Public health after a nuclear disaster: beyond radiation risks

Abstract

In the five years since Japan's triple disaster there has been a growth in media coverage and public interest in disaster recovery. An earthquake in March 2011 triggered a tsunami that hit the Fukushima Daiichi nuclear power plant, leading to loss of the plant's core cooling capacities, followed by hydrogen explosions and subsequent radiation leakage. The nuclear accident is often discussed, both within Japan and abroad, from a perspective of radiation leakage--as would be expected in the aftermath of such an accident. Yet this has led to confusion about the importance of radiation risks, due to conflicting reports and a lack of awareness of ongoing problems that are unrelated to radiation. These misunderstandings deserve attention. This paper provides a brief review on post-disaster health in Fukushima prefecture, highlighting areas in need of further recognition by medical professionals and policy-makers, including the risks faced by one vulnerable population: the elderly. The framework for understanding the health issues in post-disaster Fukushima is radiation, due to substantial amounts of radioactive material released after the nuclear accident. Although numerous studies have been published, the health risks of radiation are still not well understood, and controversy is abundant even within the realms of scientific research. No deaths or acute health effects related to radiation exposure were reported in the general public immediately after the disaster. (1) In October 2015, the results of two studies concerning the children of Fukushima were reported within two days of each other; one found no detectable internal radiation contamination, (2) while the other found an increased risk of thyroid cancer. (3) Although the study reporting an increased risk of thyroid cancer was later publically criticized by the scientific community for faulty study design, (4) this follow-up has not reached everyone and many members of the public, and even health professionals, continue to be confused by inconsistent results. This is unfortunate, in more ways than one. Controversy over radiation risk not only increases the difficulty in creating an appropriate public health response, but also diverts attention away from other post-disaster health problems that are unrelated to radiation, resulting in issues that are neglected in disaster awareness and response. Over 80 000 people in Fukushima prefecture were forced to evacuate their homes following the nuclear accident. (5) The event brought many changes to the affected region, including widespread social disruption through the breakdown of communities (due to the evacuation and the separation of families) and social stigma attached to being from Fukushima (largely due to incorrect assumptions about radiation exposure and risk). (1) These social effects of the nuclear accident have been documented, (1,6) and hold great implications for health. After the catastrophic nuclear accident in April 1986 in the city of Chernobyl in Ukraine, it was found that the increased mental health burden was the most severe of any of the post-disaster public health problems. (1) Fukushima appears to be facing a similar situation. (1) In addition to its impact on mental health, social disruption can be seen as a risk factor for physiological disease. Rapid life changes can lead to social isolation and psychosocial stress, which are known to be associated with poor health outcomes, including an increased risk of noncommunicable diseases. Unsurprisingly, an increase in noncommunicable disease risks, such as high blood glucose levels and hyperlipidaemia, have been found in Fukushima, (7,8) alongside an increased burden of psychosocial distress, a phenomenon which has been described as a physical and mental health crisis. (7) In contrast with the findings of only marginal internal radiation contamination among children and adults, (2,9) it appears that the increasing burden of noncommunicable diseases and mental health problems may outweigh the burden of disease caused directly by radiation. …