Twenty years after New Orleans area hospitals faced fatal infrastructure failures in the aftermath of Hurricane Katrina, Louisiana’s health care facilities are still extremely vulnerable to flood risks and other natural hazards, according to a new nationwide study.

Louisiana came out 49th overall on a range of health and environmental metrics, which means that the state faces intense and frequent hazards, while lacking comprehensive energy and environmental policies, researchers at Northeastern and Yale Universities found.

The District of Columbia was included alongside the 50 states, making Louisiana third-to-last across the country. Kentucky and West Virginia performed worse, while Mississippi and Florida scored higher. The state ranked near the bottom on health care facility risk from floods and other natural hazards, as well as energy efficiency policy. It performed better on metrics such as average air quality. Vermont and New York ranked first and second nationwide. 

Commonwealth Fund, a healthcare philanthropy organization that funded the independent research, released the state-by-state scorecard Thursday. It is the first study comparing all states and Washington, D.C. on the environmental risks “that threaten people’s health and the health care systems that serve them,” the report says. 

“Climate change and extreme weather are really healthcare issues and they’re impacting directly people’s health, sometimes even their lives,” said Lovisa Gustaffson, vice president at Commonwealth Fund. 

The state Department of Health did not respond to a request for comment.

Flood risks, low energy efficiency

Among the eight metrics that the researchers studied, Louisiana ranked worst on its health care facility flood risk. 10.5% of inpatient facility beds are in a “high-hazard flood zone,” according to data the researchers analyzed from the Federal Emergency Management Agency. Only Florida, where 15% of the beds are at risk, exceeded Louisiana. 

The study did not provide examples of specific facilities and associated risks.

“Louisiana is more vulnerable to environmental hazards and climate risks, so it has more health care facilities in locations facing greater natural hazard risks than other states,” said Melanie Marino, a PhD candidate at Northeastern and one of the authors of the study. “While states can’t change their geography, they can make policy decisions that affect healthcare systems and public health are impacted.” 

The state also ranked near the bottom of the country — number 46 — for health care facility risk for natural hazards in general, including hurricanes and heat waves, and energy efficiency. 

Some of the state-level policy recommendations from the report include building more resilient and clean energy infrastructure and giving more funding to relief centers in high-risk areas. The researchers also noted the importance of individual structural improvements, such as raising buildings and erecting flood barriers. 

Efforts to combat some of these vulnerabilities have expanded in recent years. Together Louisiana, a statewide coalition, is trying to bring solar and battery-powered “resilience hubs” to every neighborhood in New Orleans and North Baton Rouge. Another nonprofit, the Louisiana Public Health Institute, is similarly proposing to bring the clean technology to community health centers to keep operations running before, during and after a disaster. 

Slightly better air quality 

While Louisiana and many of its neighbors in the Southeast ranked on the lower end of the study, the state performed better on its air quality ranking, coming in 9th across the nation.

On this metric, Southwestern states performed the worst. Arizona had the worst air quality in the nation followed by California based on the federal Air Quality Index, which gauges pollution levels from five chemicals regulated by the Clean Air Act. This is likely due to pollutants from wildfires among other geographic factors. 

“Even though Louisiana shows up down the list a bit, it’s certainly not at the bottom for every indicator, and as we found when we looked across the country, it’s a mixed bag for every state,” said Matthew Eckelman, a researcher on the project and professor of civil and environmental engineering at Northeastern.

Still, he noted that the air quality index isn’t focused on many of the pollutants that come out of petrochemical facilities. The state’s industrial corridor between New Orleans and Baton Rouge is dubbed ‘Cancer Alley’ by activists due to its high levels of air pollution and health risks. Those pollutants — called volatile organic compounds — are not part of the index on their own, though they affect the levels of ground-level ozone, which is one part of the index. 

On other metrics incorporated into the study, Louisiana ranked slightly worse than average. This includes health risks from extreme heat, health impacts from electricity emissions, health care sector greenhouse gas emissions and emissions from health care worker commutes.