Testimony Thomas R. Frieden, M.D., M.P.H. Commissioner, New York City Department of Health and Mental Hygiene before the House Committee on Government Reform Subcommittee on National Security, Emerging Threats, and International Relations Assessing Sept 11th Health Effects: What should be Done? October 28, 2003 Mount Sinai Medical Center Good morning. I am Dr. Thomas Frieden, Commissioner of the New York City Department of Health and Mental Hygiene. I want to thank Chairman Shays, the Committee, and especially Congresswoman Maloney, for holding these hearings in New York City to discuss the health affects of the World Trade Center disaster and what is being done to assess their impact. I am pleased to have the opportunity to be here, and in particular, to describe our progress with the World Trade Center Health Registry, which I believe will be key to understanding the extent of these health effects. The immediate health effects of the tragic events of 9/11 include the deaths from the terrorist attack of nearly 2,800 New Yorkers, in addition to the passengers and crew of the two airplanes that were deliberately crashed into the World Trade Center towers. Our efforts now are focused on the many people who may experience long-term health problems as a result of the events of 9/11. The World Trade Center Health Registry is a critically important effort to evaluate the short- and long-term health effects to both physical and mental health that may have resulted from exposure to the 9/11 disaster. The Registry, a comprehensive, strictly confidential health survey of the most highly exposed people will be used to assess the possible long-term health effects of the disaster in different groups including those who were in close proximity to the World Trade Center site on 9/11/2001 and those who were exposed as recovery and cleanup workers, residents, and students in the ensuing weeks as the fires burned. Significant findings will be shared as soon as they become available, and reports will be posted on the Registry website every three months. We intend to track the health of persons who enroll in the Registry for up to 20 years. We hope to contact participants every three to five years to inquire about their health as well as to undertake specific, focused studies, resources permitting. The World Trade Center Health Registry is unique, in that it is the only project that will allow comparisons across groups, and facilitate long-term follow-up of a large, population-based cohort that includes people with a wide range of exposures and health histories. It is our best chance to find out the true incidence and spectrum of health effects resulting from 9/11. Let me be clear about what the Registry is and what it is not. It is a systematic evaluation that should allow us to make conclusions about the health effects of 9/11, both for those who participate in the registry, and those who do not participate. It is not an attempt to identify and monitor every exposed person. It also is not a telephone diagnostic program intended primarily to find people with medical problems and provide care. Clinical evaluation of those most affected cannot tell us about rare effects, nor can it indicate the rate of illness. The Registry will be able to identify syndromes and conditions associated with exposure to the disaster, and help determine what is and is not associated with the disaster. The Registry provides the only comprehensive information available to put the clinical studies in perspective. We need both the detailed clinical evaluation that is provided by Mount Sinai, NYU, and others; as well as the comprehensive survey approach the Registry provides. This will provide information to support evaluation and treatment regimens. We will be able to identify who is at risk and what kind of exposure is more likely to put people at risk so that people can be identified and receive appropriate screening and treatment. Findings will be available to the participants, the general public, and the medical professions to help their evaluation and treatment of exposed persons at risk - whether or not they are in the Registry. The Registry allows us a pivotal opportunity to evaluate the health of people who were closest to the site on 9/11 and in the subsequent months. It allows for understanding of various levels of exposure to dust, fumes, and debris, and provides information on both physical and mental health problems that may occur. The larger the number of eligible people who enroll in the Registry, the more valuable the project will be in terms of delineation of long-term health effects of 9/11 and identification of possible subgroups needing further evaluation and treatment. It will allow us to compare the health effects of people who worked for weeks on the burning pile, people who worked in office buildings in lower Manhattan during the Fall of 2001, and residents who returned to live near the World Trade Center site while the fires still burned, with those experienced by lessexposed persons, including those who were in lower Manhattan only briefly on 9/11 and never returned, or residents who did not come back until after the fires were out. The Registry is the most systematic approach currently available to evaluate the possible health effects from 9/11. It does not depend on selected sub-populations, but rather encourages all eligible persons to participate. Findings from the Registry will allow us to put in perspective the important clinical data from medical evaluation studies conducted by Mount Sinai, the Fire Department, NYU, New York State, and others. The Registry will enable DOHMH to conduct targeted surveys and investigations based on the more general findings from the larger enrolled population. It may also facilitate the future development of effective treatment regimens for these possible health effects. The Registry is a collaboration between the New York City Department of Health ATSDR has committed funding of $1 million per year for project years two The development of the scientific plan for the Registry has, from its inception, We are very pleased with the response to the Registry during the first 8 weeks of data collection. More than 10,000 people have completed the full telephone interview, and another 5,000 have pre-registered on the Registry website or by calling the toll-free Public awareness and understanding about the availability of the Registry is I would like to thank Senator Clinton and her colleagues in the Senate and House for targeting a portion of emergency funds to be used for post-disaster health assessment. While hundreds of thousands of New Yorkers were exposed to the environmental effects of the disaster, we worked with our scientific advisors to devise a realistic definition of those who were likely to be the most heavily exposed, whom we are now inviting to join the Registry. The World Trade Center Health Registry will include a large representative sample of people who were in a building, on the street, or on the subway below Chambers Street on September 11, 2001; people living south of Canal Street; school children and staff from schools and day care centers located south of Canal Street; and people involved in rescue, recovery, clean-up, and other support services at the WTC site or the recovery operations on Staten Island from September 11, 2001 through June 30, 2002. The Registry will provide information about health effects for everyone exposed and will provide a basis for all of us to make public health and policy decisions related to the health effects of 9/11. The World Trade Center Health Registry does not substitute for or replace the other World Trade Center-related studies and what has and will be learned from those studies about the effects of 9/11. Many of the measures that were included on the baseline Registry survey were derived from exposure and health measures found to be important from prior research conducted by NYAM, Mount Sinai, FDNY, NYU, NYSDOH, and Columbia University, among many others. The World Trade Center Health Registry, nonetheless, is unique in that it will include a high proportion of people in the highly exposed populations, will be more comprehensive (including study of multiple populations), and long-term, and will provide a foundation for conducting future World Trade Center-related evaluations. We have recently published on the World Trade Center Health Registry website BE: DI 2002-22-100 30'd were south of Chambers Street on the morning of 9/11; 28% worked at the World Trade The World Trade Center Health Registry is vital to our ability to put in The World Trade Center Health Registry, which is the culmination of planning that began shortly after 9/11, is the most recent of many health evaluations and activities conducted by the DOHMH in the days and weeks following 9/11. These include: Syndromic surveillance, a system to identify clusters of illness in hospital • Inspection of food distribution and band washing stations, leading to • Emergency department surveillance for injuries to survivors on 9/11, in Rescue worker injury and illness surveillance. For a month following system Community Needs Assessment of Lower Manhattan. DOHMH and CDC |