1. Public Health Activities in Local Communities Ichiro Yamaguchi National Institute of Public Health Japan POINT/COUNTERPOINT DISCUSSION: FUKUSHIMA RISK COMMUNICATION STRATEGY 2 1

2. All authors declare they have no actual or potential competing financial interest. 2

3. Thyroid ultrasound examinations As one of Fukushima Health Survey, thyroid ultrasound examinations is covering roughly 360,000 residents aged 0 to 18 years at the time of the nuclear accident From this survey, concerns from local residents are arising, such as the purpose of the survey and the interpretations of the initial results and follow-up surveys Research to find scientific evidences or Public Health Service to show your child is OK ? Research to find scientific evidences or Public Health Service to show your child is OK ? 3 Around half children have small cyst in their thyroid ｓ … My child is not an experimental animal…

4. Are you ready to explain? How to explain the results of scientific research with inevitable uncertainty such as Dr Tondel’s ecological studies that have certain effects on Japanese citizens? 4 It was revised in 2011 Fukushima city Tondel 2004 Tokyo

5. What suggestions do you give? A local resident asked me about the difference on detected ratios of thyroid cancer between cities and villages in Fukushima during 2011- 2014. 5 City (n=13)Town (n=31)Village (n=15) Detected radio of thyroid cancer *) 0.035%0.027%0.056% *) Including suspicion of malignancy According to her observation, ratio in villages seems to be high... According to her observation, ratio in villages seems to be high...

6. Detected ratios of all municipalities, Fukushima 6 Red: fiscal year 2011 Green :fiscal year 2012 Blue: fiscal year 2013 Random variation would depend on a sample size In each municipality n=59 In each municipality n=59

7. What is your opinion on these Issues… We need communication to deal with ethical issue 7

8. Risk information Should we do no harm by avoiding to inform negative information or disclose the risk information to strengthen a trusting relationship as Prof. Tsuda claimed? Do no harmTell about risk Listening to risk story is not easy thing… Depending on the psychological phase as explained by regulatory-focus theory… 8 People might need supports to bear

9. Cons of a screening test Should we explain the cons of a screening test? Yes!No! Do you wish to make me anxious? I wish to know whether my child is OK or not! Do you wish to make me anxious? I wish to know whether my child is OK or not! Psychological impact of research results should be considered…. Are you trying to disturb the screening programme? 9

10. Disclosure of study results Should we disclose result to study participants before a presentation at a scientific conference or publishing in a scientific journal? Yes!No! We wish to be informed about this research results at our town meeting! 10

11. Our observations Ethical issues regarding the thyroid mass screenings were presented at seminars during 2012 to 2014 for nursery teachers (n=359) organized by Fukushima prefectural government and NIPH. 11

12. Honest attitudes were accepted They recognized the honest attitudes of the facilitators and eventually understood their explanations 12 Although the explanation of cons of the thyroid- screening test would not be easy for nursery teachers to understand Did you understand the lecture on Fukushima Health Survey? Improvement on relationships

13. News Letter on Thyroid examination Cons of thyroid screening is mentioned. fukushima-mimamori.jp 13 Greetings from the director team member Thyroid examination provides pros. However it also provides cons… Thyroid examination provides pros. However it also provides cons… It was also mentioned in the interim report (2015) of the committee organized by Fukushima prefecture

14. Discussion It is inevitable for public health activities in local communities during the recovery phase from a (nuclear) disaster to be involved in difficult ethical issues, such as how to communicate (radiation) risks and empower residents for their own risk decisions, how to carry out scientific research that solves problems, how to share the burden of risks fairly, and to find a solution to the settlement of compensation issues. 14

15. Conclusion Public health activities in Fukushima are revealing that consideration of ethical issues regarding complex situations is a key factor to strengthen public trust. 15