Hasegawa, et al., report that the Fukushima accident was a compounding disaster following the strong earthquake and huge tsunami. The direct health effects of radiation were relatively well controlled considering the severity of the accident, not only among emergency workers but also residents. Other serious health issues include deaths during evacuation, collapse of the radiation emergency medical system, increased mortality among displaced elderly people and public healthcare issues in Fukushima residents. The Fukushima mental health and lifestyle survey disclosed that the Fukushima accident caused severe psychological distress in the residents from evacuation zones. In addition to psychiatric and mental health problems, there are lifestyle-related problems such as an increase proportion of those overweight, an increased prevalence of hypertension, diabetes mellitus and dyslipidaemia and changes in health-related behaviours among evacuees; all of which may lead to an increased cardiovascular disease risk in the future. The effects of a major nuclear accident on societies are diverse and enduring. The countermeasures should include disaster management, long-term general public health services, mental and psychological care, behavioural and societal support, in addition to efforts to mitigate the health effects attributable to radiation.
The Three Mile Island nuclear power plant (NPP) accident in 1979, the Chernobyl accident in 1986 and the Fukushima accident in 2011 have issues in common that were not directly related to the physical effects of radiation exposure. Of course, in the Chernobyl accident, acute radiation injuries in acute phase and thyroid cancer in the paediatric population were reported. However, the other health effects, such as mental health issues, behavioral changes and lifestyle-related health problems, have become more significant as those have not been properly addressed as general health risks after major nuclear accidents. An extreme example was the loss of life in the evacuation of hospital inpatients in the Fukushima accident. Evacuation of the inpatients and elderly residents of nursing care facilities was hurriedly carried out by buses shortly after the accident. No medical personnel accompanied the evacuees who were laid down on the seats of the jam-packed buses with full protective suits on. No medical care, even food or water, was provided for many hours during the evacuation. As a result, scores of patients died in an evacuation that was supposedly intended to minimise radiation exposure. The life-threatening risk to these people was not radiation, but discontinuation of daily medical care. A recent study indicated that the severe health risk associated with the rapid evacuation of elderly residents from nursing care facilities after the Fukushima accident was 30 times higher than the radiation risk of the reference levels for evacuation that are recommended by the International Committee for Radiological Protection.
Presently, more than 400 NPPs are operated in the world, and more will be built in developing countries in search of efficient and stable energy sources. Of course, we should never underestimate the menace of nature that can lead to a compound disaster, such as in Fukushima. We need to prepare for the worst case scenario even if the chance of a severe nuclear accident is quite rare. We need to clarify what we have learned from the Fukushima accident and how we will utilize it, what are the unanswered questions we are faced with and what we need to share with the next generation.
This overview describes the initial medical responses after the Fukushima accident and the health consequences encountered in the evacuation and relocation of residents, with a special emphasis on not only medical but also psychological and societal perspectives related to the Fukushima accident.
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