Chapter 38
Disasters and Public HealthField of expertise: Disaster and Public Health

Shinichi Kuriyama
Translated by Catherine Sachi Kikuchi

Summary
The Great East Japan Earthquake highlighted the following major issues for disaster public health:
1) the psychology of not escaping immediately, 2) countermeasures immediately after the disaster,and 3) clarification of and countermeasures for medium- and long-term health issues. It isnecessary to intervene in the entire population, develop measures that will increase the possibilityof saving lives even if people are swallowed by the tsunami, as well as to take measures against
many mental and physical challenges in the medium and long term.
Keywords: public health, population strategy, float pack, health survey, medium- to long-term
health effects

Introduction
The study of public health in disaster management aims to mitigate disasters at the predisaster, immediate post-disaster, and mid- to long-term post-disaster stages using the methods ofpublic health as preventive medicine.

1: Problems Revealed by the Great East Japan Earthquake
What happened?
At 2:46 p.m. on Friday, March 11, 2011, the Great East Japan Earthquake occurred with its
epicenter off the coast of Miyagi Prefecture. This earthquake generated a huge tsunami that wasover 10 meters high in some places, causing devastating damage to the Pacific coast of theTohoku and Kanto regions. This massive disaster was named the Great East Japan Earthquake.
The reality of the damage
The Great East Japan Earthquake left 15,899 people dead and 2,529 people missing(National Police Agency, March 7, 2020). Most of the victims of the Great East Japan Earthquake
died from drowning, but there were also many other causes, such as respiratory distress from1

swallowing toxic substances, injuries from debris, hypothermia, and death by fire. After the Great
East Japan Earthquake, earthquake-related deaths caused by the worsening of injuries haveemerged. In addition, most of the physical and mental health issues that surfaced as a result of theGreat East Japan Earthquake remain unknown.

2: Paradigms Destroyed by the Earthquake
Conventional wisdom and necessary responses
Many people died, and there are concerns about medium- to long-term health issues.
There are at least three possible causes for this.
(1) The psychology of not escaping immediately:
Why did so many people drown? One of the main reasons is that people did not evacuate
immediately. Believing the tsunami would not reach them, or having a false sense of security may
have prevented people from evacuating early.
(2) Countermeasures immediately after the disaster:
It is necessary to take measures to reduce the risk of death even in the event of being
swallowed by a tsunami.
(3) Clarification of and countermeasures for medium- and long-term health issues:
In addition to earthquake-related deaths, it is necessary to understand the actual situationof what health problems will emerge after a major disaster, and to plan and implement
countermeasures accordingly.

3: A New Approach
1) The psychology of not escaping immediately
In public health and preventive medicine, the goal is to prevent infectious and lifestylerelated diseases such as cancer and cardiovascular diseases. We have achieved smoking
cessation and salt reduction for those who have no pain or itch. One of the most important findingsof public health is that people do not change their behavior easily even if you tell them thatsmoking causes lung cancer. So what measures have been taken? One summary is shown inFigure 38-1. The term "population strategy" is used here in contrast to "high-risk strategy," which isa strategy of intervening in entire populations, regardless of their risk level, without limiting thetarget audience. The same applies to disasters. It is important for everyone to be aware of theimportance of disaster prevention and mitigation on a regular basis, and to conduct drills,
regardless of the level of risk.

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Figure 38-1. Public health has transformed the behavior of people not experiencing pain. Raising
health and disaster prevention awareness: An example of a population strategy(2) Countermeasures immediately after the disaster
When a disaster occurs, we must evacuate as necessary. When evacuating, people often
have an emergency bag or emergency evacuation kit. Equipping these bags with a life jacket
function can increase the possibility of saving lives in the event of a tsunami. We have devised alife jacket within an emergency bag, as shown in Figure 38-2, and named it the Float Pack.
In the event of a Tokai, Tonankai, or Nankai earthquake, a tsunami of 34 meters isexpected to hit some areas within two minutes of the earthquake. In addition, heavy rains in recent
years may cause sudden flooding, and it is necessary to take concrete measures, including theuse of float packs.

Figure 38-2. The Float Pack
(3) Clarification of and countermeasures for medium- and long-term health issues

3What kind of health problems will emerge after a major disaster? We have conductedseveral large-scale health surveys to identify health issues, and plan and implement necessary
measures. We have published 24 original papers in English related to the Great East Japan
Earthquake so far.
(1) Research on child health in areas affected by the Great East Japan Earthquake (Ministry ofHealth, Labor, and Welfare Research Grant)
In order to clarify the effects of the Great East Japan Earthquake on children's
development, we collected physical measurement data that had been conducted and stored atnursery schools nationwide. Questionnaires were returned from 3,624 day-care centers
nationwide, totaling 69,004 questionnaires.
The results of the survey showed that a large proportion of children who experienced theearthquake at the age of 4 to 5 years were overweight about 6 months after the disaster, and thatthe disaster tended to be significantly associated with atopic dermatitis, especially in boys, and withasthma, especially in girls (Ishikuro et al., 2017).
(2) Child Long-Term Regional Health Survey
The Community Long-Term Health Survey for Children was conducted from 2012 to 2015
for parents of elementary and junior high school students in 28 cities, towns, and villages in Miyagi
Prefecture, and a total of 17,043 people participated over the four-year period. As a result, wefound that the percentage of children with symptoms of atopic dermatitis and the percentage ofchildren who struggle with their mental health tended to be larger among children who experienced
the tsunami and changes in their living environment compared to children who did not experience
the tsunami (Kuniyoshi et al., 2019). The results of the survey have been sent to municipalities andlocal boards of education.
(3) Three-generation cohort survey
The three-generation cohort survey began on July 19, 2013, at a medical institution in thesouthern part of the prefecture (Figure 38-3). It is the first in the world to use a three-generation
birth design, and more than 70,000 people have participated (Kuriyama et al., 2020).
From the three-generation cohort, pregnant women who experienced damage to the homethey were living in at the time of the earthquake tended to have a higher percentage of smoking by
their husbands/partners than those who didn’t experience damage to the home. The rate ofsmoking by the pregnant women themselves was also higher. The results were similar when
adjusted for age and region. In response to these findings, Ishinomaki City established a newsmoking cessation outpatient clinic at Ishinomaki City Hospital in January 2019 (Figure 38-4).

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Figure 38-3. Three-generation cohort survey

Figure 38-4: Long-term health survey and subsequent measures

5Conclusion - from the author“Preserve the lessons, leave no root problem.”
The health effects of the Great East Japan Earthquake may leave a large negative health legacy
for the next generation of people living in the affected areas, namely the children. The lessons fromthe disaster must be preserved, but we do not want to keep the root problem, such as an increasein illnesses.

References
Ishikuro, M., Matsubara, H., Kikuya, M., et al. (2017). Disease prevalence among nursery school
children after the Great East Japan earthquake. BMJ Glob Health, 27;2(2):e000127.
https://doi.org/10.1136/bmjgh-2016-000127. eCollection 2017. PMID: 28589008
Kuniyoshi, Y., Kikuya, M., Miyashita, M., et al. (2019). Prefabricated Temporary Housing andEczema or Respiratory Symptoms in Schoolchildren after the Great East Japan Earthquake: TheToMMo Child Health Study. Disaster Med Public Health Prep, 13(5-6):905-911.
https://doi.org/10.1017/dmp.2019.8. PMID: 31156072
Kuriyama, S., Metoki, H., Kikuya, M., et al. (2020). Cohort Profile: Tohoku Medical Megabank
Project Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study): rationale,progress and perspective. International journal of epidemiology, 49(1), 18–19m.
https://doi.org/10.1093/ije/dyz169. PMID: 31504573

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