 209?216.
Racism and Katrina 123
Quigley, B. (2006, June 23). No place like home. The Times-Picayune. Retrieved June 29, 2006 from
http:/ /www.nola.com/news/t-p/otheropinions/index.ssf?/base/news-0/115104297973020.xml
&coll=1.
Report of the National Advisory Commission on Civil Disorders. (1968). Washington, DC: Washington
Government Printing Office.
Ross, B. (2005, September 2). Katrina after math raises questions of race: Largely poor, Black survivors
deal with charges of lawlessness, loaded history. ABC News. Retrieved December 19, 2005,
from http://abcnews.go.com/Primetime/HurricaneKatrina/story?id=1089382&page=1.
Saad, L. (2005, September 14). Blacks bash Bush for Katrina response. Gallup Poll News Service. Retrieved
May 11, 2006, from http://web.lexis.nexis.com/universe/document? m=64eb31361594
5542f8e79163963b457b& docnum=1&wchp=dGLbVtb-zSkVA& md5=bdaa8c7fa7043bf8c4
79c3ac46ae08d0.
Saucier, D. A., Miller, C. T., & Doucet, N. (2005). Differences in helping Whites and Blacks: A
meta-analysis. Personality and Social Psychology Review, 9, 2?16.
Scott, R. T. (2005, September 28). Nagin says some residents can return Friday. The Times-Picayune.
Retrieved July 7, 2006 from http://www.nola.com/newslogs/breakingtp/index.ssf?/mtlogs/
nola Times-Picayune/archives/2005 09 28.html.
Sears, D. O., Henry, P. J., & Kosterman, R. (2000). Egalitarian values and contemporary racial politics.
In D. O. Sears, J. Sidanius, & L. Bobo (Eds.), Racialized politics: The debate about racism in
America (pp. 75?117). Chicago, IL: University of Chicago Press.
Seitles, M. (1996). The perpetuation of residential racial segregation in America: Historical discrimination,
modern forms of exclusion, and inclusionary remedies. Journal of Land Use and
Environmental Law, 14(1), 1?30.
Select Bipartisan Committee toInvestigate the Preparation for andResponse to Hurricane Katrina.
(2006). A Failure of Initiative: The Final Report of the Select Bipartisan Committee to Investigate
the Preparation for and Response to Hurricane Katrina. Retrieved May 7, 2006, from
http://katrina.house.gov/full katrina report.htm.
Sharockman, A. (2005, September 17). Neighboring town denied evacuees. St. Petersburg Times, National,
p. 1A. Retrieved July 8, 2006 from http://web.lexis-nexis.com/universe/document? m=
ab7637d9749a572f7de2a64d85077bd8& docnum=60&wchp=dGLbVtz-zSkVA& md5=2a6c
8b08704ae5bbf00fb128f03382ed.
Shavers-Hornaday, V. L., Lynch, C. F., Burmeister, L. F., & Torner, J. C. (1997). Why are African
Americans underrepresented in medical research studies? Impediments to participation. Ethnicity
and Health, 2, 31?45.
Sidanius, J., & Pratto, F. (1999). Social dominance: An intergroup theory of social hierarchy and
oppression. New York: Cambridge University Press.
Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.) (2003). Unequal treatment: Confronting racial
and ethnic disparities in health care. Washington, DC: National Academy Press.
Smith, M. R. (2006, January 27). Study cites racial makeup of New Orleans. Associated Press Online.
Retrieved May 11, 2006, from http://web.lexis.nexis.com/universe/document? m=4bd229970d
2824f5c1f0be58a630e484& docnum=1&wchp=dGLbVtb-zSkVA& md5=9a553b535847095
6f7d1b62c5e315b4e.
Tajfel, H. (1970). Experiments in intergroup discrimination. Scientific American, 223, 96?102.
Treadway, J. (2005, June 27). Groups tackle recent racial tensions; Local organizations strive for harmony.
Times-Picayune (New Orleans). Retrieved on May 11, 2006, from http://web.lexis.nexis.
com/universe/document? m=f4b5ac9ab314380e42b64997ec7cc73e& docnum=1&wchp=dG
LbVtb-zSkVA& md5=47314d18311364c9c615747803f5fbea.
KRISTIN E. HENKEL is pursuing her Ph.D. in social psychology at the University
of Connecticut. Her current research interests are in stereotyping, prejudice, and
discrimination. She is a National Institute of Mental Health Fellow in the Social
Processes of AIDS Training Program supported by grant T32 MH074387.
124 Henkel, Dovidio, and Gaertner
JOHN F. DOVIDIO is professor of Psychology at the University of Connecticut.
His research interests in social psychology are in stereotyping, prejudice, and discrimination;
social power and nonverbal communication; and altruism and helping.
He is the editor of the Journal of Personality and Social Psychology?Interpersonal
Relations and Group Processes.
SAMUEL L. GAERTNER is professor of Psychology at the University of Delaware.
His research interests involve intergroup relations, with a primary focus on reducing
prejudice, discrimination and racism. He has served on the Council of the
Society for the Psychological Study of Social Issues (SPSSI) and on the editorial
boards of the Journal of Personality and Social Psychology, Personality and Social
Psychology Bulletin, and Group Processes and Intergroup Relations. He and John
Dovidio shared SPSSI?s Gordon Allport Intergroup Relations Prize in 1985 and in
1998 and the Kurt Lewin Award in 2004.


 

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Discuss some of the factors that increased the vulnerability of African-American residents (Henkel article)

What connections can I make regarding the research into expert discussions

What connections can I make regarding the research into expert discussions.

What connections can I make regarding the research into expert discussions

INSTRUCTIONS:
Choose one (1) of the case studies below and address the two (2) associated questions. Your Assessment will be written in academic essay format with an introduction, body and conclusion. Using evidence specific to your chosen case study, address the following two (2) questions:
1. Describe the pathophysiology of the presenting complaint in the scenario (300-500 words) and link this to question 2. ?
2. Evaluation of the nurse?s role to deliver developmentally appropriate nursing care in relation to care of the child and family in the chosen case study including:
I. growth and developmental theories, ?
II. family centred care and, ?
III. the effects of hospitalisation of the child and family (1100-1300 words). ?
CASE STUDY

Steven is a 15-year-old indigenous boy who lives in a remote town in rural Australia. Steven was diagnosed with asthma at the age of two. His asthma has been well managed over the years predominantly with relievers and preventers with the occasional need for steroidal anti- inflammatory medication.
Steven has presented to the local hospital complaining of shortness of breath and relays to the triage nurse that he has a past history of asthma.
A health history taken by the triage nurse on arrival reveals that Steven has had a two-year history of smoking cigarettes and is not always compliant with his asthma medication or management plan.
Steven lives with his mother and his 6 brothers and sisters.

Order Description

CASE STUDY
atleast 16 primary reference from year 2011- 2016
1600 words case study
please see the attachment for case study and further assistance with assignment

Assistance
The following is a guide to assist you in writing your essay.
Using the research, you have undertaken for your chosen scenario, discuss how the information will guide evidenced based Australian Nursing practice. This should a reference to: –
1. The pathophysiology of the presenting complaint in the scenario.
This section is science based and the expectation is that you have a pathophysiology text book and scientific journal articles to discuss the science related to the presenting problem in your chosen scenario. You should aim at 300-500 words for this section. The aim of this is that you attain knowledge of what is happening at a cellular, organ and system level so that you understand the presenting clinical manifestations
2. Evaluation of the nurse?s role in relation to nursing care of the child and family in the chosen scenario; which should include a reference to: –
i. growth and developmental theories,
This part of the assessment task is concerned with ensuring the essay has a child and adolescent focus. Throughout the essay discussion, it is expected that you make reference to the child?s expected developmental milestones at that age, depending on which scenario you have chosen. It is expected that growth and development research is undertaken for your chosen scenario and you make reference to growth and developmental theories that you think are relevant in enhancing your essay argument. Some ideas include things like, at what age do you include a child in medical related conversation, how does a child/adolescent make decisions based on their developmental level, and even through your pathophysiology, you can make mention of underdeveloped organ systems that might influence your nursing care.
ii. developmentally appropriate care;
This part is a follow on from discussing the growth and developmental expected milestones of the child and really focuses on how it influences your care. How does a nurse provide developmentally appropriate care to the specific age presented in your scenario inclusive of the presenting complaint?
iii. family centred care and,
Neonatal/paediatric and adolescent nurses provide a family centred care model. It is important that this is reflected in your essay and may bring forward issues of consent, compliance and child presentation into care. How are siblings are affected, the role of the extended family, cultural influences and whatever may be specific to the scenario.
iv. Reference to the hospitalised child and family.
This part follows on from the family centred care component where it is important to understand the effects of a child?s presentation to services particularly in a hospital setting on not only the child but the whole family.
All of the above points should be in reference to how your nursing care will be guided in a paediatric setting.
As a guide only I have provided the following general essay information.
The assessment task is 1600 words.
Paragraph and Essay Structure
An essay includes an introduction, body and conclusion.
1. The introduction should provide the reader with a framework for the essay and
what will be discussed. Sometimes it?s easier to write the introduction last or after you have
completed outlining what you will be discussing. (Approximately 100 words)
2. The pathophysiology ? as discussed above. (Approximately 300-500 words)
3. The body of the essay is the crux of your discussion and will consume the bulk of your words. Your paragraph structure is important to note as follows: –
? ? Each paragraph should have an introductory and concluding statement.
? ? Each paragraph should have a direct connection with the one prior and one after it. This allows the essay to flow.
4. Theconclusionshouldprovideasummaryofthekeypointspresentedintheessay.
(Approximately 100 words)
5. The definitions used in your essay should only use academic references (not online dictionaries)
6. It is important to note that this is an academic essay and should be written in the third person.
7. There are no minimum requirements for the number of sources you use however as a general guideline an academic paper can have 1 source per hundred words.
8. In regards to the currency of the references, it is generally expected that sources are within 5 years published age. However, if you have sourced a reference that is older than this you must demonstrate how it is relevant in your writing.
Finally defining what we mean by the following:
ANALYSIS ? What do the experts state regarding the topic? Here you present the research you
have undertaken and looking at different perspectives.
SYNTHESIS ? What connections can I make regarding the research into expert discussions
EVALUATION ?What conclusion do I come to after presenting the arguments based on my analysis and synthesis?


 

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Write an assignment, responding to the scenario above and drawing on relevant literature. The assignment is broadly about organizational change, although within this there is a choice of addressing a specific aspect of organizational practice that can be used to facilitate change.

Write an assignment, responding to the scenario above and drawing on relevant literature. The assignment is broadly about organizational change, although within this there is a choice of addressing a specific aspect of organizational practice that can be used to facilitate change..

Write an assignment, responding to the scenario above and drawing on relevant literature. The assignment is broadly about organizational change, although within this there is a choice of addressing a specific aspect of organizational practice that can be used to facilitate change.

Order Description
Organizational Practice in Social Work – Assessment 2

Assessment Task 2: worth 40%, length 1800 words.
Scenario:
You are one of several social workers working in a hypothetical state-government community health centre in a city (population 95 000) in central New South Wales. The centre provides multi-disciplinary services (including nursing, home care, occupational therapy, psychology and physiotherapy) to a wide range of clients, including people with drug and alcohol problems, people with mental health needs and people with disabilities (including assessment of children with suspected development delay) .
Some recent cases presented by allied health staff at case conferences have indirectly involved children. You and your social work colleagues are concerned that child welfare issues are not being fully considered. (One of the cases was where a parent?s depression was identified as impacting on her ability to care for her daughter. It had been agreed with Human Services: Community Services (DoCS) that she would receive counselling from the
psychologist, however when she repeatedly did not turn up for sessions, DoCS was not informed.) Your impression is that there is not a good understanding of child and family welfare issues and ways of dealing with them amongst many of your non-social work colleagues.
The social workers meet to discuss this issue. Amongst other things they are concerned about how the centre will respond to proposed state government changes which will mean responsibility for child protection will be shared by health and human services staff in all government agencies, not just DoCs. Going on past experience the social workers are worried that the Local Health District management will simply impose a structure and processes for dealing with child welfare issues. They are concerned that the new arrangements may not be the best for children and families and also that implementation could be problematic because staff may not be appropriately trained.
The social workers consider a range of strategies to address the problem. They think it is important that there be a multi-disciplinary staff working party to plan and implement new arrangements. One essential task would be to conduct a file audit of all cases over the past two years to identify those where clients had children, or where children and young people were themselves clients, to map the child and family welfare issues and how they were responded to by staff (including liaison with DoCS and other support services in the community).

Tasks:
Write an assignment, responding to the scenario above and drawing on relevant literature. The assignment is broadly about organizational change, although within this there is a choice of addressing a specific aspect of organizational practice that can be used to facilitate change. Although it is recognized that there may be some overlap, please select one aspect to focus on.

You should include an introduction and a conclusion to the paper and ensure that the following questions are addressed:

? What are some possible challenges facing the social workers in pursing their change agenda?

? Focus on one of the following aspects of organizational practice, apply it to the scenario and discuss how it could be used to assist the social workers? efforts:

? Overcoming obstacles and resistance to change, OR
? Leadership, OR
? Interagency and/or interdisciplinary collaboration.

This assignment addresses all three course learning outcomes in that it asks students to consider the issue of organizational change, particularly the application in practice of theory and knowledge about facilitating organizational change, in an hypothetical human services organization.

Assignments should have numbered pages, be one and a half spaced and in at least
11 point font. Assignments should be properly referenced and in text citations must be included. Assignments, which do not comply, will not be marked. Assignments more than 10% over the maximum word count will be penalized.

Marking criteria:
? Understanding of theory and knowledge about issues of change in organizations
? Relevance to the given scenario
? Development of arguments
? Written expression
? Referencing


 

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The post Write an assignment, responding to the scenario above and drawing on relevant literature. The assignment is broadly about organizational change, although within this there is a choice of addressing a specific aspect of organizational practice that can be used to facilitate change. appeared first on THE NURSING PROFESSIONALS.

Write an assignment, responding to the scenario above and drawing on relevant literature. The assignment is broadly about organizational change, although within this there is a choice of addressing a specific aspect of organizational practice that can be used to facilitate change.