ENVIRONMENTAL PUBLIC HEALTH IMPACTS OF DISASTERS

HURRICANE KATRINA

WORKSHOP SUMMARY

Lynn Goldman and Christine Coussens, Rapporteurs

Roundtable on Environmental Health Sciences, Research, and Medicine

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu



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Environmental Public Health Impacts of Disasters: Hurricane Katrina - Workshop Summary ENVIRONMENTAL PUBLIC HEALTH IMPACTS OF DISASTERS HURRICANE KATRINA WORKSHOP SUMMARY Lynn Goldman and Christine Coussens, Rapporteurs Roundtable on Environmental Health Sciences, Research, and Medicine Board on Population Health and Public Health Practice INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Environmental Public Health Impacts of Disasters: Hurricane Katrina - Workshop Summary THE NATIONAL ACADEMIES PRESS 500 FIFTH STREET, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by contracts between the National Academy of Sciences and the National Institute of Environmental Health Sciences, National Institutes of Health (Contract N01-OD-4-2193, TO#43); National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention (Contract 200-2000-00629, TO#7); National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (Contract 0000166930); National Health and Environment Effects Research Laboratory and the National Center for Environmental Research, U.S. Environmental Protection Agency (Contract 282-99-0045, TO#5); American Chemistry Council (unnumbered grant); ExxonMobil Corporation (unnumbered grant); and Institute of Public Health and Water Research (unnumbered grant). The views presented in this book are those of the individual presenters and are not necessarily those of the funding agencies or the Institute of Medicine. International Standard Book Number-13: 978-0-309-10500-2 International Standard Book Number-10: 0-309-10500-5 Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, N.W., Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2007 by the National Academy of Sciences. All rights reserved. Cover photos: Christine Coussens and National Oceanic and Atmospheric Administration. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2007. Environmental Public Health Impacts of Disasters: Hurricane Katrina. Washington, DC: The National Academies Press.

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Environmental Public Health Impacts of Disasters: Hurricane Katrina - Workshop Summary “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Advising the Nation. Improving Health.

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Environmental Public Health Impacts of Disasters: Hurricane Katrina - Workshop Summary THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Environmental Public Health Impacts of Disasters: Hurricane Katrina - Workshop Summary ROUNDTABLE ON ENVIRONMENTAL HEALTH SCIENCES, RESEARCH, AND MEDICINE* Paul Grant Rogers (Chair), Partner, Hogan & Hartson, Washington, D.C. Lynn Goldman (Vice Chair), Professor, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland Jacqueline Agnew, Professor, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland John Balbus, Director of Health Program, Environmental Defense, Washington, D.C. Roger Bulger, Advisor to the Director, National Center on Minority Health and Health Disparities, Bethesda, Maryland Yank D. Coble, Immediate Past President, World Medical Association, Neptune Beach, Florida Henry Falk, Director, Coordinating Center for Environmental and Occupational Health and Injury Prevention, National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, CDC, Atlanta, Georgia Baruch Fischhoff, Howard Heinz University Professor, Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania John Froines, Professor and Director, Center for Occupational and Environmental Health, Southern California Particle Center and Supersite, University of California, Los Angeles Howard Frumkin, Director, National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, CDC, Atlanta, Georgia Paul Glover, Director General, Safe Environments Programme, Health Canada, Ottawa, Ontario Bernard Goldstein, Professor, Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pennsylvania Myron Harrison, Senior Health Advisor, ExxonMobil, Inc., Irving, Texas Carol Henry, Acting Vice President for Industry Performance Programs, American Chemistry Council, Arlington, Virginia John Howard, Director, National Institute of Occupational Safety and Health, Washington, D.C. Peter Illig, Consultant, Association Internationale pour l’Ostéosynthèse Dynamique, Trauma Care Institute, Nice, France Richard Jackson, Adjunct Professor, Environmental Health Services Division, University of California at Berkeley * Membership current as of December 31, 2006.

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Environmental Public Health Impacts of Disasters: Hurricane Katrina - Workshop Summary Lovell Jones, Director, Center for Research on Minority Health, and Professor, Gynecologic Oncology, University of Texas, M. D. Anderson Cancer Center, Houston Alexis Karolides, Senior Research Associate, Rocky Mountain Institute, Snowmass, Colorado Patrick Leahy, Acting Director, U.S. Geological Survey, Reston, Virginia Donald Mattison, Senior Advisor to the Directors of the National Institute of Child Health and Human Development and Center for Research for Mothers and Children, Bethesda, Maryland James Melius, Administrator, New York State Laborers’ Health and Safety Fund, Albany James Merchant, Professor and Dean, College of Public Health, University of Iowa, Iowa City Dick Morgenstern, Senior Fellow, Resources for the Future, Washington, D.C. John Porretto, President, Sustainable Business Solutions, Dewees Island, South Carolina Lawrence Reiter, Director, National Exposure Research Laboratory, Research Triangle Park, North Carolina Carlos Santos-Burgoa, General Director for Equity and Health, Secretaria de Salud de Mexico, Mexico D.F. David Schwartz, Director, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina Jennie Ward-Robinson, Executive Director, Institute for Public Health and Water Research, Chicago, Illinois Samuel Wilson, Deputy Director, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina Harold Zenick, Acting Director, Office of Research and Development, Research Triangle Park, North Carolina Study Staff Christine M. Coussens, Study Director Dalia Gilbert, Research Associate (until December 2006) Nora Hennessy, Research Associate (from February 2007) David Tollerud, Project Assistant Vera Diaz, University of California Intern Board Staff Rose Marie Martinez, Board Director Hope Hare, Administrative Assistant Christie Bell, Financial Associate

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Environmental Public Health Impacts of Disasters: Hurricane Katrina - Workshop Summary Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Aurora Amoah, Mid-Atlantic Center for Children’s Health and the Environment, George Washington University Claire L. Barnett, Coordinator, Coalition for Healthier Schools and Executive Director, Healthy Schools Network, Inc. Ginger Chew, Sc.D., Assistant Professor, Environmental Health Sciences, Columbia University Nancy L. Hughes, RN, MHA, Director, Center for Occupational and Environmental Health, American Nurses Association Bailus Walker, Jr., Ph.D., M.P.H., Professor of Environmental and Occupational Medicine, Howard University Medical Center Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by Melvin Worth, MD, Scholar-in-Residence, Institute of Medicine, who was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Environmental Public Health Impacts of Disasters: Hurricane Katrina - Workshop Summary Contents     PREFACE   xi     SUMMARY   1 1   INTRODUCTION   9      Role of Environmental Health,   10      Integration of Environmental Health,   10 2   HURRICANE KATRINA: CHALLENGES, CONCERNS, POLICIES, AND NEEDS   12      EPA’s Response to Hurricane Katrina,   12      EPA’s Concerns and Challenges in the Wake of Hurricane Katrina,   13      EPA’s Commitments,   15      Future Challenges,   15 3   HURRICANE KATRINA: CHALLENGES FOR THE COMMUNITY   16      Environmental Health Issues in New Orleans and Louisiana,   17      Challenges and Needs for Health in New Orleans,   19 4   NATURE AND EXTENT OF ENVIRONMENTAL EXPOSURES   22      Short- and Long-Term Environmental Health Concerns in the Gulf Coast Region,   22      Protecting Workers During Recovery and Rebuilding,   29      Cleanup, Exposure Guidelines, and Environmental Policy During Disaster,   32

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Environmental Public Health Impacts of Disasters: Hurricane Katrina - Workshop Summary            5   HEALTH MONITORING, ASSESSMENT, AND RESPONSE   35      Rapid Assessment for Identification, Management, and Prevention of Environmentally Related Disease,   35      Post-Katrina Medical Surveillance,   39      Ethical Harms in Community Health Research,   43      Best Practices in Community Health Research,   46 6   COMMUNITY INVOLVEMENT IN RESPONSE TO DISASTERS   48      Katrina Environmental Research and Restoration Network,   48      Rural Health Networks,   49      Ensuring Public Health in the Right of Return,   52 7   RESEARCH TO ADDRESS GAPS IN ENVIRONMENTAL HEALTH ASSESSMENTS DURING DISASTERS   55      Surveilance for Environmental Health,   55      Defining and Working with Susceptible Populations,   58      From Exposure to Disease Outcome,   61 8   MOVING FORWARD   68      Ensuring Environmental Safety and Well-Being,   68      Impacts on the Health of Communities and Their Residents,   69      Themes from the Workshop,   69      Strategies for the Future,   70     REFERENCES   72     APPENDIXES     A   Workshop Agenda   75 B   Speakers and Panelists   80 C   Workshop Participants   82

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Environmental Public Health Impacts of Disasters: Hurricane Katrina - Workshop Summary Preface The Institute of Medicine’s Roundtable on Environmental Health Sciences, Research, and Medicine was established as a mechanism for bringing various stakeholders together to discuss timely scientific issues in a neutral setting. The goal is not to resolve these issues but to create an environment conducive to scientific debate. The Roundtable comprises representatives from academia, industry, nongovernmental agencies, and government whose perspectives range widely and represent the diverse viewpoints of researchers, federal officials, and public interest. It has been more than a year since Hurricane Katrina made landfall in the Gulf Coast region. One does not need to sensationalize the events of the days, weeks, and months after this category 3 hurricane devastated the region—a region that has yet to fully recover. The tragic loss of human life overshadowed the ongoing social and economic disruption in a region that was already economically depressed. On October 20, 2005, the Roundtable on Environmental Health Sciences, Research, and Medicine held a workshop to bring together members of the scientific community not only to highlight the status of the recovery effort but also to consider the ongoing challenges in the midst of a disaster, to look at the scientific issues, and to be able to reassure the public with the best scientific information. The workshop provided an opportunity to explore some of the most pressing research and preparedness needs related to the health risks of Hurricane Katrina. It also provided an opportunity to discuss the larger issues for scientific collaboration during a disaster of this magnitude. Hurricane Katrina reemphasized to the public and to policy makers the importance of addressing long-term needs after a disaster. Almost every day, there were reports in the news media about the status of the recovery effort in the region. Questions were arising daily around basic human needs, whether related to transportation, housing, or medical services. Over a year later, the recovery is

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Environmental Public Health Impacts of Disasters: Hurricane Katrina - Workshop Summary still continuing. For some individuals, daily life is still a hardship, and for others, life is beginning to approach normalcy. Hurricane Katrina called attention to the need to prepare for large-scale disasters. In brief, what is clear is that preparing for health risks must occur long before a disaster strikes and that addressing health problems continues long after the initial search and rescue and other activities of the emergency period. In a disaster, integrated, up-to-date scientific information is required to respond to rapidly changing circumstances. Significant strides toward integration have occurred, but it is clear that additional planning, research, and integration are needed. Unlike many scientific subjects, for which the practitioner’s knowledge is solid but public awareness lags, disaster response and preparedness are areas in which professional understanding, capabilities, and approaches are evolving rapidly and substantially. In illuminating these ideas during the workshop, the Roundtable stimulated scientific discussion about the ongoing needs for responding to Hurricane Katrina. By capturing the discussions and presentations by the speakers and participants, we hope to continue to spark discussion on the larger health issues related to responding to a disaster, whether it is the result of natural hazards, such as a hurricane or earthquake; biologically induced, such as pandemic flu; or an intentional act. The workshop did not consist of lessons learned from the hurricane response, but instead looked at how up-to-date scientific information could aid the recovery process. This workshop summary also captures the areas identified by the speakers and participants for additional research and the processes by which changes can occur. The views expressed here do not necessarily reflect those of the Institute of Medicine, the Roundtable, or their sponsors. Paul G. Rogers, Chair Roundtable on Environmental Health Sciences, Research, and Medicine