Public health assessments in disaster settings: recommendations for a multidisciplinary approach.

INTRODUCTION Rapid assessments of needs and health status have been conducted by the U.S. Centers for Disease Control and Prevention (CDC) in natural disaster settings for gathering information about the status of affected populations during emergencies. A review of eight such assessments (6 from hurricanes, 1 from an ice storm, and 1 from an earthquake) examines current methods and applications, and describes the use of results by policy makers so assessments in post-disaster settings can be improved. OBJECTIVE Because the results of assessments greatly influence the nature of relief activities, a review can: 1) ascertain strengths and limitations; 2) examine the methods; and 3) ascertain the utility of results and their use by policy makers. This review compares assessments for similarities and differences: 1) across disaster types; 2) within similar disasters; 3) by timing when the assessments are conducted; and 4) in domestic and international settings. The review also identifies decision-making actions that result from the assessments, and suggests direction for future applications. METHODS Assessments reported in CDC's Morbidity and Mortality Weekly Report from 1980 through 1999 were reviewed because they applied a systematic methodology in data collection. They were compared descriptively for study characteristics and content areas. RESULTS Of 13 assessments identified from six reports, eight were reviewed because they focused on initial assessments, rather than on repeated studies. Of the eight, six pertained to hurricanes; one to an ice storm; and one to an earthquake. Seven (88%) were performed during or after the third day post-impact (range: 1-70 days, median: 7 days). All eight addressed demographics, morbidity, and water availability; seven concerned food, sanitation, and transportation; and six queried access to medical care and electricity. Of the three assessments conducted more than 10 days post-event, two addressed vulnerable children, the elderly, pregnant and lactating women, and migrant workers; two singled storm preparation and evacuation behavior; and one concerned mental health, preventive health care, and social programs. Only one, after an earthquake, asked about disaster-related deaths in household members. Two were international assessments and both were performed at least 60 days post-event. All eight provided estimates of proportions of needs based on survey respondents; none, however, extrapolated the proportions to estimate the magnitude of needs for populations at risk. Of the eight, five confirmed a policy decision, such as accelerating delivery of food supplies. CONCLUSION Assessments typically were conducted within 1 week after the precipitating event occurred. Most, performed within 3-10 days, focused on demographics, health status, food and water, and restoration of utilities. Three assessments, conducted > 1 month later, concerned long-term planning. Only one was performed < 72 hours post-event. Five assessments resulted in policy actions to guide relief activities. Increasing application of health assessments provides: 1) impetus for improving current methodologies; 2) standardizing collection instruments; 3) involving other sectors in emergency relief; and 4) ensuring useful information for decision makers.