Healthcare’s Youngest Victims: Inequality in Pediatric Healthcare and How We Can Fix It

 by Cameron Takmil, February 24, 2024

Millions of children visit the emergency room every year with cuts, bruises, and a myriad of other diagnoses. Many are turned away from necessary treatments for seemingly nothing except one thing – race. While seemingly trivial, disparities across racial and ethnic lines persist, underscoring a critical need for systemic reform. Recent research spearheaded by experts at Northwestern revealed that healthcare inequities are widespread, affecting non-white minorities profoundly in pediatric care. 

The most concerning disparity was in pain management. When comparing kids of color to their white counterparts, they were not given proper medication at the same rate (Godoy 2024). 

These disparities manifest in other ways, including but not limited to diagnostic imaging, surgical complications, emergency care wait times, and treatment for developmental disabilities. Children of color often get the short end of the stick in these circumstances, receiving less than optimal care. UCLA researchers determined that white pediatric patients were more likely to receive sepsis treatment, compared to their black counterparts who also were less likely to be given full diagnostic testing through automated sepsis-alert systems (Li et. al 2022).

Premature infants of color tend to have increased rates of morbidities with regard to bronchopulmonary dysplasia, intraventricular hemorrhage, and necrotizing enterocolitis (Fanta et. al 2021). Those same infants generally had a lower birth weight, were born more prematurely, and had a higher mortality rate compared to white infants.

Differences lie not only in physical health, as mental health has seen its fair share of disparities amongst pediatric patients. Post-diagnosis, Latino and Black children receive medication and treatment at a lesser rate than White children (Fanta et. al 2021). Underdiagnosed and undertreated, patients of color were less likely to be evaluated on evidence-based mental health care and be given the correct medication all in all.

These inequalities persist despite the families having insurance, pointing towards the idea that these disparities are caused by other factors (Godoy 2024). Nevertheless, Hispanic and Black populations were much less likely to be uninsured, which is another hindrance in access to ubiquitous healthcare (Zhang et. al 2019).

The source of these inequalities stems from decades-long structural racism. Race-based residential segregation, institutional racism, and concentrated poverty have led and in many cases today, continues to worsen quality of housing, safety, and healthcare access and quality. A Harvard study found that in nearly all of the largest urban areas in the United States, two-thirds of non-Hispanic Black children and more than half of Hispanic children lived in areas graded as low- or very low opportunity (Slopen, Heard-Garris 2021). On the other hand, fewer than 1 in 5 Asian or White children live in low- or very low opportunity neighborhoods, clearly more affluent than their minority counterparts.

Government programs that have kept many afloat are slowly falling to the wayside, exposing vulnerable populations to even worse conditions. The Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, served nearly half of the U.S’s infant population, and over six million children overall (Center for Health Journalism 2024). WIC has been able to improve birth metrics such as birth weight, preterm birth, and infant mortality rates. Despite being seemingly essential, the refusal by Congress to adjust its budget has put close to a million Americans at risk of losing their benefits.

These disadvantages extend into overall health as “toxic stress” – a term used by researchers at the Dana-Farber Cancer Institute – leads to negative consequences in physical and psychological health. Their study discovered that adversity during childhood was associated with poorer neurocognitive, neonatal, and cardiovascular health (Umaretiya et. al 2022). Due to red-lining – residential segregation policy in the 20th century – environmental risk is increased in more impoverished areas, posing a risk of safety and exposure to its residents (Samuelson 2024). Pediatric patients of color who live in these areas with higher density of housing code violations are more likely to be admitted and return to the ED due to asthma and related complications  (Fanta et. al 2021). 

If that was not enough to overcome, this prejudice has been baked into society with false, harmful, and misleading stereotypes, which many internalize, whether consciously or subconsciously. Minority parents, especially Hispanic parents, frequently report that healthcare providers do not dedicate sufficient time to understand their child’s needs, respect their parenting expertise, or align with their child-rearing preferences (Flores 2005). These same populations also reported that topics such as community violence, household smoking, alcohol usage, issues paying for the child’s basic needs, and spouse/partner support were discussed more frequently than white parents.

These sentiments extend far beyond healthcare, as anti-minority beliefs have come to the forefront in the past years. According to a recent national survey, “51% of whites think that blacks are prone to violence, whereas only 16% of whites think that whites are prone to violence” (Flores 2005). In the doctor’s office, we see much of the same, as the prevalence in which community violence was discussed quadrupled and tripled for Hispanic and Black patients respectively. Similar trends were found with regard to substance use, even in families where average income exceeded $75,000 (Flores 2005). 

This gap in communication and understanding only exacerbates the feeling of marginalization and can lead to decreased satisfaction with care and impaired patient-provider communication. These same minority populations have been reported to have higher levels of distrust of their provider, mainly due to implicit and explicit discrimination (Umaretiya et. al 2022). Such interactions might not only perpetuate discrimination but also detract from providers’ ability to educate, inform, and aid these patients.

It is not all hopeless, though, as there is a pathway for solutions to reduce the gap between patients of color and white patients. Addressing and solving disparities in pediatric healthcare is a multifaceted challenge that demands an in-depth and multidisciplinary approach. The strategies to promote health equity in pediatrics can be categorized into three levels: individual, institutional, and structural as demonstrated in research (Fanta et. al 2021). 

At the individual level, healthcare professionals can make up ground by engaging in continuous professional development focused on understanding and mitigating the impact of interpersonal racism, discrimination, and bias on pediatric health inequities (Fanta et. al 2021). It is crucial to educate providers on not only their explicit biases, but more importantly their implicit biases that they might not be aware of. Through this, a mindset of cultural humility and openness, being other-oriented, and recognizing the impact of power dynamics on building trusting relationships with patients and their families can be cultivated. 

These shortcomings of healthcare are not only the responsibility of the providers to ameliorate, as the onus is on institutions to invoke change themselves. Diversifying the workforce can enhance the relatability and effectiveness of the patient-provider relationship (Fanta et. al 2021). This could help patients feel more comfortable with providers who might be more apt to understand their plight. 

In a broader sense, addressing structural disparities requires moving outside of the healthcare system and advocating for policy reform aimed at eliminating inequities in critical social determinants of health. These determinants include healthcare access and quality, economic stability, education, neighborhood and built environment, and social and community context (Fanta et. al 2021). A study from Dana-Farber notes that adopting universal and systematic social determinants of health – coined as SDOH in their paper – screening within pediatric care can identify key areas where interventions can be most effective (Umaretiya et. al 2022). Identifying the specific root causes on a patient-to-patient basis will allow for much more optimized solutions.

Something as simple as integrating SDOH screens into each visit, within national pediatric protocols, can help identify mechanisms driving disparities and opportunities for intervention (Jindal et. al 2024). Developing multilevel health equity interventions that address identified pathways, such as access to care, patient-health-care-system interaction, and the impact of toxic stress, is crucial (Umaretiya et. al 2022).

It will be imperative to focus on improving the various systems that lead to poorer healthcare outcomes for pediatric patients of color. Efforts to dismantle the underlying racism that perpetuates pediatric racial and ethnic health inequities must focus on policies within multiple interdependent systems. This includes challenging housing policies that sustain poor housing, limiting access to resources like high-quality education and healthcare, and increasing exposure to environmental risk factors (Jindal et. al 2024). Enhancing family resilience through evidence-based psychosocial interventions can also play a role in mitigating the effects of toxic stress (Umaretiya et. al 2022).

To effectively reduce and solve disparities in pediatric healthcare, a concerted effort from all stakeholders—healthcare providers, institutions, policymakers, and communities—is required. This involves addressing not only the immediate healthcare needs of children but also the broader structural and social determinants of health that contribute to disparities. By implementing these strategies at the individual, institutional, and structural levels, we can move closer to achieving health equity in pediatrics, ensuring that all children have the opportunity to thrive and reach their full health potential.

  1. Godoy, M. (2024, January 18). Kids of color get worse health care across the board in the U.S., research finds. NPR. https://www.Godoy.org/sections/health-shots/2024/01/18/1225270442/health-inequities-pediatrics-kids-of-color-disparities
  2. Li, E., Ng, A. P., Williamson, C. G., Tran, Z., Federman, M. D., & Benharash, P. (2022). Assessment of Racial and Ethnic Disparities in Outcomes of Pediatric Hospitalizations for sepsis Across the United States. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2022.4396 
  3. Fanta, M., Ladzekpo, D., & Unaka, N. (2021). Racism and pediatric health outcomes. Current Problems in Pediatric and Adolescent Health Care, 51(10), 101087. https://doi.org/10.1016/j.cppeds.2021.101087 
  4. Zhang, X., Carabello, M., Hill, T., He, K., Friese, C. R., & Mahajan, P. (2019). Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States. Frontiers in Pediatrics, 7. https://doi.org/10.3389/fped.2019.00525 
  5. Slopen, N., & Heard-Garris, N. (2021). Structural Racism and Pediatric Health—A Call for Research to Confront the Origins of Racial Disparities in Health. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2021.3594 
  6. The Health Divide: Pediatric care is worse for kids of color; federal nutrition program faces worrying shortfall | USC Center for Health Journalism. (n.d.). Centerforhealthjournalism.org. Retrieved February 10, 2024, from https://centerforhealthjournalism.org/our-work/insights/health-divide-pediatric-care-worse-kids-color-federal-nutrition-program-faces 
  7. Puja J. Umaretiya, Robert J. Vinci, Kira Bona; A Structural Racism Framework to Guide Health Equity Interventions in Pediatric Oncology. Pediatrics May 2022; 149 (5): e2021054634. 10.1542/peds.2021-054634, https://publications.aap.org/pediatrics/article/149/5/e2021054634/186711/A-Structural-Racism-Framework-to-Guide-Health
  8. Pediatric care for non-white children is universally worse across U.S. (n.d.). News.northwestern.edu. Retrieved February 10, 2024, from https://news.northwestern.edu/stories/2024/01/pediatric-care-for-non-white-children-is-universally-worse-across-u-s/ 
  9. Glenn Flores, Lynn Olson, Sandra C. Tomany-Korman; Racial and Ethnic Disparities in Early Childhood Health and Health Care. Pediatrics February 2005; 115 (2): e183–e193. 10.1542/peds.2004-1474 https://publications.aap.org/pediatrics/article/115/2/e183/67379/Racial-and-Ethnic-Disparities-in-Early-Childhood 
  10. Jindal, M., Barnert, E., Chomilo, N., Gilpin Clark, S., Cohen, A., Crookes, D. M., Kershaw, K. N., Kozhimannil, K. B., Mistry, K. B., Shlafer, R. J., Slopen, N., Suglia, S. F., Nguemeni Tiako, M. J., & Heard-Garris, N. (2024). Policy solutions to eliminate racial and ethnic child health disparities in the USA. The Lancet. Child & Adolescent Health, 8(2), 159–174. https://doi.org/10.1016/S2352-4642(23)00262-6 

Exploring the Roots of the Controversies Arising from the Fukushima Incident – Particularly from the Perspective of Pluralistic Public Attitudes Toward Government Decision-making

   by Zijun Zhou, February 20, 2024

With the rapid development of technology, mankind has been able to obtain energy in many ways. From the early days of relying on coal to drive thermal power plants, to the gradual recognition of the importance of clean energy, people began to use wind turbines to generate electricity and to obtain tidal energy from the rising and falling of the tides. The emergence of nuclear power plants has made it seem as if we have an endless supply of energy, and technological advances have brought many conveniences to our lives.

In 1986, when the Chernobyl accident occurred, people were reveling in the convenience of nuclear power plants and the great success of clean energy. Twenty-five years later, the Fukushima Daiichi earthquake and tsunami in Tohoku, Japan, and the nuclear leak at the Fukushima Daiichi nuclear power plant have again raised the alarm and prompted a re-examination of the use of nuclear power plants.

Moreover, accidents at nuclear power plants are not the only issues that have caused widespread concern. After the Fukushima accident, Tokyo Electric Power Company was faced with the challenge of dealing with large amounts of contaminated water. This water, which contained radioactive substances, posed a potential threat to the environment and ecosystem. Tokyo Electric Power Company decided to discharge the treated contaminated water into the Pacific Ocean, a practice that immediately drew widespread international attention and controversy. The practice has also caused much controversy.

This article will examine the controversy over the disposal of contaminated water from the Fukushima nuclear power plant and possible solutions.

On March 11, 2011, the most serious nuclear accident since the Chernobyl disaster occurred at the Fukushima Daiichi nuclear power plant. The accident was initially rated as a Level 5 by the International Nuclear Event Scale (INES) and was later upgraded to a Level 7, ranking it as the most serious nuclear accident alongside Chernobyl. The Fukushima nuclear accident was primarily caused by the Tohoku earthquake and subsequent tsunami.

At the time of the earthquake, the active reactors at the plant automatically shut down their normal fission power generation reactions. Its emergency diesel generators were automatically started to remove residual decay heat. The seismic design basis for the six units at Fukushima ranges from 0.42 g to 0.46 g. The plant experienced no damage to critical parts of the reactors when ground acceleration reached 0.125 g for 30 seconds after the 1978 Miyagi earthquake, which is an indication that the plant is sufficiently earthquake-resistant (Brady 1980). However, the ensuing tsunami flooded the lower portion of the reactor building for Units 1-4, resulting in the loss of power to the emergency generators and circulation pumps and disrupting all AC power to Units 1-4 (Fackler 2011). Due to the lack of cooling water, reactors 1, 2, and 3 suffered meltdowns. Reactors 5 and 6 were offline at the time of the earthquake.

Approximately 110,000 residents were evacuated in the days following the accident. The accident released a large amount of radioactive material into the atmosphere, 80% of which was deposited in the ocean. In addition, a portion of the radioactive material was released directly into the ocean. About 18,000 TBq of radioactive cesium-137 was released into the Pacific Ocean during the accident, and as of 2013, about 30 GBq of cesium-137 was still flowing into the ocean every day (Fackler and Hiroko 2013).

Although some nuclear radiation experts say cancer-related deaths may not increase, a monitoring system operated by the Preparatory Commission for the Comprehensive Nuclear-Test-Ban Treaty Organization tracks radioactive dispersion globally. Within just one month, by day 15, traces of radioactivity could be detected throughout the northern hemisphere (CTPTO 2011). This rapid rate of spread has raised concerns about TEPCO’s decision to discharge nuclear wastewater.

To prevent groundwater from flowing into the buildings of the three damaged reactors at the Fukushima Daiichi nuclear power plant, the Japanese government invested 3.4 billion yen to build a frozen underground barrier (Fackler 2016). Although the barrier succeeded in reducing the flow of groundwater from about 260 tons per day to about 500 tons per day, at Fukushima Daiichi, cooled molten nuclear fuel mixed with groundwater flowing into the reactor buildings, producing contaminated water. In particular, the wastewater from Unit 2 has a high level of radioactivity.

To securely store this wastewater, TEPCO decided to transfer it to a centralized radiation waste treatment facility. Currently, nuclear wastewater is increasing at a rate of about 1 ton per day. TEPCO treats this wastewater using equipment such as the multinucleated removal system (ALPS) and storing it in tanks. By 2020, this wastewater has accumulated to about 1.2 million tons. According to TEPCO’s projections, the tanks will be filled by the summer of 2022 under the current tank expansion plan.

Construction of the equipment needed for treatment and review by the Nuclear Regulatory Commission is expected to take two years, so it is thought that this summer will be the deadline for a decision. Previously, about 10,000 tons of low-level radioactive wastewater and groundwater have been stored in the drainage pits of Units 5 and 6 and are scheduled to be discharged into the sea. The total discharge of radioactive substances is about 1.5×10¹¹ becquerels.

According to TEPCO’s assessment, even if an adult person consumes fish and seaweed from the adjacent sea every day, the effective radioactive dose absorbed is only 0.6 mSv per year, a figure that is only a quarter of the annual radioactive dose (2.4 mSv) received by the public from the natural environment. Complementing this assessment, Ken Buesseler, a marine chemist at the Woods Hole Oceanographic Institution in Massachusetts, successfully persuaded an organization to collect water samples for testing up and down the west coast of North America. The test results showed that the samples contained a maximum of only 8 becquerels of radiation per cubic meter, with less than 2 becquerels originating from Fukushima’s cesium-134 and the rest coming primarily from strontium-90 and cesium-137. This is consistent with the U.S. Environmental Protection Agency’s guidelines for drinking water, which allow for a maximum of 7,400 becquerels of radioactivity per cubic meter of water (Sherwood 2014). These provide support for TEPCO’s view.

In February 2023, a committee of experts from the Ministry of Economy, Trade and Industry (METI) submitted a proposal stating that discharging wastewater into the ocean or atmosphere is a “realistic option” and that ocean discharge is a method that can be “reliably implemented. Since April, the Japanese government has held numerous consultations with local governments, the agriculture, forestry, and fishery sectors, economic organizations, and other stakeholders, and cooperated with the International Atomic Energy Agency (IAEA), eventually gaining the support of the IAEA.

On April 13, 2021, the Japanese Cabinet meeting officially decided that the nuclear wastewater (NW) stored in TEPCO’s FDNPP, or treated water as it is called in Japan, will be discharged into the ocean through the construction of port tunnels. Some experts point to the World Health Organization’s drinking water standard for tritium of 10,000 becquerels (Bq) per liter. This is several times higher than the planned concentration of water discharged from Fukushima.

The Asahi Shimbun, Yomiuri Shimbun, and other mainstream Japanese media provided in-depth coverage and analysis immediately after the Cabinet meeting announced the decision to discharge Fukushima nuclear wastewater into the sea. The decision sparked widespread discussion and enthusiastic reactions in Japanese society. According to a nationwide public opinion poll conducted by the Asahi Shimbun, public support and opposition to the discharge of nuclear wastewater were almost evenly divided, which fully reflects the complexity and dilemma of the issue (Ishimoto 2023).

Following the announcement of the government resolution, a large number of protesters gathered outside TEPCO headquarters, where they demanded that the company take responsibility for the 2011 core meltdown at the Fukushima Daiichi nuclear power plant and provide adequate compensation to the victims. Meanwhile, the protesters strongly demanded the cancellation of plans to send nuclear wastewater into the sea. Activists warned that tritium, a radioactive substance that is readily soluble in water, could enter the human body through the food chain once it is discharged into the ocean, potentially causing long-term contamination of marine life, especially fish and seaweed, and possibly serious public health effects. These concerns have sparked serious public concern about marine pollution in Japan and around the world.

Although TEPCO insists that treated and diluted nuclear wastewater is safe, this claim has been widely questioned and challenged. After the government lifted the evacuation order for all areas of Fukushima Prefecture in August 2021, only a small number of residents chose to return to their hometowns, no doubt reflecting the deep public concern about the safety of the Fukushima area.

In addition, the fishermen’s groups most affected by the decision have launched large-scale protests (Rikimaru 2023). Since the Fukushima nuclear accident, seafood from Fukushima and the nearby Chiba region has been widely rejected by consumers, which has led to serious damage to the reputation of seafood from these areas (Takagi 2021). To preserve their livelihoods and the economic interests of the region, fishermen have launched fierce protests.

As mentioned earlier, the decision to discharge nuclear wastewater from Fukushima sparked widespread controversy in Japanese society. Although two years have passed, a large number of Japanese people still question and disagree with the government’s decision, and they are disappointed with the government’s failure to adequately explain and convince the public to accept the decision (Motoyama 2023). In response, large numbers of people protested outside the Japanese Diet and TEPCO headquarters to express their discontent and concern. They criticized the government’s lack of transparency in the decision-making process and the public’s failure to fully participate in and understand the process. They believe that the government needs to pay more attention to environmental protection and public participation to ensure the fairness of decision-making and the rights of the public.

The Japanese cabinet government’s decision on the discharge of nuclear waste water from Fukushima has also provoked strong reactions internationally. Environmental groups, neighboring countries, and Pacific Island countries, among others, have expressed strong dissatisfaction.

Greenpeace International released a report called Stemming the Tide 2020: The Reality of the Fukushima Radioactive Water Crisis, which refutes the claims of the Japanese government and TEPCO in detail (Burnie 2020). The report states that the three reactors at the Fukushima Daiichi nuclear power plant contained 520 petabytes of strontium-90 in their radioactive cores before the meltdown, of which about 1 to 3 percent has been released into the Pacific Ocean, causing massive water contamination. The report warns that this huge amount of strontium must be stopped from entering the environment.

The Japanese government and TEPCO have adopted the ALPS system designed by Purolite USA and Hitachi General Electric Nuclear Energy Ltd (HGNE) to reduce the concentration of radioactive materials. However, in the process of building and operating the ALPS based on Purolite’s ion exchange technology, the contract was transferred to Toshiba and then to HGNE, and Purolite was excluded. This is particularly significant because Purolite has decades of experience in water treatment ion exchange, while Toshiba and HGNE have little experience in this area. TEPCO’s plans to stop such practices in the next few years are not credible under the current circumstances.

The report further notes that the half-lives of tritium and strontium-90 are 12.3 and 28.8 years, respectively, and that even considering only these radionuclides, the radiation risk would last 125 to 290 years (the risk period is usually considered to be 10 half-lives). Because strontium-90 is similarly absorbed by the body to calcium, it poses a significant health risk and may increase the risk of leukemia. In addition, while TEPCO claims to have addressed the risk of tritium, they may be ignoring the effects of organically bound tritium (OBT) on the human body and the possible conversion of tritium water (HTO) to organically bound tritium in the event of a steam release.

The report also emphasizes that, Unlike the oceanic behavior of tritium, large amounts of radioisotopes are more likely to be absorbed into marine communities or deposited on the seafloor. For example, the bioconcentration factor of carbon-14 in fish is 50,000 times higher than that of tritium. In addition, isotopes such as cobalt-60 may be associated with seafloor sediments by as much as 300,000 times. As these radioactive materials are released from nuclear power plants into the marine environment, the exposure of marine organisms to radioactivity will inevitably increase. The specific exposure levels are influenced by many factors, and the concentrations in these biomes are directly related to humans because people may consume these contaminated marine organisms.

TEPCO made a bad decision by focusing on tritium monitoring and ignoring other radioactive materials that could have an impact on humans. Jennifer Morgan, executive director of Greenpeace International, strongly criticized this approach. She said, “It is unacceptable that in the 21st century when our planet and especially the global oceans face so many challenges and threats, the Japanese government and TEPCO should justify the deliberate dumping of nuclear waste into the Pacific Ocean. This decision is a violation of Japan’s legal obligations under the United Nations Convention on the Law of the Sea (UNCLOS) and will be strongly opposed in the months ahead.”

The decision by the Japanese government and TEPCO to begin discharging treated water from the Fukushima Daiichi nuclear power plant into the ocean in the summer has caused widespread concern in its neighboring countries. Sun Xiaobo, director general of the Chinese Foreign Ministry’s Arms Control Department, publicly criticized the decision and said at a press conference in Beijing that “Japan’s unilateral decision to discharge treated water into the ocean is an extremely irresponsible act.” Sun stressed that he would work with neighboring countries to oppose the decision (Paid Article 2023). The Chinese government has long expressed strong concern about such actions and opposes any discharge of treated water into the ocean. Sun also said that if Japan decides to force the discharge of wastewater into the ocean, he will join with neighboring countries such as Russia and South Pacific countries in protest (Hayashi 2023).

On March 24, 2023, China and Russia issued a joint statement expressing once again their serious concern over the Japanese government’s decision to discharge nuclear wastewater into the ocean (Tomina 2023). Meanwhile, South Korean President Moon Jae-in’s office announced that South Korea would file a lawsuit with the International Tribunal for the Law of the Sea over Japan’s resolution to dispose of the water discharge and that interim measures might be taken (Toyoura 2021). Although South Korea’s foreign minister later said that his government would not object to Japan’s decision if it met International Atomic Energy Agency (IAEA) standards (Tateishi 2021), a survey by the University of Tokyo showed that about 90 percent of South Koreans and Chinese believe that food produced in Fukushima Prefecture could be affected by the planned spring and summer discharges of nuclear wastewater into the ocean from TEPCO’s Fukushima Daiichi nuclear power plant, and would therefore be potentially risk. The findings further underscore the serious concerns of Japan’s neighbors about the country’s discharge of nuclear wastewater (Fukuchi 2023).

In exploring the opposition of Japan’s neighbors to Japan’s nuclear wastewater discharge decisions, we must consider a variety of possible influences. First, the historical context and the long-standing relationship between Japan and its neighbors may be a source of these opposing voices. International political issues in recent years may also have had an impact on the relationship between Japan and its neighbors, which in turn may have generated opposition to this decision.

Environmental groups’ opposition to Japan’s decision is likely based on deep environmental concerns. They are concerned that the discharge of treated nuclear wastewater into the ocean could have serious negative effects on the ecosystem, which in turn could threaten human health and life.

The public’s opposition attitude has also drawn our attention. We need to recognize the complexity of forming people’s attitudes toward government decisions, where people’s approval or disapproval of government decisions is not always based on rational judgments based on in-depth knowledge and comparison of various expert opinions. In this regard, Robert C. Solomon has argued that in many (if not most) trust relationships, trust itself is invisible or transparent.

The environment in which we are raised, both culturally and socially, has a profound effect on our attitudes toward government decisions. Even when we are not aware of it, these environmental factors are shaping our views. For example, we may have a natural affinity for a certain viewpoint, perhaps because of our nationality, our beliefs, or the environment in which we were raised.

Jennifer A. Reich makes a similar point in her work, Calling A Shot: Why Parents Reject Vaccines. She points out that people may trust or reject a certain point of view due to a variety of factors such as religious beliefs, educational background, and nationality (Reich 2016). This phenomenon is evidence that our opinions and attitudes are not always based on rational analysis and judgment, but are influenced by our beliefs and environment.

In addition, our interests can also influence our attitudes toward government decisions. When a decision may harm our interests or position, we may choose to oppose the decision. This is why in some cases, even if expert opinions support government decisions, people may still be opposed to them because their interests may be harmed as a result.

Therefore, we must note that people’s attitudes toward government decisions are not based on rational analysis and judgment of experts’ views alone, but may also be influenced by their beliefs, circumstances, and personal interests.

On the other hand, the public is informed by a variety of sources, including government announcements, news media, environmental organizations, scientific experts, and social media. These sources may provide different or even conflicting information, leading to differences in the public’s understanding and perception of a particular decision.

In addition, the public’s level of trust in other countries and organizations may also influence their attitudes toward Japan’s nuclear wastewater discharge decisions. For example, if the International Atomic Energy Agency supports Japan’s decision, then some members of the public may take this to mean that the discharge of wastewater was fully evaluated and deemed safe. However, if other countries and organizations like neighboring governments or international environmental organizations express opposition, the public may be skeptical and concerned about the Japanese government’s decision as a result.

In the decision-making process of discharging nuclear wastewater from the Fukushima nuclear power plant, we see the involvement of a large number of experts from the IAEA and the Japanese government to representatives of neighboring countries, international organizations, and environmental groups who have a significant impact on the decision-making process. These experts play different roles in Pielke’s “honest broker” theory, including pure scientist, science arbiter, issue advocate, and honest broker (Pielke 2007).

The role of the pure scientist is primarily to provide scientific information, and they are not concerned with how that information is used to make decisions. Similarly, science arbiters answer questions about science but do not try to influence the outcome of decisions. However, in the case of the Fukushima nuclear wastewater discharge, we find that many experts are closer to the role of issue advocate. They not only provide information but also try to persuade people to accept their views by limiting the scope of the information.

Although the role of an honest broker is to provide people with all the information and help them make decisions based on their preferences, it may be difficult to find a truly honest broker on this issue. because all parties have their interests and positions, which makes it possible for them to provide information while trying to influence people’s decisions.

However, it is important to recognize that people’s trust in a particular idea is not constant and that every trust relationship undergoes a dynamic process of change. No matter how much people trust a certain idea in the initial stage, this trust relationship will always change with time and the emergence of new information.

The decision-making process for the treatment and discharge of nuclear wastewater from Fukushima demonstrates how a policy issue of great public concern has generated widespread and in-depth debate worldwide. The Japanese government’s announcement of its decision provoked widespread concern and alarm from people around the world. Professionals from all sides with different positions actively participated in the public discussion, using their expertise and insight to express their views, which had a significant impact on the public’s understanding and thinking on the issue.

In particular, Japan’s neighbors, including China, Russia, and South Korea, have expressed strong opposition to the decision. They criticized the Japanese government for its lack of transparency and irresponsibility in its decision-making process. South Korea even summoned the Japanese ambassador to South Korea to voice its opposition.

Greenpeace, an internationally influential environmental organization that has been both a promoter of several international agreements, such as the Kyoto Agreement, and a persuasive opponent of the proposal, has led to questions about whether the Japanese government’s decision was problematic and publicly released its criticism of Japan’s policy. Other influential experts have also published condemnations of Japanese policies on important academic platforms. These public criticisms have led to a serious split in Japanese society’s position on the policy, creating a clear polarization, i.e., a clear balance of public support and opposition to the policy. At the same time, these persuasive opponents have led to increasing skepticism about the Japanese government’s decisions. Indeed, Japan’s decision-making process does lack transparency, which increases suspicion of its decisions.

To solve the problem, the Japanese government chose to invite experts from the International Atomic Energy Agency to participate in the development and evaluation of the solution, and the solution was made public to the international community. This has increased the scientific nature of the Japanese government’s decision-making to some extent and has also restored some of the people’s trust in it.

On the other hand, the actions and stance of Greenpeace, an international environmental organization that has long been an active advocate of reducing carbon emissions, have been the focus of public attention, but its senior leadership’s frequent commuting by air has been a stark contrast to its environmental advocacy, raising questions about its consistent stance (Webster 2014). In addition, Greenpeace has taken some extreme actions in its environmental fight that could lead to permanent environmental damage around certain well-known geographic landmarks (Kozak 2014).

More controversially, Greenpeace seems to have taken too much of a political stance on some environmental issues at the expense of the scientific basis. For example, they strongly oppose the use of diisononyl phthalate (DINP), even though DINP has been confirmed as safe by multiple government agencies and independent evaluators. Greenpeace’s credibility took a serious hit when DINP was again scientifically evaluated and confirmed to be harmless to human health (Moore 2008).

This incident led to a re-examination of the accuracy of Greenpeace’s views in opposition to the Japanese government’s decision in question, as well as their true motives. As time went on, public attitudes began to shift and more and more people began to lean in favor of the Japanese government’s decision (Ishimoto 2023).

This example again illustrates that the public’s views are not static, but change with the environment, information, and time. The role of experts and the way they convey information have a significant impact on the public’s decision-making. At the same time, it reveals why the resolution of nuclear wastewater treatment at the Fukushima nuclear power plant was so controversial and the complexity of people’s attitudes toward it. Advances in technology have been accompanied by diverse perspectives, making it more difficult to clarify the facts.

This article explains why the issue of the Fukushima nuclear power plant is controversial in terms of the changing attitudes of the public. Both the Fukushima and Chernobyl nuclear accidents are among the worst nuclear disasters in history, and they have sparked a deep global rethinking of the safety of nuclear energy. People have different understandings and perspectives on these events from their backgrounds and positions, and this has led to controversies over such events.

In evaluating the veracity of different viewpoints, we need to fully understand that each person’s position and background will influence their perspective. One position may focus on one side of the issue and ignore the other. Therefore, we need to synthesize various viewpoints to get a more comprehensive understanding.

In the context of the contemporary knowledge society, openness and transparency of information play a decisive role in resolving complex disputes and issues. Taking the Japanese government’s response strategy as an example, the progression from its initial state of information asymmetry to inviting the participation of experts from the International Atomic Energy Agency can be viewed as a significant increase in the awareness of openness to information and professional collaboration. Such an information strategy not only allows the public to understand the factual details more systematically and in-depth but also creates a platform for consensus and collaboration among multiple stakeholders to discuss and develop effective solutions. However, for a complex event like Fukushima, relying on information transparency alone cannot fully satisfy the entire process of problem-solving. More critically, based on this information, parties can engage in continuous, in-depth, and constructive exchanges to ensure that the optimal solution path is identified and implemented in a synergistic manner.

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