Communities in southwestern Haiti were devastated when Hurricane Matthew struck the Tiburon Peninsula on October 4, 2016. Accompanied by rapid winds, heavy rainfall, and subsequent flooding, the Category 4 storm on the Saffir-Simpson scale killed at least 1,000 people, destroyed countless homes, and displaced thousands. Approximately 2.1 million people have been affected, 1.4 million need humanitarian aid, 750,000 need urgent help, and 806,000 are at an extreme level of food insecurity. Haiti, which is roughly the size of South Carolina, was ill-equipped to withstand another natural disaster. For the past six years this Caribbean country has been trying to recuperate from the 2010 earthquake that left more than 200,000 dead (according to Haitian government figures) and wreacked havoc upon a preexisting weak infrastructure. Now history seems to be repeating itself.

Communication networks are down, crops were destroyed, and roads have been blockaded by debris–making it all the more strenuous for citizens to receive the assistance they desperately need. Simultaneously burdened by two catastrophes, once again Haitians are bracing themselves for another cholera outbreak. Yet with limited financial resources and crumbling medical facilities, some hospitals don’t even have enough gasoline to put into ambulances or any antibiotics left to ward off the waterborne disease.

“Needs are growing as more affected areas are reached,” said UN Secretary General Ban Ki-moon, whose organization recently pledged $120 million for humanitarian aid in Haiti. “Tensions are already mounting as people await help. A massive response is required.”

Oftentimes referred to as the “republic of NGOs” (non-governmental organizations), Haiti rarely receives the aid it is promised. Although some would consider the poorest country in the Western Hemisphere to be susceptible to certain ailments (like inclement weather and bad governance), the reality of the situation is that Haitians haven’t gotten the necessary support to thrive as a sovereign nation after decades of economic exploitation, American military intervention, and poorly implemented aid projects.

Colonial History

Much of Haiti’s tumultuous past stems from its colonial predecessors: Spain and France. From 1492 to 1625, the island of Hispaniola (present-day Haiti and the Dominican Republic) was administered by Spain. Originally the native Taíno inhabited the island, but the Arawak group was essentially wiped out after Christopher Columbus and his fellow voyagers brought infectious diseases. During this era, however, a variety of European powers were competing for geopolitical power and resources in the Caribbean. The 1697 Treaty of Ryswick allowed France to inherit Haiti from Spain in order to mitigate conflict between the two colonial powers. The western third of the island became “Saint-Domingue” under French rule, while Spain maintained its sphere of influence in the neighboring Dominican Republic.

Throughout the 1700s, Haiti became the wealthiest colony in the “New World”–making up more than a quarter of France’s economy in the process. During the peak of the Transatlantic Slave Trade, however, such wealth was only achieved through brutal means. Thousands of enslaved Africans were brought over to the French territory to perform backbreaking labor on Haiti’s many sugarcane plantations. This exploitation continued until 1801 when a successful slave revolt defeated the French army, making Haiti the first black republic in 1804. However, in order to achieve international recognition and persuade French warships to leave Haitian harbors, Haiti was coerced in 1825 into paying their oppressors an “independence debt” worth 150 million gold francs. Valued at approximately $21 billion by today’s standards, this large sum of money was meant to compensate French colonists for their lost profits. Although the remaining $36 million of debt was forgiven by the World Bank in 2010, some attribute this initial debt to having predisposed Haiti to immense economic shortcomings. 

The United States has also contributed to Haiti’s myriad of problems. Concerned about European rivals in 1914, former President Woodrow Wilson deployed American troops in Haiti to ensure that no other country would try to exert influence in the region. Another reason why the United States interjected was the political instability of Haiti. In fact, between 1888 and 1915 no Haitian president managed to complete their seven-year term due to numerous military coups, assassinations, and deaths of natural causes. American intervention lasted from 1914 to 1934 until President Franklin Roosevelt enacted his “Good Neighbor Policy.” Following three decades of American occupation, despotic dictatorships under François “Papa Doc” Duvalier and his son Jean-Claude “Baby Doc” Duvalier plummeted the country into further political and economic turmoil. Democracy was only temporarily restored with the appointment of President Jean-Bertrand Aristide, who was temporarily ousted in a 1991 military coup.

American Intervention & Clinton Administration Controversies

In contrast to other American politicians, Bill and Hillary Clinton have made Haiti a focal point of their foreign policy, but that focus hasn’t been without controversy. In the early 1990s Bill Clinton won the love and admiration of many Haitians after helping the democratically-elected President Aristide return to office after he was ousted in a 1991 coup. However, this was only accomplished by enforcing another U.S.-led intervention that lasted approximately two years. Ever since then, Washington has played an immense role in dictating Haitian politics and economics. While serving as Secretary of State, for example, Hillary Clinton’s administration was accused of threatening to withhold foreign aid to Haiti if the 2010 presidential elections didn’t yield the candidate Washington desired. Additionally, the highly anticipated Caracol Industrial Park–a 600-acre textile factory meant to provide much-needed jobs to Haitians–was a Clinton Foundation project. The Clinton Foundation promised it would create 60,000 jobs in five years, but the enterprise only employs approximately 5,000 laborers as of mid-2015.

Other adverse effects of American involvement can be found in Haiti’s agriculture and economy. For example, during Bill Clinton’s presidency, Haiti became more dependent on international imports. Pressured by the United States, the Haitian government was persuaded to lower tariffs on imported food (including rice) from 50 percent to about three percent–making their main export less valuable in the process. Instead of growing their own rice, Haitians started to rely more heavily on exported rice, therefore becoming less capable of feeding themselves with domestically-grown products. 

The Clintons were also accused of mishandling 14.3 billion dollars of donation money that was intended to go toward relief efforts following the 2010 earthquake. Under Ban Ki-moon’s jurisdiction, Bill Clinton became the UN envoy to Haiti tasked with spearheading relief efforts. Based on a report by neoconservative group PJ Media, though, this money allegedly went to “friends of Bill” instead.

Effectiveness of Non-Profits

Among the estimated 10,000 non-profits operating out of Haiti, perhaps the most notorious is the American Red Cross. Normally held in high regards, the humanitarian organization pledged to help Haiti rebuild itself after the fatal 2010 earthquake. The charity managed to fundraise approximately $500 million through soliciting donations. The money was supposed to fund the construction of new homes, roads, schools, etc., but after six years it appears as though the Red Cross has not fulfilled its promises. In fact, it’s unclear where all the money even went.

This past summer ProPublica and NPR conducted an extensive investigation that revealed a series of fabrications and haphazard estimations among the samaritan group. The joint effort examined an array of confidential memos and emails from administrative higher-ups that show how “the charity has broken promises, squandered donations, and made dubious claims of success.”

One of the most garish falsifications involved housing. Apparently, the Red Cross claimed to have built homes for over 130,000 people in the neighborhood of Campeche in Haiti’s capital Port-au-Prince, but in reality only six were constructed. Another controversial discovery is the amount of overhead costs that the Red Cross gives to its employees, which more often than not are non-Haitians. For example, a project manager working in Haiti receives an allowance of $140,000 meant to cover housing, food, paid trips home, four vacations a years, and relocation expenses. In contrast, a Haitian senior engineer earns $42,000 a year. Because of such disparities, Haitian non-profits are known for perpetuating inequalities among a small group of wealthy foreign elites–most of whom cannot speak Haitian-Creole, nor French.

Conclusion

Despite the UN’s current attempts to rejuvenate Haiti, even it isn’t immune to scrutiny–especially when it comes to the ongoing health crisis surrounding cholera. The fact of the matter is that Haiti was cholera-free for over a century before UN peacekeepers reintroduced the infectious disease back to the island. Cholera is a fast-spreading infectious disease known for causing severe diarrhea and dehydration. As certain reports have proven, waste generated from UN facilities crept into a river, which in the end contaminated other nearby bodies of water. Since fresh water was scarce in Haiti to begin with, now it is even more difficult to find sanitary water to drink or bathe in.

“The need for a new UN response that both controls and eliminates cholera and compensates the victims who have suffered so much is now more dire than ever,” said Beatrice Lindstrom, who serves as a human rights lawyer with the Institute for Justice and Democracy in Haiti.

Haiti will continue to be plagued with problems if the impoverished country is unable to properly recover from disease outbreaks like this, as well as devastating natural disasters. Decades of economic exploitation, flawed aide efforts, and further interference and exploitation from other countries inhibit this country’s ability to thrive as a sovereign nation.

Resources

Al Jazeera: Ban Ki-moon in Haiti Inspects Matthew’s Damage

Al Jazeera: Haiti Death Toll from Hurricane Matthew Passes 1,000

Alternet: How America and the Rest of the World Ruined Haiti

BBC: Haiti Quake Death Toll Rises to 230,000

BBC: The Long History of Troubled Ties Between Haiti and the US

TIME: The World Must Not Abandon Haiti to the Devastation Left by Hurricane Matthew 

The Daily Beast: How Hillary Helped Ruin Haiti

Foreign Policy in Focus: Are Foreign NGOs Rebuilding Haiti or Just Cashing In?

The Guardian: Hollande Promises to Pay ‘Moral Debt’ to Former Colony Haiti

Miami Herald: In Post-Hurricane Haiti, a Picture of the Human Toll Begins to Emerge

NPR: In Search of the Red Cross’ $500 Million in Haiti Relief

Newsweek: Reasons Behind Haiti’s Poverty

New York Times: Cholera Deaths in Haiti Could Far Exceed Official Count

PJ Media: Former Haitian Senate President Calls Clintons ‘Common Thieves Who Should Be in Jail’

Politico: The King and Queen of Haiti

ProPublica: How the Red Cross Raised Half a Billion Dollars for Haiti and Built Six Homes

Reuters: World Bank Cancels Remaining Haiti Debt

London Review of Books: Who Removed Aristide?: Paul Farmer Reports From Haiti

Editor’s Note: This post has been updated to correct the year in which the Treaty of Ryswick was signed. 

Jacob Atkins

Jacob Atkins is a freelance blogger and contributor for Law Street Media. After studying print journalism and international relations at American University, Jacob now resides in Madrid where he is teaching English, pursuing multimedia reporting projects and covering global news. Contact Jacob at staff@LawStreetMedia.com.

http://jacobson.pressfolios.com/

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Treating people when they’re already sick is like beating back invaders who have already breached your defenses. In either scenario, prevention through good defense saves money, time, and lives. But when it comes to boosting our nation’s wellness defenses through public health spending, America falls short.

When it comes to health, concerns abound that we’re wasting money, time, and lives by spending too much on treatment and recovery and not enough on prevention. Public health interventions like smoking cessation programs and disaster preparedness initiatives save lives. The more we learn about the power of these interventions, the more experts call to keep them afloat with better funding. Spending a few dollars to get a person to quit smoking makes more sense than spending thousands of dollars to try to treat their lung cancer several years down the road. Preparing for a natural disaster beforehand is preferable to picking up the pieces afterwards.

So what is public health? It’s something that aims to keep you alive as long as possible. From preventing diseases to preparing for disasters, public health programs keep a wary eye out for threats and then help populations avoid or mitigate them. For example, if data shows a high diabetes risk for a certain population, public health programs will target that population with preventative messages about diet and exercise. Public health departments might also help local school systems prepare for potential natural disasters, like Florida does with its Children’s Disaster Preparedness Program.

Read on to learn about public health spending in the United States, and where we might need to invest some more time and money.

Where’s the money?

In April, the Trust for America’s Health (TFAH) released its report Investing in America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts. The report highlights many ways America falls short on public health spending. They say America’s public health system “has been chronically underfunded for decades.” In Why We Don’t Spend Enough on Public Health, author David Hemenway says this is because the benefits of public health spending today aren’t seen until potentially far in the future. Governments and politicians want to see the benefits of their investments in the present day, so they favor spending on medical treatment and other immediately fulfilling initiatives.

Here are some of the key findings:

Public Health Spending is Actually Shrinking

According to TFAH, when you adjust for inflation, public health spending in 2013 has sunk 10 percent from 2009. Many simply don’t see the benefits of spending on public health programs that yield intangible, future benefits when money could be spent on initiatives that produce immediate results like transportation or construction projects.

All States are Not Created Equal

States vary widely in what they spend on public health as funding is determined by the set-up of each state’s unique public health department. Indiana came in at a low of $15.14 per person, while Alaska spends $50.09 per person. This could be why health levels also vary widely from state to state.

Communities Aren’t Prepared for Public Health Emergencies

Public Health Emergency Preparedness (PHEP) Cooperative Agreement Funding helps communities respond to natural disasters, epidemics, and outbreaks. It was backed by $919 million in 2005. In 2013, it was supported by just $643 million.

Hospitals Aren’t Prepared for Public Health Emergencies

The Hospital Preparedness Program (HPP) gives healthcare facilities funding to beef up their preparedness measures. Funding for this program has been slashed by almost half, dropping from $515 million in 2004 to $255 million in 2015.

It’s estimated that 2/3 of all deaths in the United States result from chronic diseases typically linked to behaviors like diet or substance abuse. These diseases could be prevented by well funded intervention programs to decrease the behaviors that eventually lead to chronic diseases. Public health spending could save Americans millions in treatments for preventable diseases. Likewise public health under-spending could be costing us more than we’re saving.

In this video, the American Public Health Association outlines financial returns on every dollar of public health spending for different activities:

The above video states that every dollar spent on fluoride in our water supply could save $40 in dental care costs and that a dollar spent on nutrition education could save $10 in health care costs. The main point? Public health programs make for a smart investment.

The Consequences of Meagre Public Health Budgets

So, America spends too much money on treatment and not enough on prevention. The results aren’t pretty. In Integrating Public Health and Personal Care in a Reformed US Health Care System, authors Chernichovsky and Leibowitz write,

Compared with other developed countries, the United States has an inefficient and expensive health care system with poor outcomes and many citizens who are denied access.

The State of U.S. Health, 1990-2010 report put the U.S. up against other members of the Organization for Economic Cooperation and Development (O.E.C.D.), a program that advocates to improve economic and social outcomes. Since 1990, the U.S. has fallen in rankings for both life expectancy and healthy life expectancy. In 1990, the U.S. stood at the number 20 spot for life expectancy.  By 2010, it was down to number 27.  In 1990, the U.S. also enjoyed the number 14 spot for healthy life expectancy. The year 2010 found us in the 26th spot.

Under-spending in public health doesn’t just lead to generally poor health, it also impedes our ability to respond to emergencies. Assistant professor at the Harvard Business School, Gautam Mukunda, referred to Ebola as a “wake-up call” for the state of U.S. health preparedness. In Ebola as a Wake-Up Call he wrote,

Ebola may serve as a badly needed wake-up call about something the public health and biosecurity community has been banging the drum about for years: the U.S. has massively underinvested in public health.

Mukunda says the Ebola situation highlighted the measly number of extreme disease cases our U.S. hospitals can handle. Hospitals have decreased their capacity for extreme cases to increase their efficiency, only to lose the ability to treat patients when rare diseases strike. Although the need for extreme treatments arises only occasionally, hospitals should always be prepared for them. But with limited funding, it’s hard to be prepared for the unlikely “worst case scenarios.”

How does the future look?

The good news: The Senate finally passed a joint budget resolution after a five year absence of agreement.

The bad news:  Their budget slahes non-defense government spending by about $500 billion over the next 10 years.

The budget cuts spell trouble for discretionary educational public health programs. From disease prevention to health care worker training, programs to promote good health may suffer across the board.

In an APHA press release opposing the measure, Georges Benjamin, executive director of APHA, says,

Simply put, our federal, state and local public health agencies will not be able to do their jobs to protect the health of the American people if these drastic cuts are enacted.

The budget would also annihilate the Affordable Care Act, including the Prevention and Public Health Fund, a program that focused on moving America towards a preventative health model by funding prevention communications, research, surveillance, immunizations, tobacco cessation programs, health-care training, and more.

The resolution isn’t yet a binding law, but indicates a set of collective and alarming priorities that steer America farther from the path of an integrated, preventative public health system. The Appropriations Committee still has to draft the spending bills, so there’s room for opposition. President Obama for one said he’ll veto bills following the restrictive budget.

Evidence to Inform the Future

According to the article, Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths, published in Health Affairs, mortality rates fall anywhere from 1.1 – 6.9 percent for every 10 percent uptick in public health spend. The researchers made observations over thirteen years and found that the localities with the highest upsurges in public health spending had the most significant reductions in preventable deaths. The relationship held true in multiple causes of death and across different demographics. While the study is only a correlation, the linkage presents compelling evidence for the death-decreasing value of public health spending. The researchers believe a lack of substantial evidence for the ROI of public health campaigns may have hindered spending in the past, and their report takes one step towards getting that evidence.

The Trust for America’s Health (TFAH) advocates for an America with increased core public health spending. They also recommend ways to spend the money correctly. They call for a solid public health foundation for all populations in all states so everyone can be healthy no matter where they live. After that’s established, they advise investing in strong, evidence-backed public health programs and efforts to fortify emergency preparedness. Finally, they believe public health expenditures should be completely transparent and accessible to the American public.

Experts at a recent forum of National Public Health Week looked past mere spending to consider the future of public health and consider novel ways of approaching health to make America a healthier nation. The speakers want to stretch health thinking beyond the doctor’s office to focus on environmental and lifestyle factors that promote well-being like employment, housing, education, and even racism.

These experts dream of an improved, 360 degree view of public health. But sadly, their dreams need funding to become reality. If we continue on this path, it will be very hard to become a more healthful nation.

Resources

Primary 

U.S. Department of Health and Human Services: Prevention and Public Health Fund

Additional

American Journal of Public Health: Integrating Public Health and Personal Care in a Reformed US Health Care System

The New Yorker: Why America is Losing the Health Race

Harvard Business School: Ebola as a Wake Up Call

Public Health Newswire: NPHW Forum: Creating Healthiest Nation Requires Addressing Social Determinants of Health

The Trust for America’s Health: Investing in America’s Health

The Washington Post: Senate Passes Budget Even as Impasse on Spending Continues

Public Health Newswire: House Adopts ‘Devastating’ Budget Agreement

Public Health Newswire: Senate Passes Budget that Batters Public Health

American Public Health Association: APHA Calls Budget Agreement Devastating

The Trust for America’s Health: Investing in America’s Health: A State-by-State Look at Public Health Funding & Key Health Facts

Health Affairs: Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths

The National Priorities Project: Military Spending in the United States

New England Journal of Medicine: Why We Don’t Spend Enough on Public Health

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

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Folks, today marks the one-year anniversary of Hurricane Sandy.

Last year, on October 28^th, I walked to a nearby pub called Onieals to grab dinner for me and my wife (then fiancée). Onieals has the best burgers in Hoboken, and I figured it would be our last opportunity to eat meat for awhile.

The storm was supposed to roll in that night. As I walked the three blocks to pick up our order, it was dark, cold, and cloudy, the wind biting sharply against my sweater. The streets were eerily empty. Back at home, we had stocked up on cases of bottled water and plenty of non-perishable food. The whole town waited with baited breath for the worst.

Finally made it to the grocery store to stock up. No more bread. Who needs bread anyway? Too many carbs. #Sandy pic.twitter.com/lF8iJPBG

— Casper Andreas (@CasperAndreas1) October 28, 2012

As it turns out, the storm didn’t hit until the next day. From morning until night on the 29^th, my wife and I watched the local news, our heat cranked up, making the most of our final electricity-filled hours. We watched as the storm submerged Atlantic City, working its way up the coast. Rain pelted our windows. The lights stayed on.

Until they didn’t. Around 9 p.m., I took a peek out of our bedroom window, hearing screams from outside. The streets were empty. All was well.

Then, ten minutes later, when the screams got louder, I looked again. All of a sudden, there was three feet of water in the street, and rising. Our car was floating. Our apartment building—and all the buildings around us—became an island in a sea of gasoline-tinged floodwaters. The lights went out. My wife and I huddled in bed, trying to block out the screams of thousands of car alarms blaring outside. It sounded like the end of the world.

Morning came, and the water was higher. Firemen paddled through the streets on inflatable boats, looking for people to rescue. I called out to them from our open window, asking if there were any evacuation orders. No, they told me, stay where you are. It took my wife and I days just to get out of our third-floor apartment—the flood waters filled the first floor of our building, along with an array of garbage it had washed in, blocking our exit.

Taken by yours truly, from our apartment window.

On day three, the waters in our neighborhood had drained. Stir crazy, we went outside to survey our destroyed car. We took a walk through the town, detouring around the areas that still hadn’t drained. Every basement and ground floor apartment in town was destroyed. Every car was totaled. Abandoned ambulances floated in the middle of flooded streets, signaling failed rescue attempts.

Once again, taken by yours truly.

FEMA set up camp downtown, and volunteers from around the world gathered to help. Wealthier residents, who paid to live on higher ground, offered their newly recovered electricity to the public, stringing power strips out of their front windows. They served hot food and drinks while strangers—including us—charged their phones at their front doors.

My wife and I had no power for 8 days. We lost our car. Our apartment was so cold, we spent most of our time huddled together, napping under mountains of blankets, trying to ignore the visibility of our breath. When the heat came back on, we both nearly cried for joy.

That was a year ago, and we were pretty lucky. Tons of other Hoboken residents lost everything. Our families in southern New Jersey lost a lot of things too. And those epic photos you’ve seen of the destroyed boardwalks along the Jersey Shore? That’s where we grew up. Things still aren’t quite the same.

Since the storm, I like to joke that we’ve all come down with PTSD—Post Traumatic Sandy Disorder. Nowadays, we all sleep with a flashlight on the nightstand, with an extra tank of gas in the garage, with a zillion spare batteries in the fridge. The sound of car alarms still makes me want to hide under the covers. And the word hurricane strikes a new kind of fear into our hearts.

But the fact is, while we were all deeply affected by Hurricane Sandy, memorializations of tragedies like these tend to gloss over the realities of wealth inequality and marginalization. I’ve stumbled across countless stories detailing the destruction of the storm, and the resilience of communities who are rebuilding and bouncing back. But that ability to bounce back isn’t the same for everyone.

I’ve written before about how women, queers, and people of color are more likely to struggle with poverty. So, let’s take a wild guess as to who was hit hardest by a storm like this, and who would have the most difficulty recovering afterwards?

In Hoboken, it was easy to see. This city is basically a tiny microcosm—it’s an incredibly small town geographically, but it’s filled to the brim with people, spatially divided by race and socioeconomic class.

The projects and low-income housing options are located in the lowest section of town—that means that the poorest people experienced the worst flooding, and went without power for the longest period of time. By contrast, there’s a whole other neighborhood that’s filled with multimillion-dollar condos—unsurprisingly, their elevated position meant they experienced the least flooding, and lost power for all of (maybe) 24 hours.

Not to mention, early childhood education programs and local emergency healthcare—all crucial services for the economically disadvantaged—were completely destroyed in the storm. These facilities were closed unceremoniously, and no alternatives were provided. Many of them have only just reopened, if they’ve managed to do so at all. Add that to the reality that many of the folks affected by these closings could have easily lost their cars, homes, and jobs in the storm, and you’ve got a situation that’s overwhelmingly difficult to get out of.

A destroyed Hoboken basement apartment, next door to our building.

My wife and I were lucky. We lost plenty, but neither of our jobs were destroyed in the storm, we had good insurance coverage, and a healthy savings account. We had the economic resources and infrastructure to rebuild our lives post-Sandy, and these days, things are pretty much back to normal.

But we’re white, college-educated, working to middle-class women. We have a certain level of privilege that tipped the scales in our favor. Not everyone has that. And as a result, not everyone could bounce back from this storm as well as we did.

So this Halloween season, while you’re reading all of these post-Sandy retrospectives in the news, think critically about who the storm affected and how. Is there something you can do to help those who haven’t been able to bounce back—and who, likely, haven’t been featured in the upbeat, restore the shore narrative?

Because when economic disadvantage is a problem before a tragedy like this happens, it’s not always so easy to pick up the pieces afterwards.

—

Hannah R. Winsten (@HannahRWinsten) is a freelance copywriter, marketing consultant, and blogger living in New York’s sixth borough. She hates tweeting but does it anyway. She aspires to be the next Rachel Maddow.

Images courtesy of [Hannah R. Winsten]

Hannah R. Winsten

Hannah R. Winsten is a freelance copywriter, marketing consultant, and blogger living in New York’s sixth borough. She hates tweeting but does it anyway. She aspires to be the next Rachel Maddow. Contact Hannah at staff@LawStreetMedia.com.

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