The Nuclear Accident at Fukushima
Education and the right to healthAnand Grover, UN Special Rapporteur on the right to health
21 March 2014

The Right to Health— Article 12, ICESCR - Right of individuals to enjoy the highest

attainable standard of physical and mental health— General Comment 14, CESCR- lays down the framework ofthe right to health and principles contained therein— It is not the right to be healthy— It is built on rights and freedoms, and entitlements

necessary to realize the right to health

The Right to Health— Rights and freedoms include the right to information, informed

consent and right to participation in decision making processes— Entitlements include healthy environment, adequate andnutritious food, education and information— Non-discrimination in all aspects of and decisions taken

towards the realization of the right to health

The Right to Health— Independence, transparency, and accountability must beensured, including private non-state actors— Quality health facilities, goods and services must be available inadequate and sufficient quantity; accessible without
discrimination and; acceptable— Laws impacting the right to health must be evidence-based

State Obligation— States have an obligation to— Respect – States must refrain from interfering directly or

indirectly with the right to health of people, such as bywithholding information— Protect – States must prevent third parties (non-state actors)

from interfering with the right to health of people— Fulfill – States must adopt a national health policy andplan of action and put in place appropriate measures towards
the realization of the right to healthState Obligation— Right to health is progressively realizable— State has three kinds of obligations – continuing, immediate andcore obligations— Continuing obligations mean that the right to health is progressively

realizable— They are subject to maximum available resources— State are obliged to continuously take steps and have a time bound plan

towards the full realization of the right to health— There must be non-retrogression in policies

State Obligation— Immediate obligations are not resource dependent— They include non-discrimination and participation— Taking targeted, deliberate and time bound steps towards

the full realization of the right to health— Putting in place benchmarks and indicators to measureprogress— Core obligations are non-derogable obligations of the State

State Obligation— There is no justification for non-compliance with them
— Minimum essential levels of the right, such as provision of

essential medicines, must be satisfied— Ensuring participation of affected communities is a core andimmediate obligation— Affected community and not just their elected

representatives must be at the decision making table, forinstance when formulating and implementing evacuation plans andshelters, resettlement and decontamination policy

Content and Meaning ofRecommendations in the ReportDisaster Management andDissemination of Information— The government lacked efficient disaster management

system to contain an accident of this scale and magnitude— There was a significant time lag in disseminating information

after the accident and designating certain areas asevacuation zones— Evacuation orders were not coordinated— No distribution of Iodine prophylaxis, which is a standard

step in nuclear disaster management was not undertaken andundermines people’s right to access essential medicines

Post accident policies and decisions— State has based it’s policy on the ICRP recommendation, there is no

significant increase in cancer incidence in doses below 100mSv— Policies are based on information on Chernobyl which may not be

reliable as it was released after 4 years— WHO and UNSCEAR dismissed evidence of health anomalies,

other than those related to thyroid— Long-term exposure to low doses of radiation is linked toincreased incidence of cancer

Resettlement Policy— The policy is based on the ICRP recommendation of increasingradiation dose to a reference level of 1mSv-20mSv/y during
emergencies, based on a risk-benefit analysis— This is contrary to domestic law of the country which requires

areas with radiation doses of 1.3mSv/quarterly to be designated ascontrolled areas— Post the Chernobyl accident countries such as Ukraine instituted laws

under which acceptable radiation dose for living and working without
limitations is 1mSv/yearMonitoring health risks of radiation
exposure— The government instituted four health monitoring survey(excluding basic health survey) based on reports after Chernobyl,
which acknowledged only the effect of radiation on the thyroid
gland in individual exposed during childhood— Surveys are restricted in scope, as other health anomalies havebeen ignored and they do not capture all potential health effects— Surveys were not conducted in all affected areas

Monitoring health risks of radiation
exposure— Results of thyroid examination of children are not easily

accessible to parents— Nuclear power plant workers who were exposed to highlevels of radiation during the accident and clean-up have been
given no health survey or medical examination— Monitoring stations set up by the government to measureradiation dose in the atmosphere do not capture radiation
doses of areas, including hot spots, further away from thestations

Decontamination Policy— There is no concrete and time bound plan for reducing

levels of radiation dose to maximum acceptable level of
1mSv/year beyond 2013
— Play grounds and residential areas are used to bury

contaminated soil, putting people, especially children, at risk ofgetting exposed to radiation. There are no warning signs
indicating the presence of such radioactive debris

Decontamination Policy— Affected communities are undertaking decontaminationactivities. Though participation is good, the government should
provide residents with necessary information and appropriate
equipment before decontamination is undertaken— There is no plan for temporary or permanent storage ofthe contaminated debris. In furtherance of its right to healthobligation, the government should, at the earliest, announce thesite for temporary and permanent shelters with the participationof communities.

Transparency and Accountability— TEPCO was not held accountable due to collusion between theprevious regulatory regime and the industry— Recognising the need for transparency and independence in governance,

the government created the Nuclear Regulation Authority— TEPCO is liable under domestic law but the government’s take overof TEPCO may help it avoid accountability and liability for damages— Taxpayers may have to continue bearing the liability of the nuclear

damage, for which TEPCO alone should be liableParticipation— Direct and effective participation of affected community is crucial tofulfilment of the right to health— It is necessary to take into account needs of vulnerable groups such as

persons with disability, older persons, pregnant women and young mothers— Lack of participation led to ill-equipped evacuation shelters. Some people

returned to their homes in contaminated areas— Affected communities should be involved in decision-making processes

including, planning disaster management and evacuation zones, designing
temporary shelters, implementing and monitoring these decisions

Importance of Education andInformation to the Right to HealthLink between education, information and theright to health— Article 13, ICESCR –Right to education is necessary for the fulldevelopment of the human personality and a sense of dignity, and respectfor rights and freedoms. It shall enable all persons to participate
effectively in a free society— Education is also an underlying determinant of the right to health,which means that the full realization of the right to health is dependent on
providing accurate education and information to people— It is the State’s obligation to recognize education as a right in addition toan underlying determinant of the right to healthLink between education, information and theright to health— Information in textbooks gives the impression that exposure toradiation dose below 100mSv is safe
— Textbooks fail to mention the greater vulnerability ofchildren to irradiation and that special protection should beaccorded to them
— People have the right to education and the right to right to seek

and receive correct, accurate and scientific information— It empowers people to provide informed consent

Link between education, information and theright to health— Informed consent includes refusal to consent and agree with,and oppose decisions, including policies of the State which arebeing imposed on an individual— Informed consent allows individuals to make their own choiceswhich lends itself to the autonomy of the individual— Without sufficient information, people will be unaware ofunsafe radiation levels and harm that is likely to caused byradiation exposureLink between education, information and theright to health— Lack of information will play a role in people’s decision tocontinue to stay in evacuation zones or move elsewhere— As radioactive debris is buried in playgrounds, without

information through children friendly signs and warnings,
children may get exposed to radiation— Without information there will be no effective participation

by affected communities and vulnerable groups in health related
decision-making processes, including implementing, monitoringand enforcing such decisions