Social Science & Medicine 74 (2012) 1833e1841

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Social Science & Medicine

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Mississippi front-line recovery work after Hurricane Katrina: An analysis of the

intersections of gender, race, and class in advocacy, power relations, and health
Lynn Webera, c, *, DeAnne K. Hilfinger Messiasb, c
a
Department of Psychology, University of South Carolina, Columbia, SC 29208, United States
b
College of Nursing, University of South Carolina, Columbia, SC 29208, United States
c
Women’s & Gender Studies Program, University of South Carolina, Columbia, SC 29208, United States

a r t i c l e i n f o a b s t r a c t

Article history: By disrupting the routine practices and social structures that support social hierarchy, disasters provide
Available online 24 September 2011 a unique opportunity to observe how gender, race, and class power relations are enacted and recon-
stituted to shape health inequities. Using a feminist intersectional framework, we examine the dynamic
Keywords: relationships among a government/corporate alliance, front-line disaster recovery workers, and disad-
USA vantaged residents in Mississippi Gulf Coast communities in the aftermath of Hurricane Katrina, which
Intersectionality
struck in August, 2005. Data were collected between January 2007 and October 2008 through field
Hurricane Katrina
observations, public document analysis, and in-depth interviews with 32 front-line workers representing
Disaster recovery
Health disparities
27 non-governmental, nonprofit community-based organizations. Our analysis reveals how power
Burnout relationships among these groups operated at the macro-level of the political economy as well as in
Advocacy work individual lives, increasing health risks among both the disadvantaged and the front-line workers serving
Gender and advocating on their behalf. Socially situated as outsiders-within, front-line recovery workers operated
Race in the middle ground between the disadvantaged populations they served and the powerful alliance that
Class controlled access to essential resources. From this location, they both observed and were subject to the
Social justice processes guiding the allocation of resources and their unequal outcomes. Following a brief period of
hope for progressive change, recovery workers became increasingly stressed and fatigued, particularly
from lack of communication and coordination, limited resources, insufficient capacity to meet over-
whelming demands, and gendered and racialized mechanisms of marginalization and exclusion. The
personal and collective health burdens borne by these front-line recovery workers e predominantly
women and people of color e exemplify the ways in which the social relations of power and control
contribute to health and social inequities.
Ó 2011 Elsevier Ltd. All rights reserved.

Introduction power relationships in the experiences of front-line recovery

The World Health Organization Commission on Social Deter-
minants of Health (CSDH) directly implicated social inequalities,
including gender inequality, as causes of health disparities and
called their elimination an ethical imperative (CSDH, 2008a,b).
Among its top priorities, the CSDH called for understanding the role
of power in producing health, recognizing a range of types of
evidence, and shifting focus from individual bodies to the envi-
ronment in communities and nations across the globe. In response,
this research uses multiple types of evidence to explore the role of
* Corresponding author. Department of Psychology, Barnwell College, University
of South Carolina, Columbia, SC 29208, United States. Tel.: þ1 803 546 5645.
E-mail addresses: weberl@sc.edu (L. Weber), deanne.messias@sc.edu (D.
K. Hilfinger Messias).
workers along the Mississippi Gulf Coast after Hurricane Katrina,
a group largely overlooked in Katrina research.
In this study we examine how power relations among
a government/corporate/elite alliance, front-line recovery workers,
and the disadvantaged (low income, minority, and predominantly
female) operated at the broader level of the macro political
economy and at the micro-level of individual lives to produce
health inequalities. Front-line disaster recovery workers situated in
community-based organizations (CBOs) occupied an intermediary
space between the vulnerable populations whose interests and
needs they sought to serve and to promote and multiple levels of
government, elite, and corporate entitiesdwhere the decisions and
policies about recovery resources were shaped and directed (cf.,
Lipsky, 1980; Lowe & Shaw, 2009; Luft, 2009). This position in the
middle provided these workersdmost of whom are white women

0277-9536/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2011.08.034
1834 L. Weber, D.K.H. Messias / Social Science & Medicine 74 (2012) 1833e1841
and people of colorda unique perspective on the health conse-
quences of social inequalities for the communities, families, and
individuals they serve. And this position, as well as the context of
their recovery work, also affected their personal health and well-
being.
Approach: feminist intersectional framework
Using a feminist intersectional framework addresses CSDH
priorities by analyzing the contexts and social relationships where
power is exerted, resisted, transformed, and reproduced across
multiple levels (societal/community/individual) and systems of
inequality (e.g., gender, race, class, nation). This approach compli-
cates traditional gender-based analyses by treating gender as a set
of social relations, not merely as characteristics of individuals that
vary across race, ethnicity, class and other dimensions of social
inequality (Hankivsky et al., 2010; Weber, 2006; Weber, 2010;
Weber & Castellow, in press; Weber & Fore, 2007; Weber & Parra-
Medina, 2003). By focusing on the intersection of multiple
inequalities, an intersectional approach also foregrounds the
experiences and perceptions of those occupying social positions
that provide a unique angle of vision on the workings of power. In
one such position, labeled by intersectional scholar Patricia Hill
Collins (1986) as outsiders-withindincumbents have some access to
dominant group knowledge without the full power afforded
dominant group members. We contend that from the vantage point
of outsiders-within, these front-line recovery workers operating in
CBOs along the Mississippi Gulf Coast were able to both observe
and to experience the mechanisms producing dominance and
subordination in the aftermath of disaster.
The broader focus of this research is the situation itself e
posteKatrina recovery work in Mississippi e rather than people as
units, individually or collectively. Intersectional attention to power
and gender, race, and class relations highlights the perceptions of
the disadvantaged and vulnerable populations as well as the ways
in which disadvantage is tied to the privilege and control of more
powerful groups (Collins, 2000; Hankivsky et al., 2010; Weber,
2010). Examining the experiences of front-line recovery workers
within this broader social contextdthe vulnerability of the
communities they served and the power of the institutions they
confronteddbroadens our understanding of 1) risks to recovery-
worker health and well-being, including work stress and burnout
and 2) the role of macro-level social inequalities in producing and
maintaining health disparities and inequities.
Political and economic context of Mississippi Gulf Coast post-Katrina
recovery work
When Hurricane Katrina struck in August 2005, it became the
most devastating and costliest hurricane in United States history. It
is estimated that the hurricane impacted 90,000 square miles,
displaced 1.5 million people, initially killed over 1300 people and
resulted in costs of over US$80 billion (FEMA, 2005). While
considerable national media and scholarly attention focused almost
exclusively on New Orleans, the destruction in Mississippi alone
would qualify as the most devastating natural disaster in U.S.
history (Savidge, 2006).
Before Hurricane Katrina, the Gulf Coast states of Louisiana,
Mississippi, and Alabama had among the highest national levels of
race, class, and gender inequality and the worst quality of life
indicators among the poor, people of color, and women. When
Katrina made landfall in 2005, Mississippi had been ranked worst
in the nation for six straight years in the overall status of women in
political participation, employment and earnings, social and
economic autonomy, reproductive rights, and health and well-
being (Gault, Hartmann, Jones-DeWeever, Werschkel, & Williams,
2005). The extreme inequality in these Southern states reflects
a legacy of government/elite/corporate alliances that promoted
slavery and the plantation system, post-slavery agricultural
peonage, the convict-lease system, emerging agribusiness, and
more recently the non-union, low-wage, and internationally driven
industrial/retail sector (Goldfield, 1997; Key, 1949; Lowe & Shaw,
2009; Williamson, 1984). Currently, the Mississippi Gulf Coast has
high levels of poverty, particularly among women of color;
a substantial African American community; a small but important
Asian American community; a growing Latino population; and an
economy largely based on tourism, oil, and fishing (Cutter et al.,
2006; Gault et al., 2005; Jones-DeWeever, 2008).
In the aftermath of Katrina, opportunities to improve conditions
for many Mississippi Gulf Coast residents clearly existed. Mis-
sissippi officials were well positioned to procure relief fundsfrom
the Republican-dominated federal government. Republicans
controlled state government, its congressional delegation included
Senator Cochran on the appropriations committee, and Governor
Haley Barbour was both former head of the Republican National
Committee and of his own Washington lobbyist firm. An indication
of the power and influence of Mississippi’s political leadership was
the initial federal allocation of US$3.4 billion in Community
Development Block Grant (CDBG) funds for rebuilding housing and
other infrastructure in Mississippi, an amount larger than the entire
state budget (USDHS, 2010). Yet despite the initial enthusiasm and
availability of new resources, the outcomes in Mississippi five years
after Katrina suggest a continuing concentration of resources
within existing structures and increased social inequalities, similar
to the situation after Hurricane Camille hit Mississippi in 1969
(Smith, in press).
Post-Katrina Mississippi mirrored Klein’s (2007) description of
the recovery phase immediately following a massive collective
disaster. In the context of generalized public disorientation and
chaos and under the guise of service to recovery, corporate powers
may advance unpopular agendas, including for-profit enterprises,
in ways that would be unacceptable under normal circumstances
(e.g., no-bid contracts, relief from adherence to labor laws, less
transparent government and business transactions). In post-
Katrina Mississippi, Governor Barbour instituted a tightly
controlled distribution process for recovery funds. Priorities
included the gaming and tourist industries and homeowners who
already had insurance. The Mississippi legislature’s first post-
Katrina act was to eliminate the prohibition of on-land gaming so
that casinos could move from offshore barges. The state received
approval for a waiver from the federal Department of Housing and
Urban Development to divert US$600 million in CDBG funds ear-
marked for low-income housing to expand the Port of Gulfport
(Governor’s Office, 2008; STEPS, 2009).
This close connection between corporate and government
interests harmed low-income and other vulnerable groups in
Mississippi. Four years post-Katrina, Mississippi had spent only 52%
of its Disaster Recovery Grant funds. By 2008, the state had spent
virtually none of its allocation for public housing while spending
99% of its US$1.38 billion Phase 1 homeowner grants designated for
homeowners with insurance. In addition, the state had diverted
US$600 million of housing funds to Port of Gulfport expansion and
US$800 million to economic development (STEPS, 2009). In the face
of massive social and environmental destruction, these political
priorities, along with stalemates resulting from unspent or diverted
funds, further threatened the survival of more vulnerable
communities. Operating in the middle between government and
corporate elites and the disadvantaged, front-line recovery workers
in Mississippi coastal communities had unique personal and
collective perspectives on this social, political, and economic
 L. Weber, D.K.H. Messias / Social Science & Medicine 74 (2012) 1833e1841
context. They experienced firsthand its impact on individuals and
on the collective health of these vulnerable communities.
Methods
Qualitative data for this analysis derive from a larger longitu-
dinal, interdisciplinary, multi-method study aimed at under-
standing the geospatial and social inequalities in post-Katrina
recovery along the Mississippi Gulf Coast (cf., Cutter & Smith, 2009;
Smith, in press). In 2007, a team of interdisciplinary researchers
began background research on coastal communities, instrument
development, and on-site field activities, including identifying
community contacts. Research activities conducted over the
following 22 months included multi-site observations, photo-
graphic evidence, attendance at public meetings, extensive docu-
ment analysis, and semi-structured in-depth interviews with
residents and recovery workers. A University Institutional Review
Board approved the study, and the research team implemented
verbal and written informed voluntary consent and participant
protection processes throughout the research.
Participant recruitment and representation
In the effort to obtain a wide range of community perspectives
on the Mississippi disaster recovery processes, we sought individ-
uals connected with a variety of organizations, agencies, and
initiatives, including government officials, business leaders, and
formal and informal community leaders. To identify and recruit
research participants, we employed various approaches (e.g.,
personal encounters, on-line research, snowball referrals).
Early in the fieldwork process, we realized the importance of the
recovery efforts of individuals working with CBOs. As a result,
understanding these individuals’ and organizations’ ongoing work
became a primary research focus. Trained researchers conducted
a series of in-depth, face-to-face interviews with 56 different indi-
viduals between February and October 2008. Participants repre-
sented nonprofit CBOs (n ¼ 32), government (n ¼ 9), business (n ¼ 5),
education, media, and other sectors (n ¼ 10). The CBO participants
worked in 27 distinct nonprofit organizations focusing on a wide
range of recovery concerns including disability, race, and gender
advocacy, social services, housing, healthcare, economic develop-
ment, empowerment, and legal aid and advocacy. Eighteen organi-
zations existed in the area before Katrina, six formed locally after the
storm, and three pre-existing national and regional organizations
established a presence on the coast after the disaster. Many of the
long-standing local groups had previously communicated and
collaborated with one another on issues of overlapping concern.
This analysis draws primarily on the 32 interviews with CBO
workers. Of these, 25 (78%) were white women or people of color,
19 (60%) were women, 15 (47%) were persons of color and 27 (83%)
reported having earned a college degree. We intentionally sought
to interview people from a wide range of organizations. Although
we cannot know if this sample is representative of the broader CBO
workforce along the Mississippi Gulf Coast, the gender, race/
ethnicity, and educational characteristics of these front-line
workers were consistent with the representation observed at on-
site coalition meetings.
Individual in-depth interviews
Individuals who agreed to participate in the research indicated
their availability and preference for interview time and place, often
agency offices or churches. Trained researchers conducted the
semi-structured interviews. The interview guide consisted of
a series of open-ended questions designed to elicit respondents’
1835
descriptions of their Katrina-related experiences during and
immediately after the storm and throughout the ensuing recovery
process. We asked about personal experiences of the storm and its
impact on respondents’ families and homes; workplace roles and
experiences of the recovery process; assessment of the progress of
recovery in various areas (e.g., healthcare, housing, education,
employment, workforce); perceptions of how different groups
handled the recovery; and descriptions of the major actors, forces,
obstacles, and successes in the recovery. This format allowed
participants to tell their personal stories, which clearly intertwined
with their disaster recovery work. Audio-recorded interviews las-
ted from 1.5 to 4.0 hours. Participants received US$25.00 in cash at
the conclusion of each interview. To ensure accuracy and correct
discrepancies, interviewers reviewed and compared the profes-
sionally transcribed files to original audio files.
Data analysis and interpretation processes
To analyze the qualitative interview data we used a combination
of coding, thematic analysis, and feminist narrative interpretive
approaches (Messias & DeJoseph, 2004; Strauss & Corbin, 1998).
The beginning analysis phase involved open-coding of individual
interviews by separate researchers. Based on the review of the
initial codes, we consensually developed a detailed code list.
Subsequently, at least two researchers coded each of the transcripts
using a qualitative data management software program. The
subsequent phases of thematic analysis and narrative interpreta-
tion involved more focused and comparative approaches. For
example, in examining data coded as burnout, effect on self/family,
gender, role in recovery process, vulnerable groups, and tensions
between race/class/gender groups, we noted certain patterns
among recovery workers associated with different types of orga-
nizations or recovery work. We then re-analyzed CBO work based
on organizational context, missions, and programs and identified
three categories of work: building, advocacy, and service. Recovery
workers in building (n ¼ 3) focused on home design, construction,
and repair; those associated with advocacy (n ¼ 13) worked
primarily in governmental and political arenas to advance the
rights and status of local constituencies; and service providers
(n ¼ 16) engaged in direct aid and assistance related to health,
health services, financial counseling, housing procurement, and
education. We then undertook a more explicit intersectional
approach to the analysis, focusing on micro- and macro-power
relations of gender, race, class, and ethnicity and the ways in
which political, economic, and social processes in the recovery
posed health threats for the front-line workers as well as for the
disadvantaged populations they served. Throughout the process we
compared the data within the dynamic social, political, economic,
and environmental contexts of the post-Katrina Mississippi Gulf
Coast and to findings from relevant interdisciplinary research
(Clarke, 2005; Messias & DeJoseph, 2004; Strauss & Corbin, 1998).
Findings
Our major findings illustrate how macro- and micro-level power
relations of gender, race, class, and ethnicity shaped the contexts
for health and well-being among front-line recovery workers and
the disadvantaged populations for whom they advocated and
served. We discuss our findings, presenting representative quotes
from the interviews, under four broad themes: 1) the shared
context of disaster, characterized by initial shock accompanied by
hope for change in the status quo; 2) macro-level power relations
shaping and directing local recovery processes, policies, and
outcomes; 3) micro-level experiences of front-line recovery
workers e situated as outsiders-within e of these raced, gendered,
1836 L. Weber, D.K.H. Messias / Social Science & Medicine 74 (2012) 1833e1841
and class-based power relations; and 4) the individual and
community health burden of social justice advocacy work in these
high stakes, highly unequal power struggles over recovery
resources and the future of the Mississippi Gulf Coast.
The shared context of disaster: initial shock and hope
Across diverse Mississippi communities, most inhabitants
shared experiences of suffering and loss in the aftermath of
Hurricane Katrina. Although their individual experiences varied,
many front-line workers had lost homes, family members, and
neighborhoods. Looking back, participants described their initial
feelings of shock, disbelief, and disorientation and the intense
efforts to establish a sense of normalcy:
There’ve been.phases that I’ve noticed going through . that
first period of just being so shell-shocked and not knowing what
to do. And then when we had some idea of what our recovery
plan was gonna be .we couldn’t do it fast enough and we just
had to race, race, race, race, race to get it done. (White female,
childcare services/advocacy)
They also recollected the collective surge of hope for the
possibility of social improvement:
After the storm we had a lot of hope that things would be put
back together again better. That was what people were saying,
you know? (White female, service/advocacy consortium)
During the early recovery period, representatives of govern-
ment, business, education, and a vast array of community-based
and nonprofit organizations also envisioned the disaster recovery
as an opportunity to make Mississippi better. The tone for this
collective hope and focus on opportunity was set, in part, by the
official discourse from Governor Haley Barbour’s office. Six weeks
after Katrina hit, Governor Barbour and James Barksdale, former
Netscape executive and Chairman of the Governor’s Commission on
Recovery, Rebuilding and Renewal (GCRRR), invited local officials to
participate in the Mississippi Renewal Forum, designed to plan the
future of the coast. The formal invitation rang with enthusiasm and
the assurance of progress, referencing a “once-in-lifetime oppor-
tunity.to rebuild the Coast the right way and make it bigger and
better than ever..we’ve got the cleanest slate we’re ever going to
have. the money. the resources are pouring into this area; it will
never happen again” (GCRRR, 2005, p. 3). Although initially sharing
this hopefulness, over time front-line workers became increasingly
aware that those in power did not share their vision of a “better”
Mississippi that would improve the lives of the most disadvantaged
citizens.
Macro-level power relations directing the recovery
When the necessary resources for recovery and rebuilding failed
to materialize, the short-lived hope for progressive change gave
way to the day-to-day challenges of environmental, economic, and
social recovery. In this process, many participants recognized that
the source of power and the direction of recovery efforts were
centered in a formidable alliance between government and large-
scale corporate entities that set the priorities and directed the
flow of federal and state resources to their Mississippi Gulf Coast
communities. Reminiscent of the political process after Hurricane
Camille hit the region in 1969 (Smith, in press), the GCRRR set
recovery priorities and directed funds. Subsequently, the Gulf Coast
Business Council (GCBC) created the nonprofit Renaissance
Corporation, representing local developers, to enact the recovery as
defined by the GCRRR.
The corporate influence on defining the Mississippi Gulf Coast
recovery processes reflected not only class but also race and
gendered power. The GCRRR’s board of directors consisted of seven
white men, all with close ties to the governor, five of whom were
executives of major corporations representing communications,
shipbuilding, energy, and poultry farming. The executive director
was the governor’s nephew, whose law firm represented large
corporate tobacco and shipping interests (Burger, 2007). No women
and only one African American, the state director of the NAACP,
were on the commission, and no members of vulnerable pop-
ulations or local nonprofit or grassroots community activists
(mostly women and people of color) participated in decision-
makingdeven in areas of critical interest such as housing grants
(Lowe & Shaw, 2009).
Despite the lack of transparency in the GCRRR’s processes,
front-line workers clearly recognized the commission’s role in
defining the recovery. When asked to identify the principal
influences on recovery priorities and direction, participants
overwhelmingly identified the governor’s office, GCRRR, Renais-
sance Corporation, and GCBC. They repeatedly cited the rapid,
substantial support for the casinos/gaming industry and the
diversion of CDBG block grant funds earmarked by Congress for
low-income housing to both the expansion of the Port of Gulfport
and to “workforce housing” to include those making up to 120% of
the poverty line.
The vast majority of nonprofit CBOs worked with vulnerable
groups, but a few served as advocates for business and corporate
interests. The following statements from four front-line CBO
recovery workers illustrate the ways in which their distinct social
locations and relationships to the dominant powers in the state
reflected not only their individual perspectives on those macro
political economic powers but also their differential access to
information on the direction of the recovery:
It was the business community.that said, “Governor, you need
to allow temporary casinos within a e I think its 800 feet of the
high tide e so that we can get our casino revenues flowing
again.”. It’s been the business community that has pushed to
get the port expanded and to get some of our port workers back
in, so that we can e you know, we were a huge importer and
exporter.and it was the business community that got the
governor to recognize that. (White female, business/casino
advocacy)
The Gulf Coast Business Council .is an entity in and of itself
that’s almost as secretive as like the Knights Templar. You
cannot gain access to who is on their membership lists.which
are predominantly businessdhigh level business leaders from
across the state and elsewheredyou have the Renaissance
Corporation, which is the nonprofit. They have had their hands
in every single possible aspect of recovery dollars . on the way
programs have rolled out, on shaping what those programs
looked like, on a focus on this euphemismdit’s not new, but it’s
new to us herednot affordable housing, but “workforce
housing.” . Sounds like company housing to me. (White female,
faith-based advocacy/service)
And that’s the frustrating part of ite the Governor himself said,
“We’re never gonna have this opportunity again to reinvent this
city.”.But I don’t see the attempt by local or state government
to make that come to fruition..I think it will go down in
history that we messed up an opportunity to really help people
and do what the government is supposed to do e govern of the
people, by the people and for the people. And not for the people
out there who are trying to make more money. (African Amer-
ican male, racial justice advocacy)
 L. Weber, D.K.H. Messias / Social Science & Medicine 74 (2012) 1833e1841
I believe there are a lot of efforts towards making sure that they
[poor people] go somewhere else and that’s what the Governor
sees as recovery. Get these poor people out of here, so then we
can build our state different. (White male, housing/community
development)
Social location in the political economy as either advocates for
business/corporate interests or for vulnerable populations shaped
front-line workers’ views across race and gender. The business/
corporate advocate took for granted having easy access to the
governor and praised the business community for shaping the
state’s priorities. The respondents working with the disadvantaged,
however, agreed on the powerful forces directing the recovery and
identified the beneficiaries, noting the vulnerable constituents who
would be left behind in the process.
Micro-level power relations as mechanisms reproducing inequality
Power relationships can be characterized as the dynamic
interplay between opposing forces seeking different outcomes in
a struggle over resources (Weber, 2010). With the bulk of financial
and other recovery resources directed to business/corporate
interests, fewer funds and support mechanisms were available for
vulnerable populations. Further, since Mississippi’s social safety
netditself a legacy of long-standing race, class, and gender ineq-
uitiesdwas already among the least generous in the nation,
volunteers and nonprofit organizations became the primary source
of support for projects left behind in the GCRRR’s priority rankings
(Lowe & Shaw, 2009). Front-line recovery workers succinctly
described this context and its implications for CBOs working with
the most vulnerable residents in their communities:
A lot of the recovery effort here was done by people who are
nonprofit people.Instead of the state setting up solid struc-
tures to actually make sure that people knew about Phase 1 or
Phase 2 e which are the grant programs e it was left to the
nonprofit community. The nonprofit community was the
community that said, "There’s formaldehyde in these trailers,
and they’re making everyone sick." The nonprofit community
has been pushing the Port issue. The nonprofit community is
talking about how unfair it is to not have people covered
because they suffered wind damage. (African American female,
housing/advocacy)
When the government fails, your court of last resorts are the
nonprofits, and so folks are doing as much as they can to help
people who are in incredible binds put their lives back together.
(White female, community-based service/development)
Across interviews, we identified several sub-themes that illus-
trated how front-line workers experienced this “failure of govern-
ment” and “unfairness” at the micro-level. In describing their daily
work, participants discussed the overwhelming demands and
needs in the face of limited resources, reported a lack of training or
capacity on multiple fronts, and complained about how the lack of
coordination and communication made their work even more
difficult.
Limited resources for overwhelming demands
Front-line workers conveyed an ongoing sense of being over-
whelmed by a flood of basic needs among their constituents/clients
and repeatedly described themselves and their organizations as
being “stretched to the max".
I think everybody is just trying to keep their heads above water.
Everybody’s overtaxed. The school systems are e if they have
adequate funding in place, they don’t have adequate
1837
facilities..A lot of schools, they’re in trailers.It isn’t unique to
south Mississippi after the storm for children to be going to class
in trailers, but here everybody goes to school in a trailer. I think
a lot of agencies are just struggling to keep things going. My
wife’s a social worker and.worked primarily with the home-
less population and mental health is a huge, huge concerndvery
little assistance, if any, [is] available.in the homeless pop-
ulation. (White male, housing self-help)
Lack of training and insufficient capacity
Recovery workers pulled in multiple directions had difficulty
doing the work they intended to do, when at the same time they were
expected to do work they were unprepared for and could not do.
Individual workers and organizations that focused on one aspect of
recovery (e.g., housing, childcare, or race relations) confronted clients
with multiple social, economic, and mental and physical health
problems but were unprepared to recognize or respond to these
complex needs. The result was work dissatisfaction and frustration:
We’ve all got psychological problems that have been derived
from Katrina.I see people every day come to me e because I’m
a [racial advocacy organization] leadere wanting me to help
with matters that are not [racial-advocacy] related. [They say,] “I
need you to help me find a place to stay.” I’m a last resort.
They’ve gone to all the people they thought could help ’em and
now they are still searching for additional help that they just
can’t find. (Black male, racial advocacy)
In some cases, the emotional burden far exceeded mere frus-
tration at not being able to meet the needs and expectations of
clients, as illustrated by this housing case manager’s remorse over
a client suicide:
We spend far too much time in this office trying to counsel
people, and we’re not trained to do that. We’re not trained to do
any of this work.we’re not trained to deal with people that are
suicidal. I wasn’t trained to deal with [name of an individual
who committed suicide]. I didn’t recognize the signs. I just
pretty well told her to suck it up and we’d just see what we
could get done, so I live with the guilt of that every day. (White
female, housing case management)
Lack of coordination and communication
The generalized lack of coordination and communication among
government officials, CBO employees, and volunteers further
compounded front-line workers’ frustration and contributed to job
overload and stress. Smaller organizations were especially hard-hit
by this frustrating fragmentation and the devaluation and lack of
recognition of their efforts:
The recovery effort is fractionalized.it has got so politicized,
a lot of us are just shying away because we don’t have time for
the politics.There was no central agency in charge of anything,
not even to do the work for us. There’s not even a central agency
where I can report back what I’m even doing. That’s even worse.
They don’t even know what we’re doing out here.that’s sad
because we’ve got the data, if they’ll just let us tell them what’s
going on. It’s frustrating. (White female, housing relief)
Lack of coordination among the various organizations further
fragmented and hindered the collective aims of recovery work:
We’ve separated the advocacy, the direct services, and the
community organizing. It needs to be a three-legged stool-
.until these three groups begin to understand that they’re all
working together with the same purpose but have a different
focus, and can work with each other, no one of these groups can
1838 L. Weber, D.K.H. Messias / Social Science & Medicine 74 (2012) 1833e1841
work without the other to make any successful change. (White
female, faith-based housing/community development)
Social justice advocacy, gendered and racial inequalities, and worker
health
The recovery process was stressful for all these front-line
recovery workers, especially for those who lived on the Mississippi
Coast before the storm. Even those in more privileged social posi-
tions recognized the health impact of the disaster itself and the long
and difficult recovery process. In the words of a white male legisla-
tive aide, “This storm has aged everybody, I mean, it’s everybody,
including myself.” Although everyone had suffered, the evidence of
the additional health burdens on front-line CBO workers, most of
whom were women and people of color, was widely recognized:
A lot of the folks that are running these nonprofits, they’re three
years into the disaster recovery, and they are fried. They are so
fried. They’re burned out. They’re fatigued. They’re just sort of
beyond themselves.I see that a lot, in terms of our sitting at the
table, sensing that it isn’t somebody that doesn’t care.or know
how to do it, they’re so damn tired, psychologically, that they
just can’t take on this suddenly very complex CDBG funded,
federal rules and regulations ad nauseum [sic] production
scheme. (White male, federal government agency)
A closer examination of advocacy workers’ personal health
burdens revealed that their location as outsiders-within enabled
them to see the power dynamics at play. Trying to work against the
unfairness as it unfolded, they became increasingly frustrated and
dissatisfied by their inability to substantively change the outcomes.
For those whose work was centered on social justice, growing feelings
of self-doubt, lack of faith in their own and others’ ability to alter the
balance of power, and the ensuing “battle fatigue” from their frus-
tratingly unsuccessful recovery efforts was particularly distressing:
I think people are wondering two and a half years later, sitting in
the same sort of situation, “What have I been doing? What really
is my purpose for staying here?”.It was not the disaster itself.
It’s been the response. It’s been the recovery process that has
made me, and I know others, feel that way, that it’s just been too
hard.It’s just the. fatigue, like battle fatigue from recover-
y.One mental health official here called what people are
experiencing now as.“malignant malaise”.He said what
we’re experiencing is not PTSD.People are not waking up in
the middle of the night now having dreams of the room flying
off or seeing their house, going back to see a slab..It’s not that.
What it is, is a complete and utter sense of bewilderment at the
lack of recovery and how slow the process is, and how many
times they’ve tried to, as our governor says, "Pull themselves up
by their bootstraps" to only find there are no straps on those
boots. (White female, faith-based housing advocacy/service)
Gendered, racialized, and anti-immigrant mechanisms of
marginalization and exclusion
Front-line CBO workers situated in the middle reported highly
stressful working conditions, with notable variations by gender and
race. In particular, the white women and women of color who
worked as advocates for the disadvantaged described several
mechanisms of social control that were absent in the narratives of
white men working in similar locations/positions. The frustration,
disappointment, and fatigue resulting from the constant blocking
of their repeated attempts to be a voice for unmet needs in the
community was a common narrative theme among women
engaged in advocacy work:
I think that one of the things that was really, really, really
frustrating for everybody .is that time and time and time
again people were invited to come to some kind of a public
meeting to give their input about what unmet recovery needs
were, or how the redevelopment of the coast needed to
happen, and the recommendations that had to do with
affordable housing.[or] affordable childcare.All of these
recommendations that were not related to this resort devel-
opment agenda.You know, you got tired of going to meetings
where you said things over and over again and they were over
and over again ignored. especially after this big effort that
people put out to try to prevent the diversion of money out of
the housing grant program to the poor, losing that. I think in
addition to feeling weary, people are dispirited as well. (White
female, childcare service/advocacy)
Women talked of marginalization and exclusion from decision-
making on the basis of gender and race, of routinely being denied
a voice, and of being disrespected as they confronted more
powerful, usually white male, actors. Working for social change
against entrenched power structures added a gendered layer of
emotional, psychological, and physical struggle to front-line
recovery work. One advocate described constantly navigating
unequal social and gendered spaces of power:
I’m not talking about sitting across the table from an African
American woman who doesn’t have a formal education and me
sitting here. I’m talking.when all other factors being equal,
women in these more high powered settings, advocacy, policy
type settings, will by and large not have remotely an equal voice to
the men in the same room. Nor do they have access to the same
networks in terms of connections in Washington, in terms of
connections to media. (White female, faith-based housing advo-
cacy/service)
Particularly insightful into these power relations was an African
American woman who lost several immediate family members, her
home, and her business in the storm. After the storm she became
a local leader in the rebuilding, heading a nonprofit aimed at
empowering and improving the status of women. Her race-based
analysis of the business rationale for building casinos on her
Black community’s land was that of “slavery”:
Why is nobody on the ground sayin’, “Let’s rebuild these people’s
community?” Why are there people on the ground saying, “Let’s
redevelop and do condos and casinos?” Can you help me with
this, because I seem to be confused! They’re like, “You believe in
redevelopment?” I said, “Oh yes I do! .We had Mom & Pop
businesses, we had beauty salons, we had gyms, we had gyms for
our children. [Now] there’s no community center, there’s no
library. Is that not investment for our future?”.They say, “Yeah,
but we want to put the casinos up to give people jobs.” I said, “But
that kind of reminds me of slavery because you’re not thinking
about us being entrepreneurs and on our own.” (African American
female, community organizing/women’s advocacy)
Adding another level of discrimination and inequality to the
equation, the rising anti-immigrant and nativist sentiment across
the country made immigrant advocacy work especially isolating
and stressful:
I think that one of the things that happens is, for instance, when
there’s a housing issue, and they call on us. a lot of us come
together and we see the need, and we go out and take care of
that housing issue. Now, immigrant issues, that’s a different
story. Nobody really wants to get involved with that. (Latina,
immigrant advocacy)
 L. Weber, D.K.H. Messias / Social Science & Medicine 74 (2012) 1833e1841
Women who advocated for social change from outsider-within
locations expressed deepening disillusionment and frustration
with the loss of focus on social justice in the recovery process:
This whole community, I guess the word would be depressed.
Folks in the nonprofits will tell you that they are exhausted and
frustrated with trying to affect the community changes that are
needed.Now I know I feel disillusioned and a lot of other people,
too. I guess recovery for us has more to do with social justice,
seeing some of the social justice issues appropriately addressed.
Once you do that, things like affordable housing will be eas-
ier.And to me recovery is about equality and restoring, not just
restoring, but improving the level of equality that existed before
the storm. (White female, community-based development)
Implications for individual and community health
These women also recognized that the long-term health impact
of this wearing down was not only on the health of individuals but
also on communities. Two African American women advocates
described the link between individual and community health:
Here on the coast, these are people who are used to being self-
reliant and they don’t ask for help very easily. So when they take
the time to ask for help and it just doesn’t come, it beats down
on the spirit in a different way.What’s happening now is you
have people who have fought a long time to kind of destroy old
power structures and they’re tired. And old power structures are
kind of creeping back into place because people are, a) going
back to what they know as familiar, and b) everyone’s really
tired. (African America female, fair housing advocacy)
You go to the community, you see: One house. No neighbor. One
house. No neighbor. And people can’t live without people, it
makes you weak.A house can’t live without people in it
because it dies and that’s what’s happening to our people.
They’re dying because they’re tired of fighting. (African American
female, community organizing/women’s advocacy)
Front-line workers advocating for social justice and struggling to
rebuild their communities recognized the overwhelming force of
structural inequalities in the lives of the individuals and commu-
nities with whom they worked. The force of these structural
inequalities was reflected in their representations of being
personally and collectively beaten down and exhausted. Their
personal stories provide evidence of the differential and dispro-
portionate effects of their gendered, raced, and class-based advo-
cacy work on their physical, mental, and social health.
Discussion and conclusions
Through a feminist intersectional lens, we examined evidence of
how macro and micro-level power relations of gender, race, and
class affected the lives, work, and well-being of post-Katrina front-
line recovery workers along the Mississippi Gulf Coast. The extreme
conditions of disaster and its aftermath provided a unique oppor-
tunity to observe how power relations were enacted and recon-
stituted when the routine practices, places, institutions, and social
structures that support hierarchy in everyday life were disrupted.
In the initial period of shock after the hurricane, those in positions
of power saw an opportunity to change the face of Mississippi and
to improve conditions for business/corporate interests. In contrast,
front-line recovery workersdpredominantly women and people of
colordsaw an opportunity to challenge the social disparities and
inequities that had characterized the region for years. For shaping
the terms and direction of recovery, the aims of the two groups
were diametrically opposed.
1839
While pre-disaster inequalities are often replicated and
exacerbated after a disaster, some researchers have suggested
that this result is not always so (Powers, 2006). In this context,
seeing an opportunity for change and social justice, many front-
line workers initially intensified their activities, not just to
recover but to change the balance of power. Over time, as their
efforts were met with repeated inattention and opposition, they
became discouraged, dispirited, and exhausted. The result was
personal and collective burnout. The lack of clear communication
channels, training, and ongoing support further contributed to
their work stress and compromised their personal health and
well-being.
In the social landscape of the Gulf Coast, these front-line
workers occupied a position that was outside both the power
centers of government and business and the disadvantaged
populations they serveda middle-ground, outsider-within loca-
tion, where they were invited to participate in planning and
implementing recovery but repeatedly found their voices dis-
missed. Despite having more resources, like their clients and
constituents, they were survivors of the storm and its aftermath.
Further, they were predominantly women and people of color
whose marginality extended beyond the economic realm of work
to other domainsdpolitical, justice, familial, media, education,
and health.
One critique of social determinants approaches to health dispar-
ities is that they identify the underlying social inequalities but cannot
explicate how the inequalities play out in specific contexts to affect
health (Bates, Hankivsky, & Springer, 2009; Weber, 2006; Weber &
Fore, 2007). Likewise, research on compassion fatigue and burnout
in the health and social service professions has focused largely on
identifying and managing symptoms (Adams, Figley, & Boscarino,
2008; Craig & Sprang, 2010; Tehrani, 2010) and much less on expli-
cating the conditions creating symptoms, the links between envi-
ronments and unequal experiences of burnout, and the social
processes that discourage/dispirit and wear down care workers. To
the extent that compassion-fatigue research does address worker’s
environments, it implicates bureaucratic demands and high case
loadsdnot advocacy for social change in high stakes encountersdas
precipitating factors (Acker, 2008; Lloyd, King, & Chenoweth, 2002;
Sabo, 2006). In contrast, research that directly addresses the work
involved in social movements for change tends to focus on the
strategies, effectiveness, and internal dynamics of the movement
organizations but not on the health consequences of advocating for
justice against significant and powerful opposition (cf., INCITE!, 2007;
Luft, 2009, in press).
Intersectional scholars highlight the importance of identifying the
mechanisms through which social hierarchy produces unequal
outcomes in specific contextsdthe linkages between macro- and
micro-level relations of power (Reskin, 2003). Our findings provide
some evidence of those mechanisms at work among the front-line
workers who serve and advocate on behalf of the most disadvan-
taged populations in the Mississippi Gulf Coast recovery. Situating
these workers in the gendered, racialized, and class-based hierarchies
of power in post-Katrina Mississippi, the findings also reveal the
broader contexts of the workers’ fatigue, stress, and burnoutdbeyond
their individual experiences:
 Overwhelming demands, limited resources, lack of training and
capacity. Mississippi’s political economy is historically charac-
terized by a government/corporate/elite alliance that provides
little in the way of public support for vulnerable populations.
Not surprisingly, the state directed new disaster resources
away from the vulnerable, and front-line workers faced over-
whelming demands without adequate resources and capacity
to meet them.
1840 L. Weber, D.K.H. Messias / Social Science & Medicine 74 (2012) 1833e1841
 Lack of transparency. Government funding disbursement at the
state and local levels lacked transparency, and regulations were
often opaque, cumbersome, and unequally applied.
 Failure of coordination and communication. Most non-
governmental, nonprofit CBOs engaged in recovery work for
disadvantaged populations were small and had limited
resources. The lack of coordination and often chaotic and
haphazard communication among these organizations and
with government agencies consumed front-line recovery
workers’ time and energy and contributed to high levels of
frustration and stress.
 Gendered and racialized marginalization, exclusion. Front-line
workers were excluded from the processes of developing and
setting priorities for the recovery. Although repeatedly invited
to meetings to present their positions, they became discour-
aged and fatigued at not being heard. White women and
women of color experienced and discussed marginalization
and exclusion in gendered and racialized ways.
 Separation of key elements of social activism. Divisions between
advocacy, social service, and community development groups,
brought about in part by competition for funding and recog-
nition, produced not only obstacles to effective social action but
also frustration and exhaustion among many workers (Hunt &
Zajicek, 2008; INCITE!, 2007; Luft & Ward, 2009).
Research seeking to define, measure, and build community
resilience to disasters encourages reducing risk and resource
inequities, engaging local people in recovery efforts, creating
organizational linkages, boosting and protecting social supports,
building decision-making skills and trusted sources of information
that function in the face of unknowns, and including gender and
social equality principles throughout (Cutter et al., 2008; GDN,
2005; Norris, Pfefferbaum, & Pfefferbaum, 2008). Mechanisms to
reduce social inequality include formalization, transparency, and
accountability in decision-making and allocation processes (Reskin,
2003). Having these practices and processes in place before Katrina
and during the immediate and longer-term recovery could have
mitigated the physical, psychological, and social health effects of
the disaster on front-line workers, individual residents, and
communities.
The aftermath of Hurricane Katrina, when routine physical and
social markers and practices that structure inequality were swept
away, provided a unique opportunity to examine how gender
inequality and its health effects are recreated and reinforced. This
intersectional analysis focusing on the social locations and
perspectives of outsider-within, front-line recovery workers
revealed a complex picture of the ways in which gender, race, and
class power structures contributed to individual and collective
health and well-being. By exposing the underlying processes link-
ing multiple inequalities and health, this research reinforces the
need for examining the social mechanisms that produce health
disparities and inequities. It also suggests directions for disaster
preparation, response, and recovery that could facilitate the work
and promote the health of the women and people of color who
predominate in community-based organizations and of the
communities they live in and serve.
Acknowledgments
This research was supported by the National Science Foundation
under Grant CMMI-0623991. Any opinions, findings, and conclu-
sions or recommendations expressed in this material are those of
the authors and do not necessarily reflect the views of the National
Science Foundation. The authors thank members of the research
team: Steve Hardin, Christina Griffin, and Joanne Stevenson for data
gathering, coding, and data management in early stages of the
project, and in the later stages, Jennifer Castellow for data
management, analysis, and literature reviews. The co-editors of this
volume, with the support of The Robert Wood Johnson Foundation
Health & Society Scholars Program Working Group on Gender and
Health at Columbia University provided extensive feedback
throughout the conceptualization, writing, and revision process.
We also thank the anonymous reviewers, whose recommendations
greatly improved the manuscript.
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