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

All rights reserved

Outline – A Personal View

Introduction – Risk Management

Risk Assessment

Communication

Perception

Stigma

Stakeholders

Intervention Re-assessment

Concluding Comments

Date City Oct 2012

All rights reserved

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.)

All rights reserved

Risk Assessment and Risk Management

All rights reserved

2008

All rights reserved

PHASE III: 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 ?

2008 All rights reserved

Radiation Risk Assessment

What is the

population dose ?

All rights reserved

Fukushima is not Chernobyl

“Fukushima is not Chernobyl”

CNN 3-21-11

http://www.youtube.com/watch?v=5XbitM9LiYk&list=SL

UNSCEAR 2011 (Feb)

All rights reserved

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 All rights reserved

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 All rights reserved

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

All rights reserved

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 1015 Bq 1 PBq = 27kCi

Comparisons of Iodine-131 Releases

The winds blew to the sea, mostly but not always

All rights reserved

Why was the Population Exposure Very Low ?

Evacuation

Recommend to stay indoors

(shelter in place)

Food restrictions

Monitoring, masks

Extensive population screening

(200,000)

Quick action taken to

minimize adverse health

consequences

1,080 children examined for

thyroid dose – lower than the

screening level.

All rights reserved

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.

14

What is the Evidence for Low Doses?

All rights reserved

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

All rights reserved

Ukrainian – American Chernobyl Thyroid Study

Brenner et al EHP 2011

Mean dose 650 mGy

Chernobyl Study

Fukushima Dose Level

(median ~ 4 mGy)

All rights reserved

"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

All rights reserved

Health Management

Survey

2 million subjects

Fukushima University Medical School

Yamashita Yasumura

Is there Other Evidence for Low Doses?

All rights reserved

Radiation Exposure to Residents

Cumulative Dose (mSv) Number %

<1

1 −

5 −

10 + (max 14.5)

5,636

3,583

457

71

57.8

36.8

4.7

0.7

External exposure; Fukushima Health Management Survey (n = 9,747)*

Internal (whole-body counts; NIRS & JAEA) (n = 4,463)

Committed Effective

Dose (mSv)

Number %

<1

1

2

3

4,447

6

8

2

99.6

0.1

0.2

0.0

*Excluded 721 workers.

All rights reserved

(http://wwwcms.pref.fukushima.jp/）

• 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

256,281

Estimated from location and time course on questionnaire

110,894

A. Ohtsuru

<

<

<

.

< mSv

All rights reserved

LSS Dose Response - Solid Cancer Mortality, 1950-2003

Ozasa et al, Rad Res 177; 2012

Fukushima

Dose Level

All rights reserved

22

Is there Consistent Evidence for Low Doses ?

All rights reserved

Is there Consistent Evidence for Low Doses ?

WHO, 2012; UNSCEAR, 2012: NIRS; U.S. Military – Operation

Tomodaichi; Evaluation of Russian Citizens (Sergey Shinkarev) All rights reserved

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

TomoDachi

(Operation Friends)

TOMODACHI

is friend in

Japanese

All rights reserved

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

detected.

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.

All rights reserved

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.

All rights reserved

Explaining Risk

Thanks to Mike Joiner

All rights reserved

JUST KIDDING !

Explaining Risk

All rights reserved

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

All rights reserved

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

management.

How?

The Importance of Communication The Importance of Communication Rebuilding Trust

All rights reserved

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

All rights reserved

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

All rights reserved

Fukushima Diaichi NPP

Sept 13, 2011

63 uSv vs

200 uSv

For flight All rights reserved

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

challenges.

Communicate Strategies of Highest Priority

Slovic Bull Atomic Sci 2012

All rights reserved

RISK COMMUNICATION & OUTREACH

Health Physics

101: 2011 Paul Locke,

Program Chair

All rights reserved

The Importance of Communication and Perception

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

standards.

All rights reserved

Bags of Rice Certified as to Level of Radioactivity

All rights reserved

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

divorce".

All rights reserved

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)

All rights reserved

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 All rights reserved

Goals of Risk Management

Equally as important is the need to reestablish trust with stakeholders

and credibility in authorities.

All rights reserved

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.

All rights reserved

“Stakeholders” Meeting Oct 2012

All rights reserved

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?

All rights reserved

Board for Atomic Veterans

All rights reserved

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

All rights reserved

Opportunity

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 University

All rights reserved

Concluding Comments

Population Dose is Tiny – Be Realistic about Future Risk

Educate – Public, Scientists, Medics, Health Care

Providers

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…”

All rights reserved

Soon to be Published in Health Physics

NCRP 2012 Annual Meeting

March 12 - 13, 2012 Annual Meeting, Bethesda

EMERGING ISSUES IN RADIATION PROTECTION IN

MEDICINE, EMERGENCY RESPONSE, AND THE NUCLEAR

FUEL CYCLE

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

All rights reserved

Dedicated to the People of Fukushima - Webinar

RADIATION DOSE AND IMPACTS ON EXPOSED

POPULATIONS

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

All rights reserved

Domo - Arigato

All rights reserved