The European Journal of Public Health Advance Access originally published online on September 26, 2006
The European Journal of Public Health 2007 17(1):5-6; doi:10.1093/eurpub/ckl079
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The Dutch experience with Health Impact Assessment of disasters
Marc Ruijten11 Centre for Health Impact Assessment of Disasters (CGOR), RIVM MGO (mailbox 10), PO Box 1, 3720 BA Bilthoven, The Netherlands, e-mail: Marc.Ruijten{at}rivm.nl
Over the past decade, the Dutch government has learned that a crisis/disaster is not over when the fire has been extinguished, chemical spills have been contained or affected livestock has been cleared. Examples are as follows:
- The crash of an El Al airplane in a residential area in Amsterdam (1992, 39 fatalities), where a disaster Health Impact Assessment (HIA) amongst 7300 victims was initiated after 8 years under political and societal pressure.1
- Fireworks explosion in Enschede (2000, 22 fatalities): integral aftercare programme for the 20 000 involved people including HIA was started within weeks, and lasted 5 years.2,3
- Café fire in Volendam (2001, 14 fatalities, 350 youngsters injured), where an integral aftercare programme was initiated within days.4
- Avian flu epizootic (2003, 1 human fatality) with an immediate health response including infectious disease outbreak investigation and mental health aspects.5
After the learning experiences with more reactive approaches to disasters, the Dutch government has adopted a three-pronged pro-active approach to health care provision and follow-up of disaster victims as follows:
- Development of a single information and assistance authority.
- Development and implementation of an integrated mental (health) care programme.
- Disaster HIA to develop an information basis for health care provision.
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Why conduct disaster HIA |
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The underlying goal of disaster aftercare is to contribute to the restoration of control at both individual and societal level. A disaster HIA may contribute to a pro-active government response by providing information on the needs of the victims and, consequently, on the relief facilities required to support individual and collective post-disaster care activities. It may also serve to recognize and acknowledge the victims and their post-disaster problems. The following three main objectives of disaster HIA are recognized:
- Provision of (health) care information:
- Determining victims' health state: type, numbers, development, and possible trends/patterns of health problems, either directly related and/or attributed to the disaster.
- Identifying groups at increased risk, need for special health care (provisions).
- Monitoring the effects of interventions.
- Provision of (health) care policy information:
- Initiation, adaptation and co-ordination of suitable (health) care provision.
- Co-ordination and dissemination of information on the public health consequences of the disaster.
- Development of protocols to improve disaster relief in future events.
- Scientific objectives:
- Improving understanding of mechanisms that affect the health and well being of disaster victims.
- Improving understanding of the possibilities to prevent or minimize (persistent) health problems resulting from disasters.
In the above-mentioned Dutch disaster HIAs different approaches have been applied, ranging from surveillance of existing or ad hoc health care registries, surveys of health and exposure end points, exposure assessment in contact media, screening, and evaluation or effect studies. Each study type has distinctive strengths and weaknesses depending on objectives, circumstances, and burden to participants.
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Organization of disaster response in The Netherlands |
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In The Netherlands, disaster preparedness and response are managed by the regional public health authorities, fire brigades, police, and the municipalities. The mayor has overall command over disaster control, usually the fire chief has operational control. Depending on the severity, or if the (consequences of the) crisis or disaster cross administrative boundaries, the command and control can be scaled up to national level.
Therefore, any preparedness planning for disaster HIA needs to include all these players in local government, emergency response and public health organizations, and health care providers. This is a challenge in itself.
Disasters are rare, and hence the complicated undertaking of a HIA is not often needed. It would be unrealistic to expect that every regional public health authority prepare for such events. For this reason, a national Centre for Health Impact Assessment of Disasters (CGOR) was founded by the Ministry of Health, Welfare, and Sports to serve as a clearing house and support unit for local authorities.
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Initiate a disaster HIA, or not? |
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One main function of CGOR is to provide the government with rapid and authoritative advice on whether or not to initiate a disaster HIA, its possible objectives, and an outline of the study programme. To this end an independent Expert Advisory Committee has been set up to provide such advice within 24 h after alert, on the basis of previously agreed rules of engagement.
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References |
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1 Yzermans J and Gersons BPR. (2002) The chaotic aftermath of an airplane crash in Amsterdam: a second disaster. In Havenaar JM, Cwikel JG, Bromet EJ (Eds.). Toxic turmoil. Psychological and societal consequences of ecological disasters(Kluwer Academic/Plenum Publishers, New York) pp. 85–100.
2 Roorda J, van Stiphout WA, Huijsman-Rubingh RR. (2004) Post-disaster health effects: strategies for investigation and data collection. Experiences from the Enschede firework disaster. J Epidemiol Community Health 58:982–7.
3 Van Kamp I, van der Velden PG, Stellato RK, et al. (2005) Physical and mental health shortly after a disaster: first results from the Enschede firework disaster study. Eur J Public Health doi:10.1093/eurpub/cki188.
4 Reijneveld SA, Crone MR, Verhulst FC, Verloove-Vanhorick SP. (2003) The effect of a severe disaster on the mental health of adolescents: a controlled study. Lancet 362:691–6.[CrossRef][Web of Science][Medline]
5 Bosman A, Mulder YM, de Leeuw JRJ, et al. Avian flu epidemic 2003: Public health consequences. Executive summary. RIVM report 630940004. Bilthoven: RIVM 2004.
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