The document discusses responses to Hurricane Katrina in 2005 and the 2010 Haiti earthquake and cholera outbreak. It summarizes that Hurricane Katrina revealed issues with coordination between different levels of government and emergency response organizations. This led to reforms, including clearer definitions of roles and a focus on including all relevant departments. The response to the 2010 Haiti earthquake showed improved organization and deployment of aid. However, the subsequent cholera outbreak highlighted Haiti's vulnerable infrastructure and populations, especially regarding access to clean water. Public health efforts have focused on these issues and supporting vulnerable groups.

1. Three reponses dicussion board
-Lorraine Hurricane Katrina and changes in response by the Federal and State governments.
Although the tragedy of 9/11 sounded a need for emergency response, it was the reality
that since most lives were lost after that event, the emergency response system in its fullest
capacity was not fully ignited. I chose to address Hurricane Katrina, which occurred in 2005
before addressing my topic concerning an outbreak of Cholera in 2010, after the earthquake
in Haiti, first of all because it was 5 years earlier and because it is interesting to compare
and contrast the two(2). With respect to both events the question is, was anything learned
from the devastation of Katrina in New Orleans, that later helped guide the efforts and
Public Health responses of the devastating effects produced after the Haitian Earthquake of
2010? Why was this response ignited, when after 9/11 response efforts trickled? After
Katrina in 2005, the National Response Plan and the National Incident Management System
existed, but the experience with Katrina made it clear that these systems in place were not
well understood or widely used or even widely read. (Katz, 2012,2019) About 1800 lives
were lost, but damage was estimated at 125 billion dollars in assessment of infrastructure,
and housing, and multiple governmental levels did not have a common operating picture,
and communication was misunderstood as to who oversaw which aspects of the
response.(Behr,2013) In 2006, goals were made to fix this disarray with the recognition
that all offices and branches of DHHS became involved, and that was when the department
of Homeland Security came to have under one roof the many offices that were available, but
not speaking to each other effectively. In fact, it became clear that because services provided
and needed were so pervasive, that all these separate offices needed to respond
simultaneously during such crises. Needs as large as damage to infrastructure, helping
people including the vulnerable young and old requiring assistance for immediate relief of
bodily harm, provisions of housing for those who lost everything, medicine, food, homes; all
these requirements were a wake-up call to the reality of disorganization and poor
leadership with respect to emergency response. (Aldrich, 2008) This hurricane led to the
Incident Command System (ICS) taking on more specific definition, hierarchical structure,
and in the after math of this disaster, the White House released a “lesson Learned” with 17
lessons and 125 recommendations for strengthening disaster response. (Katz, 2012.2019)
Cholera- a Public Health Emergency after 2010 Earthquake in Haiti More than 2,000 years
after its first recorded mention by Hippocrates, and only 5 years after Hurricane Katrina,
the disease caused by the Vibrio cholerae bacterium is thriving across the world. Although
easily prevented and treated, cholera kills nearly 100,000 people annually in communities

2. weighed down by poverty and conflict. The World Health Organization continues to tackle
disease outbreaks and other health emergencies worldwide, but continued disparagement
to moving forward with these operations has the common denominator of underfunding,
and needs continue to grow. (WHO, 2018) I became interested in this disease after the
devastating earthquake in Haiti in 2010 which killed more than 200,000 people and
displaced more that 1 million persons, because with this emergency response came prompt
reaction from the US Coast Guard, the US Navy, the US Air Force and many US branches
responded to this initial disaster. Baby deliveries were served in better environments and
these efforts provided means of evacuating the vulnerable to places where care could be
given. The US army provided for forces on the ground to help keep order and deployment of
these people helped keep stability when everyone was vulnerable to both physical and
emotional mishap. Although there were many instances of unrest, where even military
peacekeepers were vulnerable to injury, this was a demonstration of an emergency
response, now better organized and put into action. In Haiti, within 10 months of the 7.0
magnitude earthquake that struck and killed over 220,000 and injured over 300,000, a
cholera outbreak was confirmed. It was the first time in more than 100years and since then,
cases of cholera number more than 665,000 with approximately 8,183 deaths. Since the
beginning of that outbreak, only 17% of the population had access to sanitary conditions.
Public Health Role and aid to Vulnerable populations With global health risks for further
spread of cholera the CDC worked closely with the Haitian Ministry of Public Health and
Population (MSPP) to combat the cholera epidemic and reduce the impact of the disease.
Especially vulnerable people in all communities with this type of disaster are the poor, the
elderly, and women of reproductive age who might be pregnant. There are many great
suggestions of preparing and being prepared for these events,(FEMA,2013); but with
families already at risk and who have limited food, health care, medicine, and less resources
including access to clean water, education, and abandonment from connectedness to media;
are situations left that define vulnerability at its summit.(Behr, Diaz, 2013) Although to this
day new cases continue to emerge, improving Haiti’s water and sanitation improvement is
critical and the country will continue to achieve gains in reducing cholera cases with this
type of critical repair to the infrastructure that is being worked on. (CDC,2018) Cholera’s
Effects on the Vulnerable of Haiti after the earthquake of 2010 Already the poorest country
in the Americas with 80% of the population living under the poverty line and 54% in abject
poverty, the earthquake inflicted $7.8 billion in damage in Haiti and caused the country’s
GDP to contract 5.4% in 2010. The basic infrastructure was vulnerable well before the
earthquake, and a catastrophe of this epic nature cause further hemorrhaging of the
economic system and only further added to the vulnerability of this population. Funding
first and foremost needed to be provided for clean water systems. Slowly, Haiti is getting
back on its feet, but it will take years. References Aldrich, N., & Benson, W. F. (2008).
Disaster preparedness and the chronic disease needs of vulnerable older adults. Preventing
chronic disease, 5(1). Behr, J. G., & Diaz, R. (2013). Disparate health implications stemming
from the propensity of elderly and medically fragile populations to shelter in place during
severe storm events. Journal of public health management and practice, 19, S55-S62.
Centers for Disease Control.(CDC).(2018).Retrieved from

3. https://www.cdc.gov/cholera/haiti/index.html FEMA. (2013, May 6). Preparing Makes
Sense for Older Americans [Video file]. Retrieved from
https://www.youtube.com/watch?v=SByTKf2rrlg Katz, R. PhD, MPH, Banaski, J., MS, MEP,
CEM (2nd Eds). (2019) Essentials of Public Health Preparedness and Emergency
Management. Burlington, MA: Jones & Bartlett Learning, LLC. World Health Organization
(WHO). (2018). Ten Threats To Global Health in 2018 https://medium.com/@who/10-
threats-to-global-health-in-2018-232daf0bbef3 Shineca At-Risk and Vulnerable Populations
in Public Health Emergencies Collapse Summary of Hurricane Maria’s Impact on the Elderly
Hurricane Maria hit the island of Puerto Rico on September 20, 2017. Three months after
the storm, Puerto Rico’s elderly population is among the most vulnerable. Puerto Rico has a
higher percentage of people 65 or older than any U.S. state (Wyss, n.d.). Puerto Rico’s
population consists of approximately 20% elderly with 40% of them living at or below
poverty level (The Claude Pepper Center, 2019). There were 2,975 deaths attributed to
Hurricane Maria, with the elderly accounting for a disproportionate number of these deaths.
Men over the age of 65 were found to continue to have elevated death rates four months
after the storm. Only 2% of the elderly in Puerto Rico live in assisted living facilities and the
majority live at home, relying on family and neighbors for assistance. Hurricane Maria made
access to healthcare more complicated by damaging roadways and disrupting public
transportation, leaving many elderly community members alone and unable to find care
when needed (Wyss, n.d.). The risk of death for the elderly was up to 35% higher than
expected and had not returned to baseline by February 2018 (GWU, 2018). Public Health’s
Role with At-Risk/ Vulnerable Populations in Preparation, Response, and Recovery
Vulnerable populations such as the elderly, women who are pregnant or of child bearing
age, low income populations, immigrants, people with disabilities, people with access and
functional needs, and others are at a disproportionate risk during and after and natural or
man-made disaster. These groups are often left out of disaster planning and experience
delays in assistance during response and recovery. Hurricane Katrina brought many of
these gaps to light, and since then, many organizations have taken steps to improve
emergency preparedness and response planning to include these vulnerable populations.
Five functional areas relevant to the needs of vulnerable populations have been discussed in
literature: maintaining independence, communication, transportation, supervision, and
medical care (ASPE, 2018). It is the role of public health on both the federal and local level
to consider these functional areas during emergency preparedness and response planning
to ensure that these vulnerable populations are not left out and to decrease morbidity and
mortality amongst these groups. Post-Hurricane Katrina Reforms in Addressing the Needs
At-Risk/Vulnerable Populations in Preparation, Response, and Recovery Since Hurricane
Katrina, improvements have been made to address the needs of vulnerable populations
through national policies, reforms, and directives. -Katrina Emergency Response Act was
enacted to improve collaboration, increase sharing of resources, provide more consistent
policies, and integrate services among federal, state, and local agencies. This has reduced
barriers to helping people during an emergency who have additional medical and functional
needs (Rader, Edmunds, & Bishop, 2010). Hurricane Maria and its effects on the elderly and
other vulnerable populations in Puerto Rico have proven there are opportunities for

4. continued improvements. The Federal Emergency Management Agency (FEMA) was unable
to provide adequate support to hurricane victims in Puerto Rico during and after Hurricane
Maria. Puerto Rico was lacking key supplies prior to the storm, there were challenges with
delivering emergency supplies, and emergency staff were unqualified for the roles in which
they were placed. Puerto Rico’s emergency-supply warehouses were almost empty due to
many of their supplies being rerouted to US Virgin Islands. FEMA was understaffed during
the hurricane season. The initial response encountered communication challenges with
almost 95% of cell towers down after the storm. FEMA did not have enough working
satellite phone to provide to leadership in Puerto Rico, making damage assessment difficult.
FEMA also was unaware of what was being sent from government and private agencies
when emergency supplies arrived, further complicating tracking and distribution. FEMA
also did not have enough generators and was unable to quickly obtain more (Sullivan &
Schwartz, 2018). Although there have been several post-Katrina reforms and policies on
emergency preparedness, response, and recovery, these reforms did not effectively address
the needs of Puerto Rico or its vulnerable populations before, during, and after Hurricane
Maria due to poor planning and preparation prior to the storm. References Assistant
Secretary for Planning and Evaluation. (2018, December 1). Analysis of Risk Communication
Strategies and Approaches with At-Risk Populations to Enhance Emergency Preparedness,
Response, and Recovery: Final Report. Quality and Content of the Literature on Public
Health Emergency Risk Communication with Vulnerable Populations. Retrieved from
https://aspe.hhs.gov/report/analysis-riskcommunication-strategies-and-approaches-risk-
populations-enhance-emergency-preparednessresponse-and-recovery-final-
report/quality-and-content-literature-public-health-emergency George Washington
University. (2018). Poor, elderly Puerto Ricans faced a persistent risk of dying after
Hurricane Maria. Medical Xpress. Retrieved from https://medicalxpress.com/news/2018-
10-poorelderly-puerto-ricans-persistent.html The Claude Pepper Center. (2019). Crisis in
Puerto Rico for the Elderly. Retrieved from https://claudepeppercenter.fsu.edu/slider-
archive/crisis-in-puerto-rico-for-the-elderly/ Sullivan, L. & Schwartz, E. (2018). FEMA
Report Acknowledges Failures in Puerto Rico Disaster Response. NPR. Retrieved from
https://www.npr.org/2018/07/13/628861808/fema-report-acknowledges-failuresin-
puerto-rico-disaster-response Wyss, J. (n.d.). Puerto Rico: The Forgotten Island. Miami
Herald. Retrieved from https://www.miamiherald.com/news/nation-
world/national/article217793145.html Rader, A., Edmunds, M., & Bishop, J. (2010). Public
Health Preparedness and Response for AtRisk Populations. 32. Ashley Pevia At risk
vulnerable populations in public health emergencies Collapse Public Health Emergency &
Impact on vulnerable populations The Flint Water Crisis occurred on April 25, 2014.
Michigan changed their water supply source which lead to pipe corrosion and lead leaking
into the drinking water. An estimated 140,000 individuals were exposed to lead and other
hazardous contaminants in drinking water (Ruckart, 2019). Michigan’s adolescence
population is among the most vulnerable. Many of the individuals and families affected by
the water crisis was found to be living at the poverty level. The 2013 Pandemic and All-
Hazards Preparedness Reauthorization Act defines at risk individuals as children, older
adults, pregnant woman, and individuals who may need additional response assistance.

5. Lead exposure can lead to nervous system damage, slowed growth, learning and behavioral
problems and hearing and speech problems (Ruckart, 2019). Populations affected have
tested much higher than most populations regarding lead blood level (Felton, 2016).
Decades of studies have shown effects of elevated blood lead levels can lead to hinder
mental growth in young children and behavioral problems. According to research done on
at risk populations found “50% of households reported that at least 1 member of the family
had more behavioral concerns than usual” (Ruckart, 2019). A survey done on community
members found 77% of respondents reported skin rashes during the same time they
noticed changes of water color, odor and taste. Public Health Role Public health
professionals need to work closely with community organizations and state and federal
agencies to ensure quality measures to be taken to assist at risk populations. The Flint
Water Crisis made the nation aware of the hazardous effects of the disaster incident.
Immediate response to disasters can aid in recovery. Officials communicative efforts play a
vital role in preventing illnesses and promoting recovery efforts. Public health officials
needs to ensure vulnerable communities receive adequate mental care, health care and
financial help. Similar disaster outcomes has led public health officials to learn from past
experiences and enhance response efforts. Hurricane Katrina reform After Hurricane
Katrina, federal and state organizations attempted to help in relief efforts. Congress passed
a bill that would direct $7.4 billion of funding to storm recovery (Mann, 2017). Vulnerable
populations are still not fully recovered from the disaster. Low income historically black
neighborhoods was hit the hardest. According to the Environmental and Energy Study
Institute, stated minority populations were hit the hardest and not an “equal opportunity
storm” (Laporte, 2019). The lower ninth ward did not receive much funding and community
members are still trying to rebuild their lives. This is an indication that policies and laws did
not address the needs of at risk vulnerable population. Resources Mann, T., & Jamerson, J.
(2017, September 7). Back-to-Back Hurricanes to Test Post-Katrina FEMA Reforms.
Retrieved from https://www.wsj.com/articles/back-to-back-hurricanes-to-test-post-
katrinafema-reforms-1504815848. Ruckart, P. Z., Ettinger, A. S., Hanna-Attisha, M., Jones, N.,
Davis, S. I., & Breysse, P. N. (2019). The Flint Water Crisis: A Coordinated Public Health
Emergency Response and Recovery Initiative. Journal of public health management and
practice : JPHMP, 25 Suppl 1, Lead Poisoning Prevention(Suppl 1 LEAD POISONING
PREVENTION), S84–S90. doi:10.1097/PHH.0000000000000871 Piccirilli Dorsey, Inc. (n.d.).
Fourteen Years Later, New Orleans is Still Trying to Recover from Hurricane Katrina.
Retrieved from https://www.eesi.org/articles/view/fourteen-years-later-new-orleans-is-
stilltrying-to-recover-from-hurricane-katrina.