title: A comparative assessment of major international disasters: the need for exposure assessment, systematic emergency preparedness, and lifetime health care.
abstract: The disasters at Seveso, Three Mile Island, Bhopal, Chernobyl, the World Trade Center (WTC) and Fukushima had historic health and economic sequelae for large populations of workers, responders and community members.
  
  
  
  Comparative data from these events were collected to derive indications for future preparedness. Information from the primary sources and a literature review addressed: i) exposure assessment; ii) exposed populations; iii) health surveillance; iv) follow-up and research outputs; v) observed physical and mental health effects; vi) treatment and benefits; and vii) outreach activities.
  
  
  
  Exposure assessment was conducted in Seveso, Chernobyl and Fukushima, although none benefited from a timely or systematic strategy, yielding immediate and sequential measurements after the disaster. Identification of exposed subjects was overall underestimated. Health surveillance, treatment and follow-up research were implemented in Seveso, Chernobyl, Fukushima, and at the WTC, mostly focusing on the workers and responders, and to a lesser extent on residents. Exposure-related physical and mental health consequences were identified, indicating the need for a long-term health care of the affected populations. Fukushima has generated the largest scientific output so far, followed by the WTCHP and Chernobyl. Benefits programs and active outreach figured prominently in only the WTC Health Program. The analysis of these programs yielded the following lessons: 1) Know who was there; 2) Have public health input to the disaster response; 3) Collect health and needs data rapidly; 4) Take care of the affected; 5) Emergency preparedness; 6) Data driven, needs assessment, advocacy.
  
  
  
  Given the long-lasting health consequences of natural and man-made disasters, health surveillance and treatment programs are critical for management of health conditions, and emergency preparedness plans are needed to prevent or minimize the impact of future threats.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.|University of Brescia, Brescia, Italy.
authors.forename: Roberto G
authors.initials: RG
authors.lastname: Lucchini
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA. dana.hashim@mssm.edu.
authors.forename: Dana
authors.initials: D
authors.lastname: Hashim
authors.affiliation: Imperial College London, London, UK.
authors.forename: Sushma
authors.initials: S
authors.lastname: Acquilla
authors.affiliation: National Academy of Medical Sciences, Kiev, Ukraine.
authors.forename: Angela
authors.initials: A
authors.lastname: Basanets
authors.affiliation: University of Milan, Milan, Italy.
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Bertazzi
authors.affiliation: Federal Medical Biophysical Center, Moscow, Russia.
authors.forename: Andrey
authors.initials: A
authors.lastname: Bushmanov
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Crane
authors.affiliation: New York University, New York, USA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Harrison
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Holden
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Landrigan
authors.affiliation: Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Luft
authors.affiliation: University Milano-Bicocca, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mocarelli
authors.affiliation: Federal Medical Biophysical Center, Moscow, Russia.
authors.forename: Nailya
authors.initials: N
authors.lastname: Mazitova
authors.affiliation: New York State Laborers' Health and Safety Trust Fund, New York, NY, USA.
authors.forename: James
authors.initials: J
authors.lastname: Melius
authors.affiliation: Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY, USA.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Moline
authors.affiliation: University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Mori
authors.affiliation: New York City Fire Department, Brooklyn, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Prezant
authors.affiliation: New York University School of Medicine, New York, NY, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Reibman
authors.affiliation: National Institute for Occupational Safety and Health, Atlanta, Georgia, USA.
authors.forename: Dori B
authors.initials: DB
authors.lastname: Reissman
authors.affiliation: Belarus National Commission on Radiation Protection, Minsk, Belarus.
authors.forename: Alexander
authors.initials: A
authors.lastname: Stazharau
authors.affiliation: University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Robert Wood Johnson Medical Center, Piscataway, NJ, USA.
authors.forename: Iris G
authors.initials: IG
authors.lastname: Udasin
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Todd
mesh_terms: D055908:Bhopal Accidental Release; D002959:Civil Defense / Q000266:history / Q000379:methods*; D004189:Disaster Planning / Q000266:history / Q000379:methods*; D004190:Disasters / Q000266:history / Q000706:statistics & numerical data*; D004781:Environmental Exposure / Q000032:analysis*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D010414:Pennsylvania; D011159:Population Surveillance / Q000379:methods*; D018788:Radioactive Hazard Release / Q000266:history; D018570:Risk Assessment / Q000379:methods; D047851:September 11 Terrorist Attacks; D055906:Seveso Accidental Release
keywords: Disaster epidemiology; Disaster exposure assessment; Emergency preparedness; Epidemiological health surveillance; Major accidents