Disasters are the destructive forces that overwhelm a given region or community. These disasters can be natural or human-induced and require external assistance and coordination of services in order to address the myriad of effects, including housing needs, transportation disruption, and health care needs, including physical injury, premature death, increased risk of communicable diseases, and psychological effects-anxiety, neuroses, and depression. Destruction of local health infrastructure—hospitals, doctor's office, clinics—are also likely to impact the delivery of health. Long-term health care needs may occur due to food and water shortages, and shifts of large populations to other areas.
The majority of these disasters affect developing countries, as the casualty and death toll from natural disasters has remained relatively low in the United States and other developed countries for the past few decades. However, events such as the deaths of over 6,000 residents following the 1995 Kobe, Japan earthquake, the death of 700 individuals in Chicago in 1995 due to a heat wave, and the recent deaths of approximately 10,000 individuals during the heat wave in Europe in 2003, are reminders that, despite world-class engineering, even advanced countries are not immune to devastating losses caused by natural disasters. Often the effects target more vulnerable populations—the poor, minorities, and the elderly.
For developed countries, willful disasters are likely to continue to pose serious health risks. The September 11th event is one example of the complexity of disasters facing the United States. In addition to the tragic loss of life of the victims and the psychological effects on their families and communities, health care officials and policy makes are still investigating the effect on the first responders, many of whom are experiencing health effects such as the World Trade Center cough and psychological stress.
The Disaster Roundtable and the Roundtable on Environmental Health Sciences, Research, and Medicine of the National Academies sponsored a joint workshop to examine the issues of health risks and disasters, with an emphasis on the type of health risks, capacity needs, and research needs that are necessary to adequately respond to a variety of crisis conditions. This workshop was one in a series of workshops that both examined the larger views of disasters or environmental health, and served as a discussion to illuminate ideas.