Hiroshima, Nagasaki, and Fukushima.

In this issue of The Lancet, three Series papers and a Viewpoint commemorate 70 years of caring for survivors of the atomic bombings of Hiroshima and Nagasaki, as well as the more recent extension of that care to those aff ected by the Fukushima nuclear accident. As a result of this unwelcome triple legacy, Japan has become a uniquely important site for understanding radiation-related health eff ects and the aftermath and eff ects of nuclear accidents. As the From Hiroshima and Nagasaki to Fukushima Series makes clear, the three Japanese locations are linked by more than tragedy. The events of 1945 shaped institutions and research programmes that came to play a major part in Fukushima prefecture 66 years later. 70 years after the end of World War 2, the monitoring of Japanese atomic bomb survivors, known as hibakusha, for radiation-related health problems continues. The atomic bombings of Hiroshima and Nagasaki in 1945 were the beginnings of a long and deep engagement by Japanese people and institutions with radiation health. Ironically, the two rebuilt cities, and especially their universities, became global centres of research and expertise on radiation health with medical communities that have a unique responsibility towards survivors. Indeed, one of the fi rst and most infl uential Japanese chroniclers of hibakusha and their suff erings, Takashi Nagai, was a radiologist and himself a survivor who succumbed to radiation poisoning. Experts from both cities, some of them descendants of A-bomb survivors, have also been involved since 1986 in monitoring health in the former USSR after the Chernobyl nuclear disaster. Given this legacy, medical personnel from Hiroshima and Nagasaki were among the fi rst to arrive at the Fukushima disaster site, and many have stayed on to buttress expertise at the Fukushima Medical University, which is now a leading centre for health care after nuclear accidents. Experience from Hiroshima and Nagasaki, as well as Chernobyl, has had a direct bearing on the Fukushima Health Management Survey, a long-term monitoring plan of the aff ected population modelled on the treatment of post-war hibakusha. There are now at least 350 000 individuals to be followed over their lifespans for eff ects of low-dose radiation. The linkages between Hiroshima, Nagasaki, and Fukushima are thus more than just symbolic, having shaped current health management practices and the institutions that run them, as well as public responses to these events. The contexts of 1945 and 2011 are clearly very diff erent, and intervening events have also shaped current discourse about Fukushima. The post-war introduction of nuclear energy to Japan was initially distant from medical discussion, given Cold War concerns with nuclear weaponry. During this time attitudes were also infl uenced by the Lucky Dragon incident of 1954—when Japanese fi shermen aboard the Daigo Fukuryu Maru (Lucky Dragon) were aff ected by a US hydrogen bomb test at Bikini Atoll—from which Japanese antinuclear activism can be dated. A series of large industrial pollution incidents in the 1950s and 1960s, along with the subsequent occurrence of small nuclear plant accidents, have also kept the spectre of radiation-related public health crises before the Japanese public. More recently, there has been growing controversy about the overuse of medical radiation technologies in Japan. The legacy of Hiroshima and Nagasaki has nonetheless been a lens through which these and subsequent events have been fi ltered. For the Japanese medical community, a clear diff erence between the legacy of Hiroshima and Nagasaki and that of Fukushima has been the crisis of communication and trust with the general population. At the local and clinical level, doctors and nurses in Fukushima were dedicated and heroic fi rst-responders, but had little training for a radiation-related disaster. See Editorial page 403