Since the attacks on the World Trade Center in New York City, at the Pentagon in Arlington, Virginia, and near Shanksville, Pennsylvania on September 11, 2001, scientists and clinicians have learned much about the enduring effects of exposure to environmental toxins and hazardous materials. A perspective paper, published today in JAMA, highlights some insights from long-term follow-up of people with 9/11-related health effects, lessons learned in terms of care delivery and clinical understanding, as well as some implications for future disaster responses.
The perspective paper, titled “Twenty-Five Years After 9/11—Lessons From the World Trade Center Health Program,” is authored by scientists and clinicians affiliated with the World Trade Center Health Program (WTC Health Program), National Institute for Occupational Safety and Health, which is part of the U.S. Centers for Disease Control and Prevention.
It begins by highlighting some of the health effects experienced by the cohort including the fact that “many affected individuals have experienced multimorbidity” and developed multiple conditions such as “cancer, respiratory disease, gastroesophageal reflux disease, and mental disorders.” Some of these conditions developed years post-exposure “underscoring the importance of sustained clinical monitoring and research.”
Other findings from their analysis indicate that people in the cohort have a higher prevalence of both chronic conditions and poorer health-related quality of life compared to the general population. They noted that this “multimorbidity contributes to increased disability, more complex clinical management, and higher health care utilization and cost.” However, “access to no-cost care for covered conditions may improve survival, illustrating the interplay between exposure-related risk and access to care.” Elsewhere in the paper, multimorbidity is also listed as a “defining feature of care” as this population ages, although to be clear, not all their conditions are related to 9/11 exposures. The data also suggests that “integrated systems combining surveillance, clinical care, exposure assessment, and research may improve their chronic disease management.”
Insights from the program have also shaped the patient health management strategies adopted by the program over time and expanded the list of covered conditions. As part of the study, the scientists assessed the effectiveness of the WTC Health Program in helping patients manage their conditions and improve their health outcomes. According to numbers reported in the paper, as of June 2026, more than 154,000 responders and survivors have enrolled in the program. Eligibility is based on documented occupational or environmental 9/11 exposure, and clinical coverage is limited to specific conditions described on the program’s website.
Their analysis of program data indicates that its efforts have been largely effective. Specifically, the scientists reported “strong performance in preventative care and chronic disease management” with screening rates for some cancers “exceeding national benchmarks.” They also found that “responders with cancer who participate in the WTC Health Program experienced 26% to 64% lower mortality rates compared with the New York State general population across multiple cancer types.” They further observed a lower smoking prevalence, about four percent, in the cohort compared to the U.S. adult prevalence of 9.1%, which “may reflect the availability and uptake of smoking cessation and related WTC Health Program services.”
The data for chronic disease management efforts was similarly positive. For people with chronic respiratory disease, “program data indicate high levels of guideline-concordant asthma management, with most members achieving an appropriate balance between controller and rescue medications,” the scientists wrote.
Overall, there are lessons from the program that could inform future disaster response initiatives and improve public health preparedness programs among other benefits. “First, the health effects of large-scale environmental and occupational exposures may unfold over decades, requiring sustained investment in monitoring and care,” the scientists wrote. The evidence also shows that “integrated systems that link surveillance, research, and clinical care are essential for identifying and responding to emerging health risks” and “access to care at no out-of-pocket cost can help mitigate the long-term health effects of large-scale environmental exposure and support overall member well-being,” they said.
