The European Journal of Public Health Advance Access originally published online on September 26, 2006
The European Journal of Public Health 2007 17(1):6-7; doi:10.1093/eurpub/ckl080
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Recommendations to improve post-disaster HIA: planning before the disaster
Pierre Verger1, Marc Ruijten2, David Russell3 and Thierry Lang4
1 Observatoire Régional de la Santé, Provence Alpes Côte d'Azur, Marseille, France
2 Centre for Health Impact Assessment of Disasters (CGOR), RIVM MGO (mailbox 10), PO Box 1, 3720 BA Bilthoven, The Netherlands
3 Chemical Hazards and Poisons Division, The Centre for Chemicals Radiation and Environmental Hazards, The Health Protection Agency, Cardiff, Wales, UK
4 Institut Fédératif de Recherche 126 Santé, Société Inserm U558 et Institut National de Veille Sanitaire, Toulouse, France
Correspondance: Pr Thierry Lang, Inserm U558, IFR 126 Santé Société, Faculté de Médecine, 37, Allée Jules Guesde, 31073 Toulouse, France, e-mail: lang{at}cict.fr
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Why? |
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 Top Why? Which disasters?When and how?Who? |
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Establishing the health impact of a disaster as completely, reliably, and credibly as possible is essential to provide information for a democratic debate about all of the issues (health, social, and economic) that these events might raise. Health Impact Assessment of disasters may provide essential information for designing, adjusting, and implementing the aftercare activities following a disaster, and improve decisions about future risk prevention and choices in development and zoning. Lack of appropriate and timely HIA response after disasters such as the Chernobyl accident or the Schiphol aircraft crash have proved to favour mistrust of experts and public authorities, rumours about the health consequences, and even indictment actions against public health authorities (as in France, 15 years after the Chernobyl accident).
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Which disasters? |
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TopWhy?Which disasters?When and how?Who? |
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Preparation should facilitate HIAs of a wide range of disasters and scenarios. Some disasters have a clear initiating event and develop rapidly (e.g. fireworks explosion, airplane crash), others are primarily manifested as a disease cluster (toxic oil syndrome in Spain) and yet others develop slowly and sometimes insidiously (Camelford water contamination incident). Besides short- and long-term effects caused by physical trauma or shocking events, preparedness should focus on the assessment of the health impact of individual exposure to chemical, physical (including radiation), and (micro-)biological agents. Most EU countries have arrangements for infectious disease outbreak investigation in place; a HIA might be initiated in addition to study medium-to-long-term sequelae and non-infectious (e.g. mental) health endpoints that are not routinely covered.
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When and how? |
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It is important to realize that some elements of disaster HIA need to be performed within a critical time window (such as chemical exposure assessment), which can be as brief as hours after the event. As in any disaster-related activity, the efficiency, efficacy, and success can be greatly enhanced with appropriate preparation. Preparation should be timely, of adequate quality, and recognize the existing structures and organizations. Therefore, infrastructure, tools, and methods needs to be developed on as follows:
- Organization (arrangements for decision-making, funding, and command and control of disaster HIA, communication of results, and access to relevant information);
- Prior information on the quantities and distribution of hazardous materials and their hazard profiles, release scenarios (including reactants, products, and media contaminated), and characteristics of at risk populations;
- Environment exposure assessment (comprehensive access to monitoring, environmental sampling, and modelling and mapping);
- Identification and registration for follow-up of exposed populations and victims (necessary for epidemiological purposes or for indemnification);
- Individual exposure or doses assessment (biosampling, development of novel biomarkers, and questionnaires on behaviour and protection during and after exposure...);
- Health end point assessment (questionnaires, indicators, and biomarker suitability and validation, availability of reference data, etc.);
- Practical and logistical arrangements;
- Data collection, management, and analysis.
Such preparation involves setting up a permanent system of scientific teams and independent specialists responsible for preparing disaster Health Impact Assessment and an arrangement for access to funding. This system should have a mechanism of control and regulation that enables rapid access and that facilitates and monitors the implementation of disaster HIA. Improving cooperation between institutions and agencies is part of the challenge. Rules of engagement should be the basis for deciding whether or not to initiate a health impact assessment programme after a disaster.
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Who? |
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Clearly, the diversity of arrangements that need to be in place to enable a rapid disaster HIA requires that preparations are made by a well-managed multidisciplinary network organization. Only in the Netherlands a dedicated unit (CGOR) has been formally established.
The optimal scale to prepare for disaster HIA has not yet been established. Disasters or their health consequences do not respect national borders and may require a multinational health response (cf. Chernobyl). Development, validation, and standardization of tools and methods, and a systematic approach to learning lessons from previous disasters may prove to be an activity beyond the capabilities and resources of individual European states. International collaboration, or even EU level preparedness may be a more realistic approach.
Decisive action is required to put the subject on the agenda, gather information and expertise globally, draft plans, and set up specialist centres to ensure a proper response following the next disaster.
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