Considering social issues for developing health surveillance and health care programme following a nuclear accident: contribution from the SHAMISEN Project


The 2nd International Symposium of the Network-type Joint Usage/Research Center for radiation Disaster Medical Science.
Nagasaki University, Japan - 3-4 February 2018.


The Chernobyl and Fukushima accidents have caused significant social and economic disruptions that have affected the local populations, with effects extending over years or even decades, inevitably impacting their health and welfare. It appears that affected populations are very concerned about health consequences of living in a contaminated environment. However, they generally lack information, support and basic knowledge to cope with the radioactivity in their daily environment. This in turn limits their ability to act to reduce or avoid exposure to radiations and impact their living conditions. Following the Chernobyl accident, several studies highlight the need for developing new and innovative approaches to respond to concerns of populations affected by long-lasting contamination of their environment and to improve their living conditions.

In the framework of the SHAMISEN project (*SHAMISEN project: Nuclear Emergency Situations Improvement of Medical and Health Surveillance – OPERRA Project, European Commission FP7, Project number 604984 – Final report 2017), a review of the health concerns of populations living in contaminated areas following radiation accidents was performed with the aim to identify recommendations for improving the development of health surveillance programmes. In particular, the subtask aims at identifying the impacts on living and social conditions, and summarising the worries, needs and expectations of the affected populations with regards to their health and welfare.

A series of case studies have been drawn in different situations observed after the Chernobyl accident in Norway and in Belarus. Activities carried out in Japan after the Fukushima accident have also been reviewed, incorporating an analysis of testimonies of medical experts and local stakeholders from two affected villages - Iitate and Miyakoji - as well as the feedback collected during a dedicated workshop jointly organised with, and hosted by, the Fukushima Medical University, in March 2016. This analysis pointed out the importance for sharing and taking into account well-being issues in the development of health surveillance programmes, which should embrace many dimensions such as health and welfare, psychosocial issues, as well as environmental, social and economic aspects, etc.

>> The health surveillance programme needs to be adapted to the population concerns and should contribute to the improvement of their well-being beyond the early phase of the accident (e.g. evacuation) i.e. during the transition phase (e.g. decontamination, return of people) and the longer term (e.g. reconstruction and recovery, improvement of welfare, health surveys). As a consequence, a health surveillance programme should be enlarged to other than radiation induced diseases. In particular, the development of infrastructures (transports, schools, care homes...), job opportunities and pleasant and secure living environment are important contributions to the well-being.

>> Adaptation of the health care programme to cope with the post-accidental context has to be considered, including notably the redeployment and renewal of the health care services, involvement of dedicated health professionals to address the concerns of the local population.

>> In a context of long-standing mistrust towards institutional experts and authorities, communication and counselling actions towards public cannot be effectively and trustworthy done directly by traditional national experts. To grasp the situation and issues at stake, people would preferably refer to reliable local persons (local facilitators) such as local medical doctors, nurses, teachers and elected people. These facilitators ensure a liaison role between the national and local levels by relaying and balancing the scientific expertise with the local concerns and context. This calls for developing dedicated structures for dialogue contributing to develop a practical radiological protection culture at the local level and to improve the well-being of affected population.

>> The participation of affected populations to self-help protection actions and measurement (of foodstuff, environment, etc) provide people with opportunities to regain control over their daily life. It helps people to understand what is at stake in their own environment and how they can take decision to avoid or mitigate individual exposures. To be effective, these initiatives should be sustained first by the authorities and radiation protection experts and notably thanks to the dissemination and the transmission of the radiological protection culture towards actual stakeholders and future generations.

>> In order to maintain the citizen vigilance in potential affected territories, specific education and training programmes, material and resources have to be anticipated before an accident and developed if it occurs.

>> Finally, health surveillance should always respect the autonomy and dignity of affected populations and consider justice and fairness associated with the inequitable distribution of risks and impacts. In this perspective, the participatory process for establishing and following health surveillance programme has to be implemented with favouring the participation of local stakeholders.


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