Epidemiologic approaches to disasters: reducing our vulnerability.

Disasters are an increasing global health concern. On average, one disaster per week requires external international assistance somewhere in the world. Recent events, most notably the tsunami of December 26, 2004, have emphasized mankind’s vulnerability to these events and the necessity for preparedness. These ecologic disruptions are emergencies of great magnitude that overwhelm existing resources, resulting in a call for outside help (1). A March 16, 2005, New York Times article outlined ‘‘15 Nightmares for Disaster Planning’’ (2). As could be predicted because of the tragic events of September 11th, the majority of those making the top 15 list were related to terrorist attacks, including bioterrorism as well as chemical, radiologic, and cyber attacks. Notably, natural disasters, including pandemic flu, hurricanes, and earthquakes, also made this priority list. The potential deaths and health impacts of natural disasters can dwarf those related to terrorism, as documented by the more than 200,000 deaths related to the recent Indian Ocean tsunami and the pandemic flu of 1918, believed to have caused as many as 40 million deaths worldwide (3). Focusing on the theme of Epidemiologic Approaches to Disasters, the 2005 issue of Epidemiologic Reviews, the Journal’s sister publication, is a substantial and timely addition to our understanding of the health impacts of disasters. The information provided will assist the development of strategies and interventions important to the public’s health. The focus is predominantly on a spectrum of natural disasters, including floods, weather disturbances, and earthquakes (4–7). Man-made disasters can be defined as technological events or emergencies occurring in human settlements (1). These are also described in articles dealing with the Chernobyl nuclear power plant accident (8) and civil conflicts in Africa (9). The role of public health in disasters is certainly not new but is now being recognized and highlighted. This emphasis on preparedness was engendered by the tragic events of September 11, 2001, and the subsequent concerns about anthrax, smallpox, and ‘‘dirty’’ bombs. Throughout history, the definition of public health activities has been forged by the need for collective action to counter hazards: controlling transmissible disease, removing environmental threats, and providing a safe drinking water and food supply (10). All of these are of prime importance in the aftermath of contemporary disasters. However, the recent concerns about terrorism have put local public health agencies back on the front lines with respect to public safety. New techniques of surveillance, informatics, and communication are key tools. Public health infrastructure is integral to preparedness, not only for terrorism but also for natural and other man-made disasters (11). In the life cycle of a disaster event, activities to protect the public health of a community include preparation before the event, capacity to predict and identify occurrence of the adverse incidents, and measures in the aftermath to reduce the rate of injury, illness, and death. Epidemiology is a discipline that can inform and guide public health efforts aimed at prevention and preparedness tasks related to