What is health impact of a nuclear accident?
Time to reconsider what to monitor
原発災害の健康被害とは?
「何」をモニタリングすべきかの再考
Sae
Ochi, MD, MPH, PhD
Department of Internal Medicine, Soma Central Hospital
Clinical research fellow, Imperial College London
Assumptions of health problems
after a nuclear accident..
原発災害と健康災害の思い込み
• Acute radiation poisoning
急性放射線障害
• Chronic radiation exposure leading to cancer
慢性被ばくと悪性腫瘍
• Managed by health professionals
専門家に任せるべき問題
• Problems limited in the affected area
被災地のみの問題
However: health impact following the accident was much larger than that of radiation.
しかし:原発事故による健康被害>>放射線被害 The number of the victims are still increasing 被災者は現在も増え続けている
Monitoring is a key to prevent further health deterioration at disaster area. それらを把握するためのモニタリングは非常に重要
2okm: ‘no-entry zone’ 警戒区域
20-30km: ‘evacuation zone in case of emergency’;
people were recommended to stay at home 避難準備 区域:屋内退避指示
30-50km: ‘planned evacuation zone’ 計画的避難区域
Case1: Impact of the settlement of evacuation zone
例1:避難区域設定による健康被害
Data from: Ministry of Education, Culture, Sports, Science and Technology
80km
30km 20km
Scientifically ‘reasonable’, but in the real world..
科学的には正しい。しかし現実には
àAll who could evacuate left the place 移動手段のある人は皆避難
àNo supply within 50km 50km圏内の流通は停止
àThe most vulnerable were left without food 弱者が食料もなく放置
“ I did death investigation for a month after the disaster…several elderlies apparently died from starvation or dehydration at home..”---a medical docter 震災後1か月の間に、自宅で衰弱死しているお年寄りを何人も見ました―検死医
Case 2. Impact of evacuating care homes
例2:長期療養施設の健康被害
•
Evacuation cause physical and mental stress..
避難行動が高齢者に与える精神・身体ストレス
▫
Traveling a long distance
長距離移動
▫
Evacuating without adequate equipment
(Water, mattress, clothes, etc.)
十分な装備(水
、
マットレス
、
防寒具など)なしの移動
▫
Sudden change of environment
急激な環境変化
▫
Non-smooth handover
between the facilities
申し送りの不充分
•
A retrospective study targeting 5 care homes in
Minamisoma City
1このような背景を元に、南相馬市から避難した5つの長
期療養施設を調査
1. Nomura S, Gilmour S, Tsubokura M, Yoneoka D, Sugimoto A, et al. (2013) Mortality Risk amongst Nursing Home Residents Evacuated after the Fukushima Nuclear Accident: A Retrospective Cohort Study. PLoS ONE 8(3): e60192. doi: 10.1371/
Time series trend of death in elderly homes. Dotted
line indicates the time of the earthquake (11/3/2011)
死亡率の時系列変化:点線が震災時
Nomura S, Gilmour S, Tsubokura M, Yoneoka D, Sugimoto A, et al. (2013) Mortality Risk amongst Nursing Home Residents Evacuated after the Fukushima Nuclear Accident: A Retrospective Cohort Study. PLoS ONE 8(3): e60192. doi: 10.1371/ journal.pone.0060192
Estimated pre- and post-earthquake
survival.
震災前後の生存曲線の比較
Nomura S, Gilmour S, Tsubokura M, Yoneoka D, Sugimoto A, et al. (2013) Mortality Risk amongst Nursing Home Residents Evacuated after the Fukushima Nuclear Accident: A Retrospective Cohort Study. PLoS ONE 8(3): e60192. doi: 10.1371/ journal.pone.0060192
Case 3. Impact among ‘healthy’ elderly at temporary housings
例
3.「健康な」高齢者の仮設住宅生活による健康被害
Cause of health deterioration may include..
健康被害の原因
•
Immobility 不動
▫
Loss of job 失業
▫
Poor living condition 狭い居住環境
•
Poor access to healthy foods & exercise
健康な食生活や運動の不足
▫
Increased car dependency 車への依存
•
Deterioration of mental status
精神状態の悪化
▫
Poor living condition 住環境
▫
Loss of family members 家族の喪失
Gender Control Temporary
housings Coef. 95% C.I. p
Grip strength (kg)
握力 Male 32.2 35.2 1.62 0.92 2.32 <0.01
Female 21.3 23.7 1.29 0.88 1.70 <0.01
% OR 95% C.I. p
Open-eyed one leg standing
(<15 sec)
Male 31% 64% 5.2 2.97 9.21 <0.01 Female 30% 66% 5.4 3.43 8.49 <0.01
Physical condition among the elderly at temporary
housings (2012)
仮設住宅の高齢者の身体能力
→
Residents at temporary housing showed
stronger grip, but worse stability
仮設住宅の住民は握力が高く下肢筋力が低
い結果
Persistent health deterioration among
the residents at temporary housings
仮設住宅の健康被害はまだ続いている
。
Male Female Control* (N=70) Temporary housing (N=78) p p’ ** Control N=85 Temporary housing N=104 p p’ * ⊿BMI*** -0.41 0.17 <0.01 <0.01 -0.28 0.45 <0.01 <0.01 ⊿HbA1c* -0.21 0.28 0.01 0.02 0.01 0.06 0.74 0.8 Improved Obesity**** 10% 0% <0.01 0.02 8% 1% <0.01 0.03*Control: residents in Fukushima who stayed their home Control: 自宅に留まった相馬市の住民
** p’ : controlled for age *** ⊿: value in 2012 – value in 2011 were calculated for individual ⊿:2012年の値から2011年の値を引いたモノ *** Improved obesity: proportion of those who were obese in 2011 and not obese in 2012
Summary
要約
•
Health impact due to the nuclear accident is much larger than that
of radiation.
原発による健康被害は放射線被害よりはるかに大きい。
•
By focusing only on radiation, many victims could be ignored.
放射線にのみ囚われることにより、他の健康被害が無視される可
能性
•
Monitoring broader aspects of health is essential for
evidence-informed policy making.
より広い健康アウトカムを評価することが、適切なエビデンスに
基づく政策へもつながる。
•
To broaden our perspectives, multidisciplinary management is
essential.
Acknowledgement 謝辞
Soma Central Hospital
Soma local government 相馬市役所
Soma health centre 相馬市保健センター
Tokyo University Global Health Policy 東京大学Global Health Policy Tokyo University Social Communication System for Advanced Medical Technology 東京大学医科学研究所
Houei-kai Hospital 豊栄会メンバー
Minamisoma City Hospital 南相馬市立病院
All the residents in Soma and Minamisoma City 相馬市・南相馬市の皆様