Recommendations to improve post-disaster HIA: planning before the disaster.

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: 1. 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. 2. Provision of (health) care policy information: Initiation, adaptation and coordination of suitable (health) care provision. Coordination and dissemination of information on the public health consequences of the disaster. Development of protocols to improve disaster relief in future events. 3. 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. 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 …