Fukushima Global Communication ProgrammeWorking Paper Series
Number 02 — February 2015

The Experiences of People
with Functional Needs in Timesof Disasters
Results from the 2013 Sendai Grass-roots Assessment Workshop

Shigeo Tatsuki Doshisha University, Kyoto, Japan

Fukushima Global Communication ProgrammeThis working paper series shares research produced as part of the Fukushima Global Communication (FGC) Programme, aresearch initiative of the United Nations University Institute for the Advanced Study of Sustainability (UNU‑IAS). The FGC
Programme applies a human security approach to examine impacts of the Great East Japan Earthquake, tsunami and nuclear
accident of 11 March, 2011 on people and society, and the challenges of the recovery process in Fukushima. It also focuses on
issues of risk and information provision, aiming to improve understanding of how the threat of radiation is perceived, and thespecific challenges of risk communication related to nuclear energy.
To find out more, please visit fgc.unu.edu© 2015 United Nations University. All Rights Reserved.
The views expressed in this publication are those of the author(s) and do not necessarily reflect the views of the United Nations University.

The Experiences of People with Functional Needs in Times of Disasters

ABSTRACT
In order to identify functional needs of people with disabilities(PWD) during the 2011 Great East Japan Earthquake, 41 impacted
PWD and their supporters were invited to a grass-root assessment
workshop on October 14, 2013. The workshop participants werefrom 16 different organizations for people with visual, auditory,
speech, physical (including paraplegia and quadriplegia), mental
and developmental/ intellectual disabilities as well as for people
with internal organ disorders. They were asked to report on post-itcards what challenges and difficulties they encountered in eachdisaster process phase from 0 to 10 hours, 10 to 100, 100 to 1,000,
and 1,000 hours and later after the 2011 disaster. Following the
Total Quality Management (TQM) method, the participants
themselves sorted/grouped the difficulty and challenge cards
according to the affinity. There empirical clustering processes led
to form a hypothesis that experienced difficulties could beunderstood according to and explained by International
Classification of Functioning, Disability and Health (ICF). Thus
was formed an ICF-by-disaster-time-phase cross-tabulation data.
Its correspondence (dual scaling) analysis revealed quantitatively
the affinity association between ICF (row) categories and theircorresponding disaster phase (column) categories. The results
indicated that “mobility” and “products and technology” were thecritical ICF category during the first 10 hours, “self-care” andreasonable accommodations in “attitudes” of the society arose
during the next 10 to 100 hours, “domestic life” tasks as well as
utilizing “services, systems and policies,” and “general tasks anddemands” especially dealing with psychological stresscharacterized the phase after 1, 000 hours.

1. INTRODUCTION
Japan is a country that is taking the lead in promoting
evacuation and sheltering assistance for the elderly and
PWD in times of disasters. In 2004, Japan experienced aseries of natural disasters such as the Niigata-Fukushima
flood (July), Typhoon Tokage (October), and the Niigata
Chuetsu earthquake (October), in each of which higher
mortality rates were recorded among the elderly and
PWD. Therefore, the Japanese Cabinet Office established
a committee on “Communication of Disaster Informationand Evacuation/Sheltering Assistance for the Elderly andOther Members of the Population during Heavy Meteoro‑
logical and Other Disasters”. This committee published the
Evacuation/Sheltering Assistance Guideline for People with
Special Needs in Time of Disaster on March, 2005. The
committee continued working: they revised the guideline in2006 and also published a report on the guideline in 2007.
The term saigai-jakusha or disaster vulnerable people has
been customarily used since the 1995 Kobe earthquake.
The 2005 and the following committees coined the newterm saigaiji-youengosha or “people with special needs intimes of disaster.” The development of these new termi‑
nologies was based on a paradigm shift in disability stud‑ies, from “medical model of disability” to “social model ofdisability” (e.g. Tatsuki, 2013).

2

The paradigm shift of disability studies has been madepossible by the redefinition of disability by PDW them‑selves. The new definition of disability is based on the per‑spective that disability is socially constructed. The medical
model of disability, an old paradigm, is a one way causal
model. The individual physical condition (impairments)
causes activity limitations and participation restrictions (dis‑abilities), and these cause social disadvantages (handicaps).
The solution proposed by the medical model is medical
intervention for individual impairments. The new social
model, on the other hand, assumes interactive relationships
between individual impairments and social factors. In otherwords, individual impairments do not lead to disabilities,
and disabilities are caused by society when it fails to givereasonable accommodation to the needs of individuals
with impairments. Society has therefore a responsibility
to relieve disabilities (e.g. Oliver, 1990; Hoshika, 2007). In
the field of disaster research, only a very few studies havefocused on people with disabilities from this new social
paradigm of disability (Tatsuki, 2013).
The International Classification of Functioning, Disabilityand Health (ICF) is an international standard that describes
and measures health and disability based on the integrativemodel that accommodate both medical and social modelof disability (WHO, 2002). ICF was accepted by WHO in
2001 as a response to the paradigm shift in disability stud‑ies. In contrast to the International Classification of Impair‑ments, Disabilities and Handicaps (ICIDH), ICF includes
environmental factors and places more attention on theinteractive relationships between individual impairments
and social/environmental factors. By using ICF, it becomes
possible to operationally specify what types of “special
needs” the PWD experienced and more importantly whattypes of “functional supports” are needed in the interac‑
tive relationships between the PWD and their environment
in times of disasters. This paper, therefore, proposes theterm saigaiji-seikatsu-kinou-youshiensha or “people withfunctional needs in times of disasters” (Kailes & Enders,
2007). This term is more operationally specific and there‑
fore implementation-oriented rather than “disaster vulnera‑ble people”, which neglects the social interaction aspect of
why disability is constructed, or “people with special needsin times of disasters”, which is more conceptually vague
and thus less prescriptive to emergency actions.
The purpose of the current study is two-fold: to document
the difficulties that the PWD experienced during and after
the 2011 Great East Japan Earthquake and to analyze theirfunctional needs from a social model of disabilities. The
study draws on qualitative accounts provided by 41 PWD in
Sendai city about their life difficulty experiences in a TQM(Total Quality Management)-style workshop.1 The work‑
shop data was classified by ICF and by disaster time phase(Hayashi, 2003; Kimura et al., 2014). The “ICF category
by disaster time phase” cross-tabulation table was then

The Experiences of People with Functional Needs in Times of Disasters

analyzed by dual scaling (also known as correspondence
analysis) method (Nishisato, 1980), which yielded particu‑
lar sets of a given disaster time phase and corresponding
specific functional needs. The research findings indicatedhow PWD-in-environment interactions needed to be ac‑commodated

2. METHODOLOGY
2.1. Participants
On October 14, 2013, a grass-roots assessment workshop
was held in Sendai city. A total of 41 PWD participated in
the workshop and they were recruited from 16 different
organizations catering for people with visual, auditory,
speech, physical (including those suffering with paraplegia
and quadriplegia), and mental, developmental/intellec‑
tual disabilities as well as for people with internal organ
disorders. They were asked to report on post-it-cards whatchallenges and difficulties they encountered during each of
the disaster time phases (Hayashi, 2003; Kimura et al., 2014)
from 0 to 10 hours, 10 to 100, 100 to 1,000 and to 1,000
to 10,000 hours after the Great East Japan Earthquake.
Following the TQM method that was originally introducedin life recovery assessment workshops for the 1995 Kobe
earthquake survivors, ideas and opinions were sorted ac‑
cording to their affinity.

3of body (physiological functioning and impairments), thewhole person (activity, activity limitation participation andparticipation restriction), and the whole person in a social
context (physical, social and attitudinal environment). As ameasurement instrument, ICF postulates 4 constructs (ordomains) such as Body Functions (b), Body Structure (s),Activity and Participation (d), and Environmental Factors(e), each of which is operationally defined in a hierarchicalfashion (e.g., Chapter, Second level, Third level, and Fourthlevel where Chapter being the most abstract construct andthe following levels operationalizing it by more detailed
nomenclature). Table 1 below illustrates the complete listof chapters in ICF. For this study, each statement that theworkshop participants produced was considered using the
ICF framework and was coded at all four levels.2
Table 1: Chapters of ICF (WHO 2002, p16).
Body
Functions

Structures

Mental functions

Structure of the nervous system

Sensory functions and pain

Eye, ear and related structures

Voice and speech functions

Structures involved in voice and speech

Functions of the cardiovascular, haema‑
tological, immunological and respiratory
systems

Structure of the cardiovascular, immuno‑
logical and respiratory systems

Functions of the digestive, metabolic andendocrine systems
Genitourinary and reproductive functions
Neuromuscular and movement-related
functions
Functions of the skin and related structures

Figure 1: Conceptual diagram of ICF. (WHO 2002, p.9)

Structures related to the digestive,
metabolic and endocrine systems
Structures related to the genitourinary
and reproductive systems
Structures related to movement
Skin and related structures

Activities and Participation
Learning and applying knowledge
General tasks and demands
Communication
Mobility
Self care
Domestic life
Interpersonal interactions and relationships
Major life areas
Community, social and civic life
Environmental Factors
Products and technology
Natural environment and human-made changes to the environment
AttitudesServices, systems and policies

2.2 Instrument
ICF is a classification of health and health-related do‑mains as shown in Figure 1 above and is the international
standard to describe and measure health and disability(WHO, 2002). Based on the social model of disability, ICF
views disability and functioning as outcomes of interac‑tions between health conditions and contextual factorsthat include environmental and personal factors, such as
gender, age, coping styles, and social background. ICF
identifies three levels of human functioning at the level

2.3 Procedure
The workshop data was classified by ICF and by disastertime phase. This produced an “ICF category by disastertime phase” cross-tabulation table. The association among
the table row and column categories was then quantita‑
tively analyzed by dual scaling (also known as correspond‑ence analysis) method (Nishisato, 1980), a technique for
performing quantification based on the principle of internalconsistency.

The Experiences of People with Functional Needs in Times of Disasters

4

Table 2: Grass-roots assessment workshop results
Disaster Time Phase

ICF Category0 – 10 hours

10 – 100 hours

d1: Learning and Applying
Knowledge

100 – 1,000 hours

1,000 hours +Row Total

0

(0%)

1

(1%)

0

(0%)

0

(0%)

1

(0%)

d2: General tasks and demands

12

(10%)

11

(6%)

7

(7%)

9

(21%)

39

(9%)

d3: Communications

0

(0%)

2

(1%)

1

(1%)

1

(2%)

4

(1%)

d4: Mobility

13

(11%)

3

(2%)

0

(0%)

2

(5%)

18

(4%)

d5: Self care

8

(7%)

31

(18%)

15

(15%)

3

(7%)

57

(13%)

d6: Domestic life

31

(27%)

50

(29%)

33

(33%)

12

(29%)

126

(29%)

d7: Interpersonal interactions andrelationships

1

(1%)

0

(0%)

0

(0%)

0

(0%)

1

(0%)

d8: Major life areas

0

(0%)

0

(0%)

3

(3%)

1

(2%)

4

(1%)

d9: Community, social and civic
life

0

(0%)

0

(0%)

0

(0%)

1

(2%)

1

(0%)

e1: Products and technology

30

(26%)

37

(22%)

13

(13%)

0

(0%)

80

(19%)

e2: Natural environment andhuman-made changes

1

(1%)

0

(0%)

0

(0%)

0

(0%)

1

(0%)

e3: Support and relationships

12

(10%)

9

(5%)

8

(8%)

4

(10%)

33

(8%)

e4 Attitudes

1

(1%)

3

(2%)

3

(3%)

0

(0%)

7

(2%

e5: Services, systems and policies

6

(5%)

25

(15%)

17

(17%)

9

(21%)

57

(13%)

Total

115

(100%)

172(100%)

100(100%)

42(100%)

429(100%)

3. RESULTS

essential utility, transportation and other critical facilities’basic functioning that took approximately 1,000 hours.

3.1 ICF-by-Disaster Time Phase Cross-tabulation

It became clear that PWD did not experience whole rangeof ICF category-related difficulties equally but specific cate‑gory-related difficulties were experienced more often thanthe other. The current study found that all the reported
difficulties were classified either in the domain of Activities
and Participation or Environmental Factors. The four mostreported difficulties in Activities and Participation were in
the area of “d6 Domestic Life” (29%) (e.g., acquisition ofnecessities, household tasks, and caring for household ob‑
jects), “d5 Self-Care” (13%) (e.g., washing oneself, caring forbody parts, toileting, dressing, eating, drinking and looking
after one’s self), and “d2 General Tasks and Demands” (9%)(e.g., undertaking a single and multiple tasks, daily routine
and holding stress and other psychological demands),and “d4 Mobility” (4%) (e.g., changing and maintaining
body position, carrying, moving and handling objects,
walking and moving, and moving around using transporta‑tion). Within the environment factors, the top three mostreported life functioning needs were “e1 Products andTechnology” (19%) (e.g., medicines, equipment for personal
daily living and mobility, and products and technology forcommunication), “e5 Services, Systems and Policies” (13%)

Forty-one grass-roots TQM-style assessment workshop
participants produced 429 statements regarding the life
difficulties they experienced after the onset of the Great
East Japan Earthquake-procedures of the workshop was
described in detail at the footnote on page 2. These state‑ments were first categorized into one of the disaster timephases by the workshop participants themselves.
		
The statements were then clustered into more summative
groupings and each grouping was coded based on the
ICF categories. Table 2 below shows frequencies of ICF
category (Chapter and Second nomenclature level) by timephase. It was revealed that life difficulties experienced by
PWD peaked during the first 100 hours (about 70% of all
the reported difficulties) and lasted about 1,000 hours (90% of difficulties collected at the workshop). This suggested
that PWD life difficulty experiences during the disaster time
approximately corresponded to the time phase when basic
functioning of the society had been impacted by the disas‑
ter, until emergency relief activities helped to recover theThe Experiences of People with Functional Needs in Times of Disasters(e.g., utilities, services for communication, transportation,
civil protection, legal and administrative applications, social
security, general social support, and health), and “e3 Sup‑ports and Relationships” (8%) (e.g., family, friends, neigh‑bors, personal care providers, strangers, health and otherprofessionals).

5

Figure 3: Corresponding analysis results of ICF-by-time phasecross-tabulated data

3.2 Correspondence Analysis of the ICF-byDisaster Phase Cross-tabulation Table
In order to explore ICF-needs-by-disaster time phasepatterns, proportions of ICF categories at each disastertime phase were graphically displayed in Figure 2 below.
In order to identify the most characteristic associations of
the ICF needs (rows of Table 2) and time phase (columns ofTable 2) , correspondence (dual scaling) analysis was em‑
ployed to analyze quantitatively more intricate associations
among table 2 row and column categories. For example,
ICF category of “d4 Mobility” accounted for less than 4 %out of all the reported difficulties (i.e., 18/429). However,it accounts for 11 % of the ICF categories if one focuses
only to the first 10 hours (13/115) (see also Figure 2). Thissuggests that there may exist a characteristic relationshipbetween the row category (d4 Mobility) and the column
category (0hr to 10 hour). Correspondence analysis pro‑duces a two-dimensional plot (or biplot) of row and column
category of cross-tabulation data where those characteris‑tic or corresponding row and column categories are placed
in proximity in usually a 2 dimensional space (Nishisato,1980).

Note: Those categories with low frequencies (i.e., less than 1 %) were excluded fromthe analysis for robustness and stability of the analysis results.

The result of the correspondence analysis is shown in the
Figure 3 above, where 1) four time phases and correspond‑
ing ICF category sets were clustered into four groups and2) characteristic ICF and disaster time phase correspond‑ences were revealed. First of all, the left side cluster shows
the most characteristic ICF categories that appeared within
the first 10 hours after the earthquake and it included “d4Figure 2: Proportions of ICF categories by disaster time phase
35%
30%
25%
20%
15%
10%
5%
0%

0hr - 10hr

10hr - 100hr

100hr - 1,000hr

1,000hr -The Experiences of People with Functional Needs in Times of Disasters

6

Mobility” and “e1 Products and Technology.” The mostlife-threatening needs that PWD experienced in this phasewere that of mobility. In normal circumstances, PWD canrely on cars, wheel chairs, and other equipment for trans‑
portation with the support from family members and theircare workers. Most PWD, however, were not able to findthe support from the immediate relationships and thus
were not able to evacuate to nearby shelters. If they wereable to elicit extra help from neighbors and even strangers
for mobility support and to move to shelters, they faced
life difficulties due to the lack/unavailability of “e1 Products
and Technology” such as medicines, equipment for per‑sonal daily living and mobility, and products and technol‑
ogy for communication.

in the middle of Figure 3 indicating that there was no peakphase for this category and it was exhibited equally among
the four time phases which is also illustrated in Figure 2.

The right upper area shows the cluster consisting of two
disaster time phases of 10 to 100 hours as well as that of
100 to 1,000 hours. These time phases corresponded withthat of sheltering (10 to 100 hours) and of living a life whenlifeline and other basic critical facilities were not function‑
ing at normal level. The 10 to 100 hours phase was first typ‑ified by “d5 Self-Care” difficulties which included washingoneself, caring for body parts, toileting, dressing, eating,drinking and looking after one’s self either at the shelteror at their disaster affected home. These difficulties wereaccompanied by the continuing lack/unavailability of “e1
Products and Technology” such as medicines, equipment
for personal daily living and mobility, and products andtechnology for communication. The life conditions of PWD
were further aggravated by the lack of reasonable accom‑
modation from “e4 Attitudes” in family members, friends,
neighbors, shelter authority, personal care providers, stran‑
gers, health professionals, society and social norms. The
succeeding 100 to 1,000 hours phase was characterized by
gradual re-entry into post-disaster normalcy where PWD
faced daily chores associated with “d6 Domestic Life” that
included acquisition of necessities, household tasks, andcaring for household objects and those with “e5 Services,
Systems and Policies” (e.g., utilities, services for communi‑
cation, transportation, civil protection, legal and adminis‑
trative applications, social security, general social support,
and health).
The right lower cluster was characterized by the time phaseof 1,000 hours and over and “d2 General Tasks and De‑
mand” which mainly consisted of handling stress and otherpsychological demands in post-disaster recovery time.
Finally, “e3 Support and Relationships” need was situated

4. CONCLUSION
This study showed how society and PWD themselves need‑
ed to handle the situation that PWD faced in each timephase. First, the results indicate that during the first 10
hours, society in collaboration with PWD and their families
need to activate Mobility assistance plans that would help
PWD to a nearby safer environment including the desig‑
nated shelter. The evacuation assistance plan should also
enumerate a list of accompanying necessities – i.e. Prod‑
ucts and Technology – such as medicines, equipment for
personal daily living and mobility, and products and tech‑
nology for communication. Due to the fact that the PWD
were not able to rely on regular service and care personnel
for the mobility assistance, it is also important to build analternative mobility assistance team in the neighborhood
community. Second, sheltering assistance plans need to be
activated in the 10 to 100 hour time phase. Such Self-Careneeds as washing oneself, caring for body parts, toileting,
dressing, eating, drinking and looking after one’s self are
critical in this period and therefore the matching reason‑
able accommodations need to be arranged at every desig‑
nated shelter. Third, 100 to 1,000 hour phase is character‑ized by gradual re-entry into post-disaster normalcy when
PWD face the tasks associated with Domestic Life suchas acquisition of necessities, household tasks, and caring
for household objects. It is expected that a large numberof disaster volunteers could be coordinated in order to
respond to these needs. Third, specific needs that require
expert and professional assistance also tend to arise during
the same phase for utilizing Services, Systems and Policies
in utilities, services for communication, transportation, civil
protection, legal and administrative applications, social
security, general social support, and health. Professional
volunteers and other outside experts/professionals could
be mobilized to respond to these needs. Fourth, the phaseover 1,000 hours is characterized by such General Tasks
and Demands as handling the continuing stress and otherdemands in post-disaster recovery time. Traumatic stressprevention programs that focus on PWD may need to beprepared. Last, it is essential that the above indicatedsolutions need to be pre-planned before the next disasterhit the society.

Shigeo Tatsuki is Professor in the Department of Sociology at Doshisha University, Kyoto, Japan.
Email: statsuki@mail.doshisha.ac.jp
This research was supported by a 2012 to 2016 RISTEX, JST grant entitled “Optimal life recovery assistance for disaster survivors living in government-rented private apart‑ments/houses as temporary housing in a widely dispersed area” (Principal investigator Shigeo Tatsuki) and also by a 2012 to 2016 MEXT grant to Tohoku Fukushi University
entitled “reconstruction of community-based health and welfare systems after the Great East Japan Earthquake Disaster.”The Experiences of People with Functional Needs in Times of Disasters

7

Notes
1

Total Quality Management methods were developed in order to improve product quality from the perspective of factory assembly line workers (Nayatani, Eiga, Futami,& Miyagawa, 1994). The purpose of Total Quality Management workshop is to sort out verbal data, to stimulate creativity, to put complex problems into solvable form,
and to ensure that nothing is left out when planning. Sendai PWD workshop utilized affinity diagram, one of the seven TQM tools that were developed by Nayataniand his associates. The participants from divergent impairment categories formed small group (six to seven members) Quality Control circles at the workshop. Eachparticipant independently produced verbal data on experienced life difficulties on post-it cards on a one-experience-on-one-card basis. After all verbal datum werecollected, cards were grouped based on the affinity, i.e., the cards with similar statements were empirically clustered into a more summative grouping. In Sendai
workshop, each summative grouping was then classified according to ICF and disaster time phase.

2

For more detailed definitions of all ICF definitions, please refer to the ICF illustration library: http://www.icfillustration.com/icfil_eng/top.html

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