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and Russia is much diminished: from several mil lion to approximately 4,000. When one takes into account Chornobyl-related disease and disability, however, (even excluding psychological illness), the numbers of affected people increase dramatically. The result of this distinction can be illustrated by an analogy related to the difference between HIV (the virus) and AIDS (the disease). Globally, the number of individuals with HIV is millions higher than the number of individuals who have died from AIDS. When separated, the scale of the HIV pandemic is also vastly greater than the AIDS death toll. Yet for most people, HIV and AIDS are perceived as one deadly disease, and this magnifies its significance. Research and reports on the tragedy of Chornobyl, on the other hand, often separate incidence of death from incidence of cancer, which may or may not be fatal. This distinction diminishes the overall impact of the disaster and its consequences. It also colors the nature and efficacy of dealing with those people affected by the tragedy. Thyroid cancer in Ukraine, for example, has increased over the past 20 years in proportion to the age of exposure; young adults exposed to the fallout of Chornobyl are now showing up in clinics and hospitals as adults with thyroid cancer or thyroid disease. Since the latency period for adults exposed to high degree of iodine isotopes is between 15 and 20 years, we can continue to expect a significant increase in cases of thyroid cancer in the very near future. (Data from an unpublished study presented at the NY Eye and Ear Hospital Thyroid Center). How such cases are handled, medically and eco nomically, is a matter of great concern. A recent article in the New York Times recommends focusing assistance efforts on highly contaminated areas and redesigning government programs to help those that genuinely need as sistance. Suggested changes would shift programs away from those that foster dependency and a victim mentality and replace them with initiatives that encourage opportunity, support local develop ment, and inspire confidence in the future. The Chornobyl Forum report calls for continued close monitoring of workers who have recovered from Acute Radiation Syndrome (ARS) and other highly exposed emergency personnel. However, existing screening programs have not fully taken into account the incidence of spontaneous thyroid cancer, which is increasing significantly as the target population ages. Such programs should be evaluated for effectiveness as well as cost- effectiveness. In the new democratic Ukraine, the “right to know” must begin with acknowledging the dis astrous actions of former leaders and creating an opportunity for the country’s citizens to have access to scientifically valid information about the Chornobyl catastrophe and its aftermath. This is especially important because lack of integrity and conflict of interest in reporting Chornobyl news has been a constant since 1986 and has spawned universal mistrust in the information and research related to this tragedy. Fear is the strongest component behind decisions NOT to disseminate accurate information. Fear of consequences prompted the Ukrainian Communist Party to deny the existence of the Chornobyl catastrophe during the Soviet era. On some levels, this is understandable. Fear almost invariably trumps ethics as a component of decision making unless leaders have the courage to control their fear. If national and international policies are grounded in fear, dangerous conditions or events are kept secret because fear of the consequences once the danger is exposed is perceived to be greater. The Chornobyl nuclear disaster and its ongoing impact on human health exemplify the long-lasting consequences of fear-based decisions. Former leaders of the Soviet Union knowingly withheld the facts about the explosion and the 10-day fire at Chornobyl reactor #4. Because these leaders hid information critical to the health not only of the local population of Pripyat, Ukraine, but also to the entire country as well as to the people of Belarus, Russia, and much of Europe, it is estimated that 4.9 million individuals have been exposed to additional radiation. The long-term ramifications for human health are as yet unknown and will need continued scientific monitoring. Such fear-based decisions, made by govern ments who fear exposing themselves to public (often global) are not unusual. The 2003 SARS outbreak in Asia, for example, is a recent illust ration of a government’s conflict between fear and global health security. Chinese authorities viewed the release of all negative news as damaging to their international image and a threat to social stability, just as their Soviet counterparts did in 1986. Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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