6th International Disaster and Risk Conference IDRC 2016 Integrative Risk Management - Towards Resilient Cities. 28 August - 01 September 2016 in Davos, Switzerland

1. Overview of health impacts caused by the
Fukushima nuclear disaster
and our opportunity to ‘Build Back Better’
Sae Ochi,1 Shigeaki Kato,2 Claire Leppold,3 Toyoaki Sawano,3
Shuhei Nomura,4 Tomohiro Morita,1 Masaharu Tsubokura,1
Tomoyoshi Oikawa,3 Ryuzaburo Shineha1
1. Soma Central Hospital, Fukushima, Japan
2. Joban Hospital, Fukushima ,Japan
3. Minamisoma Municipal General Hospital, Fukushima, Japan
4. Imperial College London, School of Public Health
29 August 2016, IDRC Davos
相 馬
SOMA CITY
そ
う
ま

2. The 2011 triple disaster in Fukushima, Japan
②
6+
5+
4
3
2
1
Intensity
7
6-
1. Earthquake
Magnitude 9.0
2. Tsunamis
Height >15m
Rose up to 41m
Drown 561km2 within 40min- 4h
Death toll >20,000
3. Nuclear accident
Second worst nuclear disaster in the history
After 5 years from the disaster…
it is NOT radiation that is affecting health of the residents.

3. Health deterioration
Events
Bad rumorContamination Mass-evacuationExplosion Shutdown of industries
Intermediate factors
Radiation, mental stress, unemployment, decontamination, lifestyle change
Identification & Evaluation of health problems
Size Timing Duration Risk factorCost
Process of health impact by the nuclear accident
Building back better

4. <20km: Mandatory evacuation zone (no-entry zone)
20-30km: Voluntary evacuation zone (Indoor evacuation)
Case 1: Abandonment in the evacuation zone
Indoor evacuation: scientifically ‘reasonable’,
but politically fallacious
All who could evacuate left
No food supply within 50km
Medical supply e.g. oxygen was in shortage
The most vulnerable were left without food
（e.g. hospital patients, seniors living alone）
“ I did death investigation for a month after the
disaster…several elderly people apparently died
from starvation or dehydration at home..”---a
medical doctor

5. Opportunity 1
Strengthening local community capacities
After the disaster, Soma City, Fukushima
・Made a list of those who could not evacuate
in case of another explosion
・Built recovery sharing houses
Can reduce disaster-related social isolation
Can evacuate the most vulnerable in disaster settings
Can reduce vulnerability of society and prevent ‘solitary deaths’ *
*those who die alone and are not found for several days
Recovery activity
Disaster mitigation
Public health improvement

6. Case 2. Indirect health mpact of mass-evacuation
long-term displacement at temporary housings
Elderly people suffered from immobility:
• Loss of jobs (farmers, fishermen)
• Small space for exercise
• Noise issue
• Increased car dependency
• Deterioration of mental status
Temporary housing Control
Obesity (%) 43% 32%
Hypertension (%) 28% 16%
Diabetes (%) 11% 7%
Standing instability* 69% 33%
* Those who cannot stand with one leg for 15 seconds
5cm
Results of health check-ups mong the elderly in 2012, Soma City

7. About 20,000 decontamination workers in Fukushima
Severe shortage in human resources
People with low social economic status are recruited
• Bad living habits
• Poor living condition
• Poor working condition
Exacerbation of chronic condition
Case 3. Chronic disease among immigrant workers
Taking alcohol 83 (73.5％)
Binge drinker 28 (24.8％)
Smoker 94 (83.1％)
Smoke>15 /day 64 (56.6％)
Not-insured 11 (9.7％)
Causes of hospitalization N
Injuries 18
Diseases 95
Stroke 21
Infection 19
Heart diseases 7
Intestinal diseases 6
Other 2
Total 113
Background of hospitalized decontamination workers
in Minamisoma (2011-2014)

8. Opportunity 2
Increasing awareness and knowledge on health risks
• The most effective way to prevent indirect health impact after
a disaster is to improve basic health status before disaster.
Fukushima prefecture is now..
Providing medical outreach targeting
Temporary housing residents
Decontamination workers
Making exercise centres & parks
Improve health condition among evacuees
May reduce chronic diseases after the disaster
May make society healthier
Recovery activity
Disaster mitigation
Public health improvement

9. Opportunity 2
Change in the prevalence of hypertension in Soma city
9
Prevalence of hypertension increased after the disaster, but
Proportion of treated patients also increased, and
Prevalence of uncontrolled patients has been decreased
 Health check-ups might contribute to increased intervention

10. Lessons learned in Fukushima
• Health impacts caused by the Fukushima nuclear accident
are much larger than impacts by radiation
• Abandonment at the time of evacuation
• Immobility after displacement
• Health deterioration among immigrant workers
Etc.
• Understanding the problems and making effective recovery
plans can be beneficial for both disaster mitigation and
public health
• The most effective disaster preparedness is to aim at :
‘ ensuring healthy lives and promoting well-being for all at all
ages. 1 ‘
• It is achievable to ‘Build Back Better’ i.e. making our society
healthier than before the disaster.
1. United Nations Sustainable Development Goal 3

11. Acknowledgement
• Soma city government 相馬市役所
• Soma city public health centre 相馬市保健センター
• Soma-gun Medical Association 相馬郡医師会
• Hoeikai Hospital 豊栄会病院
• Minamisoma Municipal General Hospital 南相馬市立総合病院
Dr Yukio Kanazawa 金沢幸雄先生
Dr Tomoyoshi Oikawa 及川友好先生
Dr Akihiko Ozaki 尾崎彰彦先生
• Soma Central Hospital 相馬中央病院
Dr Hidekiyo Tachiya 立谷秀清先生
• University of Tokyo 東京大学
Prof Kenji Shibuya 渋谷健司教授
Prof Ryugo Hayano 早野龍五教授
Prof Masahiro Kami 上昌広教授
• Soso Public Health Institute 相双保健所
Mr Shinichi Ogata 尾形眞一様
• Hiroshima University 広島大学
Dr Shuichi Iwamoto 岩本修一先生
• Kyusyu University 九州大学
Dr Takeaki Ishii 石井武彰先生