• Registries should be established and could benefit from longitudinal studies. Registries should include objective baseline measures of exposures and should also identify possible relevant covariates.

Matte stated that, although it has become much easier to develop and analyze data, surveillance has costs. It is always important to ask whether a particular approach is likely to produce benefits in proportion to the cost and effort. Finally, Matte emphasized that follow-up surveillance efforts need to be coordinated and adequately resourced, with linkages in place to ensure that individuals involved in the follow-ups have access to needed services.

Lynn R. Goldman, Johns Hopkins University

According to Lynn Goldman, the reality that unknown numbers of individuals are being exposed to unknown hazards poses a major challenge to developing health surveillance and environmental monitoring systems for the Gulf oil disaster. Even identifying such individuals is in some cases difficult; beyond the organized responders and clean-up workers, many other people—including volunteers and residents—could be exposed to chemical and physical hazards. And that counts only physical exposure to oil. Many more suffer from diminished livelihood and exposure to substances other than oil. As a result, opined Goldman, “We are never prepared on a day-to-day basis for being able to ramp up the kind of surveillance and monitoring that we need for a disaster like this.”

Goldman stated that past experiences have nonetheless taught some important lessons about health and environmental data collection and surveillance and research methodologies. First, early collection of exposure information is critically important. Too often in disaster situations, there are gaps in knowledge about exposure during the most important time period—during and immediately after an event. Second, an effective assessment of a disaster’s health impact relies on rapid identification and collection of baseline health status data for both individuals and communities—information that is too often lacking. Because the local,