High internal radiation exposure associated with low socio-economic status six years after the Fukushima nuclear disaster

Abstract

Rationale: Managing the health of vulnerable groups is an important component of health care. Given the long-term burden of radiation-release incidents among those exposed, managing the health of vulnerable groups following a nuclear disaster is very important. However, there is limited information available concerning the long-term management of the health effects of radiation exposure in vulnerable groups following nuclear disasters. After the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, Minamisoma City launched internal radiation exposure monitoring program for local residents, using whole body counter (WBC) units. In 2017, a man of low socio-economic status (SES), was found to have the highest level of internal contamination detected in a person living in the Soma District in recent years. This report describes the case so that the lessons learned can be applied in future nuclear disaster settings. Patient concerns: A 77-year-old Japanese man, who had been homeless for 2 months and had been staying in the exclusion zone of Minamisoma City, was brought to our hospital. He had become homeless because a lack of communication between social support services had led to his eviction from leased housing after free housing support for evacuees was terminated. Diagnoses: He was admitted with a diagnosis of dehydration and malnutrition. A WBC unit was used to assess his body burden of radioactive cesium. This revealed levels of Cs-134 and Cs-137 of 538 Bq/body and 4,993 Bq/body, respectively. Intervention: He received intravenous fluid therapy and health monitoring. The paperwork required for him to receive public income support was processed during hospitalization. Outcome: He was discharged to public housing after 9 days, and municipal workers started visiting him regularly after his discharge. Lessons: A high level of internal radiation contamination may occur after a nuclear disaster. This may be associated with a decline in social support, poverty, and social isolation, and may have more impact on people in poor health than on the general population. It would be useful to strengthen linkages between local government and welfare service providers to increase social support for vulnerable groups requiring health care, not only following disasters, but also under normal circumstances.

ICRP Publication 146: Radiological Protection of People and the Environment in the Event of a Large Nuclear Accident

“…The health status of elderly people, as well as sick and/or hospitalised people, may also be particularly affected by the disturbances due to the event and the protective actions. Homeless people may also receive more exposure because of their poor living conditions (Sawano et al., 2019). Therefore, the Commission recommends the identification of vulnerable groups and their consideration in the implementation of the principle of optimisation. (68) In order to reduce individual exposures and limit inequities in the distribution of exposures, the Commission recommends using reference levels to guide the optimisation of protection during the successive phases of a nuclear accident.…”

“…The health status of elderly people, as well as sick and/or hospitalised people, may also be particularly affected by the disturbances due to the event and the protective actions. Homeless people may also receive more exposure because of their poor living conditions (Sawano et al., 2019). Therefore, the Commission recommends the identification of vulnerable groups and their consideration in the implementation of the principle of optimisation.…”

The Relation Between Socioeconomic Status and Risk Attitudes: A Nuclear Accident Scenario in Sweden

“…There is reason to discuss explanations regarding the finding that the group characterized by low education was least likely to move from the remediation area and that individual income was associated with lower concern over radiation risk-two results that were clear and statistically significant for all the controls. Previous studies have found that low income implies greater exposure to hazards, limited protection, limited choice (Hunter 2005;Link et al 1993;Sawano et al 2019;Taylor et al 1997), and generally higher levels of distress due to financial strain (Linander et al 2014), all adding to perceptions of the world as more dangerous and worrisome. We might understand the risk attitudes among the wealthy as resulting from their experience of greater control over their current and future situation and seeing the world as relatively safe.…”

“…Therefore, risk attitudes cannot be dismissed as irrational or excessive risk aversion but should be regarded as cognitions embedded and conditioned in a social context. Indeed, data point to a higher degree of actual vulnerability to various environmental hazards among those characterized by low SES (Hunter 2005), including radiation (Sawano et al 2019), most likely because they face more dangerous working conditions (Link et al 1993) and living environments (Taylor et al 1997).…”

Transition of originally external healthcare providers into local researchers: a case study of support activities in So-so District, Fukushima after the 2011 triple disaster

“…Similarly, TS also employed a bottom-up approach for key health issues following the 2011 triple disaster such as the health of decontamination workers (Sawano et al, 2016a(Sawano et al, , 2016b(Sawano et al, , 2018a(Sawano et al, , 2020. Further, he covered some radiological issues using this approach (Sawano et al, 2019a). Needless to say, the clinical care of these patients preceded the publication of their case reports.…”