Hurricane Katrina hit southeast Louisiana in late August 2005.1 The storm made its first landfall in Florida on Thursday, August 25, and weakened briefly as it passed overland before it reached the Gulf of Mexico on Friday, August 26, where it quickly strengthened over the warm water. The storm’s second landfall came early in the morning on Monday, August 29, near the Louisiana–Mississippi border. That day and the next, the levees that protected New Orleans failed, and 80 percent of the city was flooded—mostly residential areas. The mortality count is still contested, but more than seventeen hundred people were killed, and hundreds of thousands were displaced.2
The fact that a hurricane is a natural disaster might create an intuitive sense that its harms might be random, but that is far from the case. Hurricane Katrina’s impacts were unnaturally distributed, exacerbating preexisting inequalities.3 In 2005, New Orleans was a socially and culturally vibrant but profoundly unequal city, in which the legacies of centuries of slavery and legally enforced segregation were palpable. The impacts of the storm were most heavily borne by New Orleans residents who were Black and poor.
In the initial days after the storm, as mass media was captivated by wildly overblown and unfounded notions that survivors faced extreme danger of violence from other survivors, there was a great deal of worry among public health experts about the spread of infectious disease. For public health authorities, the concerns were about wound infections and waterborne gastrointestinal diseases such as cholera as sanitation infrastructures were flooded, as well as mosquito-borne diseases.4 For lay publics, the presence of dead bodies in the water seemed manifestly dangerous to survivors’ health.5 The squalid conditions in the temporary shelters of the Superdome and the Convention Center, which quickly lost plumbing and air conditioning and so were rife with putrefying human waste, seemed like obvious circumstances for an infectious disease outbreak. And yet it became clear even during the initial emergency, and certainly within weeks of the storm, that for those who survived the flooding itself, it was chronic disease—especially cardiovascular disease—that emerged as a far greater contributor to excess morbidity and mortality.6 This health impact is far less obvious: how can a flood cause chronic disease?
A crisis on the scale of Hurricane Katrina might contribute to chronic disease in many ways, including through stress.7 Especially in the days and weeks after the storm’s landfall, psychosocial stress was a key contributor to a spike in cardiovascular events and cardiovascular disease hospitalizations—a phenomenon that was particularly pronounced among African Americans, as long-standing cardiovascular disease disparities were exacerbated.8 In the first six months after the storm, the significant increase in the mortality rate has been attributed to the compromised public health infrastructure that was not able to identify and address the population’s health problems.9 Yet the increase in the incidence of such health problems as acute myocardial infarction (heart attack) continued for at least ten years after the storm and has many causes.10
In this chapter, I attend to ways in which the unnatural disaster of this storm played a role in increased chronic disease. I focus especially on how the multifaceted structural exclusion of Katrina victims from full membership in the U.S. body politic intersected with one particular, tangible element of lack of access to health care: pharmaceuticals. Focusing on pharmaceuticals is analytically helpful because, as anthropologists of pharmaceuticals have pointed out, drugs help to make dis-ease concrete.11 That is, pharmaceuticals can help to make tangible the distress in the body and in the society that might otherwise be hard to pin down.
I track the travels of pharmaceuticals in the aftermath of Hurricane Katrina to explore three key ways in which the response to the emergency exacerbated the preexisting vulnerability of the population, especially with regard to health: at emergency shelters, in drug donation programs, and in ongoing care. Each of these disrupted pharmaceutical flows provides an opportunity to see ways that those most acutely impacted by Hurricane Katrina were framed as outside of the “mainstream American public,” in intertwining ways: as criminals, as refugees, and as marginalized. Disrupted pharmaceutical flows at emergency shelters exemplify ways in which Katrina victims were impacted by discourses and practices associated with criminality; disrupted pharmaceutical flows in drug donation programs do the same with regard to global health complexes; and disrupted pharmaceutical flows in ongoing care illuminate their marginalization. Being outside ordinary pharmaceutical flows and being outside the “American public” occur through mutually reinforcing processes. These processes illustrate pathways by which racial inequality becomes materially embodied.
I conclude with discussion of how this case illustrates racialized biopolitics, with reference to philosopher Michel Foucault’s influential introduction of the idea of biopolitics in his “Society Must Be Defended.”12 In a Foucauldian biopolitics in which power fosters (some) life and lets (other) life die, being ideologically defined as outside of society is intertwined with being materially left for dead.
The most acute disruption of the flow of pharmaceuticals happened in the immediate aftermath of the storm, when the city was still largely underwater. One poignant story that I heard about events at the Superdome, where twenty thousand or more people who were trapped in New Orleans found squalid shelter from the flood,13 provides an analytical entry point. There were and are many rumors and conflicting accounts about what happened at the Superdome, and it is difficult to be definitive, and yet one physician’s account that I heard at a conference provides an evocative frame.
The context was the American College of Cardiology (ACC) meeting in New Orleans in 2007, which drew thousands of cardiologists and other health care providers to the city. The meeting had been scheduled long before Katrina and would be the first large conference held in New Orleans after the storm.14 These kinds of meetings usually feel rather placeless, a series of science-driven panels in interchangeable conference rooms with perhaps one or two panels of “local relevance.” But that entire ACC meeting felt inescapably aware of the deeply damaged city outside. The Association of Black Cardiologists sponsored a panel about Hurricane Katrina within the larger conference, and the experience of attending this “local relevance” panel has stayed with me.
At the panel, one of the local doctors who had gone to the Superdome to help serve his displaced patients gave a harrowing account. He said that the National Guard troops stationed at the Superdome had been instructed not to allow people seeking shelter there to bring in drugs—including pharmaceuticals outside of their original packaging. Some unknown amount of prescription drugs was confiscated and discarded. By the time the physician arrived on the scene, he had to try to reconstruct complex prescription regimens of elderly, distressed patients, from their memories.
I have not been able to track down much documentation for this story, and I do not know how widely followed this National Guard practice was. That said, it is a scandal at whatever scope. The National Guard practice that this physician described was clearly a policy informed by the War on Drugs, and it prioritized restricting access to illicit drugs at the expense of access to licit ones. In this practice at the Superdome, enforcing drug policies framed the racialized population of Katrina’s survivors not as members of the community in need of care but as potential criminals in need of control.15
Selective control of drugs and social control of Black people have long had intertwined histories in the United States.16 The War on Drugs is itself a central mechanism of ongoing racial inequality. As legal scholar Michelle Alexander has influentially argued, the War on Drugs is central to a contemporary system of racial control, even as it formally adheres to “color-blindness.”17 Since those with criminal convictions can be treated as less than full citizens, and since such convictions track not illicit drug use (which occurs at similar rates in all racial groups) but rather exposure to the criminal justice system, drug laws can become a way of disenfranchising whole communities—especially those that are predominantly Black and poor. In this physician’s account of what happened at the Superdome, those seeking refuge were treated as presumptive enemies in the drug war.
This particular element of the disruption of pharmaceutical flows at the Superdome was consistent with the broader ways in which criminal tropes were invoked to describe Katrina’s displaced people in the immediate aftermath of the storm.18 Within two days of the storm, when many people were still awaiting rescue, the multiple levels of government (city, state, federal) were already explicitly shifting priorities from saving lives to imposing order. As political scientist Melissa Harris-Perry has argued, “for black Americans the disastrous consequences of wind and water were deepened by the initially slow and then surprisingly militaristic response to black suffering.”19 In the progressive magazine the Nation, journalist Rebecca Solnit quoted a news report from the Associated Press on September 1, in which the mayor ordered fifteen hundred police officers “to leave their search-and-rescue mission Wednesday night and return to the streets of the beleaguered city to stop looting that has turned increasingly hostile.”20 She elaborated, “Only two days after the catastrophe struck, while thousands were still stuck on roofs, in attics, on overpasses, on second and third stories and in isolated buildings on high ground in flooded neighborhoods, the mayor chose protecting property over human life.”21
The restoration of social order was explicitly not defined as restoration of services and infrastructure but as the restoration of punishment for property crime.22 There were explicit articulations from authorities that “law and order” would have to be established before relief agencies such as the Red Cross could do their work. This resonates with the account of the actions of the National Guard at the Superdome, putting drug control ahead of public health.
The mass media intensified the articulation of those impacted by the hurricane as criminals. From the start, survivors were described as “marauding” and, most widely, “looting.” Whereas searching for food amid the debris of abandoned supermarkets might be understood to be a perfectly logical thing for a storm victim to do, the poor and Black people left behind in New Orleans were routinely described as “looting.” As Kathleen Tierney and colleagues observe in their analysis of media coverage of disasters, “in Katrina’s aftermath, among the most widely circulated media images was a set of photographs in which African Americans were consistently described as ‘looting’ goods, while whites engaging in exactly the same behaviors were labeled as ‘finding’ supplies.”23 This is of a piece with the broader and profoundly racialized characterization of Katrina victims as engaging in behavior typical of riots, rather than natural disasters.24 In riots, looting is indeed common and complexly socially condoned, though we should also question the media obsession with looting during rebellions against racial injustice.25 But the assumption that this particular community could only be antisocial in the context of crisis rendered invisible the broadly prosocial behavior that people displaced by the storm undertook—helping each other.26 The dominant framing of Katrina victims was as subhuman, lacking basic human decency, rather than as community members, much less citizens.
In response to the threat of property crimes, Louisiana governor Kathleen Blanco gave chilling shoot-to-kill orders, which were widely reported: “These troops are fresh back from Iraq, well trained, experienced, battle tested and under my orders to restore order in the streets. They have M-16s and they are locked and loaded. These troops know how to shoot and kill and they are more than willing to do so if necessary and I expect they will.”27 Even within the military response, there was dissent to this approach, as Lieutenant General Russel Honoré, Joint Task Force commander who was also a Louisiana native, attempted to set a different tone, pleading with troops: “Imagine being rescued and having a fellow American point a gun at you. These are Americans. This is not Iraq.”28 Yet even this protestation reinforces the sense that this space was understood within the frame of a war zone, not the United States.
Conventionally, there is a jurisdictional gap in domain between police forces, who are meant to protect citizens, and military forces, who are meant to enforce sovereign territorial power, but this contrast doesn’t fully hold. And during Katrina, we see the involvement of military enforcement side by side with police enforcement to protect property rather than people. This is a theme that will be relevant in later chapters as well, especially on the Flint water crisis: when it comes to people whose claim to citizenship is tenuous, property can easily outrank them in the priorities of the state.
At emergency shelters like the Superdome, as throughout the city, the survivors left behind were not afforded a presumption of innocence, as citizens to protect rather than criminals to control. The ideological criminalization—the criminal-infested city prone to urban riot—framed those affected by the storm as “un-American.” The enrollment of military personnel pointed toward an additional frame, which was the “war zone.” This, in turn, connects both to the profound othering of the victims that the criminalization rhetorics provided and to the chapter’s next theme: “refugees.”
The flows of pharmaceuticals in the subsequent days and weeks were also revealing. The governmental emergency stockpiles of pharmaceuticals did not match Katrina victims’ needs, and programs put in place to donate drugs didn’t either. Whether the overwhelmingly Black and poor communities impacted were truly part of the American public was again at stake. Whereas those seeking provisions in the flooded city and shelter at the Superdome were framed as outside the mainstream American public through rhetorics of criminalization, those in need of care in the days and weeks that followed were framed as outside of the mainstream public through rhetorics of “refugees.”
As with the othering language of “looters,” the othering language of “refugees” is also worth paying attention to. The term refugee was widely used during the peak of the crisis, even as it was pointedly contested by survivors who objected that they were not refugees but “American citizens with rights.”29 We might problematize the stigmatization of refugees on which this demand to be excepted from the category implies, but it does important work. As Tulane University anthropologist Adeline Masquelier observes, reflecting on her own journey as well as those of her fellow New Orleans residents, “the word ‘refugee,’ as this war on words suggests, carries a heavy semantic load.”30
The refugee is a more sympathetic figure than the criminal—and the figuration of refugees as sympathetic was far stronger in 2005 than it would become later in the fifteen years between Hurricane Katrina and this writing—but the refugee is still not part of the public.31 Help for the refugee is at the whim of the secure occupant. The ways that pharmaceuticals flowed show that Katrina refugees were positioned in ways analogous to the Global South citizens who are the targets of the Global Health Complex—a philanthropically driven system in which efforts to address the needs of the world’s poor operate in the service of heterogeneous private interests.32 Indeed, international nongovernmental organizations that typically provide services in the Global South became part of the chaotic network of those involved in Katrina relief. For example, the international humanitarian organization Oxfam, which focuses on alleviating poverty—its name derives from the Oxford Committee for Famine Relief, though its scope is now more broad—rarely addresses humanitarian crises on U.S. soil but made an exception for Hurricane Katrina.33
Medicines for chronic disease are not typically thought of as part of emergency provisions, at the household level or the system level. At hospitals and clinics serving Katrina evacuees, these drugs were not to hand. Fred Cerise, secretary of the Louisiana Department of Health and Hospitals, would testify in federal Senate hearings about the impact of Katrina:
Another area that we were challenged in, again having to do with people with chronic disease, was access to pharmaceuticals. Again, traditionally in public health disasters we think about things like having access to biologicals and things, antidotes for biological weapons, and that sort of medicine stockpile that is available. The stockpile we needed was the stockpile of medicines for blood pressure and diabetes and heart disease and things like that.34
Treatment for chronic conditions was a major driver of those seeking care from emergency medical treatment sites in the weeks after the storm.35 Yet these gaps in the institutional stockpiles meant that even those storm survivors who managed to carry individual backup supplies quickly ran out, and this had a serious impact on those fleeing Hurricane Katrina, especially those who were old and frail.36
Donations were coming into shelters and community health centers from heterogeneous sources and were chaotically uncoordinated. A physician reporting about preparations at the Superdome in the lead-up to the storm wrote:
At that time, the [National] Guard had trucks moving supplies of weapons (for security), bottled water and MREs (meals ready to eat) into the same loading dock, which we had full of patients. Supplies came in by the thousands—four 18-wheel truckloads of bottled water and two loads of MREs. But no one brought in standard medical supplies, such as medications for hypertension, diabetes, asthma or other chronic diseases.37
One ad hoc pharmacy opened by Public Health Service staff in a federal medical station received a limited number of drugs from the Strategic National Stockpile, but that supply was determined by particular expectations of disaster and included, for example, little insulin and no tetanus vaccines.38 This pharmaceutical portfolio problem has been recognized in global health research as well, as researchers have advocated inclusion of pharmaceuticals for noncommunicable diseases in the standard emergency health kit.39 And yet the global health paradigm’s focus on infectious disease is pervasive, and this mind-set combined with resource constraints means that it is hard to effect change.
Donation programs are a common way of dealing with crises and are inadequate. Like similar programs in the realm of global health, drug donation programs provided some essential relief during Katrina, but they were inefficient, and their provisions were often inappropriate. There was a mismatch between the medication provisions that the disaster medical teams stocked for treatment of the storm’s victims and their medication needs, such that many evacuees had to rely on retail pharmacies for their chronic disease treatments.40 The mismatch is a way in which the experience of Katrina mirrors problems in global health: pharmaceutical companies love to tout their generosity in their public relations campaigns, but drug donation programs do not necessarily serve the needs of patients.41
Community health providers serving Katrina survivors observed:
Although providers received helpful donations of medications, many—often cut off from communication channels—reported receiving large quantities of unrequested, inappropriate, and expired medications from unidentified sources. Classifying medications and disposing of unusable items was a burden on providers already struggling to dispose of disaster-related debris. In some instances, providers were forced to let surpluses become ruined in inclement weather due to lack of storage space.42
In their reliance on inadequate pharmaceutical donation programs, we can see that Katrina’s survivors were situated more similarly to those in poor countries than those in the United States. In the social science literature critical of “pharmaceuticalization,” there has been a widespread bifurcation between analysts of the Global North, who focus on “disease mongering” and overprescribing, and analysts of the Global South, who focus on access programs and the inadequacy of framing access to pharmaceuticals (iconically antiretrovirals) as access to health.43
Yet with regard to coronary artery disease therapeutics in the United States, analytical focus on excessive treatment driven by pharmaceutical industry interests has obscured attention to deep stratification: overtreatment in some populations and undertreatment in others, along economic and racialized lines.44 This extends beyond prescription rates to the physical possession of pharmaceuticals—with Black people less likely than white people to live in a household in which all members requiring medication have a three-day supply to hand in case of an emergency.45 Pharmaceuticals to avert the risk of cardiovascular disease are famously pervasive in the United States46—and yet the citizens most impacted by Katrina were left out.
Writing several months after Katrina, a group of authors from the Centers for Disease Control and Prevention urged collection of baseline chronic disease data in populations to help disaster preparedness, and yet observed:
Little has been published about treating chronically ill people during disasters. Perhaps this is because many of the disasters have occurred in poor countries where chronic disease has been historically less of a health priority. Or perhaps in wealthier countries, catastrophic damage to the medical infrastructure is uncommon, so patients with chronic diseases continue to receive care.47
In this sense, there is a profound connection between un-American-ness and being figured as a recipient of classic emergency response, and Katrina victims found themselves on the wrong side of that insider–outsider divide.
Anxieties about infectious disease might be fundamental enough to emergency management that we might not see that focus as racialized. However, the association between Blackness and those most vulnerable to emergency is also meaningful. Blackness itself has long been associated with infectious disease rather than chronic disease, and that association has a very long history in the United States. Chronic diseases—especially cancer and heart disease—are seen as “diseases of modernity,” and states of emergency and Blackness both put modernity into question.48 There has long been a tension between the idea that “germs know no color line” and the idea that there is an association between Blackness and infectiousness.49 The “imagined communities” of belonging carry with them “imagined immunities,” such that only those outside “normal conditions” of “the mainstream public” are figured as vulnerable to premodern infectious diseases.50
There are international laws regarding the treatment and rights of refugees, but these are widely violated. Refugees have more modest entitlements than full citizens, and being subject to the whims of those who tolerate them, and what they are willing to provide to them, is part of the constitution of their vulnerability. Even though it is the case that access to needed pharmaceuticals would not by itself resolve the marginalization of those impacted by Katrina,51 their exclusion from access still flags exclusion from the body politic. That Katrina victims found themselves in this structural and semantic position outside the “American public” exemplifies their unjustly incomplete citizenship.
There is a third set of disruptions of pharmaceutical flows to attend to: the disruption of already tenuous continuity of care left many patients without knowledge of, much less access to, their prior pharmaceutical treatment regimens. It is very easy for barely managed diabetes to become unmanaged diabetes, for barely managed heart failure to become unmanaged heart failure. In chronic disease, as in life more generally, those who are close to the edge are made still more vulnerable in a crisis.
Six months after the storm, the medical providers working in the diminished number of hospitals still operational in New Orleans were confronted with serious complications of unmet chronic health care needs. The chief medical officer of West Jefferson Medical Center noted, “These people come in with extremely severe problems. Diabetics have been off their insulin for six months. They come to us in diabetic ketoacidosis.”52 Since Hurricane Katrina, there has been increasing recognition of the role of chronic disease in disaster’s impacts. However, this too often leads to individual-level recommendations—for example, “a focus on personal preparedness for people with NCDs [noncommunicable diseases].”53 That is, the responsibility falls on the chronically ill individual to prepare, rather than on the state to construct resilient systems.
Before the storm, the vulnerable populations of New Orleans had largely relied on the city’s public hospital system, rather than on personal physicians. A bit of context can help to understand how this matters. In the United States, the public hospital system has never been “public” in the same sense as, for example, the National Health Service in the United Kingdom, which serves everyone. Instead, it was set up specifically for the indigent. New Orleans’s Charity Hospital was founded in the eighteenth century primarily to serve white immigrants and would later serve all New Orleanians on a segregated basis in the era of Jim Crow.54 Although the civil rights movement would end official de jure segregation at the hospital, like many such integrated institutions, it became de facto segregated as it was largely abandoned by white patients. The hospital struggled to meet its mission of serving all those in need of care, which includes those without health insurance.
Charity Hospital was the central node of the safety network on which New Orleans residents relied, and it weathered the storm poorly. It was permanently closed a month after the storm, to the alarm of human rights advocates concerned that those who had relied on it had nowhere else to turn in the private and piecemeal terrain of care that replaced the landmark hospital.55 As analysts who interviewed Katrina survivors who had relocated to Houston observed, “with Charity hospital destroyed, so were the medical records and any hope of continuity of health care for these individuals. In contrast, individuals who have health insurance coverage at the time of a crisis can access care more easily in another setting or location.”56 When the hospital system was decimated, so was these Katrina survivors’ access to care.
Because the care provided by underfunded hospitals like Charity was not necessarily up to par with care elsewhere, some might imagine that the private system that has replaced it would be less racist and provide higher-quality outcomes—but the abandonment of marginalized communities has only intensified in the new system.57 Those who have public health insurance can in principle use those resources to access the private system. That includes the state-based system of Medicaid, for the poor and disabled, and the national system of Medicare, for those age sixty-five and older. But like the New Orleans public school system that has been replaced with a publicly funded private charter system, the liberal model of education and health care for all that had been falling short for many was replaced with an education and health care system reconstructed along neoliberal models that intensified exclusions.58 Whereas the public institutions of liberal democracy have long failed to fully serve citizens who are Black and poor, market-driven neoliberal replacements for state services are not the escape that they pretend to be.
For people living in precarity, long-term risk-reducing drugs might be less pressing than other concerns, and this is even more true in the context of emergency and major life disruption. Even when patients had prescriptions, they didn’t necessarily have the means to fill them in the places in which they found refuge. And whether they remained in New Orleans or joined the far-flung diaspora, many had no clear place to turn for help. In one telephone survey of a geographically representative sample of Katrina survivors, investigators found that 73.9 percent of respondents reported having one or more chronic conditions in the year before the hurricane and that one-fifth (20.6 percent) had had their treatment disrupted.59 Of course, as the authors acknowledge, phone surveys likely undercount the sickest and most unstable of the total target population, and yet the results are still informative. Common reasons for disruption included lack of health insurance and residential instability. Those too young to qualify for Medicare, which as a national program is portable across the United States, were more likely to stop treatment.60 This disruption to the care of the relatively young points to the potential for very long-standing impacts of the disruptions of the storm, as those who forgo risk-reducing pharmaceuticals at that age come to experience increased morbidity and mortality impacts later on.
It is difficult to make comprehensive claims about the precise statistics of long-term cardiovascular and other chronic disease impacts on Katrina victims because of the dispersion of that population. But studies at particular sites are stark. For example, at Tulane University Health Sciences Center in downtown New Orleans, there was a threefold increase in admissions for acute myocardial infarction (heart attack) documented two years poststorm61 and again six years after the storm.62 Even ten years after the storm, there were no signs of heart attack rates returning to prestorm levels.63
The more chronic elements of this lack of treatment for chronic disease illustrate something fundamental about the ways that emergencies exacerbate existing inequalities. There is a resonance here with rhetorics of terrorism after September 11 discussed in the previous chapter, which misleadingly framed Americans as newly vulnerable. As geographer Susan Cutter observes, “the revelations of inadequate response to the hurricane’s aftermath are not just about failures in emergency response at the local, state, and federal levels or failures in the overall emergency management system. They are also about failures of the social support systems for America’s impoverished—the largely invisible inner city poor.”64
If many Americans could treat the devastation in New Orleans as intruding on nostalgia for a beautiful historical city and raucous “party town,” for the disproportionately Black and poor communities who had lived there, Hurricane Katrina marked an intensification of already existing exclusions and vulnerability.65 The impact of this marginalization has been borne in their hearts, not just in a metaphorical sense, but literally, as even more than a decade later, they continue to suffer greater burdens of heart disease. The etiology of this heart disease, as of chronic disease more broadly, importantly includes, even as it exceeds, the impact of insufficient access to pharmaceuticals.
An editorial published a month after the storm in the British Medical Journal by authors from a U.S. governmental research center on health disparities describes the shock of media images of Hurricane Katrina’s immediate aftermath: “Live images of uncollected corpses and families clinging to rooftops made vivid what decades of statistics could not: that being poor in America, and especially being poor and black in a poor southern state, is still hazardous to your health.”66 Yet they overstate the contrast between this event and the routine when they write:
This may truly be a “teachable moment” about the impact of poverty and race on health. The gap in health between white and black Americans has been estimated to cause 84,000 excess deaths a year in the United States, a virtual Katrina every week. Because the victims gradually succumb to various diseases such as diabetes, cardiovascular disease, alcohol and drug abuse, cancer, and HIV infection, they rarely capture the public’s attention in the way the victims of Katrina have. As a result, health inequality has persisted despite decades of important health gains, economic growth, and progress on racial issues in the United States.67
But as we have seen in this chapter, the impact of Katrina extends beyond the acute moments of being stranded on rooftops. The storm’s aftermath includes and intensifies all of these mechanisms of ordinary health disparities.
In the wake of Katrina, we see a stark instantiation of biopolitics in Michel Foucault’s sense. The name given to the set of lectures in which he introduced the concept is itself evocative: “Society Must Be Defended.”68 If society must be defended, who is in, and who is out?
The building and maintenance of the infrastructure of cities is a fundamental aspect of biopolitics, and the failure of infrastructure after Katrina illuminates its operation. Consider the meaning of biopower: Foucault argues that if, in premodern times, sovereignty was exercised by taking people’s lives or letting them live, modern power would now also operate by making people live and letting them die.69 This happens not just at the level of individuals but also in aggregates, including with regard to the engineering of environments. Foucault notes that “this includes the direct effects of the geographical, climatic, or hydrographic environment: the problem, for instance, of swamps”70—so important in shaping New Orleans. “And also the problem of the environment to the extent that it is not a natural environment, that it has been created by the population and therefore has effects on that population. This is, essentially, the urban problem.”71 The infrastructure of New Orleans was meant to foster life in the city—but for some more than others.
If the infrastructure was built to differentially foster life, in the aftermath of its failure, the inaction in the face of need intensified inequities in ways that are also revealing. The operation of racism is at stake. In his lecture, Foucault is interested in the connection between biopolitics and racism in a different sense, of eugenics, of “purifying the race”—as exemplified most starkly in Nazi Germany’s extermination of those groups of people who were considered to be biologically inferior.72 Foucault points out that the biopolitics of fostering the life of those who are legitimately part of the society can be a justification for killing those who are not. But even when racism is warlike, as when enforced by the National Guard, it is not necessarily eugenic. A racist biopolitics need not be eugenic to have racially disparate deadly impacts. Hurricane Katrina and its aftermath are emblematic of a biopolitics of racism that operates by defining who is and is not part of the society that must be defended. The most pervasive element of the racialized control of life and death is enacted, not by killing those considered to be outside of and a threat to society, but by neglecting to foster the lives of those considered to be less than full members of society.73
This chapter builds on the previous one not just chronologically but analytically as well. Some analysts have put the suffering of Katrina explicitly into the context of post-9/11 America, in which political goals took precedence over authentic disaster preparedness.74 In neither case did crisis spur investment in or engagement with addressing chronic health inequalities. As political scientist Melissa Harris-Perry has argued, “the entire nation grieved over the losses in New Orleans, but for black America, the aftermath of Hurricane Katrina forced the question of whether black people were truly American citizens worthy of fair treatment, swift response, and unchallenged rescue.”75
In the days, weeks, and years that have followed, tracking pharmaceutical travels reveals how (lack of) access to medicines reflected (lack of) access to citizenship and health for the racialized population impacted by Hurricane Katrina and its aftermath. As the next chapter turns to more explicitly biopolitical questions of “biological citizenship” that come to the fore in the structure of mass incarceration, this fundamental question of the racialization of American citizenship in its broadest senses remains inescapable.