Founded in 2011, The Citizen-Scientist International Symposium on Radiation Protection （CSRP）, is a non-profit organization established by citizens and scientists concerned about the issue of low dose exposure. Since the explosion at Fukushima’s nuclear plant in March 2011, CSRP has held several workshops each year, as well as an annual international symposium, on radiation protection from the viewpoint of citizens, inviting researchers and citizens from both Japan and overseas to find the most effective ways to deal with the issue together. The 6th CSRP symposium was held in Nihonmatsu, Fukushima Prefecture, between October 7 and 10, 2016（for full details of the symposium, please refer to our website http://csrp.jp）. The symposium published two recommendations ̶ the “Conclusions” and the “Nihonmatsu Declaration on the Risks of Exposure to Low Doses of Ionizing Radiation” ̶ based on four days of presentation sessions and roundtable discussions. We sincerely hope that discussions by both experts and members of the public on this issue allow us to deepen our understanding of the situation and better able us to recommend the wisest policy decisions in regard to management of the disaster, beyond positions and paradigms, for better radiation protection measures.
The 6th Citizen-Scientists International Symposium on Radiation Protection
For further scientific elucidation of health risks due to radiation exposure caused by the 2011 TEPCO Fukushima Daiichi nuclear power plant accident, in order to practice better public protection and response measures
Radiation protection measures should be carried out in agreement with the research of scientists from rel-evant disciplines, based on the underlying epidemiological findings. In particular, there are a number of epi-demiological evidences supporting the linear non-threshold（LNT）model that states that the health effects of ionizing radiation have no safety threshold and are linearly proportional to the exposure dose even at a cumulative dose lower than 100 millisievert（mSv）.All the radiation protection measures should presuppose this model from a precautionary standpoint（.Note 1）
Recommendations to the Japanese Government and relevant parties
Expansion of thyroid cancer examination and enhancement of support
Several epidemiological views conclude that the results of the Fukushima prefectural health management survey are already clearly showing the frequent occurrence of thyroid cancer. Considering the diagnosed tu-mor sizes and the surgery cases that resulted from the survey, the currently practiced thyroid examination is consistent with one of the objectives of the survey, “early detection, early treatment.” The survey should be expanded, and the support should be enhanced for people suffering from thyroid cancer and other thyroid abnormalities（.Note 2）
Expansion of health survey
Health protection must be provided not only to the affected residents, but also to the people who are at risk of exposure to radiation while carrying out accident-related work, such as the nuclear plant workers and the off-site decontamination workers. The survey of health effects should be expanded to these people in or-der to determine what damages are being caused by radiation exposure, whether the current measures are effective enough and what should be done to improve the situation（.Note 3）
Respect of the victims’ rights
The emigrated ex-residents or the evacuees should not be forced to return to their hometowns. Those who wish to stay evacuated or emigrated, those who wish to evacuate or emigrate hereafter, or those who want to return to their hometowns, as well as those who have decided to stay in their hometowns despite the ac-cumulating exposure dose — all of the parties should be supported so that they can build the life they de-sire, all while avoiding radiation exposure as much as possible（.Note 4）
Revision of risk communication
In order to improve the current social environment that dissuades the victims from expressing their con-cern about the health effects of radiation, it is necessary to revise the “risk communication” measures led by the central and the local administrative authorities. Measures that aim to persuade the victims of the small risk of health effects without provinding sufficient evidence and impelling them to act as the authorities want, should be revised（.Note 5）
Education and public information on nuclear power and radiation
School teaching materials and learning places are provided from the pro-nuclear standpoint, unilaterally stressing the safety of nuclear power plants and downplaying the risk of health effects. Instead, the stand-point of those who bear the risk（accident victims, workers and future generations）should be taken into ac-count fully（.Note 6）
Role of citizens and scientists
Citizens, including scientists, researchers and media professionals, are requested to promote an open dia-logue in which each party accomplishes its original mission for the pursuit of truth. Together, the victims and all the people involved are expected to create a living environment and public space that enable each of them to express what they really think and feel, to form a consensus, and thus to give rise to mutual trust. （Note 7）
（Note 1）On this issue, a separate joint statement by the epidemiologists who participated in the 6th Citizen-Scientist Symposium on Ra-diation Protection is to be published.
（Note 2）It is necessary to re-examine the thyroid surveys conducted on those who were 18 years old or younger at the time of the acci-dent, by expanding the ranges（ages and regions）and frequency of the surveys. Cases of thyroid cancer diagnosed by examinations other than the Fukushima prefecture health management survey should be disclosed, including those diagnosed in other regions that may also suffer from radiation effects. Several municipalities located outside the Fukushima prefecture indeed do carry out their own surveys. In addition, it is required to examine thyroid abnormalities other than cancer and to publish the results.
Five years after the accident, when the health effects of radiation exposure are now expected to emerge, the appearance instead, of ar-guments aiming to reduce the thyroid surveys is an issue. Building a debate based on the unsound concept of the “negative effects of the survey” does not appear as a scientifically driven decision. It is historical fact that the delay after which thyroid cancer appears after exposure to radiations, originally estimated to 10 years or more based on data from the Hiroshima and Nagasaki A-bomb survivors, had to be revised to five years after the Chernobyl nuclear accident. Continuing the survey is thus crucial because it ties into the issue of future compensation. Therefore, the review committee for the Fukushima prefectural health management survey should not be limit-ed by past ideas but should take new data and findings into full consideration.
Studies should be promoted to estimate how much irradiation happened just after the accident, and the results should be made public. As was discussed at the 5th International Expert Symposium in Fukushima on Radiation and Health（September 2016）, data on the contamination by iodine-131 are scarce. The only way to determine the initial exposure dose is to investigate the existing contamination by iodine 129 and other fission products in the environment and to reconstruct the initial dose. Studies need to be extended to regions outside the Fukushima prefecture, because contamination spreads in wide areas in Eastern Japan as shown by results from the air-borne monitoring of the Ministry of Science and Technology（MEXT）and the Nuclear Regulatory Agency.
（Note 3）The Fukushima prefectural health management survey has been criticized from the very beginning for its narrowness of appli-cation. For example, blood testing, whose importance has been emphasized in the areas affected by the Chernobyl accident, has been treated lightly in the case of the Fukushima Daiichi nuclear power plant accident. Moreover, given that contamination has spread to ar-eas beyond the border of Fukushima prefecture, it is difficult to understand why the comprehensive health check is limited to evacua-tion zones in Fukushima prefecture. Cancer registration data and other medical information essential for comparative studies of the health status in the affected areas are not made public. Concerns have been expressed about the exposure management of subcon-tracted workers. A re-examination of the health care system for all workers at risk of radiation exposure, including the off-site cleanup workers is imperative. The fact that the Government and TEPCO have failed to disclose necessary information, has given rise to the suspicion that they might be concealing inconvenient information. They are required to take action to address the spreading distrust.
（Note 4）The current policy promoted by the government under the name of “reconstruction” is laying a disproportionate emphasis on the return of evacuees to their hometowns, through the prompt cancellation of evacuation orders and while neglecting support towards victims who desire to emigrate or to remain evacuated. The government has announced the cut off, in March 2017, of the provision of free housing for what they call “voluntary evacuees”（evacuees from outside the evacuation order area）. A similar policy is expected to be applied to evacuees from the current evacuation order areas, once the orders are lifted. Such policies leave no choice to the victims who wish to remain evacuated and avoid further radiation exposure, but to return to their hometowns. Meanwhile, long-term support is needed for those victims who are living in contaminated regions, inside or outside the Fukushima prefecture, including support to resi-dents who wish to evacuate hereafter.
（Note 5）The government’s so-called “risk communication” currently underplays the health effects of radiation exposure caused by the nuclear power plant accident and merely consists in delivering basic knowledge of radiation while claiming that the risks are small, of-ten comparing the health risk of low level radiation to those of medical radiation, smoking, and obesity. This “risk communication” activ-ity has been nothing but a unilateral delivery of information that highlight optimistic views on the risk of radiation exposure. It has failed to install a dialogue that considers the diverse points of view held by the affected residents.
In particular, the conventional government-led “risk communication” has created a social atmosphere in which choosing to avoid being exposed to low-level radiations for long-term safety, is regarded as “wrong”. Victims who wish to emigrate or to remain evacuated from areas where exposure is possible, or those who desire to avoid as much radiation as they can from the food, clothing and shelter even though they chose to remain in their regions, all of them are repressed from expressing their concerns. At times, this causes conflict and cleavages between family members, friends and neighbors.
Intrinsically, “risk communication” should consider the wide range of opinions that exist regarding the risks and, through dialogue be-tween experts and residents, it should elaborate a set of measures that are adapted to each resident’s lifestyle. Initiatives such as col-lecting straightforward scientific data that is useful for avoiding exposure in daily life, illustrate the importance of mutual learning and common efforts between residents and experts.
（Note 6）In public teaching materials, such as the supplementary reader on radiation issued by MEXT in 2014, the instructional materials issued by the Fukushima Prefectural Board of Education（the 1st to the 5th editions）in 2011-16, and the exhibition of the Exchange Building（Komyutan Fukushima）inaugurated by the Fukushima Prefectural Environmental Innovation Center in July 2016, there is al-most no explanation on the official limits of radiation exposure doses, including those in radiation controlled areas（5.2 mSv/year）, the additional exposure for the general public（1 mSv/year）and those of the evacuation order area（20 mSv/year）. Nor is there any expla-nation on emergency radiation protection measures such as the administration of stable iodine, or on the Nuclear Accident Child Vic-tims’ Support Law, enacted in 2012 to protect the victims’ rights.
（Note 7）Since the beginning of the accident, not only the information needed in order to avoid radiation exposure was insufficiently dis-closed, but also the voices of victims were not reflected in the policy decision process related to radiation protection. In order to devise countermeasures that reflect the voices and needs of the most affected victims, it is also required on the side of the citizens, to make opportunities for communication, that is, dialogues widely involving citizens, including scientists, researchers, media, etc.
The symposium participants who agree on this document are as follows:
Cécile Asanuma-Brice, National Center for Scientific Research（CNRS）,France Keith Baverstock, University of Eastern Finland, Finland
Iuliia Davydova, Institute of Paediatrics, Obstetrics and Gynaecology, NAMS of Ukraine :Ukraine Shinobu Goto, University of Fukushima, Japan
Cornelia Hesse-Honegger, Scientific illustrator, Switzerland Wolfgang Hoffmann, Urnst-Moritz-Arndt-Universität, Germany Paul Jobin, Academia Sinica, Taiwan
Toshiki Mashimo, Citizen-Scientist Symposium on Radiation Protection, Japan John Mathews, University of Melbourne, Australia
Sebastian Pflugbeil, Society for Radiation Protection, Germany
Yoshiyuki Segawa, Citizen-Scientist Symposium on Radiation Protection, Japan Susumu Shimazono, Sophia University, Japan
Nanako Shimizu, University of Utsunomiya, Japan Ben Spycher, University of Bern, Switzerland Yasuyuki Taneichi, Kuwano Kyoritsu Hospital, Japan Tomoko Tsuchiya, NPO HSE Risk C-cube, Japan Takuya Tsujiuchi, University of Waseda, Japan