保健医療科学

2018 Vol.67 No.1 p.2－10

Topics: Lessons learned on public health from the Fukushima Daiichi Nuclear Power Plant accident＜ Review ＞
Tokyo Electric Power Company Fukushima Dai-ichi
Nuclear Power Plant accident and public healthNaoki Kunugita, Tsutomu Shimura, Hiroshi Terada, Ichiro Yamaguchi
Department of Environmental Health, National Institute of Public Health

Abstract
Off the Pacific coast of Tohoku Earthquake and subsequent Fukushima nuclear accident attacked Japan on
March 11, 2011. The complex disaster with an earthquake, tsunami and nuclear disaster severely damaged
and destroyed human life, properties, natural resources and the environment. Mandatory evacuation wasordered after the accident, and loss of the cooling system for safety of the public from the nuclear reactor
in the Fukushima Dai-ichi Nuclear Power Plant. This order disturbed the usual daily life of the Fukushimaresidents and caused an inconvenient situation for a long-time due to the lack of a link to their local
community. We tried to discuss various issues regarding the public health activities in response to the
Fukushima disaster in this special issue as follows.
Countermeasures: 1) emergency response to the natural disaster, to mitigate the radiation exposuredue to the nuclear accident, 2) medium- to long-term support for secondary health risks and 3) educational
activities of radiation health risks on humans and care of mental health issues due to anxiety of radiation
exposure. All were implemented by various efforts with the cooperation among national and local
politicians, residents, suppliers, distributors and so on. The World Health Organization (WHO), the United
Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), and the International Atomic
Energy Agency (IAEA) consulted on the response to the Fukushima situations. Although the Fukushima
accident was the second worst nuclear accident in the history of nuclear power generation, radiation doses
are limited among Fukushima residents and emergency responders who were apparently not exposed toradiation doses higher than the threshold for induction of acute radiation syndromes. In order to control foodcontamination, provisional regulation values (PRV) were set during radiological emergency situations. Food
monitoring and restriction were conducted to protect internal radiation exposure from contaminated food.
The Fukushima Health Management Survey was carried out to take care of and to support the health of the
Fukushima residents. As a part of this survey, some issues regarding thyroid monitoring and a medium- tolong-term secondary health risks still remained. Furthermore, we mention disaster management laws andsystems, and the role of the emergency management cycle according to each phase.
With all these matters in mind, we overview the Fukushima accident as a brief introduction to this special
issue.
keywords: Fukushima Dai-ichi Nuclear Power Plant accident, radiation protection, public health, disastercountermeasures(accepted for publication, 15th January 2018)

Corresponding author: Naoki Kunugita
2-3-6 Minami, Wako, Saitama 351-0197, Japan.
Tel. +81-48-458-6267; Fax +81-48-458-6270; Email: kunugita.n.aa@niph.go.jp

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J. Natl. Inst. Public Health, 67 (1) : 2018

Tokyo Electric Power Company Fukushima Dai-ichi Nuclear Power Plant accident and public health

I．Overview of the Fukushima Nuclear
accident

contamination and external exposure to humans in the trackof the radioactive plumes. Furthermore, these radioactive
materials may contaminate water and various foods via
the food chain. In the Chernobyl accident, no action on
restricting contaminated foods was imposed in the early
period. Highly radioactive internal exposure was foundamong children who drank contaminated milk with I-131.
The World Health Organization (WHO) reported that there
were about 6,000 cases of thyroid cancer, including 20 fatal
cases due to internal exposure of iodine at 20 years after
this accident [4]. Based on these experiences, food anddrinking water monitoring and supply protection actions
were taken immediately after the Fukushima accident.

1. A complex disaster with an earthquake, tsunami,
and nuclear power plant accident
A severe natural disaster (Off the Pacific coast of
Tohoku Earthquake) occurred in Japan on March 11,
2011. Following the magnitude-9.0 earthquake, damaging
tsunami waves struck the Pacific coast of Japan including
the Fukushima nuclear power plant (FNPP). As a resultof this complex disaster with an earthquake, tsunami, andnuclear accident, we lost precious human lives (15,894
people and 2,546 people missing) [1]. In the event of arelease of radioactive materials into the atmosphere from adamaged nuclear power plant, radionuclides may be widelydispersed leading to contamination of a variety of materials
in the environment (Figure 1) [2]. Human bodies may be
exposed to radioactive elements via two major routes.
One is “External exposure” which is exposure to radiation
released by radioactive materials from outside of the
body. The other is “Internal exposure” which is exposure
through the intake of air, water, food, and other substances
containing radioactive materials into the body by inhalation,oral intake, dermal absorption, and wound penetration. A
radioactive plume contains radioactive noble gases andparticles, such as Iodine-131 (I-131) and Cesium-137 (Cs137) [3]. The radioactive noble gas (krypton and xenon) did
not fall on the ground but incorporated into human body via
inhalation. On the other hand, I-131 and Cs-137 particles
fell out onto the ground surface, leading to environmental

2. Dose rate change following the accident
Fi g u r e 2 s h o w s t h e c h r o n o l o g i c a l c h a n g e s i nenvironmental radiation dose rates in Fukushima, Iwaki,
and Tokyo. A tremendous amount of radioactive material
was mainly discharged into the air from March 12 to March
15, 2011. The Nuclear and Industrial Safety Agency of Japan
17
16(NISA) reported that 1.6× 10 Bq of I-131 and 1.5 × 10 Bq
of Cs-137 were released into the environment during
the Fukushima event [3]. They spread to the southwest
and northwest directions from the FNPP according to
the monitoring data of air dose rates [2]. Air dose rates
suddenly increased about 20 μSv/h following the Fukushima
accident and peaked in mid-march in Fukushima-city locatedon about 60km north-west from the FNPP. Thereafter,
it gradually decreased. On the other hand, in Iwaki city
located on 43 km south-west and nearer than Fukushima

Radioactive
Plume
Nuclear Power
Plant Accident

Fallout

External
Irradiation

Inhalation
Radioactivity in spinachInternal Irradiation
Radioactive Materials

Environmental
Contamination
Food Chain
Radioactivity in seafood

Intake ofContaminated Food

People inContaminated Area

Monitoring of Food

・Biological monitoring(Urine, Blood, Breast milk)・WBC; Whole-body counterFig. 1 Situation of radioactive substances in the environment and health risk after nuclear disaster

J. Natl. Inst. Public Health, 67 (1) : 20183

Naoki Kunugita, Tsutomu Shimura, Hiroshi Terada, Ichiro Yamaguchi
μSv/hour25

Fukushima
61km

20
15

Max.

Usual Value Band:0.037～0.046μSv/h

Min.

10

Fukushima Dai-ichi
Nuclear Power Plant

5

8/26

8/11

7/27

7/12

6/27

6/12

5/28

5/13

4/28

4/13

3/29

3/14

0

μSv/hourμSv/hour
0.3

25

Iwaki
43km

20
15

Max.
0.2

Box indicates natural backgroundlevel of radiation dose rate

Min.
10

Tokyo
230km

Max.

Min.

0.1

5

3/14
3/20
3/26
4/1
4/7
4/13
4/19
4/25
5/1
5/7
5/13
5/19
5/25
5/31
6/6
6/12
6/18
6/24
6/30
7/6
7/12
7/18
7/24
7/30
8/5
8/11
8/17
8/23
8/29

8/26

8/11

7/27

7/12

6/27

6/12

5/28

5/13

4/28

4/13

3/29

0.0
3/14

0

Fig. 2 Chronological changes in environmental radiation dose rates

city, the dose rate was lower than that in Fukushima city
because of the lower concentration of contaminated soil.
Thus, air dose rate is proportional to the contaminationlevels of soil. Radiation dose rate in Tokyo in March 2011
was slightly increased compared to that before the accident,
which is indicated on box in Figure 2. After the middle ofApril 2011, the dose rate was restored to a background levelin Tokyo.

II．Governmental actions in response to the
nuclear disaster1.C ountermeasures for Fukushima nuclear power
plant (FNPP) accident
Countermeasures for FNPP accident have been arrangedby the time course after the declaration of a nuclear
emergency situation. The cabinet response office wasimmediately established after the earthquake. The Ministryof Health, Labour and Welfare (MHLW) issued an order tostand by to the Disaster Medical Assistance teams (DMAT).
Japan declared a nuclear emergency after the failure of thecooling system at the damaged reactors at 19:03 on March
11. The Japanese government issued an evacuation order tothe inhabitants around the nuclear power plant. The radiusof the evacuation zone extended from 3 km to 20 km within
about 24 hours after the breakout of the reactor accident
and the number of evacuees eventually reached 177,000(Figure 3). During evacuation, many efforts were conductedto survey residents and monitor radionuclide levels in theatmosphere, foods, farmland, and water. Unfortunately,a serious concern about the evacuation of hospitalized

4

patients was reported [5,6]. Some elderly hospital patientsdied during their transportation. Details were well
documented in this special issue by Tsubokura [7].
The Central Nuclear Emergency Response Headquarters(NERHQ) instructed that stable iodine (potassium
iodine:KI) should be administered to the evacuees younger
than 40 years old on March 16 to protect the thyroid fromradioiodine uptake by the Nuclear Safety Commission.
In fact, this order did not fully reach most of the local
governments and most people in the affected area did nottake KI due to the disordered situation of the complex
disaster. Yasui has clearly summarized governmental action
for emergency workers in response to the nuclear disasterin the book and this issue [8,9].
2. T he impact of food contamination due to the
Fukushima Accident
In order to mitigate internal radiation exposure due
to intake of contaminated food, MHLW made an effort
to control the food supply. Terada described provisional
regulation values (PRVs) in food and explained the impact offood contamination in the Fukushima accident by using foodmonitoring data [10]. PRVs are set based on past disasters
including Chernobyl nuclear power plant and others [11].
Food with radioactivity levels exceeding these values
should not be consumed and distributed in the market. The
figures on the PRVs are based on 50 mSv/year of thyroid
equivalent dose for radioactive iodine, and on 5 mSv/year of
the effective dose for radioactive cesium [12]. These PRVs
are set very conservatively. There should be no healthconcerns even if some food was consumed for a brief period

J. Natl. Inst. Public Health, 67 (1) : 2018

Tokyo Electric Power Company Fukushima Dai-ichi Nuclear Power Plant accident and public health

Date
11‐MarPM2:4611‐MarPM2:5011‐MarPM3:0411‐MarPM3:1411‐MarPM7:0311‐MarPM9:2312‐Mar
AM5:4412‐MarPM6:25

Public health measures
The earthquake occurred
The Cabinet Response Office was established
MHLW issued an order to stand by to the DMATThe Headquarters for Emergency Disaster Control
of government was established

20km; 177,000

Declaration of a nuclear emergency situation

10km; 51,000

Evacuation of residents: 3km radius from NPP
Evacuation of residents: 10km radius from NPP
Evacuation of residents: 20km radius from NPP

13‐MarStart radioactivity surveillance

15‐MarIndoor evacuations: within 20 to 30km from NPP
Medical transport: within 20 to 30km from NPP

16‐MarKI administration

18‐Mar

Health counseling

21‐MarCompleted medical transport: 700 in patients (6hospitals)

3km; 6,000

Shelter zone Evacuation zone

MHLW: Ministry of Health, Labour and Welfare
DMAT: Disaster Medical Assistance Team
NPP: Fukushima Dai‐ichi Nuclear Power Plant

Fig. 3 Initial actions following the Fukushima Dai-ichi Nuclear Power Plant accident

Average annual radiation exposure（mSv/year）

before the ban was implemented. The MHLW collates theresults of testing and emergency monitoring conducted by
the local governments on radioactive materials in food andpublishes these results on the website (http://www.mhlw.
go.jp/english/topics/2011eq/index_food_radioactive.html).
We are always exposed to natural radiation including
cosmic rays from outer space; terrestrial radiation fromnatural radioactive materials in the ground; ingested
radioactivity, principally potassium-40 and polonium-210 infoods; and inhaled radioactivity, mainly radon. So, the global
average annual effective dose from natural backgroundis 2.4 mSv [13]. In Japan, the average annual effective
dose is lower than the global average, at around 2.1 mSv[14]. According to surveillance data of foodstuff after the
Fukushima accident, the median total committed effective
3.0

Estimated effective dose fromradionuclides in food by this accident

2.5
2.0

Cosmeticrays
Terrestrial

1.5

Terrestrial

Food
Radon
Radon

0.0

3. Thyroid monitoring for children
The risk of thyroid cancer by taking in radioiodine
released from the Fukushima accident was the major
concern for the public in the early stage, because weknow that there was an increase in pediatric thyroid
cancer after the Chernobyl accident [15-17]. The Local
Nuclear Emergency Response Headquarters performeda simplified survey for thyroid internal exposure in Iwaki
City, Kawamata Town and Iitate Village from March 24 to 30
in 2011 on 1,149 children. The survey results of all of thepeople except 66 people, for whom results of the survey
were unable to be generated appropriately due to a higher
background, were below 0.2 μSv/h as a screening level,
which thyroid equivalent dose to 100 mSv for one-year-old
children [18,19]. Takahashi discussed this important issue
regarding thyroid monitoring during childhood [20].

Food

1.0
0.5

Cosmetic
rays

dose was estimated to be 0.1 mSv [12]. Fortunately,internal exposures from the contaminated food due to the
Fukushima accident were small (Figure 4).

World averageJapan

Fig. 4 N atural background radiation and estimatedeffective dose from radionuclides in food by this
accident

4. Survey of mother's milk
Since many mothers were worried about breastfeeding
to grow their infants, the MHLW planned to measureradioactive concentrations in mother's milk. We measured
I-131 levels in 126 breast milk samples from 119 volunteer
lactating women residing within 250 km of the FNPP,
between April 24 and May 31, 2011. Seven of the 23
women who were tested in April secreted a detectable

J. Natl. Inst. Public Health, 67 (1) : 2018

5

Naoki Kunugita, Tsutomu Shimura, Hiroshi Terada, Ichiro Yamaguchi
level of I-131 in their breast milk [21]. Furthermore, Cs134 and Cs-137 contents were determined in 10 placentas
from 10 women who gave birth to term singleton infants
during the period between October 2011 and August 2012using high-purity germanium detectors for gamma ray
spectrometry [22]. Degree of contamination of the placentawith radioactive Cs was lower even in women who resided
within 50 km of FNPP compared to Japanese and Canadianplacentas in the mid-1960s after repeated nuclear tests
and in northern Italian placentas from 1986–1987 after
the Chernobyl power plant accident. Actually, this low
concentration of radiocesium will not cause any detectablerisk for babies, because about 60 Bq/kg of radiopotassium,
naturally exists in their bodies. We reached the following
conclusions based on this survey: 1) Measures are being
taken to deal with radioactive materials, with evacuation
orders and food intake restrictions being issued, so even if
radioactive materials from the air, water, or food intake passinto breast milk, it is thought that this will not affect thehealth of infants. 2) Since breast milk is nutritious and hasother advantages, breast-feeding mothers are advised not
to worry too much. There is no problem with continuing tolead normal lives. Mothers with their breast milk containingsome radioactive materials were reexamined later, and noradioactive materials except natural radioactive materials
were found in the breast milk during the 2nd test.

III．D ose estimation and assessments ofhealth risks due to the Fukushima
accident by International Organizations
Initially, WHO conservatively assessed health risksof residents due to radiation exposure of the FNPP by
September 2011 in the first one year after the Fukushima
accident in order to avoid underestimation of radiation
risks. This report concluded that increases in diseases
due to radiation released as a result of the latest nuclear
accident is undetectable, and risk increases are ignorable
in Japan except for some areas in Fukushima Prefecture,
as well as in neighboring counties [23]. UNSCEAR tried
to assess health risks as realistically as possible by taking
the accumulation of scientific knowledge into considerationin the second year after the accident. UNSCEAR says thatradiation doses are small and it is hardly likely to identify
any health effects of radiation among the Japanese people
in the future [24]. However, both reports still contain
uncertainties regarding dose assessment due to thelimitations in actual data. UNSCERA continues to revise
the assessment when sufficient information was obtained[25,26].

6

IV．Risk communication
Risk communication is considered an impor tantissue not only in the emergency phases but also in therecovery phases [27]. In this issue, Shineha points out
the perturbation of relationship between the government
and public by the power of social media during the early
emergency situation. He focused on science communication
which was not solely examining the scientific contents,
but also the social contexts of science and technology[28]. Yamaguchi also introduced the good practice of theestablishment of local community engagement in Datecity [29]. Many efforts have contributed to the smoothactions to resolve various problems. The stakeholder
involvement provided a good opportunity for networking towork together in resolving the outstanding communication
challenges. Public health nurses are believed to contributeto the support of the health of the local community. They
work together with administrative officers and radiation
specialist to address problematic issues. In conclusion, we
would like to mention the risk communication based on
scientific knowledge is significantly important to reduce thesense of resident’s uncertainty and fears.

V．Disaster management laws and systems,
and the emergency management cycle
Natural disasters cause a great loss of people's lives andproperties in Japan every year. In order to protect national
land and the public, disaster management laws and systems
were developed for promoting national land conservationand progressing society's capabilities (Figure 5) [30].
The disaster management system has been continuously
reviewed and revised following the lessons learned fromlarge-scale disasters. Initially, the Disaster Relief Act
was implemented at 1947 after the Nankai earthquake toprotect disaster affected people and maintain social orderby the national government in cooperation with local public
corporations, the Japan Red-Cross and other organizations,and the general public, at the time of disaster, by providing
emergency relief. The cost for emergency response to
assist the affected people is subjected to the local andnational governments. The Disaster Countermeasures
Basic Act has constantly been reviewed and amended
since its first enactment in 1961. This act provides
the basic idea of disaster countermeasures includingorganization of disaster management administration,and planning system: development and promotion ofsystematic disaster management measures, promotion ofdisaster countermeasures, protection of affected people
and their livelihood, financial measures, and state of

J. Natl. Inst. Public Health, 67 (1) : 2018

Tokyo Electric Power Company Fukushima Dai-ichi Nuclear Power Plant accident and public healthPreparedness
DisasterCountermeasures
Basic Act

Hyperacute phase

Preparedness phase

Disaster

災害対策基本法

Reinforce health facilities
Emergency stockpile
Training

Response

Rescue and relief
Initial lifesaving care

DisasterRelief Act

災害救助法

Acute phase

１W

Intensive care
Disease control and prevention

２－３ W
Mental care
Rebuilding healthy life

Rehabilitation phase

２－３ Y

Subacute phase

２－３ M

Recovery

Psychosocial care
Disease control and prevention

Chronic phase

Act concerning support forreconstructing livelihoodsof disaster victims
被災者生活再建支援法

Fig. 5 Medical response at each phase of the disaster cycle

disaster emergency. The Act concerning the support forreconstructing livelihoods of disaster victims was enacted
in 1998 following the Great Hanshin-Awaji Earthquake.
The Headquarters for Reconstruction of the HanshinAwaji Area (headed by the Prime Minister) was established
to conduct reconstruction in disaster affected areas in aplanned manner; to rebuild disaster victim’s abilities tolive autonomously; to provide disaster-affected people withshelter, and to revitalize the local economy.
Health crisis management is responsible for thehazardous environments and health, and strengthening
public health emergency response. Emergency
management response is considered to be divided into
three phases: response, recovery, and preparedness (Figure5). In the event of a disaster (acute emergency response
phase), disaster and damage information is quickly
collected and shared by secure communications to carry out
effective emergency activities such as emergency rescue
and medical operations. The Disaster Medical AssistanceTeams (DMATs) are dispatched to provide wide-area
medical services. These teams transport severely injured
persons via Self-Defense Forces vehicles and aircrafts to
hospitals outside the disaster stricken zone. In recoveringand reconstructing from disasters (recovery phase), theaim is not merely to restore public buildings to their
original state. In order to improve the disaster resilienceof the community and to reduce disaster damages, there
must be close cooperation among stakeholders such as
residents, politicians, scientists and workers, to build
momentum for a nationwide movement. In particular, publichealth workers collaborated with volunteers and helped
to identify health problems among affected people. In the
preparedness phase, the Basic Disaster Management Plan

is a comprehensive and long-term disaster management
plan forming a foundation for the Disaster Management
Operations Plan and Local Disaster Management Plan
Disaster Countermeasures. A Disaster Management
System is established against various disasters such as anearthquake, tsunami, land-slide, large-scale floods, volcano,and blizzard. Essential actions to prepare for the futuredisaster are disaster reduction drills and exercises, andhuman resources development for local public officers whoare engaged in services for disaster management. There
are links among each phase which we described above.
Emergency management forms a cycle, rather than a linear
pathway, performing the same process over again from the
beginning at the end of each go-round.

Acknowledgements
The authors would like to thank Prof. Erik Robert
Svendsen, PhD, Department of Public Health Sciences,
Medical University of South Carolina for English editing andcareful review of the manuscript. This work was supported
by Industrial Disease Clinical Research Grants (#15080302) from the Japanese Ministry of Health, Labour, andWelfare.

Conflict of Interests
The authors declare that there is no conflict of interests
regarding the publication of this article.

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Naoki Kunugita, Tsutomu Shimura, Hiroshi Terada, Ichiro Yamaguchi

東京電力福島第一原子力発電所事故と公衆衛生欅田尚樹，志村勉，寺田宙，山口一郎
国立保健医療科学院生活環境研究部

抄録
日本では，2011年 3 月11日に発生した東日本大震災に伴う東京電力福島第一原子力発電所事故により，地震，津波，原発事故という未曾有の複合災害を経験した。事故直後より強制的な避難が強いら
れ，自治体のつながりがなくなるなど非常に困難な日々が続いている現実も残されている。本特集では，これらの課題に公衆衛生の視点で幅広く議論することを試みた。
事故後は，行政機関，自治体，住民，生産者，流通業者等様々な立場の人々の努力により，１）甚
大な自然災害に対する対応，および原発事故に伴う被ばく線量軽減の対応，２）中長期的な二次的な健康影響を防ぐための対応，３）放射線・放射能に対する理解，不安軽減対策等が実施されてきた。
WHO, UNSCEAR, IAEA等国際機関等からの多くの報告書が出され，放射性影響は限定的であると評価されている。原発事故は，チェルノブイリ原子力発電所事故に次ぐ，非常に大規模なものであったが，幸いにして原発サイト内の緊急作業従事者を含め，一般公衆住民の方々にも，被ばく線量は限定的な範囲にコントロールされ，被ばくによる急性放射線症候群を発症するような事例は無かった。
事故後に，住民の内部被ばくを防護するために飲食品の放射性物質に関する暫定基準値が設定され広範なモニタリングも開始された。福島県では事故に伴う県民の健康の見守りと将来にわたる健康増進を目的に県民健康調査が実施されている。調査の一部である「詳細調査」で実施されている，甲状腺検査の結果や，避難等に伴う中長期的な二次的な健康影響についても課題が残されている。合わせて，国内における災害対策関係法規と災害時の各フェーズの保健医療の役割を概説する。これらも踏まえ，事故の概要を紹介し，本特集記事全体の導入を行う。
キーワード：東京電力福島第一原子力発電所事故，放射線防護，公衆衛生，災害対策

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J. Natl. Inst. Public Health, 67 (1) : 2018