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John D Boice Jr

Division of Epidemiology, Vanderbilt University
National Council on Radiation Protection and
Measurements (NCRP)

Risk Assessment, Risk Perception
and Risk Management
International Academic Conference
Radiation Health Risk Management in Fukushima
25 - 27 February 2013
Fukushima, Japan
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Outline – A Personal View
 Introduction – Risk Management
 Risk Assessment
 Communication
 Perception
 Stigma
 Stakeholders
 Intervention Re-assessment
 Concluding Comments
Date City Oct 2012
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What is Risk?
 Risk is the chance (or probability) that an event (future cancer)
might occur after an exposure (radiation).

 Life is risky: about 42% will develop cancer in their lifetime and
100% will die.

 Virtually every aspect of life involves risk. How we deal with risk
depends largely on how well we understand it. (NAS 2008)

 Risk cannot be eliminated, it can only be mitigated.

 Risk assessment includes identifying the hazard, assessing the
exposure and characterizing the future risk.

 Risk management goal is to prevent cancer and other human
health effects which may result from the exposure based on the risk
assessment. (Or on the perception of risk.)
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Risk Assessment and Risk Management
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RISK MANAGEMENT – An Intervention
 What are the health (or environmental) benefits ?

 Will it affect or limit other options ?

 Is it justified considering benefits, costs, and uncertainties ?

 Have the risks of exposure and the benefits of intervention
been adequately communicated to stakeholders ?

 Have Stakeholders been involved at all stages ?

 Is it necessary to evaluate the effectiveness ?

 If so, how should this be done ? Is there a plan ?

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Radiation Risk Assessment
 What is the
population dose ?
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Fukushima is not Chernobyl
“Fukushima is not Chernobyl”
CNN 3-21-11
UNSCEAR 2011 (Feb)
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Chernobyl firemen
134 workers had Acute Radiation Sickness with doses
> 2 Gy, some > 10 Gy, highest 16 Gy.
28 died in a few months.
Thanks - Fred Mettler
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530,000 Recovery Workers (liquidators) for the
cleanup over 3 years – mean dose 100 mSv
Worgul, Basil et al. Cataracts among
Chernobyl Clean-up Workers: Implications
Regarding Permissible Eye Exposures.
Rad Res 2007
Mean dose ~ 9 mSv for
Fukushima > 20,000 workers
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Radioactive Iodines in the Environment Resulted
in Epidemic of Thyroid Cancer in Children who
Drank Contaminated Milk
Belarus Milk
Japanese children - Fukushima
Washington State
Belarus: 10,000 Bq/L milk vs 300 Bq/L limit
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 Three Mile Island 0.005 PBq
 Windscale (1957) 0.740 PBq
 Fukushima 160 PBq
 Chernobyl 1760 PBq
 Atmospheric testing 675,000 PBq

PBq= Peta Bq = 1 x 10
Bq 1 PBq = 27kCi
Comparisons of Iodine-131
 The winds blew to the sea, mostly but not always
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Why was the Population Exposure
Very Low ?
 Evacuation
 Recommend to stay indoors
(shelter in place)
 Food restrictions
 Monitoring, masks
 Extensive population screening
Quick action taken to
minimize adverse health
 1,080 children examined for
thyroid dose – lower than the
screening level.
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 Radioactivity in Thyroid Glands of 1,080
Children under age 15 y was measured in
March 2011

 The survey was conducted in Iwaki City,
Kawamata town, and Iitate village, where a high
probability of internal radiation exposure of the
thyroid gland was suspected.
What is the Evidence for Low Doses?
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Nuclear Safety Commission, Japan - website
Highest dose
rate would result
in an equivalent
dose to thyroid
of 1 yr old of
of ~ 30 mSv/y

Most Measurements Below Detection Level
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Ukrainian – American
Chernobyl Thyroid Study
Brenner et al EHP 2011
Mean dose 650 mGy
Chernobyl Study
Fukushima Dose Level
(median ~ 4 mGy)
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 "the poison is in the dose"
(Paracelsus) – it’s the amount
that matters
 the future risk is tied to the
amount, not the potential or
fact of exposure
Risk Depends on Dose, and the
Population Dose appears Very Low
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Health Management
2 million subjects

Fukushima University Medical School
Is there Other Evidence for Low Doses?
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Radiation Exposure to Residents
Cumulative Dose (mSv) Number %
1 −
5 −
10 + (max 14.5)
External exposure; Fukushima Health Management Survey (n = 9,747)*
Internal (whole-body counts; NIRS & JAEA) (n = 4,463)
Committed Effective
Dose (mSv)
Number %
*Excluded 721 workers.
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• Number of responses; 386,572
~1mSv 66.3%
~2mSv 95.0%
~5mSv 99.8%
• Maximum 25mSv
Dose (mSv)
Distribution of External Exposure Dose (mSv)
(Estimated Cumulative effective dose from March 11 to July 11)
All Fukushima Prefecture
(data released at 21 Feb 2013)
Distribution of External Radiation Exposure
(Cumulative effective dose from Marc 11 to July 11, 2011
Estimated from location and time course on questionnaire
A. Ohtsuru
< mSv
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LSS Dose Response - Solid Cancer Mortality,
Ozasa et al, Rad Res 177; 2012
Dose Level
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Is there Consistent Evidence for Low Doses ?
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Is there Consistent Evidence for Low Doses ?
 WHO, 2012; UNSCEAR, 2012: NIRS; U.S. Military – Operation
Tomodaichi; Evaluation of Russian Citizens (Sergey Shinkarev)
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U.S. Military Exposure
Internal Monitoring Preliminary
 Number monitored (in 2011) 7,740 of 61,000
 Number > MDA 183 (2.4%)
 Average internal dose 0.04 mSv
 Highest internal dose 0.4 mSv
Stars and Stripes, July 20, 2011
(Operation Friends)
is friend in
J apanese
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What Risks Should be Managed ?
 The measures taken reduced exposures to levels for which there is
essentially no chance that any excess cancers in later life could be

 The goal of risk management is scientifically sound, cost-effective,
integrated actions that reduce or prevent risks while taking into account
social, ethical, political, and even legal considerations.

 Serious health problems appearing now are:

- Mental health problems most likely consequence

- Life style disruption and changes in diet, blood pressure, alcoholism,
cholesterol, childhood obesity

Perhaps these are the risks to manage! See the log not the splinter.

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Goal is to Reduce Risk and Improve Health

 Risk management in the context of Fukushima should not focus on
refining assumption-laden mathematical estimates of the small risks
associated with tiny radiation exposures, but rather on the overall goal of
reducing risk and improving health status, taking into account an optimum
allocation of limited resources and societal needs.

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Explaining Risk
Thanks to Mike Joiner
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Explaining Risk
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Slovic Bull Atomic Sci 2012

 There is a particularly urgent need to develop improved plans and
materials for communicating with the public. IAEA initiatives are
encouraging. We need to continue to improve.

 Risk-communication strategies that help people place radiation risks
in perspective by comparing them with other risks can help reduce
fears of radiation.

The Importance of Communication
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Slovic Bull Atomic Sci 2012

 Communicating events and risks during and after the accident were not
optimal and these communication lapses led to lack of trust and credibility
in authorities.

 The acceptance of risk (of intervention strategies) is influenced by many
factors, including trust in the managers (the messengers)

 Rebuilding trust and confidence will be slow and difficult but is
EXTREMELY important. It should continue to be a major goal of risk

 How?

The Importance of Communication The Importance of Communication
Rebuilding Trust
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Risk Management and Communication
 Risk communication is as important as the risk assessment itself.

 The radiation doses are low. Risk communication and outreach that is
important to convince the public, media, authorities.

 Scientists must be willing to communicate their work to other scientists,
regulators, and the public.

 Be available

 Town meetings

 Focus Groups

 Dialogues

 Engage, Empower

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 Comparisons are more meaningful than small numbers or small
probabilities. You’re risk is only 1 in a million?

 Risks should be compared with “some of the other risks in life” and
Compare radiation exposure with radiation exposure. Exposures are
small compared with natural background radiation, medical radiation.

 The 63uSv I received visiting the Fukushima Daiichi Site was less than the
~200 uSv I received during the transcontinental flight from Tokyo to DC

 The low levels of radioactivity in foods are low compared with the 300
Bq/kg banana, the 7000 Bq human body. 1 Bq in a KI tablet.
0.03 Bq/L detected in Washington state.

Risk Management includes Risk Communication
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Fukushima Diaichi NPP
Sept 13, 2011
63 uSv vs
200 uSv
For flight
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 Enough is known about radiation and risk communication to enable
experts to design effective messages; this is the good news.

 Enough is known about radiation and risk communication to enable
experts to design effective messages; this is the bad news.

 The challenge is that communication strategies must be considered a
priority – in terms of time and money -- to be effective.

 Messages should be created and tested before the next emergency.

 If they are not, the next disaster response will, in hindsight, cast a harsh
light on officials who failed to prepare for the known communication
Communicate Strategies of Highest Priority
Slovic Bull Atomic Sci 2012
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Health Physics
101: 2011
Paul Locke,
Program Chair
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The Importance of Communication and

 Further, the perception of risk remains high and has, in combination with the
terrible loss of loved ones from the tsunami and the disruption of lives from
evacuation, resulted in anxiety and depression leading to psychological
problems requiring counseling by mental health professionals.

 Risk perception has affected decisions of returning to homes with slightly
elevated radiation levels, to concern about future effects on children, to not
purchasing food grown in the areas even when levels are below regulatory

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Bags of Rice Certified as to Level of Radioactivity
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After Fukushima:
families on the edge of meltdown
Two years after the Fukushima nuclear disaster, a new phenomenon is
on the rise: atomic divorce. Abigail Haworth reports on the unbearable
pressures and prejudices being faced by those caught in the radiation
zone. The Observer, Sunday, February 24, 2013
Marital discord has become
so widespread that the
phenomenon of couples
breaking up has a name:
genpatsu rikon or "atomic
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After Fukushima:
families on the edge of meltdown
Now that what Noriko Kubota (Iwaki Meisei University) calls
the "disaster honeymoon period" of people uniting to help
each other in the immediate aftermath is over, long-term
psychological trauma is setting in.

"We are starting to see more cases of suicide, depression,
alcoholism, gambling and domestic violence across the area,"
says the psychologist. The young are not immune either. In
late 2012, Fukushima's children topped Japan's obesity
rankings for the first time due to apparent comfort eating and
inordinate amounts of time spent indoors avoiding
contamination. "From the point of view of mental health, this
is a very critical time," says Kubota. (Feb 24 2013, Observer)
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 The Fukushima prefecture is already experiencing stigmatization (disgrace) as
a result of the reactor accident (Mackinnon, 2011).

 Consumers avoid food and other products from Fukushima, even those that
show no signs of contamination,

 Few tourists now visit the region.

 Some schoolchildren from the area have reportedly been bullied by classmates,

 Japanese atomic bomb survivors worry that the former residents of Fukushima
will suffer the same stigma that they have long faced.

 Again, the need for risk communication and risk education and outreach
Slovic Bull Atomic Sci 2012
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Goals of Risk Management

 Equally as important is the need to reestablish trust with stakeholders
and credibility in authorities.
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What is a Stakeholder?
 Not someone who holds a piece of wood!

 Although a “stake” is a pointed piece of wood or post,
American settlers would mark their property with stakes,
often referred to as “staking their claims.” The property
was also called their “stake.”

 ICRP Publication 82

(58) In the wider decision making process, the role of all interested parties,
usually termed stakeholders, should be recognized. This recognition is
particularly important in cases of remediation and rehabilitation of land
with residues from past activities and events. The extent of stakeholder
involvement will vary from one situation to another…. The weight given to
these interests could be an important factor in the acceptability of the
ultimate decision.
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“Stakeholders” Meeting Oct 2012
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Stakeholders – Trust & Credibility
 This trust and credibility has to be earned by taking measures that
go beyond what is expected. Good risk management must include
actively engaging stakeholders as equal partners, e.g., the
citizens of Fukushima.

 It must include transparency in the in the science being applied
and the decisions being made so stakeholders believe their voices
are being heard.

 Develop a plan for receiving and responding to stakeholder input

 Have a well defined schedule and product for the end

 Building credibility and trust is as important as the science itself

 What does it matter to have the best environmental and population
risk assessment and control if the results are not believed?

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Board for Atomic Veterans
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 Given that the population received only a fraction of the amount of
radiation experienced annually from natural sources, or from a few
medical radiological procedures, there is little chance of contributing
to understanding low-dose and low-dose rate effects.

 Good risk management calls for evaluating the effectiveness of
intervention strategies or actions taken and, if need be, modifying
the actions taken. ---- “Do more good than harm.”

 Reviewing and reassessment strategies is EXTREMELY
important. Programs often have a life of their own. But many
should be terminated once the job is done (or if shown to be
ineffective), or should be re-focused to new issues that have arisen
during the process of risk management.

Continually Review and Re-assess the
Interventions Strategies
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Become the focal point and world leader (working with
international community):

 Risk Management
 Providing Health Care
 Risk Communication
 Risk Education
 Risk Assessment
 Risk Perception
 Train, Engage, Retain
 Engaging Stakeholders – seat at Table
 Intervention Evaluation -
 Make Information Available (Internet) – this Conference
 Social Media. FMU Report. Journal. Twitter.

Fukushima Medical
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Concluding Comments
 Population Dose is Tiny – Be Realistic about Future Risk
 Educate – Public, Scientists, Medics, Health Care
 Communicate – be transparent and effective
 Involve stakeholders (citizens) -- continually
 Reassess interventions and strategies periodically --
have a plan to do so
 Mental health, tip of the iceberg? – focus on real not
perceived problem
 Life style changes – high blood pressure, cholesterol,
obesity, alcohol, (smoking?) – focus on real problems.
 “Miles to go before ‘we’ sleep…”
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Soon to be Published in Health Physics
NCRP 2012 Annual Meeting
 March 12 - 13, 2012 Annual Meeting, Bethesda

Implications of the Fukushima Daiichi Accident for
Radiation Protection – 8 Sessions including:

Childhood Exposure: An Issue from Computed Tomography
Scans to Fukushima
Fred A. Mettler, Jr., New Mexico Federal Regional Medical Center

Reference Levels in the Context of Fukushima: Lessons
Learned and Challenge to Radiation Protection System
Kazuo Sakai, National Institute of Radiological Sciences, Japan
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 Dedicated to the People of Fukushima - Webinar
Including presentation on:
Two Year Results from the Fukushima Health Surveys
Shunichi Yamashita, Vice Pres, Fukushima Medical University

Emotional Consequences of Nuclear Power Plant Disasters
Evelyn Bromet SUNY Stony Brook
 Coming Soon
Scientific Committee 5-1, “Approach to Optimizing Decision
Making for Late-Phase Recovery from Nuclear or Radiological
Incidents” --
Chair, SY Chen. Argonne National Laboratory
2013 NCRP Annual Meeting,
Bethesda MD, March 11- 12
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Domo - Arigato
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