Introduction

INTRODUCTION 

New Orleans and Southern Louisiana, known widely for its rich and complex cultural history, unique geographical character and fortified creative identity. Alongside this flows a multi-layered traumatic history that has both created and destroyed the area, and I am interested to look at how this has shaped the medical landscape of Greater New Orleans, and the relationship between the presence of trauma in non-communicable diseases (NCDs) and syndemic illness. The region has a very uniquely violent historical narrative of displacement and abandonment; notably the slavery and plantation legacy as well as the forced displacement of indigenous communities. More recently the devastation of the floodings after the 2005 Hurricane Katrina and the ongoing environmental burdens of severely contaminated water supplies. There hitherto remains some aspects of governance that are driven by wildly questionable political and social forces that send ripples through foggy societal, political, historical, economic, environmental, infrastructural, medical and chemical mires. Using water as a lens, I will present how cases of environmental toxicity and inadequate infrastructure intersect with medical and historical geographies, subsequently creating severe health disparities. 

Diseases like cancer, diabetes, cardiovascular and lung diseases all fall under the umbrella term of chronic health conditions or NCDs. The United States and particularly the states of Louisiana, West Virginia, Mississippi & Alabama, are recorded to have seen an unprecedented increase of NCD’s since 2012 (CDC, 2022a). Louisiana ranks consistently in the bottom five worst states for health in the country with heart disease, cancer and now Covid-19 being the top three causes of death (CDC, 2022b). NCDs are often and commonly viewed as indicators of an individual’s poor lifestyle choices or quality of life, yet I hope to elucidate the biosccial aspects of these diseases and look at their causes as being manufactured by human interventions.  

Through Merrill Singer’s writings on syndemic illness, we may acknowledge a biosocial conception of health, that focusses on “interacting, co-present, or sequential diseases and the social and environmental factors that promote and enhance the negative effects of disease interaction” (Singer et al., 2017). This marks a shift away from previously dominating and widely outdated conceptions or emphasis in health or death discourse often citing notions of ‘natural’ causes, or even the Darwinian evolutionary conception of ‘natural’ selection. How natural is a death when there are clear trajectories of neglect that have caused it? Similarly, I will examine the term ‘natural disaster’ with a critical lens, pulling focus on the political decision making that exacerbated the destruction of the city in the aftermath of Hurricane Katrina, why this happened, and how, the events should be considered a series of stark infrastructural failings rather than a natural disaster.  

The USA has held the prime position for the world’s highest gross domestic product (GDP) and (Worldometers, 2017) and has ranked world’s wealthiest country for well over a century, surpassed only in 2020 per capita rankings by China with countries like Luxembourg, Switzerland and Monaco following close behind (World Population Review, 2022). Holding this in mind I ask; How are we seeing ongoing barriers to maintaining necessary robust, basic city infrastructures in a country as affluent as America?  

I will explore the practice of biolegitimacy and neoliberal governance theories of biopower that propagate a hierarchy of access to health, something that intersects with marginalisation in other areas of political life, including the workplace, education system, living locality, food and diet, socioeconomic and racial. The people affected by poor health are most often the ones who face most barriers to accessing or affording healthcare. To understand that health burdens can be in-fact largely due to one’s environment, the goalposts we have historically been using to understand effective approaches to health governance must be moved.   

I hope to acknowledge how deeply set trauma responses to distressing events can develop if there are inadequate infrastructures to support people and communities in regaining feelings of safety following a traumatic event. In the absence of safety, traumatic memory remains in the present state as the amygdala is unable to process this as a memory, thereby restoring the body to homeostasis. The body can persist, trapped in a state of fight, flight or freeze, and this state can be further aggravated, or ‘triggered’ by additional instabilities or traumatic events. This state of trauma has perhaps somewhat undefinable consequences and it can affect a person’s ability to engage or contribute to a world that one no longer recognises, or feels threatened by. As Bessel A. van der Kolk writes on trauma it “is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present.” (Van der Kolk, 2015). He contends that what is needed to support trauma recovery, healing and growth of our physiology and social relatedness is a “visceral feeling of safety” (Van der Kolk, 2015). For the residents of Louisiana who have been impacted by displacement, dispossession and for many, sickness and the death of loved ones, a shroud of safety may not appear to be available, which I argue can lead to deeper set emotional pain, traumatic temporalities and increased potential for chronic sickness.  

This dissertation will examine the array of forces so far mentioned which impels a society that, as Roberto Barrios contends “is forever in the process of becoming” (Barrios, 2017: 7).  I hope to acknowledge the complex tapestry of language, culture and traumatic history alongside macro colonial narratives embedded in the political fray. When addressing potentially atomised issues, finding a unifying theme as an access point felt crucial to the methodology. Water provided a much-needed anchor point and while, it too remains saturated by these intersecting and changeable narratives, it has been a constant throughout the history of social evolution; it is something we all have an essential relationship with and considered to be a basic human need.  

Water and Infrastructure 

Louisiana clearly has a very special, specific relationship with water. The state is built around the Mississippi river, known as the ‘red river’ due to the sedimentary collections, and flows from Minnesota in North United States, all the way to the Mississippi-Missouri river valley of New Orleans into the Gulf of Mexico, meeting the sea in the bracken swamplands and bayous. The bayous and rivers historically provided sacred sites for indigenous communities, trade routes during industrialisation, water highways, fishing channels, hideaways for criminals, runaway slaves and those seeking safety during the civil war, and it has been termed “the soul of the state” (National Geographic, 2021). Due to its proximity on the Gulf is has a subtropical climate, with hot humid summers that temper a storm and hurricane season over six months, alternating with mild winter months.  The city land sits 6ft below sea level on swampland, and with rising sea levels this means the area is quite literally drowning. Teamed up with the threat of severe flooding through a large storm or a hurricane event, and there becomes a real precarity in the area’s geography.  

Living near such a bounteous water supply has served many cities very well in terms of agriculture, sanitation, and the transportation of goods and people. However, in Louisiana there is a sedimentary sense of epistemic murk that lingers in these natural waters and along the trade routes, perhaps largely related to its blemished past. Marya and Patel see trade routes as “colonialism’s arteries, moving people, capital, goods, and diseases around the world system, and connecting bodies, societies, geographies, and ecologies.” (Marya and Patel, 2021: 5). This metaphor helps to show how water has become both a symbolic and subsistent stream that humans have incorporated into their systems of value and like water, if left unchannelled, holds the potential for being both highly useful but also incredibly damaging.   

In public health, water can be traced back to sanitation and related to the spread of deadly diseases like cholera as well as vector borne diseases which constitute some of the big killers of the last 100 years including yellow fever, malaria and dengue fever. Yellow fever and cholera long plagued Louisiana in the late 19th century and anticipated the need for a more robust water and sewerage system in the city. The one that was bult in 1907, was of a cutting-edge design at the time, but has yet to receive significant maintenance work since construction (Manto, 2000). 

Water and sewerage infrastructures are not something necessarily obvious when looking at a city and most modern city planning largely uses structures that sit below ground or are discreet, so often invisible unless a problem becomes apparent. The water and sewerage infrastructure in New Orleans can be seen everywhere and the presence of water persists ubiquitously. Whether it was the inescapable humidity in the air, the sound of dripping air conditioning units and the puddles beneath them, water hydrants regularly burst in the streets causing road flooding disruptions and the odorous stench of the sewers across the city. There are frequent (circa weekly) ‘boil water advisories’ issued by the Sewerage and Water Board of New Orleans who, as I was informed about on several occasions by local residents, would increase water rates or completely cut off mains water supply to residential properties without warning or reason leaving thousands of people without access to water.  These infrastructural shortcomings were surprising to see in such severity throughout my fieldwork and as I seek to show, health inequities can be compounded by lack of adequate infrastructure. Given the pervasive presence of water in the area, and despite its potential for being life-giving, there is a lack of robust integrative structures in place that enable the substance to be managed or harnessed for local benefit, of which there is a lot of potential for.