The International Workshop on Radiation and Thyroid Cancer: Tutorial Session

1. The International Workshop on Radiation and Thyroid Cancer: Tutorial Session “Overview of the Fukushima Health Management Survey” Time and Date: 14:10-14:55, February 21, 2014 Venue: Shinagawa Prince Hotel, Tokyo Department of Public Health, Fukushima Medical UniversitySchool of Medicine, Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Seiji YASUMURA (yasumura@fmu.ac.jp)

2. Today’s topic 1. Overview of the Great East Japan Earthquake in Fukushima 2. Situation of evacuation and evacuees 3. Overview of the Fukushima Health Management Survey 4. Concluding Comments

3. Today’s topic 1. Overview of the Great East Japan Earthquake in Fukushima 2. Situation of evacuation and evacuees 3. Overview of the Fukushima Health Management Survey 4. Concluding Comments

4. “Great East Japan Earthquake”Triple Disasters in Fukushima 1,652 deaths were “disaster-related deaths”. No one died due to radiation due to NPP accident. 1,603 died and 207 are still lost due to Earthquake and/or Tsunami. Nuclear Power Plant Accident Tsunami Earthquake Fukushima Dai-ichi Nuclear Power Plant Fukushima City Minami-soma City

5. Today’s topic 1. Overview of the Great East Japan Earthquake in Fukushima 2. Situation of evacuation and evacuees 3. Overview of the Fukushima Health Management Survey 4. Concluding Comments

6. Number of residents who were living in evacuation area: 210,000 (March 11, 2011) Number of evacuees (including Voluntary evacuees) ・Inside Fukushima Prefecture: 88,416 ・Outside Fukushima Prefecture: 48,364 Total:136,780 (January, 16, 2014)

7. Direct deaths/Disaster-related deaths (“Asahi Shinbun”, 20, Feb., 2014)

8. Excess mortality among relocated institutionalized elderly after the Fukushima Daiichi NPP accident Excess mortality Accident Occurred. Yasumura S, Goto A, Yamazaki S, Reich MR. Excess mortality among relocated institutionalized elderly after the Fukushima nuclear disaster. Public Health 127: 186-188, 2012.

9. Evacuees outside Fukushima Prefecture(Feb. 2, 2013) 青森県 550 秋田県 925 北海道 1,802 岩手県 538 Yamagata 9,513 宮城県 2,328 Niigata 5,724 石川県 350 富山県 243 福井県 243 栃木県 2,948 群馬県 1,688 茨城県 3,943 長野県 1,003 京都府 702 滋賀県 229 埼玉県 3,820 岐阜県 228 鳥取県 133 Tokyo 7,449 島根県 107 千葉県 3,313 愛知県 795 静岡県 823 兵庫県 604 岡山県 339 Hiroshima 322 佐賀県 134 福岡県 353 神奈川県 2,449 山梨県 710 山口県　83 Nagasaki 89 徳島県 40 三重県 213 奈良県 106 和歌山県 54 大分県 176 大阪府 734 熊本県 98 香川県 45 宮崎県 134 高知県 63 愛媛県 106 鹿児島県 148 Okinawa 738 ※都道府県名に併記している数字は 各都道府県への避難者数。　　　 (Radiation Medical Center for the Fukushima Health Management Survey, Fukushima Medical University)

10. Evacuees outside Fukushima Prefecture(Jan. 16, 2014) 青森県 472 秋田県 779 北海道 1,668 岩手県 538 Yamagata 5,708 宮城県 2,514 Niigata 4,640 石川県 302 富山県 207 福井県 196 栃木県 2,922 茨城県 3,738 群馬県 1,459 長野県 921 京都府 625 滋賀県 197 埼玉県 2,797 岐阜県 219 鳥取県 119 Tokyo 6,583 島根県 99 千葉県 3,333 愛知県 747 静岡県 750 兵庫県 538 Hiroshima 241 岡山県 319 福岡県 329 神奈川県 2,117 佐賀県 104 山梨県 649 山口県　86 Nagasaki 85 徳島県 40 三重県 220 奈良県 97 和歌山県 39 大分県 127 大阪府 613 熊本県 108 香川県 50 宮崎県 136 高知県 49 愛媛県 89 Okinawa 670 鹿児島県 125 57,135 (Feb. 2, 2013) ※都道府県名に併記している数字は 各都道府県への避難者数。　　　 (Radiation Medical Center for the Fukushima Health Management Survey, Fukushima Medical University)

11. Today’s topic 1. Overview of the Great East Japan Earthquake in Fukushima 2. Situation of evacuation and evacuees 3. Overview of the Fukushima Health Management Survey 4. Concluding Comments

12. Objectives of • the Fukushima Health Management Survey 1. To monitor residents’ long-term health and to promote their future well-being. 2. To confirm whether a long-term low-dose radiation exposure has an effect on health.

14. Today’s topic 1. Overview of the Great East Japan Earthquake in Fukushima 2. Situation of evacuation and evacuees 3. Overview of the Fukushima Health Management Survey: Basic survey 4. Concluding Comments

16. Table1 Estimated external radiation doses (preceding and full-scale survey)

17. Today’s topic 1. Overview of the Great East Japan Earthquake in Fukushima 2. Situation of evacuation and evacuees 3. Outline and result of the Fukushima Health Management Survey: Thyroid ultrasound examination 4. Concluding Comments Please wait a little! Professor Suzuki will present tommorow!!

18. Today’s topic 1. Overview of the Great East Japan Earthquake in Fukushima 2. Situation of evacuation and evacuees 3. Overview of the Fukushima Health Management Survey: Comprehensive health check 4. Concluding Comments

20. The comprehensive health check in Date City

22. Results The proportion of abnormal test results (obesity, glucose metabolism, lipid metabolism and liver function) was higher in the study population compared with the reference populations; the trend was more pronounced in males. This may be due to possible lifestyle changes (such as less exercise and excessive alcohol consumption) caused by psychological distress and sleeping disorder after forced evacuation.

23. Today’s topic 1. Overview of the Great East Japan Earthquake in Fukushima 2. Situation of evacuation and evacuees 3. Overview of the Fukushima Health Management Survey: The mental health and lifestyle survey 4. Concluding Comments

25. The mental health and lifestyle survey

27. Total K6 in total population Figure Distribution of K6 (Press release, 11, Sep, 2012) ↑ ↑ Number Total score Male K6 by sex ↑ ↑ Female Number ↑ Male Female ↑ Total score

28. Today’s topic 1. Overview of the Great East Japan Earthquake in Fukushima 2. Situation of evacuation and evacuees 3. Overview of the Fukushima Health Management Survey: Pregnancy and birth survey 4. Concluding Comments

30. The pregnancy and birth survey 15,972 Subjects Mid-wife, Doctors Telephone consultation if needed E-mail /Telephone consultation Send a questionnaire Feedback of the consultation Transmit the information Letter of thanks Check questionnaire Data company Confirm the answers, especially items of depression, and decide whether telephone consultation is needed or not Order of data entry Report of the result Research Office

31. Result of the 2011 survey 1. Response Rates A total of 15,972 questionnaires were distributed in January 2012 and 9,298 (58.2%) were returned by 31 August 2012 2. Support after the Survey Invalid answers and spontaneous abortionswere excluded, and telephone counseling was provided by midwives and public health nurses for respondents who were identified as respondents requiring support on the basis of the survey. The proportion of miscarriage in Fukushima Prefecture was 0.79% and that of induced abortion was 0.09% in 2012, no different from the previous fiscal year. The proportion of premature delivery in 2012 was 5.86% which was higher than the previous fiscal year (4.75%).

32. Today’s topic 1. Overview of the Great East Japan Earthquake in Fukushima 2. Situation of evacuation and evacuees 3. Overview of the Fukushima Health Management Survey 4. Concluding Comments

33. Concluding Comments Our greatest achievement: There are so many problems caused by the nuclear power plant accident now. Fukushima residents more concerned about their health than ever and feel anxiety of their own health. Under such circumstances, we implemented the presented multifaceted Fukushima Health Management Survey within one year after the Great East Japan Earthquake. In collaboration with: Hiroshima University, Nagasaki University, Radiation Effects Research Foundation, National Institute of Radiological Science, and Fukushima Medical Association.

34. Our best efforts continues; 1. To outreach as many residents as possible. 2. To implement further detailed investigations. 3. To disseminate obtained results. We hope continued concerns and collaboration by Hiroshima University and Nagasaki University.