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      Fukushima after the Great East Japan Earthquake: lessons for developing responsive and resilient health systems.

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          Abstract

          On 11 March 2011, the Great East Japan Earthquake, followed by a tsunami and nuclear-reactor meltdowns, produced one of the most severe disasters in the history of Japan. The adverse impact of this 'triple disaster' on the health of local populations and the health system was substantial. In this study we examine population-level health indicator changes that accompanied the disaster, and discuss options for re-designing Fukushima's health system, and by extension that of Japan, to enhance its responsiveness and resilience to current and future shocks.

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          Universal health coverage in Turkey: enhancement of equity.

          Uğur Dilmen, Safir Sümer, Senay Ozgülcü … (2013)
          Turkey has successfully introduced health system changes and provided its citizens with the right to health to achieve universal health coverage, which helped to address inequities in financing, health service access, and health outcomes. We trace the trajectory of health system reforms in Turkey, with a particular emphasis on 2003-13, which coincides with the Health Transformation Program (HTP). The HTP rapidly expanded health insurance coverage and access to health-care services for all citizens, especially the poorest population groups, to achieve universal health coverage. We analyse the contextual drivers that shaped the transformations in the health system, explore the design and implementation of the HTP, identify the factors that enabled its success, and investigate its effects. Our findings suggest that the HTP was instrumental in achieving universal health coverage to enhance equity substantially, and led to quantifiable and beneficial effects on all health system goals, with an improved level and distribution of health, greater fairness in financing with better financial protection, and notably increased user satisfaction. After the HTP, five health insurance schemes were consolidated to create a unified General Health Insurance scheme with harmonised and expanded benefits. Insurance coverage for the poorest population groups in Turkey increased from 2·4 million people in 2003, to 10·2 million in 2011. Health service access increased across the country-in particular, access and use of key maternal and child health services improved to help to greatly reduce the maternal mortality ratio, and under-5, infant, and neonatal mortality, especially in socioeconomically disadvantaged groups. Several factors helped to achieve universal health coverage and improve outcomes. These factors include economic growth, political stability, a comprehensive transformation strategy led by a transformation team, rapid policy translation, flexible implementation with continuous learning, and simultaneous improvements in the health system, on both the demand side (increased health insurance coverage, expanded benefits, and reduced cost-sharing) and the supply side (expansion of infrastructure, health human resources, and health services). Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Can Community Social Cohesion Prevent Posttraumatic Stress Disorder in the Aftermath of a Disaster? A Natural Experiment From the 2011 Tohoku Earthquake and Tsunami

            Hiroyuki Hikichi, Jun Aida, Toru Tsuboya … (2016)
            In the aftermath of a disaster, the risk of posttraumatic stress disorder (PTSD) is high. We sought to examine whether the predisaster level of community social cohesion was associated with a lower risk of PTSD after the earthquake and tsunami in Tohoku, Japan, on March 11, 2011. The baseline for our natural experiment was established in a survey of older community-dwelling adults who lived 80 kilometers west of the epicenter 7 months before the earthquake and tsunami. A follow-up survey was conducted approximately 2.5 years after the disaster. We used a spatial Durbin model to examine the association of community-level social cohesion with the individual risk of PTSD. Among our analytic sample (n = 3,567), 11.4% of respondents reported severe PTSD symptoms. In the spatial Durbin model, individual- and community-level social cohesion before the disaster were significantly associated with lower risks of PTSD symptoms (odds ratio = 0.87, 95% confidence interval: 0.77, 0.98 and odds ratio = 0.75, 95% confidence interval: 0.63, 0.90, respectively), even after adjustment for depression symptoms at baseline and experiences during the disaster (including loss of loved ones, housing damage, and interruption of access to health care). Community-level social cohesion strengthens the resilience of community residents in the aftermath of a disaster.
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              Damage from the Great East Japan Earthquake and Tsunami - A quick report

              So Kazama, Seiki Kawagoe, Nobuo MIMURA … (2011)
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                Author and article information

                Journal
                Journal ID (iso-abbrev): J Glob Health
                Title: Journal of global health
                Publisher: Edinburgh University Global Health Society
                ISSN (Electronic): 2047-2986
                ISSN (Print): 2047-2978
                Publication date (Electronic): Jun 2017
                Volume: 7
                Issue: 1
                Affiliations
                [1 ] Department of Healthcare Epidemiology, Kyoto University, Yoshidakonoe, Sakyo, Kyoto 606-8501, Japan.; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, Fukushima, Japan.
                [2 ] Boston University School of Public Health, Department of Global Health, 801 Massachusetts Avenue, Boston, Massachusetts, USA.
                [3 ] Graduate School of Business Administration, Keio University, Yokohama, Japan.
                [4 ] Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, Fukushima, Japan; Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA.
                [5 ] Department of Healthcare Epidemiology, Kyoto University, Yoshidakonoe, Sakyo, Kyoto 606-8501, Japan.; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA; Joint last authorship.
                [6 ] Department of Healthcare Epidemiology, Kyoto University, Yoshidakonoe, Sakyo, Kyoto 606-8501, Japan.; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, Fukushima, Japan; Joint last authorship.
                Article
                Publisher Item ID: jogh-07-010501
                DOI: 10.7189/jogh.07.010501
                PMC ID: 5370211
                PubMed ID: 28400956
                SO-VID: 0bdd87ef-f0fb-4587-b6b8-3f724e5c0fff
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