Editorial comments--"But for the hurricane": measuring natural disaster mortality over the long term.

The publication of the paper from Lori Uscher-Pines is timely. She points to a knowledge gap in the humanitarian field: the indirect or delayed health cost of natural disasters. This is a serious shortcoming, considering as she correctly noted that humanitarian response is far more likely to reduce the delayed mortality than affect the number of deaths directly and immediately attributable to the impact. Measuring the burden of disease and risk factors in non-disaster situations has made considerable progress in the last decades. The concept of years of potential-life-lost (YLL) as presented by the author, progressively is used internationally. In the late 1990s, the years of healthy life lost as a result of disability (YLD) weighted by the severity of the disability, has been added to the tool kit of economists and health planners. The sum of both components, (YLL and YLD) namely the number of Disability Adjusted Life Year (DALY) lost, first introduced by the World Bank in 1993, is the main indicator of cost-effectiveness of risk control measures. 1 Now, it is widely used by World Health Organization (WHO) and the World Bank in their most formal publications. 2–3 The routine use of those tools remains limited in national health services. In the aftermath of disasters caused by naturally occurring hazards, the author noted the scarcity of research in the literature on delayed disaster-related mortality. Yes, indeed, little is published. Not much more was actually done to monitor the delayed health impact following the highly publicized disasters such as the Tsunami in 2004 and the recent earthquakes in India, Iran, and Pakistan. Lori Uscher-Pines listed categories of indirect death. All are important in the United States, where health services are advanced. In developing countries , excess deaths also may result from: (1) epidemics (a risk often exaggerated to justify fund-raising); (2) the loss of the most basic primary healthcare services (something that the short-term dispatch of field hospitals is not alleviating); (3) the disruption of water sanitation services; and (4) an increase of extreme poverty. Although several experts, including the author of these comments, believe that the delayed health impact caused by the disruption of health services and the loss of livelihood might be grossly underestimated, none can actually document this assertion. The reason is simple: it is not a lack of agreement on definitions or categories, but rather an absence of monitoring the delayed health impact by …