Fukushima after the Great East Japan Earthquake: lessons for developing responsive and resilient health systems

Abstract

BackgroundOn 11 March 2011, the Great East Japan Earthquake, followed by a tsunami and nuclear–reactor meltdowns, produced one of the most severe disasters in the history of Japan. The adverse impact of this ‘triple disaster’ on the health of local populations and the health system was substantial. In this study we examine population–level health indicator changes that accompanied the disaster, and discuss options for re–designing Fukushima’s health system, and by extension that of Japan, to enhance its responsiveness and resilience to current and future shocks.MethodsWe used country–level (Japan–average) or prefecture–level data (2005–2014) available from the portal site of Official Statistics of Japan for Fukushima, Miyagi, and Iwate, the prefectures that were most affected by the disaster, to compare trends before (2005–2010) and after (2011–2014) the ‘disaster’. We made time–trend line plots to describe changes over time in age–adjusted cause–specific mortality rates in each prefecture.FindingsAll three prefectures, and in particular Fukushima, had lower socio–economic indicators, an older population, lower productivity and gross domestic product per capita, and less higher–level industry than the Japan average. All three prefectures were ‘medically underserved’, with fewer physicians, nurses, ambulance calls and clinics per 100 000 residents than the Japan average. Even before the disaster, age–adjusted all–cause mortality in Fukushima was in general higher than the national rates. After the triple disaster we found that the mortality rate due to myocardial infarction increased substantially in Fukushima while it decreased nationwide. Compared to Japan average, spikes in mortality due to lung disease (all three prefectures), stroke (Iwate and Miyagi), and all–cause mortality (Miyagi and Fukushima) were also observed post–disaster. The cause–specific mortality rate from cancer followed similar trends in all three prefectures to those in Japan as a whole. Although we found a sharp rise in ambulance calls in Iwate and Miyagi, we did not see such a rise in Fukushima: a finding which may indicate limited responsiveness to acute demand because of pre–existing restricted capacity in emergency ambulance services.ConclusionsWe analyze changes in indicators of health and health systems infrastructure in Fukushima before and five years following the disaster, and explored health systems’ strengths and vulnerabilities. Spikes in mortality rates for selected non–infectious conditions common among older individuals were observed compared to the national trends. The results suggest that poorer reserves in the health care delivery system in Fukushima limited its capacity to effectively meet sudden unexpected increases in demand generated by the disaster.

Health system resilience: a literature review of empirical research

“…Overall, the empirical studies identified differed in terms of their disciplinary tradition or conceptual background. Studies from the public health sciences tended to converge in three groups: (1) quantitative studies focusing on service delivery, making use of service utilization indicators provide an easily accessible measure to assess resilience before, during and after a crisis ( Paterson et al 2014 ; Gizelis et al 2017 ; Sochas et al 2017 ; Kozuki et al 2018 ; Ray-Bennett et al 2019 ), (2) qualitative studies focusing on the health workforce, influenced by ideas of ‘everyday resilience’ and addressing the contributions of social connectedness and leadership on health system resilience ( Mash et al 2008 ; Witter et al 2017 ; Raven et al 2018 ; Brooke-Sumner et al 2019 ; Thude et al 2019 ), and (3) studies taking a broad perspective of health system resilience, looking at multiple health system building blocks or aspects of a health system to assess resiliency ( Ager et al 2015 ; Ammar et al 2016 ; Fukuma et al 2017 ; Ling et al 2017 ; Meyer et al 2018 ; Watts et al 2018 ).…”

“…Of the eight studies which assessed an entire, national health system in the context of a particular crisis, two studies took a purely quantitative approach: Fukuma et al (2017) assessed Japan’s health system responsiveness and resilience after the Great East Japan Earthquake and Watts et al (2018) assessed the resilience of 101 health systems in the context of climate change. Fukuma et al (2017) operationalized resilience by using composite routine data indicators during the time of crisis, including: service utilization, cause-specific mortality rates incl. suicides, number of hospitals, health expenditures, human resources and immunization coverage.…”

Violence against children and natural disasters: A systematic review and meta-analysis of quantitative evidence

“…Unlike violence initiated by humans, natural disasters may leave community trust intact or bolster cooperation. In some settings, natural disasters are associated with reductions in violent crime [29][30][31], increases in family functioning [32,33], and prosocial behavior in communities and families [34][35][36]. One such study on communities affected by Hurricane Andrew found that one-third of respondents reported less stress with their neighbors than before the disaster, and 90% felt that the sense of sharing had been high in the neighborhood immediately after the hurricane and one year later [37].…”

Shifting the paradigm: using disease outbreaks to build resilient health systems

“…A resilient health system can absorb the shock of an emergency while continuing to provide regular health services. [6][7][8] Most frameworks for building resilient health systems that effectively respond to disease outbreaks focus on enhancing preparedness or response capacity prior to an emergency [9][10][11] or to strengthen health systems after the emergency, typically during the recovery phase. Indeed, many aspects of outbreak response lay the groundwork for health system strengthening (HSS), such as enhancing surveillance systems and training the health workforce.…”