Recovery, Renewal, Resilience

Last month, Japan’s Nuclear Energy Agency (NEA) marked ten years since the Great East Japan Earthquake (GEJE), and the subsequent tsunami that devastated the region and caused a nuclear accident at the Fukushima Daiichi Nuclear Power Plant[1]. Post-accident analysis verified that radiation from the accident at the power plant has not had any direct impacts on human health. However, the evacuation of hundreds of thousands of people living in surrounding areas resulted in premature deaths, due to issues such as lack of access to healthcare or medicines, and stress-related problems[2]. COVID-19 is like Fukushima, in that it presents both policy makers and the general public with a range of multi-dimensional challenges that need to be addressed through recovery and renewal processes. We explore three lessons from Fukushima recovery that can support and prompt thinking for recovery from COVID-19:

Preparedness and disaster management plans

Like COVID-19, the GEJE exposed fragilities in the planning for complex and extraordinary disasters, which were addressed by reformulating disaster management plans at national and local levels in Japan. Consider the following lessons and activities to recover and renew disaster management planning in the light of COVID-19:

• Review and revise disaster management plans at both national and local level to ensure plans are kept up to date:
  • Integrate lessons learned during the pandemic to inform new disaster management planning, legislation and policies - add a new section to disaster management plans that covers the management of pandemics
  • Focus on the following issues: coordination of administrative and operational functionalities; preventative measures, such as education, safety drills, and issuing and transmitting of information and warnings; evacuation and rescue activities, and primary goods supply and distribution in emergency situations; and overall coordination of reconstruction and restoring livelihoods during the recovery phase[3]

Engaging local stakeholders

‘Resilience is strengthened when it is shared’[4]. Establishing strong communication and collaboration - between communities and local medical staff, between central government and municipalities, and with experts - was found to build awareness amongst local residents about exposure risks to radiation, and how to reduce those risks in the future[5]. Stakeholder engagement is critical in the management of future outbreaks, recovery of preparedness for future crises, and recovery from the impacts of COVID-19. Consider:

• Authentic stakeholder engagement means meaningful, creative and impactful interactions with people and communities, and the co-production of recovery and renewal strategies[6]:
  • Recognise community voice, influence, and measurable local impact as part of recovery activities
  • Actively involve community members in recovery conversations and meetings, to bring together a range of knowledge, skills, abilities and perspectives
  • Build on collaborative relationships and integration initiatives that have been developed through the pandemic in local areas. Conduct a review to identify areas where these established relationships and initiatives offer opportunity for creative and impactful engagement in recovery[7]
• Effective participation requires leaders to utilise a range of models of engagement that[8]:
  • Encourage community participation (e.g. joint planning groups)
  • Develop interactive and partnership working, by providing the community with access to expertise, advice and training (e.g. disaster risk planning)
  • Facilitate community mobilisation and empowerment, by establishing partnerships with voluntary organisations and community groups, and initiating community development programmes[9]

Recognising the impacts on mental health

Fear of exposure to radiation, plus the evacuation itself, created significant psychological distress for those who experienced the events of Fukushima. These have some similarities to the psychological effects of COVID-19: risk to health due to exposure to the virus, isolation from family, friends and critical social support networks, and the uncertain economic conditions caused by the pandemic[10]. COVID-19 has shown how significantly social and economic determinants influence mental health. Our mental health is heavily reliant on a variety of factors such as the quality of our relationships, employment, education, and access to food, income and housing[11]. COVID-19 presents key challenges, but also an opportunity to rethink our approach to mental health and implement structural changes in mental health support so as to address the aftermath. Multifaceted-support and societal recovery progress has been found to help address the impacts of the Fukushima disaster on people’s mental health[12]. Mental Health Europe offer guidance to recovery and renewal of mental health support[13]:

• Establish comprehensive long-term strategies that aim to mitigate the consequences of the crisis, co-producing these strategies with service users and the organisations that represent them
• The promotion of ‘basic social rights’, together with targeted investment in economic protection, such as ‘universal basic income, income protection schemes, loan guarantees, rent protection’ and booster packages (e.g. recovery/renewal loans, business support and advice, targeted employment programmes)
• Invest in mental health literacy about the social determinants of mental health, and how ‘experiencing distress is a normal reaction’ in the exceptional circumstances of the pandemic. This will help tackle stigma and discrimination, and further strengthen the ‘sense of community and solidarity’ that has emerged throughout the pandemic
• ‘Promote cross-sectoral collaboration and more integrated social and health care, including investments in peer support’
• Facilitate and support community-based services that ‘respect the will and preferences of users, in line with the UN Convention on the Rights of Persons with Disabilities. Involve people with lived experience in the design, implementation and monitoring of these services’

References:

[1] https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03109-1

[2] https://www.mhe-sme.org/position-paper-mental-health-in-the-aftermath-of-covid-19/

[3] file:///C:/Users/r66633rj/Downloads/ijerph-15-02381.pdf

[4] https://www.mhe-sme.org/position-paper-mental-health-in-the-aftermath-of-covid-19/

[5] https://www.worldbank.org/en/news/feature/2021/03/11/learning-from-megadisasters-a-decade-of-lessons-from-the-great-east-japan-earthquake-drmhubtokyo

[6] Hayano, R. S. (2015) ‘Engaging with local stakeholders: some lessons from Fukushima for recovery’, Annals of the ICRP, 44(1_suppl), pp. 144–152. doi: 10.1177/0146645315572291.

[7] Boyle, D and Harris, M. (2009). The Challenge of Co-Production: How equal partnerships between professionals and the public are crucial to improving public services. https://neweconomics.org/uploads/files/312ac8ce93a00d5973_3im6i6t0e.pdf

[8] http://www.scdn.scot/wp-content/uploads/2016/10/Models-of-Community-Engagement.pdf

[9] https://www.good-governance.org.uk/wp-content/uploads/2020/04/COVID-19-blog-07-04-20.pdf

[10] file:///C:/Users/r66633rj/Downloads/Empowerment-in-action-case-studies-of-local-authority-community-development.pdf

[11] https://openknowledge.worldbank.org/handle/10986/18864

[12] https://www.preventionweb.net/news/view/76401

[13] NEA, OECD (2021) Fukushima Daiichi nuclear power plant accident, ten years on. https://www.preventionweb.net/publications/view/76402?&a=email&utm_source=pw_email

The public know that there are vast amounts of money being committed to tackling the COVID-19 pandemic. However, in many countries they do not know how much this is costing as the spending is constantly being adjusted as new responses and recovery initiatives are released. Consider producing an easy to read statement to make the costs transparent. See Japan's example: https://www.mofa.go.jp/files/100061342.pdf

The "Three Cs" are:

• Closed spaces
• Crowded places
• Close-contact settings

Advising people to avoid these three Cs may contribute to a communications message to prevent new outbreaks.

Telecom data cover large populations and uses pre-existing technology that can be used to understand mobility patterns and human behaviour in near-real-time. Indicators from telecom data can inform provide information about:

• The number of people visiting hotspots
• Where those visiting hotspots came from
• Where they went afterwards
• How restrictions have impacted populations' movements
• How many people are away home and for how long

This can provide localised information on track and trace, and may be particularly useful for countries with less well developed infrastructure and access to smart technology.

This may help communities feel they have ownership over information rather than simply being told.

For particular groups consider:

• Providing parents with skills to handle their own anxieties and help manage those in their children
• Provide information in accessible formats for those with disabilities
• Offer multiple forms of communication e.g. text captioning, signed video, online material suitable for use with assistive technology
• Support the translation of information into the preferred languages for different groups, ensuring that refuges and migrant groups are included
• Adjust information for community perceptions, beliefs and practices

This can include the number of infected people, their status, characteristics (e.g. age, gender), number of inquiries to the call centre, number of people using subways, etc. The city can also provide the website's source code as open-data, so that other municipalities and institutions can use the data and replicate similar webpages.

Local government plays a key role in building trust in new measures and tackling misinformation. There may be a need for this in the UK. Of 2,250 adults surveyed:

• 15% of people thought seasonal flu was deadlier than coronavirus
• 31% believed "most people" in the UK had already had the virus without realising it
• 39% think they should be shopping "little and often to avoid long queues", when the advice is only to go out to shop for basic necessities and as infrequently as possible.
• 25% believed the conspiracy theory that coronavirus was "probably created in a lab" - one of several conspiracy theories currently circulating on social media platforms such as Facebook and YouTube.

Surveys like this help your organisation identify areas where their messaging is not as clear as it needs to be. Local government would benefit from continuing surveys on public opinion.