Chapter 7 Environmental Health    The Kyoto conference on the global warming held in December 1997 was a landmark event in the field of global environmental protection. As a host country, Japan enacted the "Anti Global Warming Act" in October 1998 and expressed its determination to observe the Kyoto protocol to combat the global warming issue.    Although the environment in Japan is generally perceived as improved over the years, Japan also has seen some environmental disasters in the past. 1. Environmental Pollution Victims Compensation System    One of the unique features of Japan's environmental protection is its "Environmental Pollution Victims Compensation System (EPVCS)". This is a collective out-of-court arbitration between polluters and victims whose health had been compromised by the pollution. Under this system, victims do not have to resort to lengthy court procedures to win damages.    The EPVCS compensates two major pollution related diseases: respiratory diseases derived from air pollution and chronic intoxication by toxic substances. The respiratory diseases include chronic bronchitis, emphysema, asthma and the chronic intoxication includes some world-famous pollution disasters that took place in Japan in the past: Minamata disease (Organic mercury poisoning), Itai-itai disease (Cadmium poisoning) and Chronic arsenic poisoning.    According to the Polluter Pay Principle (PPP), the EPVCS system is wholly financed by compensatory damage paid by polluters and the government pays only its administrative cost. As for air pollution, the compensatory damage is levied by the government from major air pollutants, namely automobiles and smoking factories in proportion to the amount of SOx emitted from each polluter. For automobiles, the damage is levied from their car tax in proportion to the size of their engine. For factories, the damage is levied in proportion to the amount of smoke emission. As for chronic intoxication, the damage is levied from the responsible corporations.    For the chronic intoxication, the Minamata disease would probably be best known in the world. It is neurological disorder caused by ingestion of methyl mercury accumulated in fish meat. It broke out in two seaside regions in 1950s and is attributed to the mercury containing sludge emitted by local chemical factories. Itai-itai disease is osteomalacia believed to have been caused by chronic ingestion of Cadmium, although controversy over the causality between Cadmium exposure and development of osteomalacia is still lingering. Chronic arsenal poisoning was first observed in two regions in the vicinity of mines in early 1970s. 2. Measures against the Global Warming issues    According to the 3rd assessment by IPCC published in 2001, the average global temperature in the year 2100 will be 1.4-5.8 centigrade higher than present level, pushing up the ocean water level by 9-88 cm from present level.    The Anti Global Warming Conference (COP3) was held in Kyoto in December 1997 and the Kyoto protocol was declared. As part of the anti global warming measures, Japan enacted the "Global Warming Control Act" in October 1998. 3. Public Health in Environmental Disasters    Japan has been hit by environmental disasters that involved potential public health hazards. Here are some descriptions how public health dealt with those disasters. (1) The Great Kobe Earthquake    At 5:46 AM on 17th January 1995, Kobe City was hit by an earthquake of magnitude 8, resulting in 5,488 casualties. According to the vital statistics, 5,175 (94.3%) died on the first day of the disaster, of whom 4,059 died of crashing, 488 died of burning, 256 died of injury.    The first few days were spent in chaotic conditions. Many casualties flooded the hospitals and clinics with very limited resources for treatment. The road was soon jammed with cars and vehicles making it impossible for fire engines and ambulances to pass. The fires broke out afterward ran rampant because fire fighters could not secure water supply. In a matter of hours, the entire city was a mass of debris and excavated bodies.    Kobe city government set up the disaster HQ one hour after the jolt. A few city officials who could manage to reach the office found themselves inundated with screaming requests from hospitals, many of which had been severely damaged and left without power and water supply. The initial efforts of Kobe health officers were aimed at securing lifelines to these facilities and transporting inpatients to hospitals in unaffected areas. Fortunately, as media reported the severity of the disaster, many offers for help came from all parts of the country as well as from abroad. More difficult task was how to bring the stuff to the needy area because most roads were too jammed to allow smooth traffic.    Shortly after the earthquake, temporary refuges were set up in a variety of locations such as schools, citizen halls and public facilities. Sanitation and public health soon became major concerns. Make shift toilets were set up at such refuges. Offensive odor filled the living spaces. Water in the swimming pool and leakage from pipe was stored and used for washing the human excrement. Public health centers distributed disinfectant to such toilets. Disinfectant for hand and finger distributed by public health centers were believed to be effective in keeping hygienic conditions of food.    It was rather fortunate that the disaster hit in the winter season in terms of preventing infectious diseases. Actually no complaints about pests were reported in most refuges.    Although a great number of victims were lost in the initial phase of the disaster, it may well be regarded as a triumph of public health activities in that it could prevent secondary casualties due to disease or unhygienic conditions, which almost always accompany such large scale disasters. [reference: Osaka University Medical School Department of Public Health "Public Health Activities under the Great Earthquake[in Japanese]" June 1995] (2)Outbreaks of Massive Pathogenic E.coli Food Poisoning    The year 1996 proved to be annus horribilis with massive outbreaks of pathogenic E.coli food poisoning, in which 17,877 had developed symptoms and 12 deaths. However, by far the largest outbreak took place in Sakai city in July of that year.    On Saturday, the 13th of July 1996, at about 10 am, Department of the Public Health of the Sakai City Office received a report from the Sakai City Hospital about 10 patients from local elementary schools whose chief complaints were diarrhea and bloody stool during the night of July 12.    Similar reports were received at the municipal public health centers from other medical institutions. Immediately, a massive food poisoning case was suspected and an investigation was started. On 13th, a total of 255 children from 33 local elementary schools received medical care for diarrhea or bloody stool. At 3 p.m., a task force was set up at the city office.    A rapidly growing number of school children started to complain of strong abdominal cramps, diarrhea and bloody stool. By 14th, over 2000 people were receiving medical care at many hospitals and clinics.    The case was later confirmed as E. coli O157:H7 infection. This strain of bacteria proved to be deadly because it secretes toxin called Bello toxin causing hemolytic-uremic syndrome (HUS).    From the onset of the outbreak, school lunch was the most suspected cause of poisoning. Thorough investigation eventually concluded that radish sprouts grown and harvested by a nearby producer were the most probable cause. [source: Sakai City "Report on the Outbreak of E.coli 157 Infection in Sakai City" December 1997, p.9]