CHAPTER 1 

Greater New Orleans: A Medical Geography

I was interested in discovering the impact of the 2005 Hurricane Katrina and the subsequent failure of Public Health relations in the region to support affected communities. I was curious to investigate 17 years on, whether this may have had any bearing on why the state ranks so low in health, in comparison to the rest of the country. Through personal experience of trauma and resulting PTSD, I am acutely aware of how traumatic temporalities can play out, and the potential long-term affect trauma can have on both the body and social relationships.  From this, I conjectured on what knowledge might be found in the space between ontological displacement, the traumatic and inadequate disaster recovery efforts, and the notable high rates of diseases (diabetes, cancer, as well as lung, heart, and cardiovascular diseases) in the local population, exemplified a high covid mortality rate in the area. For a project that is deeply dependent on an understanding of the complex web of geographical, medical, and social histories in New Orleans and some surrounding areas, I decided to visit the city and speak with people who can guide me through the intricacies of the US healthcare system and offer a nuanced account of historical issues of structural violence and racial segregation that have long beset the area. 

Prior to travelling to New Orleans and within my first week there, I reached out to a range of local individuals, health practitioners, social workers, academics, activists, artists, and psychiatrists, as well as others who have have an interest on the topic. I spoke with Dr Corine Brown, social worker and trauma practitioner living in New Orleans. I also attempted to set up an interview with an incredible influencer, Angela Chalk (Healthy Community Services).

Dr Roberto Barrios, professor at University of New Orleans and someone who has extensively researched disaster risk reduction and recovery, providing considerable encouragement to my interests. Meeting for an informal interview, once prior (online) and the again during my visit. He generously connected me with his sister (who works for a health foundation in New Orleans) and who suggested a detailed list of relevant people and organisations I should be aware of and possibly reach out to. 

In our first meeting, he also drew my attention to what is now commonly named the ‘chemical corridor’ or ‘cancer alley’, an area of Louisiana, West of New Orleans, that sits on the Mississippi river and has concerning numbers of NCDs, a result of chemical contaminants in the water supply from toxic waste of local industrial plants. He connected me with anthropologist Kim Fortun who is doing a lot of work around this currently. While my initial proposal was centred around looking specifically at the complications in the time post-Katrina, it wasn’t long before I discovered the true depths of water toxicity and infrastructural violence.

Despite various pockets of resistance and challenge from affected communities, there is very little being done to repair the latent neglect of water infrastructures that led to; levees breaking and causing the post-Katrina 2005 floodings; the inadequate and broadly harmful corporate interested recovery efforts following Katrina; and the toxic chemicals that are daily pumped out of taps pronounced as potable water suitable for human consumption and fit for agricultural purpose. On arrival to New Orleans, I was holding in the foreground some questions; How has the state’s geography impacted its susceptibility to forms of chronic illness? Why are NCD rates so high in the Louisiana?  How can we see the historical and cultural experience of trauma to the area as having a connection to this NCD epidemic? I hope that the research presented here does justice to answering these questions. 

New Orleans: A Narrative Vignette  

New Orleans, The Crescent City. Creatively rich, and aesthetically arresting. It is a popular with tourists from all over the world, with people attracted to the vibrant spirit of the city. I arrived in May, just over a week before the start of “hurricane season”, which starts 1st June. At 33°C and 80% humidity, the humidity hung thick in the air. Tourists saturate the streets of the French Quarter, particularly the wild enchantment of Bourbon Street where the layered clash of dive bars and hustlers compete for tourist’s business and where the caption seen on souvenir t-shirts ‘New Orleans or Die” starts to make sense.  

When one compares this to a neighbouring district Central City, the impression is very different. I took a walk down Martin Luther King Jr Boulevard and met a much rougher view of the city.

Biolegitimacy and Neoliberal Governmentality 

The reality is that in the USA, black lives are still very much considered secondary to white lives, similar to how cultural growth remains secondary to economic growth. I may examine how notions of biolegitimacy and discriminatory assumptions around governance of certain bodies a underpin how we function as a social body. 

The seeds of biolegitimacy are propagated in Michel Foucault’s theory of biopolitics and biopower, a concept he characterises not as something that a person can hold or exercise, rather he presents it a “capillary” (Foucault, 1979) channel that runs through society “employed and exercised through a net-like organisation” (Foucault, 1982). Through looking towards the governance of life and death he notes that power relations had shifted; pre-19th century it was a “sovereign right” to “make die and let live”, yet in the advent of biopolitics, forms of governance shifted to “make live and let die” (Foucault, 2003: 214; Fassin 2009: 47). Didier Fassin speaks to this, asserting that, for him, biolegitimacy is “the course of events which occurs from birth to death, which can be shortened by political or structural violence, which can be prolonged by health and social policies, which gives place to cultural interpretations and moral decision” (Fassin, 2009: 48).  The notion of biolegitimacy is useful to consider when examining health inequities in marginalised demographics and it is as such that I use it as a springboard to explore the biopolitical approaches to governance in Louisiana.  

Like many Southern states, Louisiana has been ruled over by both French and Spanish colonial powers and this resolute colonial history is perceptible in the architecture and culture, in the physical and social infrastructure. One cannot ignore the neo-classical French architecture which holds flag poles for the countless number of Fleur-de-Lis flags, traditionally an historical symbol of the French heraldry but here, a proud emblem of the state of Louisiana. The cultural landscape sits on an intersection of various cultures and practices and while there is a rich tapestry to regard during the Mardi Gras celebration weeks, the roots of this diversity has been largely propagated on violent historical events, something which lingers at the vortex of new memories. The so called “Trail of Tears” throughout the 19th century has been remembered as the forced displacement and genocide of five indigenous communities, Cherokee, Creek, Chickasaw, Choctaw, and Seminole, who’s inhabited the land along and around the Mississippi river (Elhe, 2011).  

The legacy of slavery, symbolically embodied in the plantations that sit tall beside the bay trees along the banks of the Mississippi river. New Orleans is widely considered the birthplace of jazz music a musical language borne out of resistance to colonial powers and the racial segregation during the Jim-Crow law era at the height of slavery and the plantations in the 18th and 19th centuries.  

Another key historical marker was the 1791 Haitian slave revolt (an event which resulted in subsequent independence of the country as well as abolition of slavery). Many Haitians went to Louisiana, and many settled there. Voodoo Catholicism was brought to Louisiana by slaves from West Africa and the Haitian migrants, it is something that continues to be practiced quite widely across the state in current times.  Similarly, Cajun culture has evolved from the French speaking Acadian settlers, many from Canada. Cajun music and cuisine are a huge part of the quotidian identity, and the French dialect of Creole is a nod to this cultural lineage. Most recently, there has been a flow of Central American migrants to the area, who initially arrived to provide cheap labour to Hurricane Katrina recovery efforts, this has once again changed the cultural fabric.  

The population in Louisiana is 4,657,757 and this population lives over the 64 parishes with 17.8% of Louisiana population living in poverty (Census, 2021b) It is a Republican ‘red’ state and shares its borders with three other red states, Arkansas, Mississippi and Texas. New Orleans is a city with an estimated population of 376,971 where 59.2% of the population are Black or African American and 23% of the total population live in poverty (Census, 2021a). Nearby, there is the state capital Baton Rouge, which has an estimated population of 222,185 where 53.5% are Black or African American and 24.4% living in poverty (double the national average) (Census, 2021a). Census bureau defines poverty as when “a family's total income is less than the family's threshold, then that family and every individual in it is considered in poverty.” (Census, 2021a). We see here that the measure of poverty has been segwayed into a fiscal language concerned primarily with economic interest, and a discourse that inherently lacks causal cognizance for understanding what poverty is in the social world, and perhaps more poignantly, what poverty is in one of the richest countries in the world. 

Poverty is considered to increase daily stressors for affected people and their communities. Social indicators of poverty may include rates of infant mortality (Lee et all, 2021), drug deaths and homicides, for which Louisiana has consistently ranked some of the highest in the country for the last 30 years (New York Times, 2021). Such poverty may also be a result of neglect or as critical theorist Elizabeth Povinelli asserts in her publication Economies of Abandonment that there is a “late liberal way of making live, making die, and letting die” (Povinelli, 2011: 29). She accounts for liberalism’s severe emphasis on individual freedom and growth, at the expense of someone else’s, and “the unequal distribution of life and death” (Povinelli, 2011: 40). Capturing the economic motivations at the crux of the neo-liberal framework of market-driven governance she comments that “any form of life that is not organized on the basis of market values is characterized as a potential security risk” (Ibid: 22) and regarded as undeserving.  

In the case of New Orleans and Louisiana, I would observe additional indicators of poverty to be observed in the neglected infrastructures and the lack of access to basic human rights (inc. housing, education, safety, water and sewerage, food), the regular threat to safety through exposure to violent crime and the lack of social support or representation in the eyes of the law. When considering these precarities as syndemically relational we can see the multiple layers of state neglect, abandonment and violence that serve to perpetuate the making or letting die of communities that have long been kept in a state of disenfranchisement, oppression and racially motivated structural violence. 

There are many layered factors at play on both macro and micro levels that may be able to explain the disease burdens of Louisiana. I hope by now I have presented some key themes that will act as a foundation for my discussions in the next chapters.