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ORIGINAL PAPER The impact of Fukushima on global health: lessons learned from man-made and natural disasters Luis Kun & K. Hirose & B. Katsumi & M. Albin & K. Prendergast & M. Mendoza Received: 22 May 2014 /Accepted: 9 July 2014 /Published online: 7 August 2014 # IUPESM and Springer-Verlag Berlin Heidelberg 2014 Abstract On July 5, 2013 a special invited session enti- tled: The Impact of Fukushima on Global HealthLessons Learned from Man-Made and Natural Disasterswas held at the Osaka Convention Center in Osaka, Japan, during the 35th Annual International Conference of the IEEEEngineering in Medicine and Biology Society. The purpose of that session was mainly to discuss what happened at Fukushima, its repercussions and what other countries particularly those in South, Central and North America, can do to be better prepared for similar events. The first three authors of this paper participated in that special session. This article examines the causes and consequences of the nuclear accident that took place March 11, 2011, at the Fukushima Dai-ichi plant in Fukushima, Japan. It explains the different security risks associated with nuclear energy and analyzes the natural, man-made and technical causes of the Fukushima disaster. While nature was the main instigator, poor design, relaxed safety standards and lack of training severely exacerbated the damage and prolonged the effects of the incident. Crisis management strategies from the incident showed how cloud computing can be useful and effective in emergency response situations. However, the articles au- thors warn of potential failures due to infrastructure inter- dependencies and of the need to build resilient systems. The ongoing crisis in Fukushima serves as a testament to the different security risks associated with nuclear power and the serious, long lasting consequences they can have on critical infrastructures, the environment, public health, commerce and societynot just in Fukushima but any- where in the world. In examining nuclear power as a viable energy resource, this article uses the Fukushima accident to encourage international discussion regarding the benefits and risks of nuclear power, the definition of government and utility companys roles and responsibili- ties to the public, and the possibility of pursuing alterna- tive energy sources. Finally, through an analysis of these risks and the lessons learned from Fukushima, this article will present policy recommendations regarding better risk analysis, plant construction, secure practices, restoration of critical infrastructures and other elements of disaster response in order to create safer, more responsible nuclear energy policies worldwide. Keywords Security . Risks . Nuclear energy . Fukushima Dai-ichi . Tokyo Electric Power Company (TEPCO) . Cesium -137 . Iodine -131 . Contamination . Radiation . Design . Emergency procedures . Critical infrastructures . Cloud computing . Crisis management . Disaster response . Policy recommendations . Risk analysis . Containment . Clean up procedures . Secure components . Secure people . Secure practices . Alternative sources of energy Disclaimer The views expressed in this paper are those of the authors and do not necessarily reflect the official policy or position of the William Perry Center for Hemispheric Defense Studies, the U.S. National Defense University, the U.S. Department of Defense, or the U.S. Government. B. Katsumi, a computer scientist contributed only on areas related to cloud computing and critical infrastructure; while Dr. K. Hirose, a nuclear engineer contributed with data and facts related to the accident and the actions that follow the crisis. The opinions and conclusions are from the first author. L. Kun (*) : M. Albin : K. Prendergast : M. Mendoza W. Perry, Center for Hemispheric Defense Studies, U.S. National Defense University, Fort McNair, 300 5th Avenue SE, Building 64, Washington, DC, USA e-mail: [email protected] K. Hirose Tokai University, Tokyo, Japan B. Katsumi Information Economy Research Institute, Yokohama, Japan Health Technol. (2014) 4:177203 DOI 10.1007/s12553-014-0090-y

The impact of Fukushima on global health: lessons learned from man-made and natural disasters

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Page 1: The impact of Fukushima on global health: lessons learned from man-made and natural disasters

ORIGINAL PAPER

The impact of Fukushima on global health: lessons learnedfrom man-made and natural disasters

Luis Kun & K. Hirose & B. Katsumi & M. Albin &

K. Prendergast & M. Mendoza

Received: 22 May 2014 /Accepted: 9 July 2014 /Published online: 7 August 2014# IUPESM and Springer-Verlag Berlin Heidelberg 2014

Abstract On July 5, 2013 a special invited session enti-tled: “The Impact of Fukushima on Global Health—Lessons Learned from Man-Made and Natural Disasters”was held at the Osaka Convention Center in Osaka, Japan,during the 35th Annual International Conference of theIEEE—Engineering in Medicine and Biology Society.The purpose of that session was mainly to discuss whathappened at Fukushima, its repercussions and what othercountries particularly those in South, Central and NorthAmerica, can do to be better prepared for similar events.The first three authors of this paper participated in thatspecial session. This article examines the causes andconsequences of the nuclear accident that took placeMarch 11, 2011, at the Fukushima Dai-ichi plant inFukushima, Japan. It explains the different security risksassociated with nuclear energy and analyzes the natural,man-made and technical causes of the Fukushima disaster.

While nature was the main instigator, poor design, relaxedsafety standards and lack of training severely exacerbatedthe damage and prolonged the effects of the incident.Crisis management strategies from the incident showedhow cloud computing can be useful and effective inemergency response situations. However, the article’s au-thors warn of potential failures due to infrastructure inter-dependencies and of the need to build resilient systems.The ongoing crisis in Fukushima serves as a testament tothe different security risks associated with nuclear powerand the serious, long lasting consequences they can haveon critical infrastructures, the environment, public health,commerce and society—not just in Fukushima but any-where in the world. In examining nuclear power as aviable energy resource, this article uses the Fukushimaaccident to encourage international discussion regardingthe benefits and risks of nuclear power, the definition ofgovernment and utility company’s roles and responsibili-ties to the public, and the possibility of pursuing alterna-tive energy sources. Finally, through an analysis of theserisks and the lessons learned from Fukushima, this articlewill present policy recommendations regarding better riskanalysis, plant construction, secure practices, restorationof critical infrastructures and other elements of disasterresponse in order to create safer, more responsible nuclearenergy policies worldwide.

Keywords Security . Risks . Nuclear energy . FukushimaDai-ichi . Tokyo Electric Power Company (TEPCO) . Cesium−137 . Iodine −131 . Contamination . Radiation . Design .

Emergency procedures . Critical infrastructures . Cloudcomputing . Crisis management . Disaster response . Policyrecommendations . Risk analysis . Containment . Clean upprocedures . Secure components . Secure people . Securepractices . Alternative sources of energy

Disclaimer The views expressed in this paper are those of the authorsand do not necessarily reflect the official policy or position of theWilliamPerry Center for Hemispheric Defense Studies, the U.S. National DefenseUniversity, the U.S. Department of Defense, or the U.S. Government. B.Katsumi, a computer scientist contributed only on areas related to cloudcomputing and critical infrastructure; while Dr. K. Hirose, a nuclearengineer contributed with data and facts related to the accident and theactions that follow the crisis. The opinions and conclusions are from thefirst author.

L. Kun (*) :M. Albin :K. Prendergast :M. MendozaW. Perry, Center for Hemispheric Defense Studies, U.S. NationalDefense University, Fort McNair, 300 5th Avenue SE, Building 64,Washington, DC, USAe-mail: [email protected]

K. HiroseTokai University, Tokyo, Japan

B. KatsumiInformation Economy Research Institute, Yokohama, Japan

Health Technol. (2014) 4:177–203DOI 10.1007/s12553-014-0090-y

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1 Introduction

1.1 Basic breakdown of events

On March 11, 2011, a severe blow was dealt to proponents ofnuclear energy worldwide when a 9.0 earthquake registered offof the coast of Japan caused a tsunami that sent a 15 m wavewashing over the Tokyo Electric Power Company’s (TEPCO)Fukushima Dai-ichi Nuclear Power Station located on Japan’snortheast coastline. With the plant’s backup systems floodedand off-site power sources inaccessible, cooling systems shutdown. Forced to find another way to control the ever-growingpressure in the containment vessel and to prevent reactors frommelting down, workers began to vent the reactors—releasingradioactive cesium−137 and iodine−131 into the air—andpumping in hundreds of thousands of gallons of ocean waterto cool the reactors’ cores. Despite these efforts, temperaturesremained high enough that hydrogen formed in the reactors,setting off explosions that sent more radioactive particles intothe air. Ultimately, three of the six reactors on site melted down,leaving behind a level of damage tantamount to that of previousnuclear disasters at Chernobyl and Three Mile Island.

The causes of the Fukushima disaster were three-fold:natural, man-made and technical. Fukushima was unique inthat nature was the main instigator. However poor design,relaxed safety standards and lack of training exacerbated thedamage and prolonged its effects. When the earthquake hitand the plant lost off-site grid power, everything functionedaccording to its design—reactors automatically shut down andthe emergency diesel-generators flipped on to supply water tocool fuel rods. However, when the tsunami struck, watersubmerged the emergency diesel generators sending, themoffline, pumps were damaged and the plants’ cooling systemsshut down causing the core to melt (see Fig. 1) [1, 2].

These failures were largely brought on by the plant’s inher-ent technical deficiencies. The facilities and equipment in theFukushima Dai-ichi plant were built to withstand an earthquakeof 7.0 and a tsunami of 5.7 m respectively. TEPCO had notbuilt the plant to higher specifications because regulation stip-ulated revisions and changes be made according to the likeli-hood of such disasters. In Japan, due to historically weaktsunamis and the presence of sea walls at 40 % of theJapanese coast, the threat was deemed to be low [1]. Yearsprior, TEPCO had revised and changed design specs andprocedures numerous times based on research done by theJapan Society of Civil Engineers (JSCE), the governmentregulatory agency responsible for determining design criteriafor earthquakes and tsunamis. In 2008, previously releasedinformation from the Headquarters for Earthquake ResearchPromotion (HERP) projected larger tsunamis based on previoushistorical records; however was not considered to be compel-ling enough to merit immediate changes due to TEPCO’sconcerns regarding the legitimacy of the methods used. In fact,

TEPCO Senior Managers were still waiting on a review of thedata and the plants specifications by the JSCE when the March2011 tsunami hit [3].

The Japanese government’s lack of urgency regarding pre-vention and safety, added to TEPCO’s own complacency creat-ed an uncertain situation where successful decontaminationefforts and a full shutdown will be largely contingent on tech-nology and equipment. Much of which has yet to be created.This false sense of security came from a long-standing, activecampaign by the Japanese government to utilize policy andgovernment money to instill a pro-nuclear culture in Japanesecommunities and grow the nuclear industry [4]. The Japanesegovernment provided TEPCO and other companies with finan-cial and logistical support for scouting potential sites, many ofwhich were rural and lured by the promise of jobs and money. Itprovided workshops for local politicians to learn how to sellnuclear power as a safe, cheap energy source. Political biasmeant that government oversight was significantly weak. As aresult, pressure on industry to consistently revise risk assess-ments and safety measures was minimal at best [5].

The ongoing crisis at Fukushima serves as a testament tothe risks associated with nuclear power and the serious,sustained consequences they can have on critical infrastruc-tures, the environment, health, commerce and civil society—not just in Fukushima but anywhere in the world. WhenFukushima Dai-ichi’s backup systems went down, it showedthe interdependency of electricity and telecommunications. Italso demonstrated the need for alternative sources of energy inorder to ensure continuity of services. Gas vented into the air,and waste water leaking from reactors before being thrownback into the sea, have contributed to a massive waste disposalproblem and a huge public health nightmare. Public confi-dence in government data eroded because of increases insafety exposure levels, levels that eventually resulted in theevacuation of approximately 341,000 residents living within50 km of the plant-100,000 of whom remain displaced orrefuse to go back [2]. Only after the evacuation was completedid the government begin to consistently distribute iodinetablets to residents to reduce the effects of radiation [2].Commerce was also adversely affected by government intakeand distribution restrictions that hurt fisherman, farmers and theJapanese economy. The subsequent social unrest in Japan hasprompted civilian groups to take to the streets with their ownGeiger counters to check government radiation levels, and hassparked mass demonstrations against nuclear power [5]. Now,TEPCO and the government must attempt to assuage thepublic’s fears and regain credibility. Together, they face thedaunting task of completely decommissioning the site, a projectthat is projected to take over 40 years and cost US $15 billion[6].

As countries seek to expand the operation life of existingnuclear plants and others consider pursuing nuclear energy forthe first time, the reverberating lessons of Fukushima take on

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renewed importance. This article uses the causes and conse-quences of the accident to: 1) Encourage dialogue about thesecurity risks posed by nuclear power; discuss what policiescan be established to protect the public, define government,private sector and international organizations’ roles and re-sponsibilities, and propose alternative sources of energy. 2)Establish a clear set of protocols for countries with andwithout nuclear power designed to protect the environment,critical infrastructures and people in the event of an accident.And finally, 3) Explore and develop recommendations formore responsible nuclear energy policy worldwide focusingon risk analysis and plant construction, secure practices,restoration of critical infrastructures and other elements ofdisaster response. This analysis will help produce more robustenergy policy and shape new, more effective responses to“unexpected, high consequence” situations—responses thatwill be key in helping to guard against future disasters andkeep communities around the world safe.

1.2 Projected effects on public health (Please referto the glossary list section, at the end of this paper, for the unitsdefinitions)

Standards for radiation protection have varied across Japanand the international community causing confusion and dis-putes over the potential impact of Fukushima on public health.The Japanese government originally mandated zones withdose levels of 20 mSv (for sievert definition, see Glossary,item #19) a year or higher be evacuated—the same interna-tional limit for power plant employees. Internationally, the

highest acceptable dosage for people in non-emergencysituations is 1 mSv per year. The Industrial SafetyRegulation for Nuclear Industry Workers in Japan (1972)stipulates workers receive no more than 50 mSv in a yearor 100 mSv over 5 years. The Japanese Rules forPrevention of Damage from Ionizing Radiation requires thatfemales receive 5 mSv or less over 3 months. The samelaw also bans citizens from areas where radiation is higherthan 5.2 mSv a year and limits exposure for pregnantwomen to 2 mSv a year [7]. Discrepancies and inconsistentlimits have led to serious questions regarding future impactsof radiation exposure. As leaks at the plant continue, andair, water and food continue to carry radiation exposure tomore and more people, uncertainty regarding safe intakelevels could become dangerous. The repercussions ofFukushima’s wide reach are turning up on shores anddinner tables all around the world making this a globalhealth issue where there is no margin for error. As a result,several surveys have been done to assess and monitor theeffects of radiation levels in residents and nearby commu-nities. However, varying results have only generated furtherconfusion as to the true impact of the accident on publichealth, water, food, the environment and the economy.

1.3 Fukushima residents’ health management survey

The Fukushima Residents’ Health Management surveyassessed and monitored radiation doses in 2,050,000 resi-dents and visitors to the Fukushima Prefecture, based onrespondents’ detailed accounts of their activities in the

Fig. 1 Loss of cooling capabilitycaused core melt at Unit 1, Unit 2and Unit 3 (Courtesy Dr.Kenkichi Hirose)

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four months following the accident [8]. Numerous prob-lems exist with the data gathered from this survey. First, itis not necessarily representative of actual exposure becausedose assessments were determined by the memory of re-spondents’ days after the accident. Second, questionnaireswere first distributed in June and did not go prefecture-wide until August. Since the most severe exposure hadlong passed, there was no scientific way to check andconfirm the internal levels of iodine 131 or other contam-inants due to external exposure later via air, water and food[8]. As a result, some researchers have said that despitelife-long screening for 360,000 residents under 18 yearsold and health monitoring for all residents for the next30 years, the project will do little to provide substantialanswers regarding the relationship between dose and ill-ness incidence [8].

1.4 WHO

The World Health Organization (WHO) issued a report inFebruary 2013 detailing the rate of increased risk of illnessdue to radiation exposure in Fukushima Prefecture residents,power plant workers and emergency responders in addition toother parts of Japan and the world. It found that for thoseliving in the most contaminated parts of the prefecture, spe-cifically the 27–100 people living in the Namie Town and ItateVillage before being evacuated, initial exposures of 12–25 mSv, would be responsible for seven percent increases inleukemia risk in males exposed as infants; six percent breastcancer risk for females exposed as infants’, four percentincreases in overall cancer risk for females exposed as babiesand most troubling, 70 % increases in risk of thyroid cancer infemales exposed as infants that received between 100 and200 mSv [9–11]. The people living in the second most con-taminated part of the region are suspected to be at approxi-mately half the risk of those who resided in the most contam-inated area and 2/3 the risk of exposed radiation workers [12].

According to Dr. Maria Neira, WHO Director for PublicHealth and Environment,

“The primary concern identified in this report is relatedto specific cancer risks linked to particular locations anddemographic factors. A breakdown of data, based onage gender and proximity to the nuclear plant, doesshow a higher cancer risk for those located in the mostcontaminated parts. Outside these parts—even in loca-tions inside Fukushima Prefecture—no observable in-creases in cancer incidence are expected [10].”

It is worth noting that the word observable is used synon-ymously with zero to no risk, which according to the afore-mentioned statistics, is impossible. Studies have shown thatwhile risks may be less in areas outside those most

contaminated, they do add a certain percentage of riskof illness, albeit minuscule. Furthermore, the report failsto take into account the potential effects of a continuedsteady accumulation of low doses over the years due toexternal exposure. Given the extent and reach of thecontamination and continued leaks, this is a very realpossibility that seems to have been overlooked in thegrand scheme of things.

Another report, issued by the Subcommittee of the UnitedNations Scientific Committee on the Effects of AtomicRadiation (UNSCEAR), found that exposure levels of100 mSv raised the risk of cancer in 167 TEPCO em-ployees—many of which were unaware of the radiation levelsinside the plant because radiation monitoring systems weredown. Other studies found that 30 % of workers were nevernotified of their cumulative radiation dosage, and only 40% ofemployees receivedwarnings that reactors could be dangerous[7]. Prior to the accident, only 67 % of TEPCO staff and 10 %of contractors knew accident procedures, and 28 and 44 %never consented to work in accident response situations [7]. Inthe UNSCEAR report, six workers were documented as hav-ing received dosages higher than the 250 mSv limit allowedby Japanese law—two of which received doses higher than600 mSv for failing to take potassium iodide tablets to preventtheir bodies from absorbing radiation. While overall numbersfrom the WHO and UNSCEAR reports are low consideringthe extent of the accident, they can be deceptive regarding thetotal overall damage of Fukushima, both in Japan andinternationally.

Neither of the studies addresses the psychological dam-age suffered by those living in and around Fukushima at thetime of the accident. In the case of Chernobyl it was be-lieved that many of the psychological effects of the incidenthad greater impact than the physical health problems,which led to monitoring of both physical and mental healthafter the accident. In smaller studies done to assess themental health of Fukushima residents, similar evidence ofserious psychological impact has been found in the form ofincreased cases of severe PTSD. Consistent health assess-ments continue to be a concern as air, food and watercontamination level and their potential correlation to futureillness provoke anxiety among residents [12].

While risks associated with the accident will be very lowaccording to these studies, the time of data collection andanalysis represents a very brief moment in time. For example,information collected by the WHO report only covered themonths of March 2011–September 2011. Assessments thattake future impacts from continued external exposure (inhala-tion and consumption of contaminated water and food sourcescaused by continued leaks) will be important in guiding policyand necessary safety measures. Without this information, theWHO’s assertion that “inside and outside of Japan, the pre-dicted risks are low and no observable increases in cancer

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rates above baseline rates are anticipated” [12] downplays thenumbers of those that will be affected in the future both inand outside of Japan [12]. These assessments are concerningbecause they are easy to support due to inconsistent safetylevels and lack of information in Japan regarding prevalenceof death from diseases like cancer prior to the accident. TheFukushima cancer registry was not started until 2011 andJapan’s relatively small population already had a high rateof cancer incidence before. Therefore, it will be difficult toestablish strong statistical evidence that future cancers areindeed the result of the Fukushima accident [13]. The factthat some people will die as a direct result of the accident andthat in the future others will die because of continued con-tamination consumption is disturbing from a health and jus-tice perspective [10, 13].

The zero risk mindset is deceptive as it may be too earlyto tell what ramifications these effects could have on publichealth in the future. As 100 tons of contaminated watercontinue to leak out of the plant every day, it is possiblethat the worst is yet to come. For example, scientific argu-ments exist that indicate mutations often form over a periodof generations. While the effects on health may seem min-iscule now, over the course of a few generations they couldbe quite dramatic. This risk will continue to rise as low-dosecontamination continues to spread to other parts of theworld by way of the ocean, wind and air, exposing largerpopulations. The risks of low-dose radiation vary, depend-ing on sex and age, but infants, young children and adultwomen are most vulnerable. Studies show that infants arefour times as sensitive to effects of radiation known tocause cancer as middle-aged adults. In pregnant mothers,10 mSv has been proven to raise the incidence of cancerduring the infant’s childhood by 40 % [9]. When exposed tothe same dosage, adult females are 40 % more likely todevelop cancer than adult males. And cancer isn’t the onlydisease caused by low levels of radiation. Low-level expo-sure over long periods of time can also contribute to heartattacks, strokes, infertility, and in women, high risk ofdeformities in children. Children under the age of 10’sprobability of dying from circulatory diseases is ten timeshigher and cancer, 20 times higher than adults older than 70[9].

One study, done by researchers at Stanford University, haspredicted that the effects from inhalation, ingestion and otherforms of residual external exposure will lead to 130 (15–1,100) cancer-related mortalities and 180 (24–1,800) cancer-related morbidities worldwide; however, these numbers aresubject to change and could increase mortalities and morbid-ities from a low estimate of 160–240 to a high estimate of1,300 to 2,500 [14]. A combination of persistent leaks and noresolution for the containment and cleanup of soil, water andair contamination mean the exposure-doses and the dose–response models used to predict tallies could change

significantly. Overall risk was projected to be relativelylow with a greater preponderance of health effects inJapan and minimal deaths predicted for other parts ofAsia and North America. For example, the United Stateswas only originally projected to see between 0 and 12radiation exposure-related deaths [14]. However, with therevelations that tanks holding radioactive waste at theFukushima site have continued to leak, as many as100 tons a day, water and food sources in and outside ofJapan will continue to be threatened. As a result, numbersof related illness incidence and death could continue torise over time. Any additional deaths will be added to thealready roughly 600 deaths across the 13 municipalitiesaffected, caused by fatigue and exacerbated chronic ill-ness due to the evacuations following the accident [14].Additional workers deaths are also a strong possibility.More than 400 workers received doses that exceeded50 mSV, the annual legal limit for Japanese nuclear powerplant employees. While no major exposure effects havebeen recorded so far, research models used indicate thatcollective exposure came to approximately 115 mSv perperson, enough to result in anywhere between 2 and 12worker cancers or morbidities depending upon the exactamount of exposure [14].

One of the commonalities found across varying studies isthe absence of future impacts, both locally and globally, on theenvironment, water, food security, and public health. Whileresearchers have called for ongoing monitoring of these is-sues, they have nonetheless excluded them from their finalassessments, which have concluded low risk for local andinternational populations.

1.5 Air, water and soil contamination

The greatest risks to public health in Fukushima and otherparts of Japan will come from consumption of contaminat-ed food and water. Between the radiation that extendedseveral hundred square kilometers around the plant to lowerdoses that were found in the United States, Canada andparts of Europe, the total percentage of radioactive materialreleased over land was only 19 %. With the majority of theradiation dispersing out over the Pacific or being dumpeddirectly into it, it was believed that the population affectedwould be relatively small. However, this has not been thecase as wind and water continue to carry around bothresidual fallout and radioactive waste that continues to leakto the continuous at the plant. The impact of wind and watercurrents in this crisis is one element that has been left out bystudies estimating public health consequences. As radioac-tive plumes continue to float around the Pacific, monitoringof wind and water patterns will become increasingly im-portant in efforts to protect populations from further radia-tion exposure.

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Large areas of eastern Japan have easily surpassedlegal limits showing soil concentrations of cesium −137higher than 100 Bq kg-1 [15]. Neighboring prefectureslike Iwate, Miyagi, Yamagata, Niigata, Tochigi, Ibaraki,and Chiba were also impacted and found to have morethan 250 Bq kg-1 [15]. With contamination escaping intothe environment on an ongoing basis, the likelihood ofthese deposits increasing is high and ongoing soil sam-pling has been recommended. Northwestern and Westernprefectures, mostly protected by the Kanto, Echigo, andOhwu mountain ranges, received lower radiation levelsof 25 Bq kg-1, which is still considered safe for agricul-tural purposes. However, the inability to account forwind complexities and precipitation means that there isa strong possibility that some areas with generally lowsoil contamination levels may have “hot spots” of highradiation. Conversely, in places with high overall con-tamination levels, places with lower levels may be pos-sible as well [15]. Although Japan imports much of itsfood, there are still many important agricultural regionswhose production is vital to the Japanese economy.Eighty percent of all vegetables consumed in Japan arelocally grown. Before the accident, the Fukushima pre-fecture had more than 70,000 commercial farmers thatproduced approximately $2.4 billion worth of spinach,tomatoes and milk annually. Once the fourth largest riceproducer in Japan, a ban on rice extending for more than9,400 ha of Fukushima’s paddy fields following theaccident caused production to plummet [16]. Ongoingcontamination and uncertainties regarding concentrationof radiation and trajectory means more land in theFukushima prefecture will inevitably remain fallow. Asa result, the agricultural sector will continue to see greatlosses in production well into the future.

The biggest cause for concern at the moment is the rapidrate of contamination to Japan’s water sources. With gov-ernment permission, TEPCO dumped approximately 3 mil-lion gallons of contaminated sea water used to cool thereactors back into the ocean. Despite assurance from PrimeMinister Abe, TEPCO has been unable to control leaksfrom reactors in addition to leaks in 350 of the approxi-mately 1,000 tanks holding radioactive wastewater onsite.As a result, 300 t of this water (71,895 gal/272,152 l), andan estimated 60 billion becquerels of cesium-137 andstrontium-90, continue to mix with groundwater and runinto the ocean everyday—enough to fill an Olympic-sizeswimming pool every 8 days [17]. These persistent leakshave raised valid questions about the increased risk ofillness and death due to accumulation of low dose con-sumption of water, fish and crops over time. The Food andAgriculture Organization of the United Nations (FAO) andthe World Health Organization’s International CodexAlimentarius Commission, charged with developing and

coordinating international food standards and practices toprotect consumer health, have deemed consumption levelsof 1 mSv per year as safe, provided contaminated foodsonly make up 10 % of the yearly diet [18].

For Japan, a country famous for its seafood and whosemain source of protein is fish, the accident has led toharmful but necessary restrictions on Japan’s fishing andagriculture industries. As leaks have continued, this willmean continued setbacks for Japan’s fisherman and thefishing industry, which never quite recovered from initialcontrols placed on fishing after the accident. Before theincident, the Japanese fishing industry brought in approxi-mately 100 million dollars per year. Fisherman have beentold to scale back their operations by the government untilfurther notice due to fears over potentially higher radiationlevels. Many have been forced to make ends meet collectingresidual trash from the accident and taking researchers out tocollect radiation measurements [19, 20]. Those that havebeen allowed to keep fishing find themselves having to gofurther and further out to be able to comply with the gov-ernment’s consumption safety levels. The Japanese NuclearRegulation Authority (NRA) has monitored Japanesefishermen’s catches around Fukushima since the time ofthe accident and has established a limit of 100 becquerelsper kilogram in fish for consumption (Bq/kg) [19, 20].Radiation testing found that 56 % of catches containedcesium-137 and cesium-134 and that 9.3 % of the catches’levels surpassed 100 Bq/kg. Despite seemingly low num-bers, radioactive materials’ slower than expected decay, andcontinued contamination caused by (on-going) leaks fromthe plant, means that levels in many species specificallythose caught and sold by other countries in the Pacific likecod, sole, tuna and halibut could grow [20].

In a country where eating fish forms an important part ofthe Japanese culture, monitoring and controlling fish con-sumption will no doubt be a continued priority for theprotection of public health [21]. Japan has the secondhighest overall fish consumption rate in the world next toChina, which consumes one-third of what Japan produces[22]. As more and more radioactive materials enter thewater, currents and fish are transporting radiation to placesfar, far away from the zone of initial impact. For example,pacific bluefin tuna carrying low levels of cesium consis-tently migrate from Japan to Southern California and otherparts of the United States West Coast. And potential forcontamination has extended even farther, with a reportedone-third of the world’s marine catches being used as feedfor farm-raised fish, pigs and poultry [23].

The ability of cesium and strontium isotopes to bio-concentrate, the transportation of radiation through precipita-tion and migrating fish species, and inaccurate food standardsthat exclude external exposure will require extensive andindefinite monitoring of radiation levels and enforcement of

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controls on consumption of water, crops and seafood as wellas other forms of residual exposure. Furthermore, these mea-sures will need to adapt and expand in scope to include allareas inside and outside of Fukushima. At the present mo-ment, little is being done in other countries affected to monitorlevels of radiation in water. For example, in the United States,there is currently no US government agency responsible forchecking radiation levels in the Pacific Ocean. TheEnvironmental Protection Agency (EPA) has been trackingradiation levels in the air, drinking water, precipitation, andmilk, but problems exist with its current air monitoring sys-tem, RadNet [24]. The EPA has 132 stationary monitorsthroughout the US close to the country’s 104 nuclear powerreactors; however, many experts have recommended 250monitoring stations for every power plant. Furthermore, anEPA audit found that only 20 % of its monitoring systemswere working correctly after the Fukushima accident resultingin an important loss of data [24]. Government complacency,lack of data, and the inaccessibility of published measure-ments, has propelled US citizens to take their own measure-ments using personal Geiger counters. In Japan, the sameconcerns and extreme mistrust of the government led to thesame community monitoring efforts. Safecast, a collaborationof the John S. and James L. Knight Foundation and the KeioUniversity in Tokyo, Japan, operates an independent networkof stationary and mobile sensors all around Japan and poststhe data it has collected on its website for free [24].

Much of the data cases to claim that levels of radiation inwater and food are low and pose neglegible risk to humans areinaccurate and unacceptable. Furthermore, previous research atChernobyl and now at Fukushima have shown evidence thatindicates animals, specifically birds, have proven that low dosedoes not equate to low risk. They show that negative effectstake time to accumulate and often times don’t manifest them-selves for several generations. Current research done atFukushima on the negative effects of low-dose radiation onbirds has confirmed that low-dose radiation disrupts develop-ment. Birds have been chosen to study the potential impacts ofradiation in humans because that they share many of the samebasic biological processes as humans [25]. At Fukushima,scientists used protocols established in Chernobyl to studyhouse martins, great reed warblers, white wagtails, Eurasianwrens, and ten other common species found in both places.Juvenile birds were consistently found to be smaller in morecontaminated areas [25]. Bird counts were 30 % lower thanprevious years and thought to be due to exposure to iodine,cesium and other radioactive isotopes losses that were twice ashigh as those found at Chernobyl after the accident [25].

1.6 Social implications

For many years, declining birth rates, families splinteringapart and the disappearance of rural communities have been

problems in Japan—problems that have worsened as aresult of the Fukushima accident. Concerns about an envi-ronment plagued by radiation and contaminated water andfood have effectively dissuaded many couples from havingchildren. The number of women in their 20’s who had achild in 2012 decreased by 16,200 and the number of deathsexceeded births for the sixth year in a row. The number ofbabies born in Japan in 2012 fell by 13,705 from theprevious year to 1,037,101. Meanwhile, deaths in 2012 hita record high of 1,256,254, increasing by 3,188 [26]. Aquarter of the country’s total population is made up ofpeople 65 years old and above, while those 14 years oldand younger comprise 12.9 % [27]. Lack of economicopportunity in rural areas has led to an exodus that has cutregional and community ties. Evacuations due to radiationlevels have broken up families, forcing people to move tonew cities or towns and begin the stressful process ofstarting anew, uncertain od whether or not they will everbe able to return. One year and 7 months after the accidentat Fukushima, 160,000 people remained displaced afterbeing evacuated from their homes. As of March 7, 2013,an additional 56,920 people left the surrounding area ofFukushima Prefecture to find homes in less contaminatedareas of Japan. According to government figures, 9,420,Fukushima evacuees live in the Yamagata prefecture, 7,415live in Tokyo and 5,688 in Niigata; 46,107 live in tempo-rary housing provided by the government and 10,681 peo-ple are living with relatives or friends [28]. It remainsunclear how long families and communities will have tocontinue living in temporary housing and whether or notthey will be allowed to go back home [29].

1.7 Distribution of radioactive materials

The 1,760 t of reactor fuel present at the Fukushima plant at thetime of the accident easily dwarfed the 180 t found atChernobyl prior to the April 1986 accident. The Fukushimaplant’s fuel pools held 70 % of the radioactive elements on site.Their position above the reactors and complete exposure meantthat when the cheap, weak containment structures were crackedby the blow of the earthquake, the impact of radioactive leakagewas considerably greater than that of Chernobyl [9].

The release of these contaminants into the air, water, andfood of Fukushima and neighboring prefectures has terrorizedresidents and resulted in the critical displacement of more than140,000 people. One of the radioactive particles dischargedfrom the plant, cesium-137, has a physical half-life of 30 yearsand can survive even longer due to its ability to be bioconcentrated and recycled by plants and animals. With noremedy in place to deal with the contamination, radiationlevels in the most heavily contaminated areas will decay veryslowly, and will take at least 300 years to decay to one-thousandth of their original amount [9].

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Nineteen percent of the cesium released was deposited onJapanese land, 2 % on land elsewhere, and 79 % over thenorthern Pacific Ocean. Half of the cesium let off throughventing and various hydrogen explosions was Cs-134, whichpossesses a half-life of 2 years. The way in which porters likerain, wind, snow and water carry radioactive materials after adisaster is crucial as they can cover vast areas in relativelylittle time. This can not only speed up the spread of theaccident, extending radioactive material beyond regional andnational borders, it can also complicate the organization ofevacuations, particularly of major metropolitan areas. Forexample, after the accident it was reported that a fallout cloudhad moved from Fukushima toward Tokyo betweenMarch 14and 15, 2011 that, had it rained, would have made it necessaryto order a mass evacuation of the city and the area outside of it.Fallout could have also potentially hit large urban populationsin Korea and China had wind or rain moved it to the West [9].

Back in Japan, continued leaks from the plants into the soiland ocean threaten local communities’ water and the crops.Rain, wind and the continued dumping of radioactive waterused to cool reactors have contaminated a major staple of theJapanese diet, fish, and negatively impacted the fishing industryand the Japanese economy. While hopes have remained highfor the quick decay of cesium-134, continued leaks and slowerthan expected declines in cesium levels in fish, particularlybottom-dwellers, has left many discouraged and worried [9].

1.8 Segway to health, environment, industry effects

“Because radioactive fallout spreads without regard to bordersand affects people indiscriminately, any nuclear disaster thatdisperses radioactive materials in the air, soil, or water is ofglobal concern [30]. The public health aspects of theFukushima disaster are therefore of global health significance.A disaster with uncontrolled radioactive release is possible atany nuclear plant [7].” Damage to Japan’s critical infrastruc-tures, communities and industry post-Fukushima has crossedborders, affecting other countries and even disturbing diplo-matic relations. As a result, new, innovative approaches toprotect critical infrastructures and develop better crisis man-agement tools will be required for a future with nuclear power(Fig. 2).

1.9 Emergency and crisis management

The accident that followed the earthquake-tsunami inEastern-Japan in 2011 demonstrated that a newer mecha-nism, cloud computing, could be useful and effective inemergency and crisis response situations. However, infra-structure interdependencies have proven that this devel-opment is far from full-proof and future success willdepend on government and industry efforts to make sys-tems increasingly more resilient (Fig. 3).

1.10 Cloud services and emergency response at Fukushima

Approximately 400,000 people lost their homes andpersonal possessions, or had to evacuate radiation-contaminated areas due to the accident at theFukushima plant. Those displaced took shelter in com-munity houses, gymnasiums, city halls and even shrinesand temples. They faced a shortage of supplies such aswater, food, blankets, clothes, fuel for heating andcooking, toiletries and prescription medications.However, this issue was not due to a lack of provisionsbut rather poor logistical coordination. Most supplieswere actually in stock but due to a lack of logisticalcapability, emergency workers didn’t always know theamount of supplies that the different refugee sites re-quired resulting in inadequate and uneven distribution.Families and friends that were separated didn’t knowwhether their families and relatives were safe and if so,where they had been evacuated to. Businesses lost con-tact with employees, and loss of communication withcustomers and the supply chain stalled operations. Theadministration also suffered from the same lack of com-munication and information. All of these problems indi-cated that transmission and information sharing were themost crucial elements and exacerbated the crisis.Furthermore, needed information was not collected anddisseminated appropiately. However, cloud computingservices proved to be up to the challenge to provideservices needed in such situations. Varieties of services1

began to be offered for free by many cloud serviceproviders. They were used in such areas as:

a) IT infrastructure for city staffs and volunteer stations forrescues and refugees support,

b) Communications between individuals, families and rela-tives in damaged and remote area

c) Backups/mirroring of governments’ and local govern-ments’ information dissemination such as radiation relat-ed or citizen services, etc.

d) IT infrastructure and services to businesses for emer-gency delivery information, employee communica-tions, business communications and emergency databackups.

Cloud services continued to be in high demand well afterthe accident. Interest in radiation levels is high in Japan andcloud computing has contributed significantly to radiationmonitoring efforts. Following the quake, physical and mentalhealthcare was facilitated by a shared healthcare database with

1 A list is available at IPA web site (in Japanese): http://www.ipa.go.jp/security/cloud/cloud_sinsai_jirei_list_V1.pdf

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an associated allied care system that was established on acloud. This system allowed a doctor from Tokyo to take careof local patients living in refugee camps and temporary houses.Local clinics and nurseries that providedmedical services wereable to share common patient information from the cloud.

1.11 Strength of Cloud Computing in Emergency Response

The various cloud services utilized following the accident atFukushima showed themselves to be superior for emergencyresponse in a number of ways. First, the cloud can be used for

Fig. 2 Radioactive materials were accumulated in the north-east direction due to the winds of days of release of them. (Source: airborne monitoring byMEXT and DOE, courtesy Dr. Kenkichi Hirose)

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any kind of application and can support high volumes at anytime. Unlike conventional disaster recovery or business con-tinuity systems which are reactive and recovery-oriented, thecloud is 1) able to be used immediately, 2) scalable whichallows it to start small and expand as needed, 3) economicalwith no significant marginal cost to provide new services, 4)tolerant to any subsequent disaster like aftershock or poorlifelines, and 5) secure compared to improvised systems setup in temporary offices where access control is insufficient.

In addition to these super Business Continuity/DisasterRecovery (BC/DR) characteristics, the cloud can change themode of emergency response activities and collaboration. 6)the cloud can absorb information directly from damaged sites.As a result, people can exploit bilateral information flow whichcan make response and rescue work much more effective. 7)The cloud can also collect and combine a variety of data eithernewly acquired or readily stored in the cloud, e.g. tweets corre-lated with geographical location, vehicle paths with map, andrefugee sites locations with satellite photos. 8) The Cloud canhandle multimedia, big data sites and support streaming. Sincesounds, voices, pictures and videos convey much more thanliteral information, emergency response is made easier and moreresponsive. 9) The Cloud provides platforms that facilitate vol-unteer coordination and collaboration. They can also participatein the development and operation of emergency systems fromanywhere on the Internet, at any time and of any length/duration,andwith any capability that can contribute to collaborativework.The ability of the cloud to support needs from the top down tothe grass-roots level popularizes rescue participation, encour-ages more democratic relief activities and creates an importantparadigm shift in emergency response and disaster reliefworldwide.

1.12 Challenges to Cloud Computing as an EmergencyResponse

As observed above, the Cloud can be very useful for emer-gency response. However, due to the effects of critical

infrastructures’ interdependencies, maintaining functionalityduring a disaster situation can be challenging. For example, anatural disaster could cause a power outage due to power plantfailure, a cut transmission line, or both. In this case, the Clouddata center would use an engine generator which requires fuelsupply. If the roads or a refinery are damaged or destroyed, theflow of fuel may be cut or become unavailable after a while.Power failures may also knock out telecommunications sta-tions or limit data centers operations.

During emergency response periods, demands constantlychange. Clouds are already occupied with normal loads thatmight include critical infrastructures demands and may becompelled to retrench services due to supply restrictions.Under such circumstances, prioritization of demands becomesvery critical. In an emergency situation, conditions changeevery minute and the elements to be considered are too manyto make consistent logical judgments. Therefore, decisionmaking algorithms should be established and tested in ad-vance during “non-emergency” periods. In these situations,“triage”-like thinking may be useful.

Figure 4, shows how the cloud supports societies,economies, businesses and people’s lives through a vari-ety of social elements that continue to function duringemergencies. The cloud’s critical information infrastruc-ture (CII) makes it fundamental for disaster preparednessand response.

1.13 Steps for making Cloud systems more resilient

Given the challenges that cloud systems face, a work groupnamed Global Inter-Cloud Technology Forum2 is studying“inter-cloud” operation or migration. The way in which acloud can be transferred from one cloud platform to another.In that way a cloud entity can survive a data center failure.

To make the cloud service available and useable during adisaster situation, the cloud’s survival is not sufficient. To use

2 http://www.gictf.jp/index_e.html

Fig. 3 Contaminated topsoil is scraped off at schoolyard. (Source Ministry of Environment, courtesy Dr. Kenkichi Hirose))

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the cloud, its end point device must work as well. By makingsure to secure a power supply in order to deal with thepossibility of failure. A communication line should also beavailable since it is essential to assure redundancy of carrierservices. One option is to use two or more carriers, usingwired and wireless networks and preferably satellite circuitas back ups.

With these requirements satisfied, cloud can become resil-ient and survivable, and making use of cloud services will beassured. 2011 East-Japan earthquake was the first and onlyexperience that a (well) developed economy faced a cata-strophic disaster. In that, we all could learn that cloud com-puting is not only useful but also dependable during emergen-cy response. Discussions and studies on this topic, to developfurther safeguards should continue and be furthered so thatsociety can rely on cloud computing being a truly a reliableCII, during major disasters (Fig. 5).

2 Discussion

2.1 Proclivities in nature

The awful accident that took place at the Fukushima Dai-ichi Plant on March 11, 2011 was a wakeup call for theworld. Japan, one of the world’s most technologicallyadvanced countries, had just experienced the unthinkable.In its initial report following the accident, TEPCOattempted to clear itself of any blame by arguing that adisaster of such proportions was impossible to predict andadequately prepare for. However, Japanese history andgeography showed that earthquakes and tsunamis capableof overtaking the plant had occurred before and weretherefore, foreseeable. Japan’s location at the convergenceof three tectonic plates makes it particularly susceptible toearthquakes. Its propensity for severe earthquakes has

been evidenced throughout history with eleven earthquakesof 8.5 magnitudes or greater taking place in the twentiethcentury and another five being recorded since the beginningof the twenty-first century—most of which were followed bytsunamis [7]. Over the past 6,000 years, earthquakes of 8.0 orhigher on the Richter scale have caused massive tsunamis sixtimes [31]. Historical records are a testament to the existenceof monstrous tsunami waves like the record high 38.9 m waveat Fukushima. One historical document, Nihon SandaiJitsuroku, written in 901, details an equally large tsunamioccurring in July of the year 869 in the Tohoku Provincefollowing the “Jyokan-Sanriku” earthquake that killed a1,000 of the 7 million people living in the area at the time—a number that by Fukushima standards would have beenproportional to 20,000 deaths in a population of 127 million[7]. Other notable waves registered at 38 and 29 m wererecorded in Eastern Honshu in 1896 and 1933 [9]. TEPCOwas alerted to this information on numerous occasions prior tothe Fukushima incident, but despite the plant’s sea walls onlybeing 5 m high, these warnings were largely ignored [31].Researchers felt their findings warranted enough concern thatscientists presented information and data directly to the METIat Advisory Committee on Energy and Natural Resourcesmeetings held in June and July of 2009 [7].

Post-Fukushima, the government created the InvestigationCommittee on the Accident at the Fukushima Nuclear PowerStations (ICANPS)3—a committee composed of scholars,journalists, lawyers, and engineers charged with determiningthe accident’s causes and developing policy recommenda-tions to stem damage and prevent future disasters. TheICANPS’ December 26, 2011 interim report revealed thatTEPCO had previously carried out simulations in 2008 tostudy impacts of tsunami waves between 10 and 15 m highon the Fukushima plant. The report containing their findings

3 Established on June 7, 2011

Fig. 4 Cloud used as the ITinfrastructure in normal andemergency situations (CourtesyBen Katsumi)

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was not disclosed to the government until March 7, 2011,—4 days before the disaster occurred at Fukushima [31]. Thethen 40 year old plant’s license had been renewed by thegovernment just a month before [9].

2.2 It takes a village: government and industry

Government bureaucrats and industry officials had put busi-ness interests ahead of their obligation to protect public safety.This was confirmed by the first independent commissionappointed by the National DIET of Japan, the FukushimaNuclear Accident Independent Investigation Commission,which stated that, the accident:

“Was the result of collusion between the government,regulators and TEPCO [Tokyo Electric Power Company].They effectively betrayed the nation’s right to be safe fromnuclear accidents.” The commission concluded that the gov-ernment and regulators are not fully committed to protectingpublic health and safety; that they have not acted to protect thehealth of the residents and to restore their welfare. The regu-lators did not monitor or supervise nuclear safety…Theirindependence from the political arena, the ministries promot-ing nuclear energy, and the operators were a mockery. Theywere incapable, and lacked the expertise and the commitmentto assure the safety of nuclear power. Across the board, theCommission found ignorance and arrogance unforgivable foranyone or any organization that deals with nuclear power.“We found . . . a disregard for public safety [9].”

One possible answer for this perceived recklessness couldhave been the need to meet increasing energy demandsspurred by growing urban areas and a boomingmanufacturingsector. Government energy policy goals, which aimed tomakeJapan both self-sufficient and a leading world-wide energyexporter, also contributed significantly.

2.3 Japanese energy needs

Japan currently imports 84 % of all of its energy.Inadequate supply of minerals and energy domesticallyhas long been the driving force behind the Japanesegovernment’s pro-nuclear policies. After World War II,Japan’s urban populations and manufacturing industriesbegan to grow and came to depend increasingly on fossilfuels, specifically Middle East oil. In Japan, meeting theincreasing demands of its growing urban populations andmanufacturing sector made and continue to make energypolicy vital to the daily functioning of society and theeconomy. Tokyo has one of the world’s largest metropol-itan area with over 35 million people in addition toseveral other large urban populations. Manufacturingcomposes 18 % of the nation’s total GDP and it is re-nowned for its electronics industry and high tech andprecision goods [32]. It is also the third largest automobileproducer in the world [33]. Despite this, fossil fuels’ costand the air pollution they produced ultimately led thegovernment to pursue other domestic energy sources.

In its pivot toward domestic production, Japan returned toits nuclear program, which had originally started in 1954 andhad built up to five reactors. In 1955 it passed the AtomicEnergy Basic Law, which promoted nuclear research, basedon ironically enough, “democratic methods, independentmanagement, transparency and international cooperation.”Supported by expanded research, the Japanese governmentshaped a new energy policy that would seek to cut oil importsand build reliance on domestically produced electricity vianuclear power—a cheap, efficient source of power without acarbon footprint that generated 30 % of the country's totalelectricity production at the time of the Fukushima accident[34].

Fig. 5 Prioritization of cloud usein emergency (Courtesy BenKatsumi)

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2.4 Bringing the community on board

With a vision of a sustainable way forward for the country’surban populations and industry, the government would haveto bring the public on board—namely the small rural popula-tions that would live in the vicinity of the plants [35]. Thegovernment would use a combination of policy and govern-ment money to grow a pro-nuclear culture in Japanese com-munities and expand the nuclear industry [4]. It schooled localpoliticians in the art of selling nuclear power to constituents asa safe, cheap energy source. It developed and utilized the“Three Power Source Development Laws (Dengen Sanpō)to charge a special “hidden” tax on electricity use and distrib-ute the money, roughly $20 million a year, to these commu-nities in exchange for their support [4]. The governmentexperienced little resistance in its efforts to literally buy thesupport of these communities. Many were sparsely populatedand somewhat impoverished and were intrigued and excitedby the promise of better living standards through the generoustax subsidies, jobs and infrastructure that would come alongwith the construction and operation of a nuclear plant. Whilemany were convinced of the economic advantages, others felta strong sense of resignation and accepted nuclear power asthe only way for Japan to sustain itself and reduce the effectsof climate change.While the government assured the public ofthe necessity of nuclear, the government courted big powercompany TEPCO and actively assisted it during its initialforay into the nuclear power industry by providing it withfinancial and logistical support to scout potential sites. As thegovernment began to embed itself in industry and vice versa, astrong, but dangerous, nuclear village formed where elitegovernment bureaucrats, politicians and company leadersaided and abetted one another in the pursuit of power andmoney. All conspired together to fabricate a case for thenecessity of nuclear power, helping to meet the country’senergy needs and revitalizing its rural, impoverished commu-nities. Together, they created an illusion of safety that lulledthe Japanese people into a false sense of security—confidentthat Japan’s technological expertise would make them im-mune to the risks and consequences of nuclear power. Thenuclear complex and concentration of decision-making powerin the hands of government elites and industry officials meantthe removal of the Japanese public from these processes,minimal oversight and a classic case of regulatory capture.4

2.5 Classic case of “regulatory capture”

In Japan a strong, self-reinforcing “Iron Triangle” made up ofbureaucracy, dominant political party(ies), and major corpo-rations and industry, have all worked in conjunction with oneanother to form a nuclear complex that has successfully sup-pressed criticism, undermined already weak government in-stitutions, and produced lax nuclear industry regulation inJapan.

Over the years, TEPCO and other utility companiesused their wealth to influence policy and politicians thatwork inside the triangle. Incentives to work for the nucle-ar cause are high. According to one report, it was discov-ered that prior to Fukushima, some 50 high-ranking METIofficials had retired and gone on to be hired in highranking positions at nine major electric power companies.It was also found that during the past 10 years, around 23TEPCO officials have been hired on to work for threenational government agencies as temporary consultants[36]. These reciprocal relationships have allowed the irontriangle to not only reinforce and sustain itself byprotecting itself from outside intervention and potentialcriticism.

Another issue was the government’s inability to sepa-rate its own nuclear proponents (energy needs) fromthose working to regulate the nuclear industry (publicprotection). For example, the government regulatoryagency responsible for plant safety, the Nuclear andIndustrial Safety Agency (NISA) functioned as a divisionwithin the Ministry of Economy, Trade and Industry(METI), the same government ministry that was respon-sible for promoting nuclear development. Therefore, withindustry interests already entrenched in government, spe-cifically the arm of government responsible for its regu-lation, it was essentially impossible to act independentlyand impartially. The government’s need to deal with theenergy shortage that was affecting its urban populationsand the big businesses that made up the bulk of theJapanese economy meant pressure from the top downfor bureaucrats to think and act like industry in orderto deliver its needs. A binary relationship was formedwhere both sides lost objectivity, and group-think orconformism prevailed. As a result, decision-making waspoor and government regulators’ willingness to look theother way or at least feign indifference enabled TEPCOto eschew expensive safety precautions. This allowed tokeep costs down and maximize production in order tosell more energy to a government desperate to resolve itsenergy crisis [36, 37].

The nuclear industrial complex that dominated Japanmeant regulators lacked perspective and were not motivatedto actively pursue and discuss scientific evidence pointing to apotential disaster at Fukushima. According to the Hatamura

4 According to Investopedia: Regulatory capture is a theory associatedwith George Stigler, a Nobel laureate economist. It is the process bywhich regulatory agencies eventually come to be dominated by the veryindustries they were charged with regulating. Regulatory capture happenswhen a regulatory agency, formed to act in the public's interest, eventuallyacts in ways that benefit the industry it is supposed to be regulating, ratherthan the public.

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Committee’s findings, NISA never asked TEPCO what itwould do in the event of an earthquake or tsunami [7, 38].In fact, after the disaster, PrimeMinister Kan specifically citedinsufficient checks by NISA as one of the causes of thenuclear accident even going so far as to say “this could bedue to the fact that it is positioned under METI, where thebasic stance is to promote nuclear energy policy” [35].

TEPCO had been shielded by government bureaucrats andpoliticians for so long that there was little to no impetus toadequately prepare the plants’ structures, systems and person-nel for an event like the Fukushima accident. The lack ofseparation between corporations like TEPCO and governmentregulatory agencies did not go unnoticed and was often crit-icized by the international community. According to YotaroHatamura:

“Placing the regulation and promotion of nuclear powerin the same location guarantees that policy will not gosmoothly. The IAEA [International Atomic EnergyAgency] even strongly said that this sort of structurewas bad and said that Japan needed to properly separatethese two functions, placing the regulatory arm in adifferent organization. But Japan insisted that every-thing would be fine, and did nothing.The way in which organizations are structured withinthe Japanese government had been criticized manytimes, but each time Japan said, “We’re fine, we’refine,” and many things were left undone [38].”This is how nuclear regulation went on in Japan foryears and years. While it appeared to function on thesurface and kept up a facade of safety and accountabil-ity, in reality it was doing the bare minimum to regulateand rein in companies like TEPCO, ultimately lettingindustry run wild until the wheels fell off [37, 38]. Thiswas not just the result of collusion, but of rampantcorruption as well.”

2.6 The epidemiology of corruption

It is commonly believed that where there is collusion, there ismost definitely corruption and Japan is no exception. Thenuclear industry has a penchant for corruption and casesinvolving governments and power companies are well docu-mented all around the world from the United States andCanada to Russia, India, Egypt, South Korea, and China.These cases are alarming because they raise concerns aboutthe integrity of the materials and processes used to generatenuclear power, the honesty of government bureaucrats andindustry officials charged with the public’s safety and thevulnerability of other populations whose countries purchaseequipment and materials from energy exporting countries[37].

For example, in Russia in May 2012, AlexanderMurach, the deputy head of the testing department at theResearch Institute for Complex Testing of OptoelectronicDevices and Systems (NIIKI OEP) and Director ofInformtekh, was charged with selling fake replicas oftesting equipment to be used in nuclear power plantsand was founded to have provided false test results andcertifications for equipment used to measure vibration innuclear power plant turbines [37].

While Japan’s nuclear industry has not been caught sellingfaulty products just yet, less than rigorous safety standards ledto many dangerous mistakes that, were it not for successfulcover-ups, could have put the safety of the equipment used inquestion and severely damaged TEPCO’s reputation locallyand internationally [9, 37]. In June 2002, it was found that thecompany had faked hundreds of repair records at theFukushima plant and several others for over 20 years. It hadalso covered up at least six emergencies and blatantly ignoredwarnings about the event of a meltdown with total power loss[39]. Japan’s role as a leading exporter of nuclear technologyhas meant that these blights could have serious internationalimplications. TEPCO exports materials for nuclear plants toother East Asian countries and has also participated in thedesign of new European reactors [34]. It is also becomingheavily involved in burgeoning nuclear countries like India,which has plans to build 18 more nuclear power reactors andis projected to buy more than 9 trillion yen ($86.1 billion) inparts from the Japanese [40]. Other Japanese companies arealso getting involved in the nuclear industry in India. ToshibaCorp owns 87 % of Westinghouse Electric Co. LL, which isbuilding a plant in Gujarat, India; and Hitachi Ltd. andMitsubishi Group are working with General Electric Co. andAreva SA (France) on plans for more plants in India [41].

Japan’s past failures to responsibly regulate corporationshas damaged the public’s confidence in the government andindustry to do the job [37]. The discovery that the governmentcollided with industry at the risk of the general population hasbeen jarring for the Japanese public, and it has been the sourceof calls for more genuine citizen participation in decision-making processes regarding nuclear power.

2.7 Calls for democratization

A once rare and uncommon sight, mass demonstrationsagainst nuclear power have become more and more frequentsince the Fukushima accident. One rally back in July 2012organized and led by a coalition of 60 citizens groups callingthemselves “Genpatsu Issenmannin Akushon” (GoodbyeNuclear Power, 100 million People in Action) reportedlygathered 170,000 people. Another group, the “MetropolitanCoalition against Nukes” relentlessly protested then PrimeMinister Noda until he conceded to a 30 min meeting withgroup representatives onAugust 22, 2012, only to be told their

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opinions would be taken into consideration, but that nu-clear power would continue [35]. Other previous attemptsby the government to engage the public had been equallyas unproductive. In July the government carried out 11public hearings to gauge public opinion of the govern-ment’s nuclear power policy. In these hearings three op-tions were given by the government for the public’sconsideration: 0 % nuclear generated energy, 15 %, or20–25 % [35]. Despite 70 % of those wishing to speakbeing in favor of the zero option, only 12 people in totalwere allowed to talk, one of which was a TEPCO officialwho supported the 20–25 option. In a poll commissionedby the government and conducted by the Keio Universityin August of 2012, 46.7 % of those polled supported thezero nuclear option presented in the previous hearings[35]. These forums represented only a slight improvementtowards the democratization of the government’sdecision-making processes, which has been complicatedby indifferent or pro-nuclear bureaucrats and politicians’reliance on elite experts [35]. Experts worked with politi-cians to regulate the same companies they promoted andworked for, creating a classic case of regulatory capturethat was facilitated by Japanese political culture [35].

2.8 It takes a village: politicians and people

For much of history, Japan’s political system has beendominated by two major parties: the Liberal DemocraticParty (LDP) and the Democratic Party of Japan (DPJ)—both of which are considered to be pro-nuclear to varyingdegrees.

The DPJ struggled for a long time to come to a con-sensus on the issue. Former Prime Minister Kan and otherDPJ party members originally came out against the BasicAct on Energy Policy in June 2010, which called for nineadditional nuclear plants by 2020 and upwards of 14 by2030. Instead, they advocated for reduced dependenceand an eventual phase out. However, when DPJ candidateYoshihiko Noda took over as Prime Minister post-Fukushima, his administration initially supported restora-tion of the country’s nuclear reactors in exchange formore rigorous safety checks, lower house elections drewnear, the administration changed and promoted initiativesto phase out nuclear energy by 2030. It also supportedlimiting the life span of nuclear reactors older than 40,mandating safety inspections before reactivation, and halt-ing construction of new plants. Despite this change, nei-ther Noda nor the DPJ could offer a viable solution to thedomestic energy production problem [35].

The LDP—an outspoken critic of the zero nuclear policyoption—strongly supported nuclear reactors restarting uponinspection. In this respect, it did little to distinguish itself fromthe DPJ. The only parties active against restarting nuclear

reactors were small third parties like the Tomorrow Party ofJapan, the Japanese Community Party and the SocialDemocratic Party—all of which possessed little influenceand power. Left to choose between the parties large andpowerful enough to be elected, the LDP or the DPJ,voters’ hands were tied [35]. That election year, despiteheavy anti-nuclear sentiment, voters gave the LDP 294seats and the DPJ another 57. Now, post Fukushima,Japanese voters have a chance to change these patterns.Paradigm-shattering crises like Fukushima are more easilyleveraged for major policy change than crises that areconsidered common or expected [42]. Japanese civil so-ciety must organize people, information and votes in orderto hold politicians accountable [35]. Only in this way willpolicy-making become more democratic and will the pub-lic have any bearing on future energy policy in Japan. Asthe saying goes, it takes a village.

2.9 The role of political culture

Our opinions, our beliefs and the way we act are the resultof our environment and what we are taught by thoseclosest to us. Over the years, institutional frameworks inJapan have allowed TEPCO and the government to accruevast amounts of wealth and power and capitalize off ofkey foundations of Japanese culture such as obedienceand reluctance to question authority to create and mold apositive public perception of nuclear power. METI hasprovided generous subsidies to communities that acceptednuclear power plants in Japan. TEPCO has paid for massmedia and advertising campaigns that have portrayednuclear power as safe.

Both have spread out their money amongst many dif-ferent politicians to gain support, funding political cam-paigns and organizing votes at the local and nationallevel. Between 2005 and 2009, 448 of the TEPCO’sexecutives (60–70 % of all executives) donated a totalof 59.57 million yen ($777,000) to the People’s PoliticalAssociation (PPA), a political fund-raising arm of the thenruling party, the LDP [43]. Other reports from 2007 showthat of the nine electric power companies that have nu-clear power plants, 70 % of their executives donated atotal of 25 million yen to the PPA. TEPCO has also takengreat care to assure support from influential experts andacademics. For example, TEPCO currently funds a chairat MIT’s Center for Advanced Nuclear Energy Systems[44].

TEPCO, Former Prime Minister Kan and NISA were allresponsible for assuring the safety of the Fukushima nuclearpower plant. However, regulators and officials failed to put thenecessary safeguards in place not just because of mutualinterests and profits but also because of a culture of

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complacency and a strong nuclear complex and that insulatedthem from change and criticism.

METI has imposed numerous safety regulations onelectric companies like TEPCO, but conformism rules inthe nuclear village and scepticism or criticism of serviceproviders is frowned upon [36]. This has resulted in whatsome have termed as risk inoculation wherein desensiti-zation to risks, produces a lack of motivation to researchand invest in ways to prevent, mitigate and prepare foraccidents or disasters. Prior to Fukushima, successfulcampaigns by the government and TEPCO created a men-tality in Japan that nuclear disasters like Fukushimaweren’t possible and that the necessary safeguards andregulations were in place to protect against such events.Fukushima was a classic example of what has been de-scribed as the “vulnerability paradox: the more invulner-able a society has seemingly become, the more vulnerableit will prove to be when a major incident does occur [42].

Japanese civil society will have an uphill battle butsome strides have been made. After Fukushima, the gov-ernment removed NISA from the METI and made anothergovernment agency responsible for safety, the NuclearPower Regulatory Agency (NPRA) under the Ministryof Environmental Protection. However, further disapprov-al and pressure caused the Diet to enact a law in 2012creating a new, independent regulatory agency, theNuclear Regulatory Commission (NRC) for which theNPRAwould serve as a secretariat. The NRC is composedof five specialists and is responsible for all regulatory rulemaking. It also maintains the right to take over a plant inthe event of a nuclear emergency [31].

Much work remains to be done in order to breakdown the institutional barriers to stricter regulative safetymeasures. In order to fight the nuclear complex in Japan,several measures should be considered. First, the removalof government subsidies to municipalities and communi-ties that supported construction and service of nuclearreactors in their vicinities will be essential in strippingpolitical power and influence from government and in-dustry. Instead of buying support for nuclear power, anenergy source that is both risky and unpredictable, thegovernment may be better served investing this money infunding research for ways to make renewable energiesmore viable and cost-effective and promote their growthin the Japanese energy industry. And finally, instead ofrelying on elite government bureaucrats, politicians andindustry heads, the Japanese government will need tomake the decision-making process regarding energy pol-icy much more democratic and actively seek to genuine-ly engage and involve more NGOs, international groups,academics and the civilian population. This will increasetransparency, trust and belief these policies and break theiron triangle.

2.10 Technical failures

The nuclear village’s complacency and relaxed cultural atti-tudes towards prevention and safety standards resulted infailure to carry out much-needed facility upgrades. This re-sulted in numerous technical deficiencies that easilyoverwhelmed the Fukushima Dai-ichi Plant when disasterstruck, exacerbating the accident, and hindering effectiveemergency response that would have deescalated thesituation.

According to Harutoshi Funabashi the main failuresand mistakes that contributed to the domino effect at theFukushima Dai- Ichi plant are considered to be thefollowing:

1. Despite Japan’s propensities for earthquakes and tsunamisdue to its geographical location, nuclear power hasremained a key part of its energy policy and the govern-ment has advocated reopening old reactors and construct-ing new plants to address energy shortages. These disasterconditions were not taken into account by TEPCOwhen itimported reactors which made them susceptible to dam-age from the earthquake and tsunami on March 11, 2011[36].

2. Six nuclear reactors were on site at Fukushima, yetTEPCO took no special preventative measures to de-velop crisis management processes in the event ofaccidents taking place at multiple reactors and the lossof power.

3. As an island, Japan’s long coastlines and close prox-imity to the sea make it particularly susceptible totsunamis and to nuclear waste leaking into the oceanand posing threats to marine life, public health andindustry.

4 & 5 The original Fukushima site had a 35 m natural seawall, but TEPCO removed 25 m in 1967 so shipscould easily dock and transport equipment to theplant when it was still under construction. TEPCOwas made aware of the potential for tsunami wavesthat could easily pass what remained of its wall;however, weak government regulation and compla-cency meant little pressure to compensate for thesewaves or consider changing the location of the plant’sbackup diesel generators which were located under-ground in the basement at the time of the tsunami[45].

6. Fukushima’s GE designed boiling water reactors(BWRS) began commercial service between 1971and 1979 and were constantly plagued by poor designand problems due to aging. One of the commonhazards of BWRs is the necessity of human interven-tion to vent radioactive steam in the case of a melt-down. The use of smaller, cheaper pressure suppression

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containment meant that containment structures wereweak. As a result, fuel pools which were located abovethe reactor core and outside the primary containmentsystem were easily damaged and exposed, sendingmore radioactivity into the air. Exposure to radiation,high temperatures and corrosion deteriorated andcracked important safety components, like the coreshroud. Since replacements are naturally very expen-sive, many companies have chosen to use patches,saving money but increasing the risk of severe damagein the event of an accident [46].

7. The foundations of the towers that supported power lineswere not sufficiently stable to handle an earthquake. Priorto building, a mountain stream ran near the power trans-mission tower for Fukushima I Nuclear Power Plant.TEPCO, filled the stream with soil and built the powertransmission tower over it. This led to soil liquificationwhich made the embankments these towers were situatedon easily collapse due to the shaking caused by the 9.0earthquake.

Before the disaster, the government and TEPCO hadboth touted nuclear power as being safe with all the nec-essary safeguards in place to prevent the unthinkable.However, the problem mentioned above proved that theplant was quite vulnerable and was in no shape at all towithstand the blow it received from the earthquake andtsunami. Weak regulations, fueled by a powerful nuclearcomplex and pressure in government regulators to solveJapan’s power problems, led to weak safety measures, poordesign and less than rigorous accident management strate-gies. In some ways a general culture of complacency was atfault.

2.11 Effects and consequences of disasters: criticalinfrastructures

The case of Fukushima is a perfect example of the fragilityand interdependence of critical infrastructures (CI). It demon-strated how in a system of infrastructures so complex andinterconnected, one failure can provoke a domino effect capa-ble of producing long-term consequences that can jeopardizethe well-being of society.

The earthquake and tsunami that paralyzed Japan’sFukushima nuclear power plant created an accident ofsuch proportions that it was only a matter of days beforethree of the plant’s nuclear reactors melted down. Thesubsequent radiation dispersal left hundreds of thousandsof people without homes, contaminated food and water,affected power grids, and took down vital communica-tion systems necessary for communities to interact andfor business and commerce to function. Fukushimaunderscored the fact that protection of critical infrastructures,

both physical and virtual, is and will be crucial insafeguarding public health, economies and security inthe future [47].

In order to fortify CI and make it more resilient in theface of disaster, a system of evaluation must be set upwherein we can make these systems stronger and whereinwe can research and develop the tools that will allow us tomanage them sufficiently in times of crisis, specificallynatural disasters like Fukushima. Research done byAngela Queste and Dr. Wolfram Geier proposes a “deci-sion support system (DSS)” that measures and analyzesthe criticality, vulnerability and severity of interdepen-dencies between infrastructure, industries and communi-ties in affected areas. The system uses the potential dam-age or failure of critical infrastructure and the likelihood itwill occur to help decision-makers establish thresholds forfunctionality in the face of disaster, and prepare infra-structure, communities and industries by developing ade-quate risk management strategies and response methodsthat will mitigate contingencies and diminish damage[48].

Looking back on the lessons of Fukushima, planning likethis could have dramatically reduced the gravity of the acci-dent and its reach on other critical infrastructures. For exam-ple, at the Fukushima plant, the earthquake easily took out thetowers on site that held up power lines, which were situated onless than stable embankments, cutting the plant’s power sup-ply. Later, the 15 m tsunami wave that hit the plant took outthe plant’s back up diesel generators that were intended torestore power. The location of these generators below thereactors meant they were quickly submerged by the waveand sent offline. This led to a total shut down of the plant’scooling systems that caused pressure to rise quickly in thereactors. TEPCO officials chose to relieve this pressure byventing air in the reactors, which released large amounts ofradioactive particles into the air. However, temperaturesremained high enough that hydrogen formed causing explo-sions that sent even more radioactive elements into the airlater—contaminating the land, the crops, and once taken outto sea by the wind, contaminated marine life. Furthermore,TEPCO officials’ decision to release sea water it had used tocool reactors back into the ocean meant strict fishing restric-tions that were harmful to the fishing industry and theJapanese economy. Now, traces of this radiation are showingup in water and fish off of the United States West Coastmaking Fukushima a global health problem.

At the root of all of these problems lies the initial lossof power and telecommunications on the day of the acci-dent. The inability of TEPCO to adequately prepare forimpacts on these critical infrastructures and their effectson others demonstrates the need to plan and have mitiga-tion strategies in place, particularly ones that address thelack of alternative sources of energy that are needed to

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ensure continuity of services. This issue had been raisednumerous times with utility companies in Japan, but itwas often downplayed or ignored despite the concern ofthe public. For example, in 2007, in a nuclear-related law-suit brought before a Hamaoka court, the Chair of theNuclear Safety Commission stated “it is not necessary tosuppose a serious situation when both diesel generatorsfor an emergency power supply are damaged simulta-neously” [37]. Failure to acknowledge the possibility ofcomplete power loss and the necessity of designing strat-egies to deal with it showed negligence on the part of theJapanese government and utility companies leading up toFukushima.

The events that took place onMarch 11, 2011, illustrate theloss of electricity and telecommunications’ far reaching anddevastating effects on industry and communities both in Japanand abroad and clearly demonstrate the dependency of water,food and other infrastructures on power [48]. With the acci-dent at Fukushima still fresh in our minds, it should serve as acritical warning and a call for better governance, educationand technical solutions that will improve risk assessment andemergency response strategies.

2.12 Cloud computing

A plethora of regulations could be recommended forimplementation, but the fact of the matter is that changeis often very slow, and done in small increments. Thatbeing said, as we pursue better policy, we should also besimultaneously looking at other mechanisms that can helpto compensate in the absence of good policy. One toolthat stands out is the use of cloud computing systems.Cloud computing showed great strength and potential as adisaster relief tool during the Fukushima crisis. Withoutcomputers, servers and other lines of communication, itwas difficult for relief teams to aid stranded evacuees anddistribute food, water, medicine, and other basic necessi-ties. However, several free cloud services provided byprivate groups in the hours following the crisis werefound to be particularly helpful. Google’s people finderwas used by millions of people to know the safety infor-mation of their family, relatives, friends and colleagues.Office tools like spread sheets and word processor workedfor people who took care of refugees. IaaS and PaaSprovided a platform and developed applications for infor-mation handling and sharing systems for specific purposesincluding daily supply and medical services”. Other cloudservices temporarily hosted government websites that hadcrashed due to high traffic in order to communicate infor-mation and radiation levels [49].

As an internet-based service where servers, storage andapplications can be delivered to computers and deviceshundreds of miles away via a host site, cloud computing

provides a continued power source and automatic backupsensuring plant functionality in the face of a cataclysmicevent. The cloud’s continuous mobility and power capac-ity mean that with enough built-in redundancy, even ifseveral power plants go down, data centers should still beable to remain online. From a continuity of operationsperspective, this makes cloud computing vital for disasterresponse planning. “You cannot expect a certain facility tobe safe and maintain operation under any type of disaster.The only way you can keep continued IT functionality isto prepare a back-up site [49].”

Another tool suggested for quick and efficient dissem-ination of information in the future is broadcast systems.General downstream information can only be distributedvia broadcasting. There are a number of broadcastingstations everywhere in Japan, but only a few are expect-ed to work. Therefore, both surface and satellite wavesshould be employed. Social media will also play a great-er role in assessing situations and need in afflicted areas.There should be a function to collect, filter, aggregate,transfer and disseminate correct information from theposts, tweets, and avoid misunderstandings informationdispatched without corroboration or evidence supportingit [49].

With clouds becoming more common, use has spread fromeveryday citizens to private industry to government. However,increasing reliance on cloud-based systems and their transfer-ability poses concerns for the privacy and security of infor-mation deposited on the cloud. Furthermore, in a time whencyber warfare is becoming more prevalent, the likelihood ofaggressive state and non-state actors targeting critical comput-er systems is greater.

Nevertheless, cloud companies provide the necessary safe-guards to protect such information. Cloud service providersoften disclose what security policy and measures are taken forthe facility and operation of their cloud services. In manycases they also make third party assessment reports availableon the security management system and/or operation such asISMS or SOC2/SOC3 by AICPA. Users can refer to thesereports or certificates (such as Trust Seal) to evaluate confi-dence level. Regardless, it is imperative that government andthe private sector recognize these risks and consider the all ofthe potential effects in order to make data centers as secure aspossible [49].

In the case of Fukushima, inaccurate and misleadinggovernment data only added to the chaos and confusionthat ensued. In order to prevent consternation and anxiety,an important element for future emergency response willbe delegating communication responsibilities and ensuringthe integrity of the data posted. One method is to draw updecision-making rules and run simulations beforehandbased on the potential scale of the disaster. For example,small-scale needs assessment and supply distribution can

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be determined by volunteers who have had similar expe-riences in the past. If larger in scale, like a prefecture, itshould be handled by municipalities. However, experienceshows that often times bureaucracy can be a significantobstacle. Three to five step approvals or reluctance to actdue to lack of precedent may inhibit people's ability tomake sound judgements. They might say it requires 3–5step approvals. Therefore, decision-making rules shouldbe prepared. Although someone will still be needed tomake decisions based off of specific conditions, with ad-equate support from policymakers and industry, preparingthese rules and providing simulation training will increaseand improve emergency response capabilities [49].”

2.13 Assessing responsibility

In Fukushima, lack of preparation and accountabilityproved that the integrity and capability of safer nuclearpolicies will hinge on ownership of these measures andleadership. In the case of Fukushima, responsibility forthe man-made and technical errors that caused the acci-dent and problems that followed was never clearlyestablished. Was the government to blame or TEPCO?The issue of responsibility is important, and the govern-ment, as chief regulatory authority, is and should be heldaccountable for the public’s protection in situations likeFukushima. The government’s inherent political biasmeant insubstantial oversight on utility companies likeTEPCO to review and revamp risk assessments [4].Responsibility is paramount and as a result, we must askourselves, what can be done to ensure greater account-ability and policies that will protect the public’s safety inthe future?

The problem of lack of accountability and transparencyis well illustrated in two videos provided by TEPCO ofofficials touring the Dai-ichi facilities on 13 June 2013,5

and 17 September 2013.6 These films demonstrate severalinformational discrepancies, disagreements about the levelof damage caused by the earthquake and tsunami, andcontradicting answers regarding design flaws, workernumbers, death counts, and the availability and accessi-bility of backup supplies. They also show attempts tominimize clean-up efforts and failure to distinguish be-tween preventative and response procedures. Evidence

presented earlier in this paper shows that TEPCO wasaware of the potential for far greater disasters than itsplant and procedures could handle. Instead of acceptingthe information, it proceeded to question experts, a pro-cess that was still underway when the earthquake andtsunami hit. TEPCO deserves blame for subpar safetypractices and emergency response, but government regu-lators are culpable for having failed to require and enforcestricter regulations. This is significant because if onecannot trust the government to make regulations, nor trustthe companies to follow them, then the future for policymaking looks bleak. However, in the end, it is ultimatelythe government that is liable for cases like Fukushima. Ithas an important obligation to the public to develop andenforce strict regulations. But, how can the governmentdevelop policies that protect the public from profiteeringcompanies?

2.14 Policies to protect public privileges from profiteeringprivate companies

One possible answer is to encourage policy making thatis more transparent and democratic providing for amplecivil engagement. One constant theme we have seen inour research is a lack of citizen involvement and disre-gard for public opinion on nuclear power issues. Basedon this, a good starting point for creating safer, morerobust policies in the future will be increasing civilianparticipation. Fukushima’s example of ineffectual regula-tion caused by a government bureaucracy dominated bynuclear interests demonstrates the need for civilian pres-ence in policy formation. The Japanese government’sattempts to remedy this issue have fallen flat. By replac-ing the old cadres with new elitist and politically biasedbureaucrats, it has only served to formulate and imple-ment superficial laws that fail to address the underlyingsafety regulation issues of Fukushima.

In 2012, the Nuclear Regulation Authority was born,and with it came an amendment to establish the JapaneseEnvironmental Impact Assessment Law (EIA). Beforethe EIA, all approvals to build nuclear reactors camefrom the Japanese Ministry of Economy, Trade andIndustry (METI), which received its recommendationsfrom two independent agencies responsible for oversightand regulation of nuclear reactor proposals, the Nuclearand Industrial Safety Agency (NISA) and the NuclearSafety Commission (NSC). Power companies presented“nuclear safety agreements” to host site municipalities inorder to: 1) get permission to install or extend the life ofnuclear reactors; 2) promise to report to the municipalityin the event of an emergency; 3) declare the right of themunicipality to enter and investigate the plant; and 4)guarantee their right to restart a reactor shutdown due to

5 Reference to Tokyo Electricity Power Company, “Fukushima DaiichiNuclear Power Station Video Tour, December 2012,” Presentation, 13June 2013. http://www.youtube.com/watch?v=YWdjQs–Oxw. Accessed20 September 2013.6 Reference to Tokyo Electric Power Company, “‘Fukushima DaiichiNuclear Power Station Video Tour,’ September 2013,” Presentation, 17September 2013. http://www.youtube.com/watch?v=sYKKnJmkm7o.Accessed 20 September 2013.

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a mistake or accident [50]. These agreements made theprocess appear open and democratic, but they served as amere formality. Poverty and lack of opportunity meantlittle resistance from municipalities dependent on subsi-dies from the national government in return for theirsupport. Agreements were only representative of hostsite municipalities—neighboring municipalities were notconsulted. Furthermore, it was not only a local or re-gional issue, but rather a national issue. The risks posedby these plants, nuclear waste cleanup costs, restitutionfor those affected by accidents, and government subsi-dies—these were all costs that were passed along toevery Japanese citizen [50].

When these attempts at citizen involvement failed, theJapanese government attempted to go another route withthe passage of the Environmental Impact AssessmentLaw (EIA.) This law would require that every proposalundergo an environmental impact assessment precededby a written environmental impact statement (EIS) fromthe utility company that had to include opinions andcomments from the public (submitted via e-mail or fax)and the prefectural governor. This document was thensubmitted to METI, which used it to determine if pro-tections were rigorous enough and, if not, to stipulaterequirements that had to be met before building couldbegin [50]. Civilians were participating, but only in themost superficial sense. There was no face-to-face meet-ing or debate, and this most likely meant their commentsdid not factor heavily into the decisions made by bureau-crats. Therefore the NRA served as an extension ofNISA and NSC. While it may function under a differentoffice (Cabinet Office), its members are still appointedby the Prime Minister and it carries out the same regu-latory functions as its predecessors [50].

With opportunities for deep, meaningful citizen inputbeing few, another option championed by Yokoyamahas been civilians resorting to legal recourse to do awaywith ineffectual nuclear safety agreements, exposing thegaping holes in existing policies and agitating forstricter regulations and safety standards. According toYokoyama, the Environmental Impact Assessment Lawdoes not do its job to protect citizens for a variety ofreasons. First, unlike a number of industrialized coun-tries, Strategic Environmental Assessments are not re-quired for permits [50]. Second, inclusion of citizenopinions in Environmental Impact Studies is not a pro-cess requirement. Finally, the EIA law does not enforceany requirements for the SEA at the time of eithercomprehensive policy planning or making a decisionon the location or size of a project—a factor of monu-mental importance in Japan considering its vulnerabilityto earthquakes and tsunamis [50]. The fact that there isno regulation enforcing assessment of location is

alarming to say the least. While Yokoyama purports thatcertain legal procedures should be available to citizensin order to facilitate challenges to the law regardingenvironmental impact assessments, the reality is thatlegal mechanisms are probably too time intensive andcostly for average citizens. While we agree that the EIAlaw should be amended to include these requirements, itis our opinion that much greater pressure is necessarythan that which the public can provide on its own. Forthis reason, one area that should be researched further isthe potential role that international organizations anddiplomacy can play in exerting pressure to expeditethese changes to the law.

Regardless, public opinion still plays an integral rolein efforts to hold government and industry more account-able and realize higher safety standards. For example, itwould be unrealistic for President Obama to speak onmatters regarding nuclear energy policy, without consult-ing with several staff members from the Department ofEnergy and the Environmental Protection Agency andusing the information provided, to come up with somegeneral statement or opinion on the issue. In a democrat-ic system everyone has a voice and is allowed to expresshis or her opinion, offering up new and sometimes con-troversial ideas that give new, needed perspective. In thisway, increasing civilian participation in these processes,and making them more democratic, will have consider-able impact on the development of Environmental ImpactStudies. A company or government agency is much lesslikely to be forthcoming with information that may im-pede or destroy their chances of being approved—whichis why public involvement is so crucial. Encouragingcitizen and other groups’ (NGOs, academics, anti-nuclear groups, etc.) participation guarantees the neces-sary oversight to keep government in check and to haltthe construction of nuclear plants that could threaten thesafety of citizens.

2.15 Reconsidering alternative sources of energy

Nuclear energy, while beneficial in many ways, carriesrisks that are too high for government, the private sectorand the international community not to address together.Methods to bolster risk assessments, accident manage-ment processes and emergency response exist and techni-cal design can be improved. However, stricter policy andbetter precautionary measures are incapable of eliminatingall risk and therefore, still put pose a danger to society.Some countries have used the case of Fukushima has animpetus to halt nuclear operations and begin to seriouslyresearch and innovate alternative energies. Post-Fukushima, Germany, which had voted the year beforeto extend the life of its nuclear reactors, decided to shut

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down all 17 of its nuclear power plants by 2022 in favorof transitioning to renewable solar, wind and hydroelectricpower. Memories of radioactive fallout from Chernobyl in1986 provoked citizens to protest and demand that thegovernment shut down its reactors. Now, Germany boastsone of the biggest renewable energy programs in theworld with over 370,000 people working in the field tomake its goal of filling the quarter of electricity previous-ly provided by nuclear energy, feasible [51]. Currently,green energy produces about 25 % of Germany’s energyand the government has plans to increase this number to40–45 % by 2025 [52]. However, the peace of mind thathas come along with renewable energy has had a veryhigh price—in the case of Germany, over 1 billion eurosper reactor for decommissioning plus storage and wastedisposal costs [52]. Regardless, higher costs still haven’tdissuaded many from looking into these alternatives.

In Japan, some private companies have started to lookinto alternative energy options. KEPCO (Kansai ElectricPower Company) has a 10,000-kW solar facility in OsakaPrefecture and hopes to continue to increase the output of itswind farms. Japanese entrepreneurs are also getting in-volved. Masayoshi Son, creator of SoftBank, has alreadygiven 1 billion yen to the Japan Renewable EnergyFoundation for solar energy research [4]. If renewable en-ergies are to fill the gap left by nuclear power, heavyinvestment will be needed. Although initially costly, furtherinvestigation of alternative, more cost-effective “green” al-ternatives could negate the need for numerous, and likelyexpensive, policy changes needed in order to bring nuclearpower facilities up to code.

3 Recommendations

3.1 Protocols for securing nuclear materials

1. Secure Components (see Fig. 6)

Fukushima was a clear demonstration that safer facilitiesand continued functionality depend on intelligent design andsometimes practical considerations. Had the emergency dieselgenerators been repositioned and placed on the upper floors ofthe plant, they wouldn’t have been flooded by the tsunamiwave and the plant’s cooling systems wouldn’t have shutdown. As temperatures climbed, the zirconium interacted withthe steam and separated the hydrogen from the water. Since itcould not be released, it accumulated, causing explosions inreactors No. 1 and 3. By installing power-free catalytic hy-drogen recombiners at the tops of reactors where gases likethese collect, dangerous hydrogen can be converted back intosteam, preventing explosions in the case of overheating [53].

Furthermore, when pressure builds, instead of ventingharmful radioactive materials straight into the air, utility com-panies should install power-free filters on vent lines to removethese radioactive materials before ventilation so as not tocompromise nearby residents’ well-being [54].

Fukushima proved that it is dangerous to rely on equip-ment from a neighboring unit to support the unit or unitsexperiencing problems. Therefore, it is crucial to createredundant back-up systems to compensate for these limi-tations [55].

When the earthquake hit the Fukushima plant, damage wasdone to the structure, yet functionality continued. However,when the tsunami hit that the plant’s security components, itbecame overwhelmed by the magnitude of the wave. DespiteJapan’s propensity for earthquakes and a historical record oflarge tsunamis, the specifications the Fukushima plant used,were not sufficient to handle a 9.0 earthquake and a 15 mtsunami wave.

Given the geographical location and scale of past disas-ters, discouraging construction of nuclear plants in theseareas can provide greater seismic and flood protections intheir design phase and could ave lives and reduce damage[56, 57]. Plants can also improve their safety standards byhaving automatic alarm systems in place to alert workers toemergency situations and to automatically shut down theplant's systems [58]. Ensuring power supply through re-dundant systems is also recommended. The loss of onsiteand offsite electrical power at the Fukushima plant causedsafety systems designed to protect and cool fuel to fail,damaging nuclear fuel and causing the cores to partiallymelt. Automatic emergency power systems, onsite powersupply trucks and better positioning of control room batte-ries either in upper levels or in watertight chambers willprevent blackouts, illuminate control room instruments forworkers and provide emergency power to contain and coolnuclear waste.7 Another necessary safeguard in the eventof power loss is the installation of an automatic backupcooling system such as an isolation condenser (IC) whichrelies on no power and utilizes convection and gravity toperform cooling functions [57]. Furthermore, ensuring thatall power-free cooling systems can be manipulated withoutpower and making sure that core spray lines apply water tothe cores from above rather than the bottom will also beimportant in such cases [59, 60].

2. Secure People (see Fig. 6)

The success of any emergency response is largely depen-dent on the education and preparation of people who mustbe ready to act in these situations. In Japan, the nuclear

7 After Fukushima, Washington Post, 18 July 2011: A.14. Washington,DC.

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culture and risk inoculation that had developed over theyears inhibited true understanding of the risks involvedand instilled a sense of complacency that was to thedetriment of the plant’s integrity and the Japanese peo-ple’s safety. In order to prevent the same mentality frompermeating future generations, citizen education and abid-ing by international agreed safety standards is crucial [55,61]. Nuclear power plants, also have the potential to be aterrorist threat. Ensuring personnel loyalty is an importantconsideration and will therefore require stricter hiringpractices and limited non-personnel access to facilities[57, 62, 63]. Another setback in the Fukushima case wasthe lack of preparation of employees when it came time toimplement emergency strategies. As a result, employeesmust to be held to a greater standard in terms of quick,efficient emergency response and both managers and low-level personnel need to be trained in emergency proce-dures [64]. In addition to training, personnel will need tohave the proper protective equipment on hand to combatdisaster conditions. These include iodine tablets forworkers to absorb radiation in the event of exposure,protective head-to-toe suits with face masks connected tooxygen tanks, and dosimeters to allow employees to

accurately measure radiation levels while moving throughoutthe facility [53].

3. Secure Practices (see Fig. 6)

In the case of Fukushima, lax government regulation of thenuclear power industry allowed utility companies to get awaywith substandard safety measures. In order to ensure thatindustry standards are met, greater oversight will be needed.Some countries like China have already allowed organizationslike the International Atomic Energy Agency (IAEA) to re-view its regulatory framework for nuclear safety. Extensivestress tests, assessment of low-probability but high-consequence risks and greater transparency and oversightthrough the involvement of international organizations likethe IAEA will build trust and confidence that nuclear powerplants are indeed safe [57, 64, 65].

In addition to safer structures, focus also needs to be placedon the facilitation of accident mitigation strategies and thedissemination of consistent, accurate information about con-ditions when accidents occur. Prior to the tsunami, theJapanese government evacuated residents living within 3 kmof the plant and then 10 km the morning after. With people

Fig. 6 Secure components+secure people+secure practices=secure nuclear materials (Courtesy Kun)

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fleeing the area, the roads in and around the area quicklybecame congested. During this time, containment vesselswere vented to relieve pressure in reactors, sending radioac-tive gases into the air. In similar situations, citizens should beevacuated prior and special access for emergency vehicles onroads are necessary to ensure timely emergency response[53–64]. Furthermore, government and corporate transparen-cy and response time must improve. For example, TEPCOinitially measured radiation in water leaking from the site at100 millisieverts an hour. However, the equipment used wasinadequate and could only read measurements of up to100 millisieverts. Using a more sensitive device, levels of1,800 millisieverts an hour were recorded. In the case ofFukushima, dissemination of information was often timesinconsistent and confusing. Increased government and corpo-rate communication with the public and the provision of clear,concise information will gain the trust and confidence of thepublic and facilitate emergency operations [66].

And finally, as TEPCO and the Japanese governmentcontinue to grapple with increasing issues related to ra-dioactive waste, (i.e., approximate 400 tons (daily) ofcontaminated water used to cool reactors and the hundredsof tons of radioactive waste stored in tanks that continuesto leak into the ground and water supply) responsibledisposal is becoming an increasingly pressing issue[67–69]. Therefore, it is crucial that nuclear facilities planfor these issues by building sufficient storage facilities forcontaminated water onsite to prevent similar containmentand disposal issues in the future.

4 Conclusions

The accident that struck the Fukushima Dai-ichi NuclearPower Plant on March 11, 2011, was an unfortunate reminderthat despite nuclear power’s safe and clean image, it is, un-predictable and its consequences far-reaching. The case ofFukushima demonstrates how problems intrinsic to manycountries with nuclear programs such as weak governance,collusion and corruption, all have the potential to raise serioushealth and environmental risks both in and out of thesecountries. Three years later, the devastating effects ofregulatory capture and complacency that created the publichealth and environmental nightmare in Fukushima stillhaven’t been resolved. It remains to be seen if contaminationcan be contained, and if people and industry in Fukushima canrecover and regain some kind of normalcy. Now, it is society’sresponsibility to take the lessons learned from Fukushima todevelop and implement strategies to prevent similar disastersin the future [70].

1. One of the first steps—indispensable to any preventionand disaster mitigation planning—is the establishment

of clear, comprehensive protocols that prepare for theunthinkable and reflect the quickly changing, untam-able responses of something as fragile and powerful asnuclear power. Rigorous examination and analysis ofcritical infrastructure needs and potential disaster im-pacts will better prepare response strategies for futuresituations and ensure the protection and functionalityof critical infrastructures that preserve the well-beingof the general population. Whilst developing theseprotocols, government, academics and internationalorganizations must determine if nuclear power is worththe risk it entails. Important questions that will need tobe addressed are disposal of used materials andstorage.

2. Second, government should dictate policy, not indus-try. Disasters and the accidents they produce are mul-tifaceted; therefore, preparation and response mecha-nisms must be versatile. The only way to assurestringent regulations capable of adequately guardingagainst these events is by diversifying the pool ofexperts that work to regulate nuclear power. Makingone agency alone responsible could result in a narrowand perhaps skewed view of policy. Alternatively, oneoverarching agency that embraces opinions frommulti-disciplines and inter-disciplines may succeed.For example, in the case of Fukushima, what waslacking in METI and in the nuclear complex in gen-eral, was perspective. It was this lack of perspectivethat contributed to the technical deficiencies that ex-acerbated and prolonged the accident. Therefore, wemust prepare for such settings by looking across abroad spectrum of fields and specialties and encour-age inter-agency collaboration between relevant gov-ernment departments and or agencies in addition tointernational organizations and NGOs. In excessivelybureaucratic or corrupt states, policy tends to centeraround the policymaker and his perception of what isbest for government or industry. More agencies andinternational organizations working together will pro-vide the heterogeneity and diversification needed tomake sure ample oversight exists and that citizenprotection—not energy needs—is the number oneissue.

3. Third, independent, international organizations likethe United Nations need to discuss the safety andsecurity of the global citizen and be involved indoing risk analyses country by country to determinethe viability of nuclear power (e.g. Japan, Chile). AUnited Nations panel composed of academics, indus-try experts and governments could be a useful tool indetermining the extent of risk—not just to that na-tion, but to its neighbors and the world community ingeneral. Furthermore, for countries dependent on

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nuclear energy, these panels could serve to assesswhat other possible alternatives could be used toreplace nuclear energy. For example, Chile possessesa long coastline whose waves could have significanthydropower potential; in the South strong windsmean that wind power production could be a possi-bility; and the deserts to the North could easily beused to generate solar power. In all, Chile could havethree different types of energy sources, which al-though they may be costly at first to interconnect,could potentially be sold to neighboring countrieslike Argentina and Peru, with more than enough leftover for Chile to meet its own energy needs.

4. The lessons learned from Fukushima and Chernobylshouldn’t be applied only to countries with activenuclear programs, but rather, they should be takeninto consideration by the entire global community.The effects of contamination and waste can spreadacross vast stretches of land and water and in amatter of hours or days. Even though one countrymay not depend on nuclear energy, it is highlylikely that a potential accident from a neighboringcountry (or a few) that do, could endanger its citi-zens, their water, their food supply and their envi-ronment. Diplomatic relations among neighborswould also be at risk. This case raises the issue ofglobal and ethical responsibility, something thatcountries that have nuclear power will have to be-come more cognizant of and be prepared to addressshould they continue to go forward with nuclearpower.

The inability to predict such disasters makes prepar-ing for the unthinkable difficult; however, have a col-lective responsibility to do everything in our power andpool our resources and combat the impacts of thesedisasters as best we can.

Preventative measures need to be thought out and createdby teams that include: engineers, architects, physicists and ofcourse policy makers in every country. The results generatedby these teams need to be shared so that countries will bebetter prepared to protect their citizens and criticalinfrastructures.

With examples like Three Mile Island, Chernobyl andnow Fukushima, how many more “wake-up calls” doeshumanity need? If we don’t attempt to learn from caseslike these, we will inevitably repeat the same mistakes,which in turn could have graver consequences in thefuture.

5. Given the interdependencies among Crit icalInfrastructures and their dependency on InformationTechnology, the resilience of these systems, is of

significant importance. During a disaster, loss of infor-mation technology due to lack of electricity can amplifythe physical damage already suffered. IT resilience, iscrucial to a good response because it can provide accurateinformation to citizens in distress, save lives and greatlyimprove the management of resources. It is recommend-ed that every nation develop a Disaster and Emergency/Crisis Management Strategy that includes the use ofCloud Computing as part of its Continuity ofOperations Plan (COOP).

The Fukushima accident has forced countries aroundthe world to re-evaluate their dependency on nuclearpower. This paper concludes with Fig. 6, which pro-vides a summary of actions that can be taken to im-prove the safety of nuclear materials and protect publichealth and the environment.

Conflicts of interest The authors declare that they have no conflict ofinterest.

Glossary

1. Activity See radioactivity2. Alpha particles A by-product of alpha decay when

ejected becomes a source of ionizingradiation. They are large subatomicfragments consisting of two protons andtwo neutrons [71].

3. Becquerel (Bq) A unit of measure of radioactivity. OneBq is equivalent to the amount ofradioactive material that will undergoone transformation in one second. Onecurie is 37 billion Bq [72].

4. Beta particle An electron counterpart that is ejectedfrom the nucleus of some radioactiveatoms [73].

5. curie (Ci) A unit of measure of radioactive decayamounting to 37 billion disintegrationsper second where disintegration is definedas the process of nuclear breakdown toemit subatomic particles [74].

6. Decay The process where any radioactiveisotope spontaneously emits radiationper unit time causing a decrease inamount of the isotope to form a newchemical species [75].

7. Decay product The product of the radioactive decay ofisotopes which include the high-energyelectromagnetic radiation emitted by thenuclei of radionuclides [76].

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8. Effective DoseEquivalent

The sum of the products of the doseequivalent to the organ or tissue andthe weighting factors applicable toeach of the body organs or tissues thatare irradiated [77].

9. Fission The splitting of the nucleus into at leasttwo other nuclei resulting to the releaseof energy [78].

10. Fusion A reaction of producing one heaviernuclei from the merging of two lighter,less stable nuclei accompanied by arelease of energy [79].

11. Gamma ray A decay product emitted from thenucleus of unstable radioactive atomscharacterized as high ionizing radiationwhich is a health hazard [80].

12. gray (GY) A unit of measurement for an absorbeddose. This is the amount of energy fromany type of radiation absorbed by anymaterial. One gray is equal to one jouleof energy deposited in one kg of amaterial [81].

13. Half-life The time required for half of the atoms ofthe radioactive element to decay ordisintegrate [82].

14. Isomer In isomeric transitions, this is the nuclearatomic species of a radioactive elementhaving the same number of protons andneutrons but a different energy [83].

15. Isotope A nuclear atomic species of radioactiveelement with the same number of protonsbut different number of neutrons [84].

16. joule (J) The SI unit of energy. One joule isequivalent to approximately 9.478170×10−4 British thermal unit (Btu) [85].

17. Radiation A form of energy traveling through avacuum or medium in the structure of awave or particle [86].

18. Radioactivity A process where energetic particles orrays are spontaneously emitted byradioactive atoms [87].

19. sievert (Sv) A unit used to derive the quantity,equivalent dose. This is the absorbeddose in human tissue from a specific typeof radiation associated with the effectivebiological damage [88].

References

1. Pool R. Fukushima: the facts. Eng Technol. 2011;6:32–6.2. Hirose K. Interview by Dr. Luis Kun []. Impact of the accident at the

Fukushima Dai-ichi Nuclear Power Station on the society and the lifeof public people. 2013, October.

3. Lessons learned from the nuclear accident at the Fukushima Dai-ichinuclear power station. Institute of Nuclear Power Operations, 1–42.2012.

4. Aldrich DP. Post-crisis Japanese nuclear policy: from top-downdirectives to bottom-up activism. Asia Pac Issues. 2012;103:1–12.

5. Pfotenhauer SM, Jones CF, Saha K, Jasanoff S. Learning fromFukushima. Issues Sci Technol. 2012;28:79–84.

6. Strickland E. Fukushima’s next 40 years: decommissioning the nu-clear power plant is the world’s toughest demolition project.spectrum.ieee.org, 47–53. 2014.

7. Ruff TA. A public health perspective on the Fukushima nucleardisaster. Asian Perspect. 2013;37:523–49.

8. Radiation Medical Science Center for the Fukushima HealthManagement Survey, Fukushima Medical University. 2012,January 1. Fukushima radiation and health. Retrieved, from https://www.fmu.ac.jp/radiationhealth/survey/.

9. Tabuchi H, Onishi N, Belson K. Japan extended reactor’s life, despitewarning. New York Times. 2011, March 21.

10. Health risk assessment from the nuclear accident after the 2011 GreatEast Japan earthquake and tsunami, based on a preliminary doseestimation. World Health Organization (WHO), 1–172.

11. Brumfiel G. Fukushima’s doses tallied. Nature. 2012;485:423–4.12. Inamasu T. Fukushima radiation health risk management. Nucl Plant

J. 2013;31:42. 44–45.13. Edwards G. Gambling with people’s lives – the perfect crime?

Fukushima - page 1. Retrieved, from http://www.ccnr.org/Gambling_2014.pdf. 2014, April 7.

14. Ten Hoeve JE, Jacobson MZ. Worldwide health effects of theFukushima Dai-ichi nuclear accident. The Royal Society ofChemistry: Energy and Environmental Science, 1–15.

15. Yasunaria TJ, Stohl A, Hayano RS, Burkhart JF, Eckhardt S,Yasunari T. Cesium-137 deposition and contamination of Japanesesoils due to the Fukushima nuclear accident. Proc Natl Acad Sci U SA 108. Retrieved March 1, 2014, from.

16. Aoki M. Fukushima farmers in two-front war. The Japan Times, pp.1–3. 2012, March 7.

17. Kiger PJ. Fukushima’s radioactive water leak: what you shouldknow. Retrieved, from http://news.nationalgeographic.com/news/energy/2013/08/130807-fukushima-radioactive-water-leak/. 2013,August 7.

18. About Codex. n.d. CODEX Alimentarius. Retrieved, from http://www.codexalimentarius.org/about-codex/en/.

19. Nagano. Fishermen watch recovery slip away; The wastewater leak-age at Japan’s Fukushima nuclear plant puts their lives back in limbo.Los Angeles Times, p. A7. 2013, October 20.

20. Roslin A. Post-Fukushima, Japan’s irradiated fish worry B.C. ex-perts. Retrieved, from http://www.straight.com/life/post-fukushima-japans-irradiated-fish-worry-bc-expertsS. 2012, July 18.

21. Bird W. Will fish-loving Japan embrace sustainable seafood?Retrieved, from http://e360.yale.edu/feature/will_fish-loving_japan_embrace_sustainable_seafood/2553/. 2012, July 19.

22. Eilperin J. China has world’s largest ‘SeafoodPrint’ China hasworld’s largest ‘SeafoodPrint’. The Washington Post. 2010,September 22.

23. A third of the world’s marine fish catches are used for animal feed.2008, October 29. Retrieved, from http://www.pewenvironment.org/news-room/press-releases/a-third-of-the-worlds-marine-fish-catches-are-used-for-animal-feed-8589935517.

24. Kazem H. US residents monitor Fukushima radiation. Aljazeera.2014, January 19.

25. Little JB. How has Fukushima’s nuclear disaster affected the envi-ronment? Audubon Magazine. 2012, March 9.

26. Aquino F. Japan’s birthrate drops to 1.03 million, number of deathskeep increasing. Japan Daily Press. 2013, June 7.

27. Torres I. Japan’s population continues to shrink for third year in arow. Japan Daily Press. 2014, April 16.

Health Technol. (2014) 4:177–203 201

Page 26: The impact of Fukushima on global health: lessons learned from man-made and natural disasters

28. Situation of the evacuees. 2014, January 1. Retrieved, from http://fukushimaontheglobe.com/the-earthquake-and-the-nuclear-accident/situation-of-the-evacuees.

29. Takano H, Takano N. Nuclear special Fukushima: the social impactof a nuclear disaster. Retrieved, from http://www.theecologist.org/blogs_and_comments/commentators/other_comments/1240157/fukushima_the_social_impact_of_a_nuclear_disaster.html. 2012,February 15.

30. KrumboltzM. Fukushima fallout may be causing illness in Americanbabies: study. Retrieved, from http://news.yahoo.com/blogs/the-lookout/study-fukushima-fallout-may-causing-illness-american-babies-165531579.html. 2013, April 5.

31. Aoki M, Rothwell G. A comparative institutional analysis of theFukushima nuclear disaster: lessons and policy implications. ElSevier 53:240–47.

32. Morris B. What does the future hold for Japan’s electronics firms?BBC News Business. Retrieved, from http://www.bbc.com/news/business-17688322. 2012, January 1.

33. Production Statistics | OICA. OICA. Retrieved April 28, 2014, fromhttp://www.oica.net/category/production-statistics/. 2013, January 1.

34. Nuclear Power in Japan. World Nuclear Association. Retrieved, fromhttp://www.world-nuclear.org/info/Country-Profiles/Countries-G-N/Japan/. 2014, April 1.

35. Howe BM, Oh JS. The Fukushima nuclear disaster and the chal-lenges of Japanese democratic governance. Korea Obs. 2013;44:495–516.

36. Funabashi H. Why the Fukushima nuclear disaster is a man-madecalamity. Int J Jpn Sociol. 2012;21:65–75.

37. Tanter R. After Fukushima: a survey of corruption in the globalnuclear power industry. Asian Perspect. 2013;37:475–500.

38. Yotaro Hatamura: was fukushima an accident waiting to happen?2012, February 28. PBS. Retrieved, from http://www.pbs.org/wgbh/pages/frontline/health-science-technology/japans-nuclear-meltdown/yotaro-hatamura-was-fukushima-an-accident-waiting-to-happen/.

39. Osnos E. The fallout: letter from Fukushima. The New Yorker.2011;87:46.

40. Toki M. Heavy lifting ahead in the Japan-India nuclear deal. Bulletinof the Atomic Scientists. Retrieved, from http://thebulletin.org/heavy-lifting-ahead-japan-india-nuclear-deal. 2014, February 10.

41. Mishra P. Nuclear power: India shouldn’t buy what Japan is trying tosell. The Japan Times. 2013, November 8.

42. Hart P. Invited essay after Fukushima: reflections on risk and institu-tional learning in an era of mega-crises. Public Adm. 1–14.

43. TEPCO orchestrated ‘personal’ donations to LDP - AJW by TheAsahi Shimbun. 2011, October 8. The Asahi Shimbun. Retrieved,from http://ajw.asahi.com/article/behind_news/politics/AJ2011100813755.

44. Parvaz D. Nuclear safety: a dangerous veil of secrecy. Aljazeera.Retrieved, from http://www.aljazeera.com/indepth/features/2011/08/2011877118599802.html. 2011, August 11.

45. Dawson C, Hayashi Y. Fateful move exposed Japan plant.Wall StreetJ. 2011, July 12.

46. Hazards of boiling water reactors in the United States - NIRS. 2011,March 1. Hazards of boiling water reactors in the United States -NIRS. Retrieved, from http://www.nirs.org/factsheets/bwrfact.htm.

47. Queste A (Director). Vulnerability of modern societies towards nat-ural disasters the impact on critical infrastructures. World Conferenceon Disaster Reduction. Lecture conducted from Federal Office forCivil Protection and Disaster Response, Germany, Kobe. 2005,January 18.

48. O’ Rourke PT (Director). Earthquake effects on effects on criticalinfrastructure. 2013 National Lifelines Forum. Lecture conductedfrom Cornell University and New Zealand Lifelines Committee.2005, January 18.

49. Katsumi B. Interview by Dr. Luis Kun []. Fukushima update. 2013,September 20.

50. Yokoyama J. Fukushima disaster and reform. Environ Policy Law.2013;43(4):226–33.

51. Baetz J. Germany nuclear power plants to be entirely shut down by2022. The Huffington Post. Retrieved from http://www.huffingtonpost.com/2011/05/30/germany-nuclear-power-plant-shut-down_n_868786.html. 2011, May 30.

52. Domanksi A. Germany counts the costs as it buries nuclear past.Reuters. Retrieved from http://www.reuters.com/article/2012/07/17/us-germany-nuclear-shutdown-idUSBRE86G0G720120717. 2012,July 17.

53. Strickland E. 24 hours at Fukushima. IEEE Spectr. 2011;48(11):40.54. Strickland E. 24 hours at Fukushima. IEEE Spectr. 2011;48(11):42.55. Scott Peterson J. What’s next for nuclear? IEEE Spectr. 2011;48(11):49.56. Virgilio M. What’s next for nuclear? IEEE Spectr. 2011;48(11):48.57. After Fukushima, Washington Post, 18 July 2011: A.14.

Washington, DC.58. Strickland E. 24 hours at Fukushima. IEEE Spectr. 2011;48(11):36.59. Strickland E. 24 hours at Fukushima. IEEE Spectr. 2011;48(11):37–8.60. Boyd J. IEEE Spectr. 2011;48(11):18.61. Kinnunen T. Finland seeks lessons after fukushima on nuclear

complacency culture. Reuters, 6 September 2013. http://www.reuters.com/article/2013/09/06/us-finland-nuclear-safety-idUSBRE98507020130906. Accessed 13 Sep 2013.

62. National Nuclear Security Administration, http://www.nnsa.e n e rgy. gov / a bou t u s / ou r p r og r ams / nonp r o l i f e r a t i o n /nuclearradiologicalmaterialsecurity/nuclearsafeguards.

63. National Nuclear Security Administration. International safeguards:challenges and opportunities for the 21st century. http://nnsa.energy.gov/sites/default/files/nnsa/inlinefiles/NGSI_Report.pdf.

64. Strickland E. 24 hours at Fukushima. IEEE Spectr. 2011;48(11):39.65. Ritch J. What’s next for nuclear? IEEE Spectr. 2011;48(11):49.66. Hassler S. IEEE Spectr. 2011;48(11):10.67. Gosling J. Fukushima leaks: Japan pledges $470 million for ‘ice

wall’. BBC News, 3 September 2013. http://www.bbc.co.uk/news/world-asia-23940214. Accessed 13 Sep 2013.

68. Fukushima leaks: radioactive water overflows tank. BBC News, 3October 2013. http://www.bbc.co.uk/news/world-asia-24377520.

69. Japan government abandons hands-off approach to fukushima clean-up. Reuters, 1 September 2013. http://www.reuters.com/article/2013/09/01/us-japan-fukushima-idUSBRE98002520130901.

70. Alarm over Argentina’s plans to relocate its nuclear fuel processingplant. 2014, January 1. Retrieved, from http://www.latinnews.com/index.php?option=com_k2&view=item&id=60299&uid=55646&acc=1&Itemid=6&cat_id=794573.

71. U.S. Environmental Protection Agency. Alpha particles.Understanding radiation: ionizing and non-ionizing radiation. EPA,26 July 2012. Web. 22 November 2013.

72. U.S. Environmental Protection Agency. Radiation: becquerel.Understanding radiation: ionizing and non-ionizing radiation. EPA,26 July 2012. Web. 22 November 2013.

73. U.S. Environmental Protection Agency. Beta particles.Understanding radiation: ionizing and non-ionizing radiation. EPA,26 July 2012. Web. 22 November 2013.

74. U.S. Environmental Protection Agency. Curies. Understanding radi-ation: ionizing and non-ionizing radiation. EPA, 26 July 2012. Web.22 November 2013.

75. U.S. Environmental Protection Agency. Radiation and radioactivity:decay. Understanding radiation: ionizing and non-ionizing radiation.EPA, 26 July 2012. Web. 22 November 2013.

76. U.S. Environmental Protection Agency. Radiation and radioac-tivity: decay products. Understanding radiation: ionizing andnon-ionizing radiation. EPA, 26 July 2012. Web. 22 November2013.

77. U.S. Nuclear Regulatory Commission. Effective dose equivalent.NRC Library. NRC, 22 November 2013. Web. 22 November2013.

202 Health Technol. (2014) 4:177–203

Page 27: The impact of Fukushima on global health: lessons learned from man-made and natural disasters

78. U.S. Environmental Protection Agency. Radiation: fission.Understanding radiation: ionizing and non-ionizing radiation. EPA,26 July 2012. Web. 22 November 2013.

79. U.S. Environmental Protection Agency. Radiation: fusion.Understanding radiation: ionizing and non-ionizing radiation. EPA,26 July 2012. Web. 22 November 2013.

80. U.S. Environmental Protection Agency. Gamma rays. Understandingradiation: ionizing and non-ionizing radiation. EPA, 26 July 2012.Web. 22 November 2013.

81. U.S. Environmental Protection Agency. Radiation: gray.Understanding radiation: ionizing and non-ionizing radiation. EPA,26 July 2012. Web. 22 November 2013.

82. U.S. Environmental Protection Agency. Half-life. Understandingradiation: ionizing and non-ionizing radiation. EPA, 26 July 2012.Web. 22 November 2013.

83. U.S. Environmental Protection Agency. Radiation: isomer (iso-meric transtions). Understanding radiation: ionizing and non-

ionizing radiation. EPA, 26 July 2012. Web. 22 November2013.

84. U.S. Environmental Protection Agency. Radiation: isotope.Understanding radiation: ionizing and non-ionizing radiation. EPA,26 July 2012. Web. 22 November 2013.

85. University of North Carolina at Chapel Hill. How many? UNC, 18September 2001. Web. 22 November 2013.

86. U.S. Environmental Protection Agency. Radiation andradioacitivty: what is radiation? Understanding radiation:ionizing and non-ionizing radiation. EPA, 26 July 2012. Web.22 November 2013.

87. U.S. Environmental Protection Agency. Radiation and radioactivity:what is radioactivity? Understanding radiation: ionizing and non-ionizing radiation. EPA, 26 July 2012. Web. 22 November 2013.

88. U.S. Environmental Protection Agency. Radiation: sievert.Understanding radiation: ionizing and non-ionizing radiation. EPA,26 July 2012. Web. 22 November 2013.

Health Technol. (2014) 4:177–203 203