greater among poorer populations and populations of color, who composed a large part of the New Orleans population. Furthermore, exposures in neighborhoods inhabited by vulnerable populations, the toxic exposures that they may have sustained, and their access to services afterward (ranging from evacuation to shelter provision) were different from those of other residents.

Short-Term Environmental Health Concerns

A wide range of environmental health issues surfaced in the aftermath of the hurricane. Even though public health concerns are important to all in government, they are not the only concerns, noted Frumkin. NCEH/ATSDR had to confront a number of crosscutting social and organizational challenges in trying to address the health, safety, and environmental problems following Hurricanes Katrina and Rita. In the lifesaving phase of the response, some immediate decisions had to be made. Identifying and addressing life-threatening environmental hazards and getting them under control was a top priority. Medium-term decisions included controlling hazards so that people could reenter the city. Long-term questions include environmental health considerations in reconstruction.

Unwatering—that is, draining of the floodwaters—was one of the first environmental concerns that people faced after Hurricane Katrina. When people try to reach destinations within the city where transportation and emergency medical services are completely impeded by water, unwatering becomes a health and safety issue.

Potable water was the next concern; people need water for hydration, food preparation, and washing. The instructions that people in the area were given after Hurricane Katrina about washing after contact with sewage water presupposed the availability of clean water, said Frumkin. Having potable water available depends on a functional water treatment facility and intact distribution systems. The disruption that followed the flooding may have interrupted the distribution system as well. That is a potentially complicated issue because infiltration of the distribution system by floodwaters may not only contaminate the inside of the distribution systems but also change the ecology and the biologically active layer of film that lines the water pipes. Once the water distribution system comes back online, it needs to be carefully inspected. Homes with wells have an additional set of concerns above and beyond those of homes that are on public water systems, noted Frumkin.

Sewage was another environmental concern. The availability of sewage treatment depends on treatment facilities and on an intact collection system. Initially, after the hurricane, there was concern that if people reentered their homes and flushed the toilet and the contents went down, that might be reassuring to them that the sewage system was actually working. There was no guarantee, however, that the sewage was in fact flowing to the sewage treatment plant to get treated, noted Frumkin. Interruptions in the collection system could have resulted in sew-



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