Old Age, Disability, and the Tohoku-Oki
Earthquake
Shigeo Tatsuki,a) M.EERI

Since the Evacuation/Sheltering Guideline was first published in March 2005,
Japan has been a leader in systematically promoting evacuation and shelter assistance initiatives for people with special needs (PSND) in times of disasters.
Despite the nationwide, community-based initiatives prescribed by the Guideline,
this paper first addresses the issue of evacuation by examining mortality data of thetotal population, the elderly, and people with disabilities (PWD). The elderly and
PWD mortality rates were not even across the three disaster-hit prefectures. Theirinstitutionalization rate was suggested as one of the causative factors; more elderly
and PWD died in Miyagi because more of them resided in their own homes, due tothe prefecture’s socially inclusive normalization policy. A case study of Miyagi’s
Hachiman community responses to its 17 registered PSND illustrated the ways toovercome the issue of mainstreaming preparedness components in the everyday
practice of social inclusion for the elderly and PWD. [DOI: 10.1193/1.4000126]
INTRODUCTION
People with disabilities (PWD) in disasters have long been a neglected issue in disasterstudies and practice. Despite some early sensitizing works (e.g., Friedsam 1960, Tierney et al.
1988), the legislative changes that ensure equality of public services and goods to PWD such as
the Americans with Disabilities Act (1990) in the United States, and the corresponding publication of guidelines for emergency managers (e.g., American Red Cross 1997, Kailes 2002,
FEMA/American Red Cross 2004), the issue has been largely invisible to the minds ofresearchers or practitioners and PWD have been excluded from planning, decision-making
or management of mitigation-preparedness-response-recovery cycles up until recently(Twigg et al. 2011). However, since the early 2000s, especially after 2004’s Indian Ocean
earthquake and tsunami and 2005’s Hurricanes Katrina and Rita, there have been a growing
number of coherent, yet limited, findings on PWD in disasters in English literature: PWD tend
to be disproportionately more vulnerable to disasters; disaster preparedness, response, andrecovery operations pay little attention to the needs and capacities of PWD; and the plando-check-action process of disaster management has not yet made significant advances toward
more social inclusion of PWD (White et al. 2007, Kailes 2008, Kett and Twigg 2007, Clive
et al. 2010, Twigg et al. 2011, Wisner, in press).
The issues of frail elderly in disasters have gained significant attention in Japan since 2004
when a series of natural disasters hit the Japanese archipelago, including the July NiigataFukushima flood, the 23 October typhoon, and the October Niigata Chuetsu earthquake,a)

Department of Sociology, Doshisha University, Imadegawa-dori Karasuma-higashi-iru, Kamigyo-ku, Kyoto,602-8580, Japan
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Earthquake Spectra, Volume 29, No. S1, pages S403–S432, March 2013; © 2013, Earthquake Engineering Research InstituteS404

S. TATSUKI

wherein notably more than 60% of the victims were over the age of 65. As a response to thesetragedies, Japan’s Cabinet Office established a committee on “Communicating Disaster Information and Evacuation/Sheltering Assistance for the Elderly and Other Population during
Heavy Meteorological and Other Disasters.” The committee published the first edition of
the “Evacuation/Sheltering Assistance Guideline for People with Special Needs in Times ofDisaster” in March 2005. After the guideline’s publication, the term saigaiji-youengosha or“people with special needs in times of disaster” (PSND) was popularized in place of saigai-jakusha or “disaster-vulnerable people.” The guideline defines PSND as follows:
Those who require assistance for a series of evacuation actions in order to obtain necessary information
promptly and accurately and thus to protect oneself in times of disaster. Examples of PSND include theelderly, PWD, foreigner, infants and pregnant women. PSND also have difficulties to adjust to new environments that are caused by evacuation, sheltering and changes in housing. They are, however, able tofunction daily, whereby living independently given the proper resources and services when necessary.

The guideline then suggests the following more practical examples that have been
employed by some municipalities that have started their own PSND counter-disaster measures initiatives:
1.

2.
3.

Those who are at his/her own residence and are assessed as long-term care (LTC)1
level 3 or more (i.e., require moderate level of home care) who cannot stand up or
walk without assistance from the other.
People with disabilities who are assessed as physical impairment level 1 or 2 and/or
intellectual disability level A.
Single household elderly, elderly couples and other forms of non-single elderly
household.

Following another series of heavy rainfall, flood and landslide disasters in the subsequent
year of 2005, another Cabinet Office committee conducted field research on the 2005 meteorological disaster sites and revised the evacuation and sheltering assistance guideline in March
2006. The 2006 guideline emphasized: (1) establishing a special team in each municipal
government that was in charge of coordinating assistance to the target population; (2)encouraging the information sharing of the special needs population within the local government and, if possible, with local community organizations, such as neighborhood associations and community emergency and response team; and (3) planning individualized
evacuation/sheltering procedures for each PSND.
In the following fiscal year of 2006, the committee on PSND continued working on moredetailed procedures and workflows in order to collect and share information on PSND, and to
make individualized evacuation and sheltering assistance plans. In March 2007, the committee published the “Report on Preparedness Procedures for PSND,” which emphasized
the establishment of a system to assist PSND by facilitating cooperation between the1

The Long-Term Care (LTC) Insurance program in Japan was introduced in 2000. Individuals 65 years old andabove are generally eligible for LTC services. However, individuals 40–64 years old may apply for “long-termcare certification” from the municipality to be eligible for LTC services. Services range from home care visitsfrom home helpers and use of special nursing homes for the elderly (Ministry of Health, Labor and Welfare 2002).
LTC Level 3 or more means that a person requires a moderate level of care because s/he cannot stand up or walkby oneself, requiring full supports for toileting, bathing, and changing clothes.

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE

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local/municipal government disaster management department and its health and welfare
department. The role of the disaster management department is to provide local hazard
information, while the health and welfare department provides information on potential
vulnerabilities within the target population. The 2007 report encouraged the use of maps
where potentially vulnerable individuals, such as the frail elderly and people with disabilities(PWD) were projected onto multiple hazard layers, such as flood, landslide, and seismicity.
The map can help identify who are at more risk because of their functional needs as well as of
their geographic locations (Enders and Brandt 2007, Tatsuki and Comafay 2012).
It should be noted that when the Cabinet Office first established the 2004 committee on“Communicating Disaster Information and Evacuation/Sheltering Assistance for the Elderly
and Other Population during Heavy Meteorological and Other Disasters,” the term saigaijakusha or “disaster-vulnerable people” was in use by the Office staffs and some committee
members. In Japanese context, the term implies that the vulnerability is defined by their
impairments and therefore is treated as a trait of those individuals. Disability literature(e.g., Oliver 1990, Twigg et al. 2011) calls this a “medical model” of disability. The
term also implies that the society should respond to them in a compassionate manner
like good Samaritans. This orientation is called a “charity model” of disability. In otherwords, it was apparent that mixtures of medical and charity models of disability were dominant when the committee started its work in the fall of 2004. After the committee started its
activities, the facts from recent disasters such as the 2004 Niigata-Fukushima Flood disasterwere briefed to the committee members: It was not simply the age or the frailty of the victims
that mattered in death and life situations and the most vulnerable were those elderly in single
or two-person (most typically elderly couple) households in a high-risk flood prone area
whose everyday life was supported solely by formal community care (i.e., LTC) services
such as home help, meals on wheels, day care, daily nurse visits and alike and, at thesame time, whose informal social support network is weak. During normalcy, these people
can rely solely on formal service providers for survival in everyday life at their own home.
During disaster, however, those formal service providers are not able to come and help. In
addition, if one’s informal support from kith and kin is weak, s/he becomes very vulnerable tothe threats of the hazards (Hayashi and Tatsuki 2004, Hayashi and Tamura, 2005). Based on
the new evidence, the committee members started talking about an alternative model of disaster vulnerability which viewed it as a relational concept and considered it as a product ofhazards, person needs as well as their capabilities, and environmental responsiveness to theirfunctional needs. In order to stress this conceptual shift, the term saigaiji-youengosha or“people with special needs in times of disaster (PSND)” was coined for the publicationof the 2005 guideline.
In order to define the degree and nature of special needs for each PSND, the person-inenvironment (PIE) model of vulnerability was proposed (Tatsuki 2012, Tatsuki and Comafay
2010, 2012), which defined disaster Vulnerability (V) as a function of Hazards (H), Person(P), and Environment (E) factors, or V ¼ f ðH; f ðP; EÞÞ. The P factor includes a demographic
variable, long-term care (LTC) level, physical/intellectual/mental disability, and physicalimmobility variables. For example, those who are over the age of 85 (“oldest-old”), LTC
Level 3 or more, with physical impairments and immobility may score high on P factor
vulnerability. E factor includes built-environment fragility, as well as levels of social capitalin the neighborhood. Those who reside in housing that was built before the new seismic

S406

S. TATSUKI

standard was introduced in 1981 and where his or her neighbors are not inclined to help eachother may be highly vulnerable on E factor. Person and Environment interaction, or the P × E
factor, includes household size and social isolation variables. If an oldest-old person answers
that s/he lives by him- or herself, that the person whom s/he relies on in case of emergency
resides outside of the city boundary, and that it would more than one hour for that help toarrive, s/he is vulnerable on this factor. The overall disaster vulnerability is estimated by asummation of all factor scores. Note that even though one is vulnerable on the P factor
because of the old age and a high (i.e., more than Level 3) LTC level, one’s overall disaster
vulnerability may not necessarily be high if s/he enjoys daily close contacts with alarge number of family members who live together in the same household, and therefore
the P × E factor counterbalances the P factor vulnerability.
The alternative thinking that led officials to coin the new term PSND in the 2005 guideline seemed to align itself closely with a “social model” of disability (Oliver 1990), which
defines disability as the social construction after having impairments. Because it is a social
construction, disaster-countermeasure planning and implementations for PSND also need tobe social. They require both society and individuals to work collaboratively in order to meet
PSND’s basic life functional needs, such as those for communication, medical care, maintaining functional independence, supervision, and transportation (Kailes and Enders 2007)
during a disaster. Unlike its UK or U.S. counterpart models, however, an emancipatory anduniversalist orientation toward social inclusion (Oliver 1990, Barnes 2001) was less emphasized. For example, the 2005 guideline and the following revisions have kept emphasizing
the use of “specially designated” shelters for PSND, and issues of universal access and social
inclusion in designated shelters were so far not discussed at all.
The Japanese approach to issues of PSND may not have been universally oriented
toward social inclusion. Nevertheless, almost all municipalities in Japan have undertaken
disaster countermeasures planning and implementation initiatives for PSND since the publication of the 2005 guideline, the 2006 revised guideline and the 2007 report. According
to the survey conducted by FDMA, as of 1 April 2011, 1,262 out of 1,644 municipalities(76.8%) completed formulating PSND assistance master plans and an additional 349 municipalities (21.2%) were expected to finish within 1 year. Similarly, 864 (52.6%) municipalities reported that they have finished creating and have been updating the PSND
registry. A total of 684 (41.5%) municipalities said that they were currently in the processof making the registries. Municipalities have also been working hard on assigning local
residents/helpers as registered evacuation supporters (RES). A total of 361 (22.0%)
reported that they have completed the RES assignment, 998 (60.7%) are in the process,and 285 (17.3%) have not yet initiated the process (Fire and Disaster Management
Agency 2011).
Until recent years, the issue of people with special needs in times of disasters have been
one of the most neglected themes in disaster research in English and Japanese. Japan was oneof a few countries where nationwide initiatives on PSND have been planned among almost
all municipalities and have been implemented among about one-fifth of them. The objectiveof this paper is to examine how these disaster countermeasures, as prescribed by the Evacuation/Sheltering Assistance Guideline for PSND (2005, 2006), worked or did not work in oneof the better-prepared nations during the 2011 Tohoku-oki earthquake disaster, in order toOLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE

S407

learn lessons from the local practices and to suggest the next actions to be taken toward better
management of issues associated with PSND. In order to answer the research questions, different sources of data on the prefectural, municipal, community, organizational, and individual levels were used. Death tolls by prefecture (Iwate, Miyagi, and Fukushima) and by age
group were obtained from the National Policy Agency. Municipal death rates of all residents,
as well as those of PWD, were obtained from the Japan Broadcast Corporation (NHK) production team who conducted a series of three repeated telephone interview- and simple facsimile-based questionnaire surveys on the death tolls for all residents and those of PWD,
directed to all 31 municipalities that recorded more than ten casualties from to the 11
March 2011 disaster. The NHK surveys were conducted in September 2011, January
2012, and September 2012. The survey repetition was necessary because municipalities
kept updating PWD death tolls. Community-level results on the death and life situationsof all 17 registered PSND in Hachiman, Ishinomaki City, was also obtained from the
NHK team that conducted snowballing-style qualitative interviews to surviving PSND,
their RESs, and key stakeholders in the community.
CASUALTY GAPS BETWEEN THE TOTAL POPULATION AND PSND2ELDERLY CASUALTIES

Despite the abovementioned national and local government initiatives and corresponding
community efforts on PSND disaster countermeasures in recent years, serious problems confronted municipalities, communities, PSND, and their families at the onset of the 11 March2011 Tohoku-oki earthquake and tsunami disaster. Table 1 shows the death toll that was officially tallied and announced by the National Police Agency on 6 March 2012, the total population as of the 2010 census date of 1 October (The Statistics Bureau and the Director-Generalfor Policy Planning of Japan 2011), and the number of deaths per 100,000 by gender, age, andprefecture. Figure 1 shows the proportion of Iwate, Miyagi, and Fukushima casualties by age
group (gray bars) for each gender. For comparative purposes, population pyramids of the threeprefectures (transparent bars) were overlaid onto the casualties-by-age-group bar charts.
Figure 1 indicates that proportionally a far greater number of both male and female elderly(those who were over 60) died. Those who were over the age of 60 accounted for 64% of all
male and 68% of all female casualties. Furthermore, gaps between gray (proportion of a given
age-group casualty out of the total casualties) and transparent (proportion of a given age groupout of the total population, which indicates the expected proportion of its age group) bars
widened as age class increased. Compared with the expected proportion as estimated by
the total population age distribution, 1.5 times more men of their 60s and 1.3 times more
women of the same age group died. For men and women in their 70s, the ratios were 2.5
for men and 2 for women. For those who were over 80 years old, proportionately 3.4
times more men and 2.6 times more women died than the expected proportion. Future
study needs to explore causes of the high elderly death toll despite the recent nationwide
2

The following mortality data for the total population, the elderly, and PWD do not distinguish those who were
institutionalized at the time (e.g., in hospitals and nursing homes) from those who were living at home. The
reported mortalities were therefore treated as the best proxies of PSND mortality.

S408

S. TATSUKI

Table 1. Death toll, total population, and number of deaths per 100,000 by gender andage group

Death toll

Number of deaths
per 100,000

Total population

Prefecture

Age

Male Female

Total

Male

Female

Iwate

0–9
10–19
20–29
30–39
40–49
50–59
60–69
70–79
80+

30
41
75
134
165
297
426
550
400

54
41
59
108
180
308
466
606
616

84
82
134
242
345
605
892
1,156
1,016

54,28765,30659,63780,39079,90095,05990,142
70,13036,961

51,93061,91858,98077,57580,17095,48698,326
93,84475,041

106,21755
127,224
63
118,617 126
157,965 167
160,070 207
190,545 312
188,468 473
163,974 784
112,002 1,082

104
66
100
139
225
323
474
646
821

79
64
113
153
216
318
473
705
907

Miyagi

0–9
170
10–19 137
20–29 177
30–39 275
40–49 321
50–59 509
60–69 900
70–79 1,070
80+
733

165
147
155
253
348
573
854
1,116
1,248

335
284
332
528
669
1,082
1,754
2,186
1,981

101,846
117,822
135,185
162,597
145,852
158,825
151,083
102,335
52,571

97,068111,475
134,457
161,165
146,619
162,591
157,214130,242
101,686

198,914 167
229,297 116
269,642 131
323,762 169
292,471 220
321,416 320
308,297 596
232,577 1,046
154,257 1,394

170
132
115
157
237
352
543
857
1,227

168
124
123
163
229
337
569
940
1,284

Fukushima

0–9
10–19
20–29
30–39
40–49
50–59
60–69
70–79
80+

29
24
25
44
51
103
167
172
156

18
29
24
33
50
92
129
233
222

47
53
49
77
101
195
296
405
378

89,226104,283
98,828
127,461
122,131
148,080
136,356
96,08654,72585,14698,804
94,349122,496
121,730
145,806
137,326
125,140
109,005

174,372
203,087
193,177
249,957
243,861
293,886
273,682
221,226
163,730

33
23
25
35
42
70
122
179
285

21
29
25
27
41
63
94
186
204

27
26
25
31
41
66
108
183
231

7,181

8,127

15,308 2,737,104 2,935,589 5,672,693 8,241

7,379

7,704

Total

Total

Male Female Total

Note: The above table does not include 414 (Age unknown) or 64 (Age and Gender unknown).
Source: The National Police Agency, 6 March 2012; The Statistics Bureau and the Director-General for Policy Planning ofJapan, 2011, 2010 Population Census.

initiatives for preparing disaster countermeasures for people with special needs, as was outlined in the previous section.
Figure 2 compares a ratio of the observed death proportion (gray bar) to the expected
proportion (white bar) for a given age group by gender and prefecture in Figure 1. If the ratio
is under 1, the observed death toll is proportionately lower than the population composition

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE

S409

Figure 1. Population pyramid and the Tohoku-oki earthquake and tsunami mortality rate by
prefecture by gender and age group as of 6 March 2012 (Source: The National Police Agency
2012, The Statistics Bureau and the Director-General for Policy Planning of Japan 2011).

for that age group. If the ratio is over 1, more deaths are observed for that particular age groupcompared with population age composition. The ratios among the three prefectures weresimilar (below 1) for men and women who were under 60 years of age. Over the age of60, the ratios became bigger than 1, suggesting proportionately more of these age groups
died in the three prefectures. Despite the nationwide counter-disaster measure initiatives
in recent years, the results indicate that more extensive and intensive efforts are needed
to counteract the vulnerability of elderly people to disasters, which have been reported in

S410

S. TATSUKI

Figure 2. Ratio of observed to expected death toll by age, gender, and prefecture (Source: The
National Police Agency 2012, The Statistics Bureau and the Director-General for Policy Planningof Japan 2011).

the field (e.g., Friedsam 1960, Blaikie et al. 1994, Tanida 1996, Wisner, in press, Sharkey2007). Furthermore, gender and prefectural differences emerged for those who are over
60 years of age. For these age groups, proportionately more male than female elderlydied. In addition, male and female elderly died proportionately more in Miyagi and Fukushima compared with Iwate Prefecture. Future investigations are needed in order to explainelderly death rate differences in gender and prefecture and to examine whether these differences are somewhat related to the differences in gender and prefecture specific initiatives.
PWD CASUALTIESWith regard to casualties among PWD, two mass-media corporations, Mainichi Shimbun
newspaper and Japan Broadcasting Corporation (NHK), independently conducted telephoneand facsimile-based surveys of the disaster-hit municipalities3 in Iwate, Miyagi, and Fukushima
Prefectures. While Mainichi data has not been updated since it was published in late3

Mainichi Shimbun reported the results from 33 municipalities in three disaster-hit Tohoku prefectures on 24
December 2011, while NHK focused on those 31 municipalities where more than ten resident casualties
were recorded. A part of NHK survey results was broadcast through ETV on 6 March 2012. Although the
NHK survey was more detailed because it examined separate casualties among different disability
categories, those numbers were not reported in the TV program. The original NHK survey data wasprovided to the author, who served as a commentator for the 6 March program. The major difference
between the Mainichi and NHK surveys appeared in Ishinomaki City, where Mainichi PWD casualties (599)
were much higher than those in the NHK survey (397 casualties). A personal communication to Mr. Kotaro
Teranishi, the producer of the 6 March show, explained that the Ishinomaki City administration confounded
direct and indirect death among PWD until February 2012. NHK thus used the direct casualties (397).

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE

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December 2011, NHK has updated the municipality PWD death toll4 in January 2012 andSeptember 2012 since the first survey that was conducted in September 2011. The
NHK data was also cross-validated with the official PWD death toll by the Miyagi Prefecture administration at the end of August 2012. Cross-validation indicated that the NHK data
was far more up-to-date and accurate than those of Mainich Shimbun. It was therefore
decided that the NHK death toll would be used in order to estimate PWD casualties forthe tsunami-hit municipalities in the other two prefectures, Iwate and Fukushima, whichhave not released the official numbers on PWD death.
Table 2 shows the mortality rates of the total population, those of PWD (all categories),
and those for such specific disability categories as intellectual, physical (including visual,auditory, and orthopedic impairments), and mental disabilities. Figure 3 displays a veryclear correlation between the total death tolls and those of PWD among the 31 tsunamihit municipalities described in Table 2. The figure further indicates that the harsher thedeath toll among the total population (i.e., over 1.4% of total population mortality), thewider the gap grew between the total population death toll and that of PWD. In otherwords, proportionately more PWD were killed in those municipalities with harsher death
tolls. Figure 4 compared municipality mortality rate distributions of the total population
with those of PWD by prefecture. The comparisons suggest that high discrepancy between
the total population and PWD casualties was found especially in Miyagi prefecture.
Figure 5 estimates magnitudes of the casualty gap between the total and PWD populationfor each of the three prefecture municipalities by means of fitting a simple no-intercept (i.e.,
no constant term) regression line:
PWD mortality ¼ Casualty gap coef f icient × Total population mortality

EQ-TARGET;temp:intralink-;e1;62;360(1)

Please note that an intercept, or a constant term, is set to zero and is thus omitted; if there
is no casualty in the total population, the predicted PWD mortality is also zero. The above
regression coefficient then indicates the degree of the total-population-to-PWD casualty gap.
The larger the coefficient, the bigger the gap exists between the total and PWD mortalities.
The regression (casualty gap) coefficient for Miyagi municipalities was 1.92
(t ¼ 15.1; p < .001) and this regression model’s coefficient of determination or R2 was.946. In other words, one can interpret with very high accuracy (R2 ¼ .946) that the
PWD mortality rate was nearly twice (1.92 times) as many as that of the total populationin Miyagi prefecture. In contrast, a simple no-intercept regression analysis of Iwate municipalities turned out to be even more accurate (R2 ¼ .995) and it showed that only slightly
higher (1.19 times; t ¼ 36.419; p < .001) proportion of PWD died. Likewise, the casualty
gap coefficient for Fukushima was even smaller than that of Iwate (1.16; t ¼ 3.776; p < .01)
and the model’s R2 was .641, indicating that the relationship between the two mortality
variables was weaker due to a bigger error variance in Fukushima. Nevertheless, simple
no-intercept regression analyses revealed that casualty-gaps were clearly observed in all
three prefectures and that the gap was much bigger in Miyagi than in Iwate or Fukushima
4

In the NHK PWD death toll surveys, PWD was defined as a person who was issued an official disability
certificate from the residing municipality.

23
24
25
26
27
28
29
30
31

Fukushima

Miyagi

9
10
11
12
13
14
15
16

17
18
19
20
21
22

Iwate

1
2
3
4
5
6
7
8

Prefecture

Miyako City
Ofunato City
Rikuzen Takata City
Kamaishi City
Otsuchi Town
Yamada Town
Tanohata Villege
Noda Villege
Iwate Total
Sendai City*
Ishinomaki City
Shiogama City
Kesennuma City
Natori City
Tagajo City
Iwanuma City
Higashi Matsushima
City
Watari Town
Yamamoto Town
Matsushima Town
Shichigahama Town
Onagawa Town
Minami Sanriku Town
Miyagi Total
Iwaki City
Souma City
Minami Souma City
Naraha Town
Tomioka Town
Okuma Town
Futaba Town
Namie Town
Shinchi Town
Fukushima Total
Total

Municipality

34,846
16,711
15,08920,41910,051
17,431
946,593
342,198
37,79670,895
7,701
15,996
11,511
6,932
20,9088,218
522,155
1,674,185

59,442
40,73823,302
39,57815,277
18,625
3,843
4,632
205,437
318,133
160,704
56,49073,494
73,14062,97944,19842,908Population

306
616
16
93
820
793
10,437
430
469
951
69
134
49
94
358
116
2,670
18,829

517
417
1,760
958
1,229
775
39
27
5,722
734
3,569
46
1,234
911
125
150
1,024

Dead

Total population

0.9%
3.7%
0.1%
0.5%
8.2%
4.5%
2.4%
0.1%
1.2%
1.3%
0.9%
0.8%
0.4%
1.4%
1.7%
1.4%
1.0%
1.1%

0.9%
1.0%
7.6%
2.4%
8.0%
4.2%
1.0%
0.6%
3.2%
0.2%
2.2%
0.1%
1.7%
1.2%
0.2%
0.3%
2.4%

Mortality

1,384
933
709
882
605
995
43,09521,004
1,903
4,398
512
861
565
377
1,155
455
31,23086,503

3,371
2,268
1,368
2,569
1,012
1,114
203
273
12,17813,432
7,893
2,997
3,508
3,749
2,318
1,770
1,920

Population

23
54
2
8
81
125
1,099
35
23
16
11
3
0
2
23
17
130
1,658

36
47
123
64
95
59
3
2
429
53
397
0
135
76
17
14
114

Dead

PWD

1.7%
5.8%
0.3%
0.9%
13.4%
12.6%
3.8%
0.2%
1.2%
0.4%
2.1%
0.3%
0.0%
0.5%
2.0%
3.7%
1.2%
1.9%

1.1%
2.1%
9.0%
2.5%
9.4%
5.3%
1.5%
0.7%
3.9%
0.4%
5.0%
0.0%
3.8%
2.0%
0.7%
0.8%
5.9%

Mortality

230
129
90
121
55
150
10,433
2,195
245
519
65
122
67
18
146
51
3,428
15,601

479
359
221
346
81
172
41
41
1,740
6,388
1,100
355
544
375
337
265
294

Population

0
3
0
0
4
3
59
3
3
0
0
0
0
0
1
2
9
89

2
2
5
2
9
0
1
0
21
2
28
0
3
4
1
3
8

Dead

0.0%
2.3%
0.0%
0.0%
7.3%
2.0%
0.6%
0.1%
1.2%
0.0%
0.0%
0.0%
0.0%
0.0%
0.7%
3.9%
0.3%
0.6%

0.4%
0.6%
2.3%
0.6%
11.1%
0.0%
2.4%
0.0%
1.2%
0.0%
2.5%
0.0%
0.6%
1.1%
0.3%
1.1%
2.7%

Mortality

PWD (Intellectual)

1004
693
574
723
456
764
53,80917,384
1,480
3,581
426
560
468
343
925
382
25,54988,643

2,465
1,742
1,019
2,052
807
859
142
199
9,285
30245
6364
2459
2872
3069
1790
1356
1440

Population

22
45
2
8
66
113
982
30
17
16
10
3
0
2
21
14
113
1,480

28
42
107
59
87
58
2
2
385
48
351
0
131
68
16
10
102

Dead

2.2%
6.5%
0.3%
1.1%
14.5%
14.8%
1.8%
0.2%
1.1%
0.4%
2.3%
0.5%
0.0%
0.6%
2.3%
3.7%
0.4%
1.7%

1.1%
2.4%
10.5%
2.9%
10.8%
6.8%
1.4%
1.0%
4.1%
0.2%
5.5%
0.0%
4.6%
2.2%
0.9%
0.7%
7.1%

Mortality

PWD (Physical)

Table 2. Comparison of mortality rates among people with developmental, physical, and mental disabilities in Tohoku-oki earthquake(NHK 2012a, 2012b, 2012c, 2012d)
S412
S. TATSUKI

Miyako City
Ofunato City
Rikuzen Takata City
Kamaishi City
Otsuchi Town
Yamada Town
Tanohata Villege
Noda Villege
Iwate Total
Sendai City
Ishinomaki City
Shiogama City
Kesennuma City
Natori City
Tagajo City
Iwanuma City
Higashi Matsushima
City
Watari Town
Yamamoto Town
Matsushima Town
Shichigahama Town
Onagawa Town
Minami Sanriku Town
Miyagi Total
Iwaki City
Souma City
Minami Souma City
Naraha Town
Tomioka Town
Okuma Town
Futaba Town
Namie Town
Shinchi Town
Fukushima Total
Total

Municipality

70
43
36
40
23
42
1166
1350
97
276
32
26
27
26
63
30
1927
3,205

176
190
87
183
Not recorded
88
5
19
112
Not recorded
Not recorded
165
205
229
123
86
104

Population(Visual)

0
4
0
1
1
11
40
6
0
0
1
0
0
2
0
1
10
54

0.0%
9.3%
0.0%
2.5%
4.3%
26.2%
3.4%
0.4%
0.0%
0.0%
3.1%
0.0%
0.0%
7.7%
0.0%
3.3%
0.5%
1.7%

0.0%
3.4%
2.2%
0.8%
1.2%
8.7%

4.5%
0.0%
0.0%
3.6%

4
0
0
4

0
7
5
1
1
9

1.1%
2.1%
12.6%
2.2%

Mortality(Visual)

2
4
11
4

Dead

90
38
21
29
40
74
1211
1201
120
275
19
34
56
28
64
36
1833
3,832

156
211
236
104
108
104

102
12
24
788

215
156
73
206

Population(Auditory)

0
2
0
0
6
11
46
0
1
2
0
0
0
0
2
0
5
75

0
9
10
3
0
5

7
0
1
24

4
3
6
3

Dead

0.0%
15.0%
14.9%
3.8%
0.0%
0.8%
0.7%
0.0%
0.0%
0.0%
0.0%
3.1%
0.0%
0.3%
2.0%

0.0%
5.3%

0.0%
4.3%
4.2%
2.9%
0.0%
4.8%

6.9%
0.0%
4.2%
3.0%

1.9%
1.9%
8.2%
1.5%

Mortality(Auditory)

644
375
310
403
206
349
10345
10010
841
2038
249
305
266
192
493
225
14619
29,720

1288
1617
2784
915
742
712

679
77
102
4756

1354
953
525
1066

Population(Orthopedic)

13
23
1
3
36
50
312
14
5
7
6
1
0
0
12
11
56
504

0
82
38
2
7
57

31
0
1
136

10
21
54
19

Dead

2.0%
6.1%
0.3%
0.7%
17.5%
14.3%
3.0%
0.1%
0.6%
0.3%
2.4%
0.3%
0.0%
0.0%
2.4%
4.9%
0.4%
1.7%

0.0%
5.1%
1.4%
0.2%
0.9%
8.0%

4.6%
0.0%
1.0%
2.9%

0.7%
2.2%
10.3%
1.8%

Mortality(Orthopedic)

150
111
45
38
94
81
1756
1425
178
298
21
179
30
16
84
22
2253
5,199

427
167
128
188
144
83
20
33
1190
6155
676
183
223
305
191
149
186

Population

1
6
0
0
11
7
38
2
3
0
1
0
0
0
1
1
8
72

7
3
12
3
0
1
0
0
26
3
23
0
3
4
0
1
5

Dead

0.7%
5.4%
0.0%
0.0%
11.7%
8.6%
2.2%
0.1%
1.7%
0.0%
4.8%
0.0%
0.0%
0.0%
1.2%
4.5%
0.4%
1.4%

1.6%
1.8%
9.4%
1.6%
0.0%
1.2%
0.0%
0.0%
2.2%
0.0%
3.4%
0.0%
1.3%
1.3%
0.0%
0.7%
2.7%

Mortality(Mental)PWD (Mental)*Almost all casualties in Sendai City were recorded in the coastal-fronting Miyagino and Wakabayashi wards. Therefore, the total and PWD population subtotals from these twowards were used in obtaining Sendai’s mortality rates.

23
24
25
26
27
28
29
30
31

Fukushima

Miyagi

9
10
11
12
13
14
15
16

17
18
19
20
21
22

Iwate

1
2
3
4
5
6
7
8

Prefecture

PWD (Physical impairment subcategories)

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE
S413

S414

S. TATSUKI

Figure 3. Comparison of total mortality and mortality among people with disabilities in Iwate,
Miyagi, and Fukushima Prefectures (NHK 2012).

Figure 4. Comparison of total mortality and PWD mortality rate distributions in Iwate, Miyagi,
and Fukushima Prefectures (NHK 2012).

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE

S415

Figure 5. Regression of PWD mortality on total population mortality by in Iwate, Miyagi, andFukushima Prefectures.

prefecture. Note that the similar results were also found from elderly mortality analyses as
was shown in Figure 2. The cause of the gaps and the prefectural difference, especiallybetween Miyagi on one hand and Iwate and Fukushima on the other, is examined in thenext section.
Figures 6 to 10 show casualty gaps between the total population and PWD by different
disability categories. Less and nearly equal casualties were observed among people withintellectual (casualty gap coefficient 0.76, t ¼ 8.29, p < .001, see Figure 6) and mental disabilities (casualty gap coefficient 0.98, t ¼ 7.44, p < .001, see Figure 7), respectively. In
contrast, bigger gaps were found among people with physical impairments. The mortality
rate of those with auditory impairments was 1.65 times (t ¼ 10.763, p < .001, see Figure 8);
visual impairments, 1.74 times (t ¼ 5.626, p < .001, see Figure 9); and orthopedic impairments, 1.84 times (t ¼ 12.77, p < .001, see Figure 10) that of the total population. Furthermore, significant prefectural differences were found in the mortality rates of those withorthopedic impairments and other physical impairments. For people with orthopedic impairments, their mortality rate in Miyagi was 2.3 times (t ¼ 14.484, p < .001) more than the total
population, while it was 1.25 times more in both Iwate (t ¼ 12.16, p < .001) and Fukushima(t ¼ 2.87, p < .05). Likewise, mortality gap coefficients for people with physical impairments (which include orthopedic, visual, and auditory impairments) were 2.15
(t ¼ 12.87, p < .001), 1.4 (t ¼ 29.27, p < .001), and 1.22 (t ¼ 4.06, p < .01) for Miyagi,

S416

S. TATSUKI

Figure 6. Regression of PWD (Intellectual) mortality on total mortality.

Iwate, and Fukushima, respectively. These findings5 may suggest (1) that people with physical impairments faced the issues of immobility far more seriously than those with otherdisability categories or those without any disability; (2) that people with physical andmore specifically, orthopedic, impairments in Miyagi were more vulnerable to the tsunami
hazards than those in Iwate and Fukushima; and (3) that the high casualty gap of those withphysical and more specifically, orthopedic, impairments seems to be responsible for prefectural (i.e., Miyagi versus Iwate or Fukushima) differences in overall PWD casualty gaps, aspresented in Figure 5.
CAUSES OF ELDERLY AND PWD CASUALTIES

Table 3 compares proportions of institutionalized elderly and their casualty rates among
Iwate, Miyagi, and Fukushima. The casualty rate for institutionalized elderly (5.2%) was
strikingly high in Miyagi, as opposed to Iwate (2.1%) or Fukushima (0.4%). This seems
to be due to the fact that nursing homes for the elderly tend to be situated in the scenic(and tsunami-prone) seaside areas in Miyagi, while in Iwate and Fukushima, nursing
5

Coefficients of determination or R2 values for regression lines in figures 6 to 10 ranged from .54 to .858. Small
number of observations with outliers seem to cause lower R2 values. The relationships between different PWD
category mortalities and the total population mortality, therefore, need to be interpreted with some cautions.

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE

S417

Figure 7. Regression of PWD (Mental) mortality on total mortality.

homes tend to be located in hillside and inland areas, respectively (Kahoku Shimpo 2011).
Secondly, when location safety is controlled, the elderly in nursing homes who are taken careby the home workers on a 24-hour basis are generally better protected against tsunami
hazards compared with the elderly living in their own homes. The rates of the institutionalized elderly are relatively higher in Iwate (2.6%) and Fukushima (2.5%) than in Miyagi(2.0%). This difference may further explain the lower elderly casualty rates in Iwate andFukushima. Thirdly, higher institutionalization may also explain lower casualty rates
among elderly women who have higher propensity to spend time alone in the nursing
homes due to their longer longevity.
Differences in institutionalization rates may also explain inter-prefectural PWD casualty
differences. Rates of institutionalized people with physical disabilities were strikingly different among Iwate (3.1%), Miyagi (0.7%), and Fukushima (1.3%). It is suspected that thelower rate of institutionalization may have caused higher casualties among people with physical disabilities in Miyagi (Table 4). Preceding studies of total population casualties havesuggested such causative factors as tsunami height and arrival time (Suzuki and Hayashi
2011, Suzuki 2012); proportion of inundated area; distance to epicenter; types of coastline(rias or plain); proportions of aged 65 or older, as well as of those in fishery and agriculture(Ueda 2012); and a ratio of recorded maximum tsunami height to expected tsunami height(Matsumoto and Tatsuki 2012). In order to examine the relative magnitude of the PWD institutionalization rate to the other causative factors on PWD casualties, data was obtained fromS418

S. TATSUKI

Figure 8. Regression of PWD (Auditory) mortality on total mortality.

preceding studies on municipality level casualties, and their correlations are presented inTable 5. Stepwise regression analyses of these variables on PWD casualties were then conducted and the final result was presented in Table 6. Among the final predictor variables, theproportion of institutionalized PWD turned out to be one of statistically significant causative
variables (t ¼ −5.674, p < .001) with its unstandardized coefficient size of about –1.0, suggesting that a 1% increase in PWD institutionalization means 1% lower PWD casualties. This
interpretation was made possible because the no-intercept regression (i.e., y ¼ ax) model wasused, as explained in the previous section. In addition to the PWD institutionalization rate, thefinal regression model also suggests that the bigger the total population casualties (thecasualty gap between the total population and PWD, however, is 1.1, implying the gap
is not so large), the wider the inundated area, the more the aged and those who engaged
in fishery and agriculture, and the sooner tsunami arrived, the more PWD died. Thesesix predictor variables accounted for almost all PWD casualty variance (R2 ¼ .968) withhigh parsimony (i.e., no sign of multicolinearity because their tolerance statistics were all
beyond .5).
THE LIFE AND DEATH SITUATIONS OF 17 PSND IN HACHIMANCOMMUNITY, ISHINOMAKI CITY
On 11 September 2012, or one and a half a years after the Tohoku-oki earthquake, theJapan Broadcasting Cooperation (NHK) ETV channel aired testimonial reports on the life

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE

S419

Figure 9. Regression of PWD (Visual) mortality on total mortality.

and death situations of the 17 PSND in Hachiman community, Ishinomaki City, Miyagi Prefecture. Hachiman community is situated along the left bank of Kyu-Kitagami River that runs
through the central part of Ishinomaki City. About 350 households, or 900 people, wereresiding in this community, and the 2011 March tsunami killed 38 residents. It should
be noted that Ishinomaki City was renowned for its citywide, community-based evacuation
planning initiatives for PSND. As early as 2004, the city was recognized as one of the tenmodel municipalities on PSND preparedness master planning. By the end of 2010, 401 out of
421 administrative districts in the city completed individualized evacuation planning for each
PSND in the neighborhood (Ishinomaki City 2008). Among Ishinomaki communities,
Hachiman has been one of the leading communities for emergency response neighborhood
networking for PSND, which began in May 2004 (NHK 2006). This was a year before eventhe first edition of the evacuation/sheltering assistance guideline was published by the Cabinet Office in 2005. In July 2002, Ishinomaki City faced a serious flooding threat due to thestrong rainfall precipitated by Typhoon 6, and the city administration issued the city’s first
evacuation public warning in its history. After the warning was lifted, the city learned that
there were people who knew about the warning being issued, but who were not able to evacuate by themselves. With the help from the citywide 369 minsei-iin, or commissioned welfare
volunteers, who were assigned to about every 160 households in the city, the city administration identified 1,780 PSND, and they were listed in the city PSND registry by the end of
October 2002. The city’s definition of PSND consisted of two categories: the frail elderly in

S420

S. TATSUKI

Figure 10. Regression of PWD (Orthopedic) mortality on total mortality.

single households or elderly dyad (couple, siblings, and parent-child) households; and the
PWD. In response to the city’s initiative for PSND support networking, local minsei-iins,
resident association leaders, shop owners, housewives, and retired residents in Hachimancommunity, where the 1960 Chile tsunami disaster caused sizable damages, decided to organize their own emergency response neighborhood network in May of 2005. The network
assigned and registered two local resident evacuation supporters (RES) for each of 17
PSND. The 9 PSND out of the 17 were registered in the city PSND registry, and theother 8 elderly people were assessed being less critical but still in need of neighbors’
help due to the frailty. These eight PSND were listed in the community’s own registry.
The Hachiman community network activities were featured by NHK ETV crew on 17 January 2006. Because the crew had developed rapport with key local residents through the 2006
production, they were able to re-enter the community and to re-interview the key stakeholders
about the network’s responses to the 2011 March tsunami disaster. The interviews took placefrom June to August of 2012.
Table 7 summarizes the life and death situations of the 17 PSND. Two out of the registered 17, or 11.8%, PSND, died due to the tsunami in Hachiman community, wherein a total
38 out of about 900, or 4.2%, residents were killed directly by tsunami. This means that the
PSND died about 2.8 times more, proportionately, in Hachiman community. This casualty
gap ratio is comparable to the citywide ratio of 2.3, that is, 397 out of 7,893, or 5.0%, PWD

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE

S421

Table 3. Number of those who are over the age of 70, proportions of institutionalized
elderly, and institutionalized elderly casualty rates among Iwate, Miyagi, and Fukushima
PrefectureOver 70 yearsof ageInstitutionalized
elderly (%)

Institutionalized
elderly casualty (%)

Iwate
Miyagi
Fukushima

275,976
386,834
384,956

7,173 (2.6%)
7,548 (2.0%)
9,779 (2.5%)

152 (2.1%)
389 (5.2%)
37 (0.4%)

Source: 2010 Population Census (http://www.e-stat.go.jp/SG1/ estat/List.do?bid=000001034991&cycode=0)
Fy 2009 Long Term Care Service Provider and Institution Survey (http://www.e-stat.go.jp/SG1/estat/List.do?
lid=000001070484)
Fy 2009 Social Service Institution Survey (http://www.e-stat.go.jp/SG1/estat/List.do?lid=000001068770)
Kahoku Shimpo, 13 December 2011.

compared with a total 3,569 out of 160,704, or 2.2%, residents who were killed in Ishinomaki
City (Table 2). Fisher’s exact test probability (an alternative to the Chi-square test where
there is less than 5 frequency in any cell) of the 2-by-2 (“PWD vs. non-PWD” by “Hachimanvs. the rest of Ishinomaki”) death toll frequencies was .188 (one-tailed), and thus there was no
significant difference in PWD-to-non-PWD death counts between Hachiman and the rest of
Ishinomaki.
It should be further mentioned that the Hachiman community mortality gap ratio of 2.3 isalso very similar to Miyagi’s mortality gap coefficient 2.15 (with standard error of .167) for
people with physical impairments, which was obtained from the previous no-intercept regression analysis. This suggests that the life and death situations in Table 7 may illustrate reasonably representative pictures of how the disaster countermeasures for PSND functioned (or did
not function) in Ishinomaki City or in Miyagi Prefecture during the Tohoku-oki earthquake
and tsunami disaster, despite its small sample size and definitional fuzziness between PSND
(for Hachiman community) and PWD (for Ishinomaki and Miyagi).
Among the 17 registered PSND in Table 7, 14 individuals (12 households) were at theirown residence in the community, and the other 3 were either at short-term stay units in anursing home, an in-patient unit in a hospital, or a day service center at the time of the event
and were able to survive with the help from these institutions. Out of the 14 PSND who wereat home, 7 individuals (cases 1, 2, 3, 12, 14, 15, and 16) in six households (cases 2 and 3 arein the same household) were assisted for emergency evacuation by their RES. Four RES
dashed to the assigned PSND residence immediately after the earthquake and the othertwo RES (each of them was the PSND’s own daughter) were with their mothers anddrove them to the designated shelter (cases 15 and 16). In contrast, no RES showed up
for rescue to six individuals (cases 4, 5, 6, 7, 8, and 13) in five households (cases 7 and
8 are in the same household) because the RES were at work, out of town, or helping themselves from tsunami attacks. These six individuals with no RES assistance were saved either
through self-help (cases 4, 6, 7, and 8), a neighbor (case 13), or a home helper or acquaintance
who happened to drive by the site (case 5). Finally, it is unknown if the RES came or not for
two PSND because both of them were dead either from the tsunami (case 11) or at her

46,039
50,476
63,985Prefecture

Iwate
Miyagi
Fukushima

5,505
9,335
6,620

Mentaldisability
certificates
1,427 (3.1%)
378 (0.7%)822 (1.3%)

Institutionalized
people withphysical disability (%)
931 (9.2%)
1,647 (17.7%)
1,521 (10.4%)

Institutionalized
people withintellectual disability (%)

53 (1.0%)76 (0.8%)
69 (1.0%)

Institutionalized
people withmental disability (%)

Types of social welfare facilities for PWD (FY 2009)

Source: Fy 2009 Social Welfare Administration Reports (http://www.e-stat.go.jp/SG1/estat/List.do?lid=000001068770)
Fy 2009 Health Administration Reports (http://www.e-stat.go.jp/SG1/estat/List.do?lid=000001068836)
Fy 2009 Social Welfare Instition Reports (http://www.e-stat.go.jp/SG1/estat/List.do?lid=000001068770)

10,141
9,285
14,636

Intellectual
disability
certificates

Note: Numbers are as of March 2010

Physicaldisability
certificates

Types of disability registry (FY 2009)

Table 4. Number of those who were issued disability certificates and those who were institutionalized at social welfare facilities for
PWD in Iwate, Miyagi, and Fukusima

S422
S. TATSUKI

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE

S423

Table 5. Correlations of the variables that were reported to be related to total population
and PWD casualty
1

2

3

4

5

6

7

8

9

1 PWD casualty
2 Total population casualty.908**
3 Distance to the epicenter −.657** −.656**
4 Proportion of innundated.696** .566** −.425*
area
5 Types of sea coast−.535** −.538** .653** −.364*
6 Sum of the proportions of.242 −.644**.547** .450* −.292
aged 65 or older andthose in fishery andagriculture
7 A ratio of recorded
.085
.068
.262 −.066.500** −.198
maximum tsunami height
to expected tsunami height
8 Tsunami arrival time−.598** −.566** .758** −.407* .875** −.446* .313
9 Proportion of.058.273 −.274 −.087 −.646** .429* −.516** −.431*
institutionalized
PWD*p<.05**p<.01
Note: Proportion of innundated area and Sum of the proportions of aged 65 or older and Those in fishery and agriculture
are from Ueda (2012). Tsunami aririval time is from Suzuki (2012). A ratio of recorded maximum tsunami height toexpected tsunami height is from Matsumoto and Tatsuki (2012).

Table 6.

Multiple regression analysis of PWD casualty rates
Unstandardized
coeffient

Predictors
Total population casualty
Proportion of
innundated area
Sum of the proportionsof aged 65 or older andthose in fishery andagriculture
Tsunami arrival time
proportion of institutionalized
PWD
Adjusted R2 = .968
Note: No-intercept regression

Standardized
coefficients

B

SE

Beta

t-valuep

Multi-colinearity
tolerance

1.129
.041

.097
.011

.715
.272

11.628
3.693

.000
.001

.507
.577

.631

.113

.487

5.577

.000

.654

−.021
−.983

.007
.173

−.197
−.371

−3.151−5.674

.004
.000

.563
.671

Mrs. SN
(Grandmother)Mr. ST (Father)* Male

2

3

FemaleFemaleMrs. SB

1

GenderNameSinglehouseholdHouseholdmembers

Bedridden/Sonphysically
Son’s wife
immobile
Left hemiplegia
due to stroke

Difficulty inwalking (usehandcart)
Old

Disability/
medical/physicalconditions

Mr. IR

Mr. A (Next-door
neighbor)

Mrs. NMr. N

Registerd
evacuation
supporters (RES)
Alive ordeadNo

Yes (came
immediately)

Alive

Yes (came after Alivethe first big
wave)
No (at work)

Did the RES
come?

PFND listed in the city registry and in Yawata community’s own registry

Case
no.

Table 7.

Note

Was attacked by the tsunami One RES (Mr.N) came partly
wave inside the house and lost because Mr. N was in good
consciousness. Mr. N (RES)
contact with Mrs. SB on acame to rescue her after the
regular basis. After the
first wave calmed down. Mr. earthquake Mr. N (RES)
N put Mrs. SB on his backthought of his family first andand climbed a nearby
then of Mrs.SB. Glad to be
mountain road while they were able to save her. Without dailychased by another tsunami
communications with Mrs. SB,wave. Mr. N handed her at the the rescue would not have
top of the mountain to otheroccured. Mrs.SB currently
neighbors.
lives in a home for the elderly
because she lost the house.
One RES came immideately
After the tremer, the wholeafter the tremor. Mrs. SN isfamily went outside looking
bedridden and had no priorfor help. Mr. A (RES) cameevacuation drill experiences. It
running to help Mrs.SN andwas hard to be transported on
Mr.ST. Local volunteer firefighters also assisted them to a wheelchair because her body
does not bend. Family
evacuate to the nearby
members and one RES were
evacuation center (Minato
not enough to evacuate her.
Elementary School).
The volunteer firefighters’
extra help was very valuable.
Mr. A is not planning to go
back to Yawata community
because he is not confident tohelp her again. Wife of Mr. A(RES) passed away.

Evacuation process

S424
S. TATSUKI

Mrs. C

Mr. O

Mrs. W

Ms. OB

Ms. OB’s
grandfather*Mr(s). AZ

Mr(s). A2
Mr(s).TM*

4

5

6

7

8

9

10
11

?
?

?

Male

FemaleFemaleMale

Female?
Auditory

Bedridden

Difficulty inwalking/
epilepsy
Difficulty inwalking/back
pain

Old

VisualLeg paralysis
Neck tumor

Mr. AK
Mr. AT (Mr. AK’s
wife)

Mr. C
Mr. I

Mr. AR(Commisioned
welfare volunteer)
Mr. T

Singlehousehold

?
?
?

?

Ms. OB’s
Mr. ST
Mother Ms.
OB’s 2 Brothers
Mr. AJ

DaughterSinglehousehold

Husband
Daughter

Alive

Alive

Alive

Alive

?
?

?
Dead

?

No (helping
Alive
oneself was all
Mr. AJ could do)

Unknown
Unknown(killed bytsunami)No

No
No

No (at work)

No (at work)(continued )No RES came but Mrs. C andher family self-helped by
evacuating to the second floorof the house. They survived
because the tsunami did notreach the second floor level.
Mrs. C is determined to go
back to her community eventhough she knew that she will
not be able to evacuate byherself. Her Husband diedafter hospital transportation.
Because the long tremor
No RES came. Mr. O selfreminded him of tsunami,
helped by asking for help from
Mr.O dashed outside andher neighbors and eventuallyasked for help. However, there rescued by his home helper.
was no reply. When he was atloss at the road side, his homehelper passed by in her car
and she picked him up andtook him to the nearby shelter.
Unknown
It is unknown if RES came.
Mrs. W Passed away after
evacuation at her temporary
housing unit.
Decided to evacuate after the No RES came and the family
big tremor followed by
self-helped. They were nottsunami warning alert fromsure where to escape. Learned
official disaster radio.
that it makes sense for a whole
Grandfather advised the whole family to decide where to go
family to climb up the path to prior to the event.
the top of the nearby
mountain.
Was at a nursing care home
Unable to locate
for a short stay on that day.
Was an in-patient at a hospital. Unable to locate
Caught by tsunami and washed Deadaway. Mr(s). TM was rescued Unknown if RES came or not.
at the nearby bridge. (S)he wastransported to the Red Cross
Hospital, but was not saved.
Evacuated to the second floorof the own house. Rescued
after a few days andtransported to the Ishinomaki
Red Cross hospital.

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE
S425

Gender

FemaleFemaleFemaleMrs. SM*

Mrs. M*

Mrs. TY*

12

13

14

(continued)

Name

Case
no.

Table 7.

Old (89 yrs
old)Difficulty inwalking (usescane)

Difficulty inwalking/diabetis

Disability/
medical/physicalconditions

SinglehouseholdSingleHouseholdSinglehouseholdHouseholdMembers

Alive ordead

No (killed bytsunami)No (living in
Sendai)Alive

Yes (escorted to Dead
Mr. K’s own
house)No (killed bytsunami)Did the RES
come?

Yes (escorted to Alivethe second floorof Mrs. M’shouse)
Mrs. TY’s Daughter No (living in
Daimon)Mrs.I

Mrs. M’s Daughter

Mrs. TS

Mrs. K (Mr.K’s
wife)

Mr. K

Registerd
evacuation
suporters (RES)
Note

Mr.K(RES) came and escorted One RES (Mr. K) came to
Mrs. SM to his house. Mr. F, escort to his house. Mrs. SM
traveled with large luggage.
the president of theneghborhood association, came That was another reason why
she could not continue
to see her and urged her towalking. A tall RC building
evacuate with him and his
was standing on the way towife. On their way to thethe shelter. Mrs. F feels thatshelter, Mrs. SM could notwalk any longer and told Mrs. they could have looked for a
F to go without her. Moment shelter in that building.
after, Mrs. SM was swept
away by tsunami. Tsunami
also attacked Mrs. F but shebarely escaped death.
When Mrs. M went outside
No RES came because thatafter the earthquake, her
person was killed by theneighbor assisted her totsunami. The neighbor assisted
evacuate to the designatedthe evacuation to the shelter.
shelter.
Currently, Mrs. M lives withher daughter in Sendai.
Mrs. I (RES) came and helped One RES (Mrs. I) came to
her to go up stairs because that assist in-house evacuation.
was what she wanted. Two
Mr. T (non-registereddays later, Mrs. I was spotted evacuation supporter), who wentby her neighbor Mr. T who
to school with Mrs. TY’s son,used a ladder to rescue her
has been looking for her for thefrom the second floor window. past two days. Currently, she
Mr. T escorted her to thelives with her son’s family indesignated shelter.
Hebita neighborhood (about
4 km away) in the same city.

Evacuation process

S426
S. TATSUKI

FemaleFemaleMrs. M*

Mrs. NM*

16

17

Difficulty inwalking/
artificial joint

Old (88 yrs
old)Mr. NRNo (helping
oneself was all
Mr. NR could
do)Mrs. H (daughter)
Yes (happened
Singleto be together)householdMr(s). M (neighbor)(familymembers living
in proximity)

Alive

Alive
Mr. TM (Daughter’s Yes (living
Singlehusband)
together at thehouseholdtime of the EQ)(familymembers living Mr(s). IT
in proximity)*means the person is listed in Yawata community’s own PFND list.

FemaleMrs. E*

15

Mrs. E was recently dischared One RES spouse (her own
daughter) assisted evacuationfrom a hospital and was
because Mrs. E wasspending a few days at her
daughter’s house. The daughter temporarlily living with thedrove Mrs. E to the top of the daughter.
nearby mountain.
Mrs. H (RES) just dropped off One RES (daughter) assisted
Mrs. M from a regular visit to evacuation because she was
the hospital. Mrs. H picked her with her.
up again and drove to thedesignated shelter. Howerever,they were not sure how to getthere and wasted some time.
Then the tsunami came after
them. Mrs. H’s friend who
was with them in the same car
dashed out but Mrs. H could
not abandon her mother. She
took a small path to the top of
the nearby mountain andescaped the tsunami attack.
Was at the day service center. Unable to locate

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE
S427

S428

S. TATSUKI

Figure 11. Hachiman community results of PSND evacuation support.

temporary housing unit (case 6). As Figure 11 illustrates, it is now clear that Hachiman community’s emergency response network functioned to help half of the registered 14 PSND whowere at their own homes and saved six lives, while self-help and informal mutual help from aneighbor or a friend saved about a third (six lives) of the most vulnerable elderly and people
with disabilities in Hachiman community. This seems to encourage the community-based
initiatives for PSND in other parts of the country. It should be mentioned that Miyagi’s casualty
gap between the total population and PWD was the biggest in the three disaster-hit prefectures
despite community-based efforts like those in Hachiman community.
CONCLUSION
This paper addressed casualty gaps between the total population and PSND by examining
prefectural- and municipal-level aggregated death toll data. It was made clear that those who
were over the age of 60 and/or those with disabilities were disproportionately more vulnerable to the Tohoku-oki earthquake and tsunami. Among PWD, those with physical (orthopedic, visual, and auditory) impairments died proportionately more than the total populationor people with the other categories of disabilities. The elderly and PWD casualty rates were
not even across the three prefectures; more elderly and PWD died in Miyagi than in Iwate andFukushima. The rate of institutionalization among the elderly and PWD was suggested as oneof possible causative factors that may explain casualty gaps among prefectures and different
PWD categories and between genders. In the case of the elderly casualties, more institutionalized elderly died in Miyagi than in Iwate or Fukushima because nursing homes in Miyagi
tended to be located in scenic (and tsunami-prone) coastal areas. This suggests more efforts inmitigation (i.e., tighter land use control for institutional facilities based on hazard maps) andpreparedness activities (e.g., more frequent disaster drills, staff training, etc.) for the institutions situated in tsunami hazard–prone areas. Given the location safety factor being controlled, however, those elderly who were in institutional facilities were better protectedagainst tsunami hazards thanks to seismically compliant buildings and care workers available

OLD AGE, DISABILITY, AND THE TOHOKU-OKI EARTHQUAKE

S429

on a 24-hour basis. The comparably higher institutionalization rates may explain lower
casualty rates for the Iwate and Fukushima elderly, as well as for female elderly acrossthe three prefectures (elderly women have a higher propensity to be institutionalized in nursing homes due to their greater longevity).
Stepwise regression analysis demonstrated that PWD casualty rates among 31 tsunami-hit
municipalities were almost perfectly (R2 ¼ .968) explained by such causative factors as total
population casualties, proportion of inundated area, proportions of aged 65 or older as well asof those in fishery and agriculture, tsunami arrival time, and PWD institutionalization rate.
Among these five predictors, PWD institutionalization rate seems to explain casualty gaps
among the three prefectures. Regression analysis indicated that 1% increase in PWD institutionalization meant 1% decrease in PWD casualty rate. Iwate and Fukushima were evidenced with higher proportions of PWD institutionalization than Miyagi. The higher
propensity of PWD residing in institutional facilities in Iwate and Fukushima in comparison
to Miyagi seems to be mainly due to the lack of socially inclusive services and resources, suchas home help, visiting care, attendant and day services for PWD, as well as centers for independent living. It should be mentioned that this author does not support the view that theinstitutionalization of the elderly and/or PWD is the implied solution to prevent higher casualties among the elderly and PWD. The notion of emanicipatory and socially inclusive
approaches to disability issues (Oliver 1990, Barnes 2001) is commonly shared in Japanesesocial service policy and administration since the introduction of the universal social service
system (Titmus 1974) for the elderly (Public Nursing Care Insurance Law 1997) and for PWD(Services and Supports for Persons with Disabilities Act 2005). In fact, Miyagi was one of theleading prefectures that promoted the socially inclusive normalization policies for PWD
under the leadership of the former Governor Shiro Asano who asserted all PWD colonies
should be dismantled (Asano, 2003). The root causes of higher casualties among the elderly
and PWD seem to lie in the fact that socially inclusive social services for the elderly and PWD
are, at this point, designed for a time of normalcy and not for times of disasters. At the sametime, Japanese disaster management policies for people with special needs or PSND havebeen non-universal in their orientations and have not been capable of collaborating withmainstream social service policies that have become socially inclusive and universal intheir orientations.
The serious casualty gaps emerged not because there was a lack of effort made to reduce
disaster vulnerability among PSND. Japan has been one of the leading countries in systematically promoting PSND evacuation and shelter assistance initiatives since March 2005.
Ishinomaki’s Hachiman community responses to 17 PSND were presented as the evidence
that pre-planned local community initiatives saved nearly half of the most vulnerable residents in this community. Ishinomaki City has been one of the leading municipalities in PSND
disaster countermeasure planning, by creating the citywide PSND registries, sharing PSND
information with neighborhood associations, and assigning two registered evacuation supporters to each PSND in almost all neighborhood communities. Hachiman community practice seems to be the answer to overcoming the issues of mainstreaming preparedness
components in the everyday practice of social inclusion of the elderly and PWD and to
bridging disaster management and social, as well as community service provisions forthis population.

S430

S. TATSUKIACKNOWLEDGEMENTS
This work was supported JSPS KAKENHI (Grant-in-Aid for Scientific Research (A)),
Grant Number 20241041, titled “the conceptual and action framework building for disasterrisk reduction among people with special needs in time of disasters.” The author expresses his
sincere thanks to Mr. Kotaro Teranishi and Mr. Makoto Ebisawa of the Japan Broadcasting
Cooperation and Mr. Yuji Kawamura of the NHK Public Welfare Organization, whoprovided municipality casualty data on the total population and people with disabilities.
The author also appreciates the constructive comments offered by the three anonymous
reviewers of this paper.

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