But because the victims die gradually from diseases such as diabetes, heart disease, cancer, HIV, and from drug and alcohol abuse, the public are generally unaware of the scale of the fatalities.

Hurricane Katrina has exposed US health inequalities, though these are not unique to America's racial legacy, argue the authors. Poverty, unemployment, alienation and neglect all contribute to the health divide for the poorest and for minority communities across the US, the UK and other western countries.

In America, however, the result is a health gap which has endured despite years of health developments and economic growth, and progress on race issues.

The hurricane's devastating aftermath exposes the policy changes from both government and the private sector which must be introduced to tackle the health divide, say the authors. These include investing in prevention not just rescue strategies, strengthening public health systems, and supporting responsible choices by individuals. For instance, promoting healthy eating and exercise is only of limited benefit in poor communities where "parks and supermarkets are less common than fast food chains and stores selling alcohol."

As the US rushes to rebuild its southern states, Americans should think carefully about how they could create healthier and more equal communities. "It is even more important that we and others apply these lessons to help the many other individuals and communities with poor health who continue to languish out of the public eye," they conclude.

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Contact: Emma Dickinson
edickinson@bmj.com
44-20-7383-6529
BMJ-British Medical Journal
20-Oct-2005