『保健医療科学』 2021 第70巻 第4号 p.399-406（2021年10月）
連載：東日本大震災からの10年―国立保健医療科学院からの発信̶ ＜総説＞
東日本大震災からの10年―災害時の公衆衛生活動体制の変遷―
奥田博子
国立保健医療科学院健康危機管理研究部
Ten years after the Great East Japan Earthquake: Changes in the public health system in times of disaster
OKUDA Hiroko
Department of Health Crisis Management, National Institute of Public Health
抄録
2011年3月11日，東北地方太平洋沿岸沖を震源に発生した東日本大震災は，広範囲に及ぶ地震と津波による被害をもたらした．また，地震と津波は，福島第一原子力発電所の電源喪失を誘発し，過去に類をみない複合災害となり，人的・物的被害は戦後わが国で最大規模となった．被災地域では発災直後から，地域診療機能や行政機能の低下が初動の遅れの誘因となり，支援人材の確保等の必要性が急速に発生した．また急性期以降においても，震災関連死が生じ，避難所等における公衆衛生対策の早期確立の重要性が明らかになった．一方，本震災に際し，保健医療福祉の立場で支援に従事した自治体職員を対象とした調査では，受援側自治体における指揮命令系統の不備，情報収集・共有などの体系的な課題が明らかにされた．これらの検証を踏まえ，自治体機能が停滞する災害時は，災害対策のための体制整備，情報収集，調整などのマネジメント機能の支援に対する専門職による応援を早期に行う新たな仕組みを創設する必要性が示唆された．そこで国は，被災自治体の公衆衛生活動を補完すべく，2018年3月災害時健康危機管理支援チーム（以下，「DHEAT」）の活動要領を定め，同年7月に発生した豪雨水害において初運用がなされた．本稿では，東日本大震災を教訓とした災害時の公衆衛生活動体制に関連する変遷と，今後発生が危惧される大規模災害に備え，標準的な支援を展開するための自治体の体制整備や人材育成について概観する．
キーワード：東日本大震災，公衆衛生活動，災害時健康危機管理支援チーム（DHEAT），人材育成
Abstract
The Great East Japan Earthquake struck off the Pacific coast of the Tohoku region on March 11, 2011, wreaking havoc. The earthquake and tsunami triggered the loss of power at the Fukushima Daiichi Nuclear Power Plant, resulting in a complex disaster of unprecedented scale, with the largest scale of human and property damage in Japan since World War II. Immediately following the disaster, the affected areas experienced a decline in medical treatment and administrative functions, resulting in a delay in the initial response and a variety of challenges, such as securing support personnel. In addition, earthquake-related fatalities occurred even after the acute phase, highlighting the significance of establishing public health measures in evacuation centers early on. On the other hand, a survey of support workers related to health and medical welfare in local governments identified systematic concerns such as a poor chain of command and insufficient information collection and sharing in the recipient local governments. Based on these verifications, it was suggested that in the event of a major disaster on a scale that would paralyze the local governmentʼs functioning, it would be necessary to create a new mechanism to provide early professional support for supporting management functions, such as the development of systems for disaster countermeasures, information gathering, and coordination and decision-making. In response to this, the government established the Disaster Health Emergency Assistance Team (hereinafter referred to as “DHEAT”) in March 2018 to supplement the public health activities of the affected municipalities. The first DHEAT operation was conducted during the torrential rains and floods of July of that year. This paper outlines the changes in public health activities during disasters as a result of lessons learned from the Great East Japan Earthquake, as well as the development of local government systems and human resources to provide standardized support in preparation for future large-scale disasters.
keywords: The Great East Japan Earthquake, public health activities, Disaster Health Emergency Assistance Team (DHEAT), human resources development
