Healthcare Financial News

Three years after Hurricanes Katrina and Rita, tens of thousands of Gulf Coast households displaced by the storms still live in travel trailers provided by the Federal Emergency Management Agency (FEMA). These internally displaced persons (IDPs) suffer from high and worsening rates of depression and other chronic diseases, but they do not have adequate access to health insurance or medical care, according to a survey of Mississippi IDPs described in a Health Affairs web exclusive published Aug. 29.

The survey, the first rigorous look at the health status of Katrina evacuees who remain displaced today, reveals a mismatch between a short-term emergency planning approach and the long-term health requirements of IDPs. During a two-week period in September 2007, the researchers interviewed members of a random sampling of the 17,789 IDP households living in FEMA travel trailer parks in Mississippi. Four-fifths of the respondents reported that at least one adult in their household had a chronic condition, and almost six in ten (58 percent) said the condition was getting worse. Also, almost six in ten (57 percent) of the survey respondents met the criteria for major depressive disorder, and 72 percent reported symptoms of depression. Yet the health resources available to the IDPs have decreased. Fewer than half (49 percent) of all respondents reported having health insurance--a drop of 10 percentage points from the 59 percent who had coverage before the storm. Loss or change of employment was the most common reason cited for losing coverage.

To improve the condition of the Katrina IDPs, as well as those displaced by future disasters, the researchers call for federal legislation to ensure healthcare coverage for IDPs, either through Medicaid extensions or via a special emergency fund for the states. The researchers also call for the federal government to fund long-term mental health services for IDPs. Read the abstract.

Health systems should be based on principles of equity, disease prevention, and health promotion with universal coverage, based on primary health care. That was the conclusion of a three-year investigation by the World Health Organization’s (WHO) Commission on the Social Determinants of Health. The commission presented its findings Aug. 28 in a report titled Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Among the examples the report cites is the fact that, in Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17,400, but in Afghanistan, the odds are 1 in 8. “Biology does not explain any of this,” says the report. “Instead, the differences between--and within--countries result from the social environment.”

The “toxic combination of bad policies, economics, and politics is, in large measure, responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible,” says the report. “Social injustice is killing people on a grand scale.” Consequently, the health sector--globally and nationally--needs to focus attention on addressing the root causes of inequities in health.

The commission makes three overarching recommendations: improve daily living conditions; tackle the inequitable distribution of power, money, and resources; and measure and understand the problem and assess the impact of action. Download the executive summary.