smarter. One shouldn’t presume that just what was there will be repaired and rebuilt; it may not have been adequate in the first place.

IMPACTS ON THE HEALTH OF COMMUNITIES AND THEIR RESIDENTS

In the long term, there will be a need for reconstituting the communities in the region—knitting back together communities that provide social support to people. This will require commitment to schools and services and the preservation of cultural, racial, and socioeconomic diversity. From a practical aspect, the question remains how people will be able to remediate their homes and where they will be able to obtain the financing for such endeavors.

The public health community has learned from 9/11 about posttraumatic stress disorder and depression in the aftermath of the terrorist attacks. It is well known that stress can be a risk factor for many diseases, and for the post-Katrina residents and evacuees, the cleanup and recovery continue to be stressful. Many individuals were flown out of their communities without knowing where they were going and without any belongings—one example of a stressful situation.

Neighborhood stability provides social stability to its residents. Previous research suggests that the loss of social networks in communities that have become fragmented has impacted health through increased drug abuse, alcohol abuse, and HIV infection. For New Orleans and the Gulf Coast region, there is unprecedented disruption to this stability, which will probably never be regained. In New Orleans, closely knit communities that provided stability to each other by being part of a social network are now scattered. This leaves the community more vulnerable and more fragile in many respects.

THEMES FROM THE WORKSHOP

During the workshop a number of major themes were discussed that cut across scientific disciplines. Many of these themes warrant future discussion, including the need for research, scientific leadership, and environmental management.

Health Studies and Scientific Leadership

There is a need for health studies, whether they are cross-sectional, case-controlled, or longitudinal. Public health needs to look at disasters systematically to ensure that the affected communities are involved and can fully participate in the recovery. Under normal (nondisaster) situations, many public health scientists have done these studies, and they can be challenging. For Hurricane Katrina and other Katrina-like events, the fact that people are dispersed around the country makes recruiting and conducting these experiments even more difficult. A further complication is that the local scientific leadership was displaced. Thus, there is a



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