Reflections on Health Reconstruction in Japan After 3-11
December 6, 2011
J. Stephen Morrison
Senior Vice President, CSIS & Director, Global Health Policy Center at CSIS
CSIS launched in Washington on November 3 the final report of its ‘Partnership for Recovery and a Stronger Future: Standing with Japan after 3-11.’ The report’s health chapter focuses on the challenges of low-dose, long-term radiation, mental health services for traumatized, elderly, dislocated populations, and reconstruction of health infrastructure.
Wednesday, November 9, CSIS briefed the report in Tokyo to its partners, Keidanren, the Japanese business federation. That same day, I and Brian Biles, of George Washington University (who contributed substantially to the chapter and our related work in Japan) had the chance to meet with several health policy experts based in Tokyo. The following day, we visited Fukushima City and the coastal city of Minami-Soma, accompanied by Ryoji Noritake of the Health and Global Policy Institute (HGPI-Japan), where we had the opportunity to meet with a diverse group of experts, both within and outside government, involved in the health reconstruction effort. Many of these individuals Ryoji and I had occasion to meet during an earlier visit in June. On Friday, Nov 11, we participated in Fukushima City in a joint CSIS-HGPI conference built around the CSIS report that featured CSIS Japan Chair Dr. Michael Green, myself, HGPI’s leadership Dr. Hiromi Murakami and Dr. Kiyoshi Kurokawa, and several Japanese national, prefectural and university-based experts.
Below are four major impressions from the week’s visit. 
First, low-dose long-term radiation is now seen as a national phenomenon that is acutely problematic. That shift was brought about in part by the discovery of new ‘hot spots’ outside the Fukushima Prefecture, including in and around Tokyo. The national government, led by the radiation minister/czar, Goshi Hosono, is making progress in moving the Daiichi plants towards an effective ‘cold shutdown,’ thereby easing the strategic threat of more radiation releases, and it has brought about greater consistency in messaging and a more systematic approach to reviewing policies and laws on radiation exposure. Nonetheless, the government continues to face a persistent lack of public trust. Government, the nuclear industry and scientists are widely seen as mutually compromised by their past and continuing close interrelationships. There is no revered and trusted national public health personality who might explain to a wary and fearful public what is known and not known with respect to safety, risk, exposure and the science behind standards and scales. Translating science to the public remains deeply difficult in Japan. So too is rebuilding basic public trust and confidence.
Second, decontamination has become a complex dominant challenge in Fukushima prefecture and beyond, focused on schools and residences. Two sizeable districts in Fukushima City, Onami and Watari, require extensive work. An estimated 3 million tons of soil will need to be removed in the Prefecture (adding to the 23 million tons of debris amassed in total in the three Tohoku prefectures hit by the earthquake and tsunami). Though work has begun, there was as of early November no national law, no clear national or prefecture-level decision structure, no clear storage plan, and no clear radiation guidance (soil, debris, food) to guide decontamination efforts. Answers in all of these areas are anticipated, thought precise timing is murky. A general government goal is to reduce radiation levels by 50% in two years. In early October, Minister Hosono made a dramatic and ambitious pledge to the Fukushima Governor Sato that any area with 1 millisievert or more of annual radiation exposure would be decontaminated, paid for by the national government. The previous standard had been 5 millisievert. Costs will exceed $15 billion.
Third, I sensed that there has been a psychological shift among Fukushima citizens to a more realistic, sober and long-term perspective on reconstruction requirements, buoyed somewhat perhaps by the expectation that major resources (an estimated $120-158 billion) will become available through the third supplemental funding, dedicated to long-term reconstruction of the three Tohoku prefectures. Fukushima residents remains very concerned that the prefecture’s population has declined by 8-10 percent, that upwards of 20% of children have departed, and understand that as the population continues steadily to diminish, it is becoming ever more elderly and less viable. 
In the meantime, investment languishes and the economy is largely at a standstill. It will likely be a few years before the downward trajectory flattens out and a new equilibrium and renewal becomes possible in Fukushima.
Fourth is the preoccupation with acute health manpower shortages. Prior to 3-11, Fukushima had a chronic shortfall in doctors and nurses. 3-11 has dramatically aggravated the problem, as health professionals have migrated out. How to staunch that trend, and stabilize Fukushima’s communities, is very much on policymakers’ and citizens’ minds, but there are no ready, clear policy solutions, nor even an early vision of how to tackle this most fundamental problem. Related to this, there is a widespread belief that mental health problems are on the rise, and yet are still under recognized as an emerging priority challenge. We can expect in 2012 much discussion of how effectively to rebuild the health workforce.
