Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

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

Behbod, Behrooz ScD, MB ChB, MSc, MFPH; Leonardi, Giovanni MD, MSc, FFPH; Motreff, Yvon MPH; Beck, Charles R. PhD, MPH, BSc, PGCHE, FFPH, FRSPH, FHEA; Yzermans, Joris PhD; Lebret, Erik PhD; Muravov, Oleg I. MD, PhD; Bayleyegn, Tesfaye MD; Wolkin, Amy Funk DrPH, MSPH; Lauriola, Paolo MD; Close, Rebecca MSc, BSc(Hons); Crabbe, Helen MSc, FRMetS, AIEMA; Pirard, Philippe MD, MSc

Journal of Public Health Management and Practice: January/February 2017 - Volume 23 - Issue 1 - p 20–28
doi: 10.1097/PHH.0000000000000489
Research Articles

Context: Epidemiological preparedness is vital in providing relevant, transparent, and timely intelligence for the management, mitigation, and prevention of public health impacts following major environmental health incidents. A register is a set of records containing systematically collected, standardized data about individual people. Planning for a register of people affected by or exposed to an incident is one of the evolving tools in the public health preparedness and response arsenal.

Objective: We compared and contrasted the instigation and design of health registers in the epidemiological response to major environmental health incidents in England, France, Italy, the Netherlands, and the United States.

Design: Consultation with experts from the 5 nations, supplemented with a review of gray and peer-reviewed scientific literature to identify examples where registers have been used.

Setting: Populations affected by or at risk from major environmental health incidents in England, France, Italy, the Netherlands, and the United States.

Methods: Nations were compared with respect to the (1) types of major incidents in their remit for considering a register; (2) arrangements for triggering a register; (3) approaches to design of register; (4) arrangements for register implementation; (5) uses of registers; and (6) examples of follow-up studies.

Results: Health registers have played a key role in the effective public health response to major environmental incidents, including sudden chemical, biological, radiological, or nuclear, as well as natural, more prolonged incidents. Value has been demonstrated in the early and rapid deployment of health registers, enabling the capture of a representative population.

Conclusion: The decision to establish a health register must ideally be confirmed immediately or soon after the incident using a set of agreed criteria. The establishment of protocols for the instigation, design, and implementation of health registers is recommended as part of preparedness activities. Key stakeholders must be aware of the importance of, and protocols for, establishing a register.

Agencies will find value in preparing and implementing registers as part of an effective public health response to major environmental incidents, including sudden chemical, biological, radiological, or nuclear incidents, as well as natural, more prolonged incidents.

Supplemental Digital Content is Available in the Text.

Environmental Change Department, Public Health England, Chilton, Oxfordshire, England (Drs Behbod and Leonardi and Mss Close and Crabbe); Santé publique France, French National Public Health Agency, Saint-Maurice, France (Ms Motreff and Dr Pirard); Field Epidemiology Services South West, Public Health England, Bristol, England (Dr Beck); Health Effects of Disasters and Environmental Incidents, Netherlands Institute for Health Services Research–NIVEL, Utrecht, the Netherlands (Dr Yzermans); National Institute of Public Health and the Environment–RIVM, Bilthoven, the Netherlands (Dr Lebret); Institute of Risk Assessment Sciences–IRAS, Utrecht University, Utrecht, the Netherlands (Dr Lebret); Environmental Health Surveillance Branch, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia (Dr Muravov); National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Bayleyegn and Funk Wolkin); and Regional Reference Centre–Environment and Health, ARPA Emilia–Romagna, Modena, Italy (Dr Lauriola).

Correspondence: Behrooz Behbod, ScD, MB ChB, MSc, MFPH, c/o Rebecca Close or Giovanni Leonardi, Environmental Epidemiology Team, Centre for Radiation, Chemicals, and Environmental Hazards, Public Health England, Chilton, Oxon OX11 0RQ, England (

The authors thank Paolo D'Argenio (Istituto Superiore di Sanità, Rome, Italy) for his help in collecting information and his comments on activities dealing with the L'Aquila earthquake health effects follow-up.

The authors declare no competing financial interests. Dr Behbod is director of Oxford Public Health Ltd, which aims to promote public health careers and increase public health capacity in the wider workforce. Dr Lebret works at an Agency of the Ministry of Public Health, Welfare and Sport. This ministry (and other ministries) has charged him with the organization and execution of disaster response and disaster aftercare.

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.