An International Comparison of the Instigation and Design of Health Registers in the Epidemiological Response to Major Environmental Health Incidents

Application of human biomonitoring data to support policy development, raise awareness and environmental public health protection among countries within the HBM4EU project

Most countries have acknowledged the importance of assessing and quantifying their population's internal exposure from chemicals in air, water, soil, food and other consumer products due to the potential health and economic impact. Human biomonitoring (HBM) is a valuable tool which can be used to quantify such exposures and effects. Results from HBM studies can also contribute to improving public health by providing evidence of individuals' internal chemical exposure as well as data to understand the burden of disease and associated costs thereby stimulating the development and implementation of evidence-based policy. To have a holistic view on HBM data utilisation, a multi-case research approach was used to explore the use of HBM data to support national chemical regulations, protect public health and raise awareness among countries participating in the HBM4EU project. The Human Biomonitoring for Europe (HBM4EU) Initiative (https://www.hbm4eu.eu/) is a collaborative effort involving 30 countries, the European Environment Agency (EEA) and the European Commission (contracting authority) to harmonise procedures across Europe and advance research into the understanding of the health impacts of environmental chemical exposure. One of the aims of the project was to use HBM data to support evidence based chemical policy and make this information timely and directly available for policy makers and all partners. The main data source for this article was the narratives collected from 27 countries within the HBM4EU project. The countries (self-selection) were grouped into 3 categories in terms of HBM data usage either for public awareness, policy support or for the establishment HBM programme. Narratives were analysed/summarised using guidelines and templates that focused on ministries involved in or advocating for HBM; steps required to engage policy makers; barriers, drivers and opportunities in developing a HBM programme. The narratives reported the use of HBM data either for raising awareness or addressing environmental/public health issues and policy development. The ministries of Health and Environment were reported to be the most prominent entities advocating for HBM, the involvement of several authorities/institutions in the national hubs was also cited to create an avenue to interact, discuss and gain the attention of policy makers. Participating in European projects and the general population interest in HBM studies were seen as drivers and opportunities in developing HBM programmes. A key barrier that was cited by countries for establishing and sustaining national HBM programmes was funding which is mainly due to the high costs associated with the collection and chemical analysis of human samples. Although challenges and barriers still exist, most countries within Europe were already conversant with the benefits and opportunities of HBM. This article offers important insights into factors associated with the utilisation of HBM data for policy support and public awareness.

Natural disasters and infectious disease in Europe: a literature review to identify cascading risk pathways

Background

Natural disasters are increasing in their frequency and complexity. Understanding how their cascading effects can lead to infectious disease outbreaks is important for developing cross-sectoral preparedness strategies. The review focussed on earthquakes and floods because of their importance in Europe and their potential to elucidate the pathways through which natural disasters can lead to infectious disease outbreaks.

Methods

A systematic literature review complemented by a call for evidence was conducted to identify earthquake or flooding events in Europe associated with potential infectious disease events.

Results

This review included 17 peer-reviewed papers that reported on suspected and confirmed infectious disease outbreaks following earthquakes (4 reports) or flooding (13 reports) in Europe. The majority of reports related to food- and water-borne disease. Eleven studies described the cascading effect of post-disaster outbreaks. The most reported driver of disease outbreaks was heavy rainfall, which led to cross-connections between water and other environmental systems, leading to the contamination of rivers, lakes, springs and water supplies. Exposure to contaminated surface water or floodwater following flooding, exposure to animal excreta and post-disaster living conditions were among other reported drivers of outbreaks.

Conclusions

The cascade effects of natural disasters, such as earthquakes and floods, include outbreaks of infectious disease. The projection that climate change-related extreme weather events will increase in Europe in the coming century highlights the importance of strengthening preparedness planning and measures to mitigate and control outbreaks in post-disaster settings.

The organization of post-disaster psychosocial support in the Netherlands: a meta-synthesis

Background: Despite numerous calls for a more evidence-based provision of post-disaster psychosocial support, systematic analyses of post-disaster service delivery are scarce. Objective: The aim of this review was to evaluate the organization of post-disaster psychosocial support in different disaster settings and to identify determinants. Methods: We conducted a meta-synthesis of scientific literature and evaluations of post-disaster psychosocial support after 12 Dutch disasters and major crises between 1992 and 2014. We applied systematic search and snowballing methods and included 80 evaluations, as well as grey and scientific documents. Results: Many documents focus on the prevalence of mental health problems. Only a few documents primarily assess the organization of post-disaster psychosocial support and its determinants. The material illustrates how, over the course of two decades, the organizational context of post-disaster psychosocial support in the Netherlands has been influenced by changes in legislation, policy frameworks, evidence-based guidelines, and the instalment of formal expertise structures to support national and local governments and public services. Recurring organizational issues in response to events are linked to interrelated evaluation themes such as planning, training, registration, provision of information and social acknowledgement. For each evaluation theme, we identify factors helping or hindering the psychosocial support organization during the preparedness, acute and recovery phases. Conclusions: The meta-synthesis illustrates that psychosocial service delivery has grown from a monodisciplinary to a multidisciplinary field over time. Suboptimal interprofessional collaboration poses a recurring threat to service quality. Despite the development of the knowledge base, post-disaster psychosocial support in the Netherlands lacks a systematic and critical appraisal of its functioning. Further professionalization is coupled with the strengthening of evaluation and learning routines.