Development of a method for analysing victims of the Great East Japan Earthquake using the International Classification of Functioning, Disability and Health (ICF): part I proposal for the disaster ICF

Figures & data

Figure 1. Epicentre and main disaster area. The Great East Japan Earthquake (magnitude 9.0) occurred at 14:46, on 11 March 2011.

Figure 2. Interactions between the components of ICF. Individual health and health-related states are expressed by the ICF components. Source: ICF Manual (WHO, 2008, p. 23).

Table 1. Structure of ICF codes.

Category level^1 Qualifier^2	Part 1: Functioning and disability						Part 2: Contextual factors
	Body functions (b)		Body structures (s)		Activities and participation (d)		Environmental factors (e)
	Physiological or psychological functions of body systems		Anatomical parts of the body		Activity: Execution of a task or action by an individual Participation: Involvement in a life situation		Physical, social and attitudinal environment
First-level^1	b1–b8^1		s1–s8		d1–d9		e1–e5
Total	8		8		9		5
Second-level (example)	b167	Mental functions of language	s730	Structure of upper extremity	d450	Walking	e110	Products or substances for personal consumption
Total	115		56		128		74
Third-level (example)	b1670	Reception of language	s7300	Structure of upper arm	d4500	Walking short distances	e1100	Food
Total	341		165		329		182
Fourth-level (example)	b16710	Reception of spoken language	s73000	Bones of upper arm	None		None
Total	61		92		0		0
First qualifier^2	Extent or magnitude of impairment		Extent or magnitude of impairment		Extent of performance problem		Extent of barrier
	xxx.0	No impairment (0–4%) ^2	xxx.0	No impairment (0–4%)	xxx.0	No difficulty (0–4%)	xxx.0	No barrier (0–4%)
	xxx.1	Mild impairment (5–24%)	xxx.1	Mild impairment (5–24%)	xxx.1	Mild difficulty (5–24%)	xxx.1	Mild barrier (5–24%)
	xxx.2	Moderate impairment (25–49%)	xxx.2	Moderate impairment (25–49%)	xxx.2	Moderate difficulty (25–49%)	xxx.2	Moderate barrier (25–49%)
	xxx.3	Severe impairment (50–95%)	xxx.3	Severe impairment (50–95%)	xxx.3	Severe difficulty (50–95%)	xxx.3	Severe barrier (50–95%)
	xxx.4	Complete impairment (96–100%)	xxx.4	Complete impairment (96–100%)	xxx.4	Complete difficulty (96–100%)	xxx.4	Complete barrier (96–100%)
	xxx.8	not specified	xxx.8	not specified	xxx.8	not specified	xxx.8	barrier, not specified
	xxx.9	not applicable	xxx.9	not applicable	xxx.9	not applicable	xxx.9	barrier, not applicable
							Extent of facilitator
							xxx + 0	No facilitator (0–4%)
							xxx + 1	Mild facilitator (5–24%)
							xxx + 2	Moderate facilitator (25–49%)
							xxx + 3	Substantial facilitator (50–95%)
							xxx + 4	Complete facilitator (96–100%)
							xxx + 8	facilitator, not specified
Second qualifier	None		Nature of impairment		Extent of capacity limitation		None
			xxx.x0	No change in structure	xxx.x0	No difficulty (0–4%)
			xxx.x1	total absence	xxx.x1	Mild difficulty (5–24%)
			xxx.x2	partial absence	xxx.x2	Moderate difficulty (25–49%)
			xxx.x3	additional part	xxx.x3	Severe difficulty (50–95%)
			xxx.x4	aberrant dimensions	xxx.x4	Complete difficulty (96–100%)
			xxx.x5	discontinuity	xxx.x8	not specified
			xxx.x6	deviating position	xxx.x9	not applicable
			xxx.x7	Qualitative changes in structure
			xxx.x8	not specified
			xxx.x9	not applicable

Personal Factors are not classified in the ICF. The official ICF updates for 2011–2018 are included.

¹ First-, second-, third- and fourth-level categories are denoted by one to two digits that are underlined.

² Each qualifier is expressed by a percentile figure. Source: ICF Manual (WHO, 2008) (totaled by author).

Table 2. Newspaper interviewees.

Items	AS^1					FM^2	Total: AS + FM
	Iwate	Miyagi	Fukushima	Others	(Subtotal)	Fukushima
Period (2011)	—	—	—	—	17 March–10 June	19 March–9 June	17 March–10 June
Number of interviewees	291	297	361	78	1,027	883	1,910
Sex (male/female)	176/115	167/130	213/148	48/30	604/423	512/371	1,116/794
Range of age (male)	7–87	6–88	6–89	8–86	6–89	1–92	1–92
Range of age (female)	5–87	8–92	4–92	12–78	4–92	2–98	2–98
Average age (male/female)	53.0/49.1	49.7/49.4	49.0/45.4	52.6/50.7	50.6/48.0	48.5/43.6	49.6/46.0
Photograph of face (male/female)	150/97	151/120	178/124	44/25	523/366	439/330	962/696
Photograph percentage (male/female)	85.2/84.3	90.4/92.3	83.6/83.8	91.7/83.3	86.6/86.5	85.7/88.9	86.2/87.6
Average of number of Japanese characters^3	138.0	145.7	131.8	96.7	134.9	88.7	113.6

¹ The Asahi Shimbun (AS, national newspaper). AS has local columns for Iwate, Miyagi, Fukushima and other prefectures.

² Fukushima Minpo (FM, local newspaper).

³ Approximately 10 Japanese characters are equivalent to 5 words in English.

Table 3. Example of ICF coding.

Interviewee: Mrs Suzuki, 73 years old, unemployed, lived by the seaside, and evacuated to a gymnasium, interviewed two weeks after the disaster
Response^1	ICF category code (second-level)
	Body Functions	Body Structures	Activities and Participation	Environmental Factors
When the earthquake^*1 hit, I was in my house. I escaped^*2 quickly. My husband^*3 was swept away in his office, and he has been missing since. There is nothing around to mark our house^*4. I’m in the evacuation centre^*5 with neighbours^*6. But I get sad and uneasy^*7 when I’m alone. I haven’t taken a bath^*8 in a long time. I hope a temporary house^*9 is built soon.	b130.1^*7	unknown	d450.8^*2	e165.8^*4 e230.4^*1 e310.8^*3 e325 + 2^*6 e525 + 1^*5 e525 + 3^*9 e580.2^*8

The harm to a hypothetical victim and corresponding ICF codes with qualifiers are presented. Applicable words or phrases in Response¹ for the ICF category codes are underlined, and the same superscript letters (*1–*9) are used for each code.

Table 4. Total number of ICF codes based on newspaper interviews.

Second-level category codes: things or phenomena	AS^1					FM^2	Total: AS + FM
	Iwate	Miyagi	Fukushima	Others	(Subtotal)	Fukushima
Body Functions
b126 Temperament and personality functions	4	9	8	5	26	15	41
b130 Energy and drive functions	3	1	1	0	5	11	16
b134 Sleep functions	1	1	5	1	8	7	15
b749 Muscle functions, other specified and unspecified	3	2	2	3	10	3	13
Others	3	3	8	0	14	16	30
(Subtotal)	14	16	24	9	63	52	115
Activities and Participation
d450 Walking	0	3	8	0	11	10	21
d570 Looking after one’s health	11	17	11	1	40	79	119
d610 Acquiring a place to live	3	6	7	1	17	18	35
d650 Caring for household objects	2	1	15	0	18	34	52
d660 Assisting others	52	47	72	14	185	170	355
d710 Basic interpersonal interactions	28	32	35	4	99	162	261
d720 Complex interpersonal interactions	16	14	17	4	51	22	73
d750 Informal social relationships	15	28	22	10	75	97	172
d760 Family relationships	20	11	12	2	45	51	96
d845 Acquiring, keeping and terminating a job	53	56	69	8	186	82	268
d850 Remunerative employment	20	12	16	3	51	5	56
d855 Non-remunerative employment	37	29	19	3	88	59	147
d865 Complex economic transactions	4	2	5	1	12	0	12
d920 Recreation and leisure	9	6	14	1	30	102	132
d940 Human rights	18	24	113	8	163	193	356
d998 Community, social and civic life, other specified	49	62	100	14	225	126	351
Others	10	10	2	2	24	27	51
(Subtotal)	347	360	537	76	1,320	1,237	2,557
Environmental Factors
e110 Products or substances for personal consumption	11	18	17	10	56	27	83
e115 Products and technology for personal use in daily living	15	26	21	5	67	34	101
e120 Products and technology for personal indoor and outdoor mobility and transportation	12	16	14	4	46	21	67
e125 Products and technology for communication	1	2	2	3	8	2	10
e130 Products and technology for education	4	5	0	0	9	4	13
e135 Products and technology for employment	28	24	11	6	69	7	76
e140 Products and technology for culture, recreation and sport	5	8	2	1	16	2	18
e165 Assets	191	183	93	37	504	229	733
e230 Natural events	149	169	116	46	480	214	694
e235 Human-caused events	2	5	143	5	155	193	348
e310 Immediate family	142	139	158	21	460	456	916
e315 Extended family	24	16	23	5	68	73	141
e320 Friends	21	20	23	4	68	33	101
e325 Acquaintances, peers, colleagues, neighbours and community members	54	89	81	14	238	362	600
e330 People in positions of authority	2	3	6	4	15	31	46
e335 People in subordinate positions	10	10	11	2	33	6	39
e340 Personal care providers and personal assistants	16	17	15	3	51	86	137
e350 Domesticated animals	8	6	28	3	45	46	91
e355 Health professionals	0	3	2	1	6	8	14
e360 Other professionals	8	14	0	1	23	11	34
e398 Support and relationships, other specified	18	14	9	1	42	22	64
e425 Individual attitudes of acquaintances, peers, colleagues, neighbours and community members	1	2	5	0	8	3	11
e445 Individual attitudes of strangers	3	1	16	0	20	4	24
e520 Open space planning services, systems and policies	2	0	1	0	3	2	5
e525 Housing services, systems and policies	53	74	49	21	197	142	339
e530 Utilities services, systems and policies	28	36	7	7	78	16	94
e535 Communication services, systems and policies	7	5	1	0	13	0	13
e540 Transportation services, systems and policies	8	11	6	3	28	6	34
e545 Civil protection services, systems and policies	0	1	1	0	2	3	5
e565 Economic services, systems and policies	3	2	5	1	11	0	11
e570 Social security services, systems and policies	9	11	27	5	52	25	77
e575 General social support services, systems and policies	1	5	1	1	8	4	12
e580 Health services, systems and policies	12	17	10	4	43	26	69
e585 Education and training services, systems and policies	4	5	2	0	11	5	16
e598 Services, systems and policies, other specified	7	11	26	3	47	47	94
Others	4	5	0	0	9	1	10
(Subtotal)	863	973	932	221	2,989	2,151	5,140
Total	1,224	1,349	1,493	306	4,372	3,440	7,812

The interviewees were 1,910 disaster victims. Their responses (words and phrases) corresponded to the ICF category codes. Multiple codes per response were allowed.

¹ The Asahi Shimbun (AS, national newspaper).

² Fukushima Minpo (FM, local newspaper).

Table 5. Total number of ICF qualifiers based on newspaper interviews.

Qualifiers	AS^1					FM^2	Total: AS + FM	Major codes (total)
	Iwate	Miyagi	Fukushima	Others	(Subtotal)	Fukushima
Body Functions
bxxx.0	0	1	1	0	2	1	3
bxxx.1	2	6	4	1	13	13	26	b126 (18)
bxxx.2	5	2	7	3	17	14	31	b126 (14)
bxxx.3	1	0	2	2	5	5	10
bxxx.4	1	3	2	0	6	0	6
bxxx.8	5	4	8	3	20	19	39	b749 (12)
bxxx.9	0	0	0	0	0	0	0
(Subtotal)	14	16	24	9	63	52	115
Activities and Participation
dxxx.0	28	39	29	7	103	240	343	d570 (81), d920 (77), d750 (61)
dxxx.1	15	21	23	5	64	50	114
dxxx.2	18	31	60	9	118	125	243
dxxx.3	16	13	22	3	54	12	66
dxxx.4	82	83	205	17	387	249	636	d940 (288), d845 (138), d998 (83)
dxxx.8	188	173	198	35	594	561	1,155	d710 (256), d998 (255), d855 (141)
dxxx.9	0	0	0	0	0	0	0
(Subtotal)	347	360	537	76	1,320	1,237	2,557
Environmental Factors
exxx.0	7	5	1	3	16	2	18
exxx.1	6	11	7	2	26	14	40
exxx.2	17	37	23	16	93	47	140
exxx.3	25	38	20	19	102	27	129
exxx.4	414	436	411	95	1,356	655	2,011	e230 (693), e165 (373), e235 (348)
exxx.8	49	53	52	15	169	90	259
exxx.9	0	0	0	0	0	0	0
exxx + 0	1	1	2	2	6	2	8
exxx + 1	5	3	2	0	10	6	16
exxx + 2	7	18	17	5	47	69	116
exxx + 3	21	33	21	2	77	39	116
exxx + 4	259	286	297	45	887	1,020	1,907	e310 (854), e325 (422), e315 (109)
exxx + 8	52	52	79	17	200	180	380	e165 (143), e525 (77), e325 (57)
(Subtotal)	863	973	932	221	2,989	2,151	5,140
Total	1,224	1,349	1,493	306	4,372	3,440	7,812

The interviewees were 1,910 disaster victims. Their category codes were linked to the dedicated qualifiers.

¹ The Asahi Shimbun (AS, national newspaper).

² Fukushima Minpo (FM, local newspaper).

Table 6. ICF codes based on interview responses and their qualifiers.

Category codes^1	Victim			Date (2011), Newspaper^3	Response^4	Qualifier^5
	Sex^2	Age	Occupation
Body Functions
b130	Energy and drive functions
b1300	F	48	-	16 May, AS	My oldest daughter escaped to the nearest community centre, but she was turned away from going upstairs. So she was washed away by a tsunami, I heard. Her death has left a vacuum in my heart since that day, even after two months have passed.	E/M	[ .0 .1 .2 .3 .4 .8 .9 ]
b134	Sleep functions
b1343	M	65	Farmer	26 March, FM	My wife and I escaped in a hurry by driving a light lorry after we saw the tsunami coming. I saw our house floating in the rear view mirror. I’d lost my house, so concerns for the future make me sleep poorly every night.	E/M	[ .0 .1 .2 .3 .4 .8 .9 ]
Activities and Participation
d450	Walking
d4501	M	73	-	22 March, FM	Walking my dog is my chore. I maintain my health every day.	P	[ .0 .1 .2 .3 .4 .8 .9 ]
						C	[ ‥0 ‥1 ‥2 ‥3 ‥4 ‥8 ‥9 ]
d750	Informal social relationships
d7501	F	47	School staff	18 March, AS	To all people in Japan, let us pick your brains! Tell us how the people in evacuation centres can live together peacefully without quarrelling.	P	[ .0 .1 .2 .3 .4 .8 .9 ]
						C	[ ‥0 ‥1 ‥2 ‥3 ‥4 ‥8 ‥9 ]
d845	Acquiring, keeping and terminating a job
d8451	M	73	Fisherman	21 March, AS	Two boats for farming kombu (a kind of kelp) and scallops were swept away, and my house was too. I can’t cultivate them again at my age.	P	[ .0 .1 .2 .3 .4 .8 .9 ]
						C	[ ‥0 ‥1 ‥2 ‥3 ‥4 ‥8 ‥9 ]
d940	Human rights
d940	F	17	High school student	8 June, AS	I know irresponsible writings and sayings about Fukushima are spreading on the web and through rumours. I don’t want it to be said that ‘women in Fukushima can’t marry’.	P	[ .0 .1 .2 .3 .4 .8 .9 ]
						C	[ ‥0 ‥1 ‥2 ‥3 ‥4 ‥8 ‥9 ]
Environmental Factors
e165	Assets
e1651	M	27	Farm staff	10 April, AS	Our vineyard, office and winery were flooded with the seawater.	B	[ .0 .1 .2 .3 .4 .8 .9 ]
						F	[ +0 + 1 +2 + 3 +4 + 8 ]
e235	Human-caused events
e235	M	29	Company employee	5 April, AS	I’m concerned about the effect of radioactive contamination on children.	B	[ .0 .1 .2 .3 .4 .8 .9 ]
						F	[ +0 + 1 +2 + 3 +4 + 8 ]
e340	Personal care providers and personal assistants
e340	M	75	Retired	16 April, FM	During our long evacuation, we really appreciate the volunteers’ help such as with meals and cares.	B	[ .0 .1 .2 .3 .4 .8 .9 ]
						F	[ +0 + 1 +2 + 3 + 4 + 8 ]
e350	Domesticated animals
e350	M	50	-	30 May, AS	Just after the earthquake hit, I’d run away with my rabbit in a paper bag. I lost my job, and my house was completely swept away. But I always feel at rest when I hold my rabbit.	B	[ .0 .1 .2 .3 .4 .8 .9 ]
						F	[ +0 + 1 +2 + 3 +4 + 8 ]
e425	Individual attitudes of acquaintances, peers, colleagues, neighbours and community members
e425	M	77	President of residents’ association	19 March, AS	Twenty-odd evacuees are staying in the evacuation centre. They are becoming irritable, so some quarrels such as disputes over food have erupted.	B	[ .0 .1 .2 .3 .4 .8 .9 ]
						F	[ +0 + 1 +2 + 3 +4 + 8 ]
e445	Individual attitudes of strangers
e445	M	64	Fisherman	14 April, AS	When the tsunami hit, I went out fishing to be safe. But I’ve stopped fishing because of the risk of the damage caused by rumour about the nuclear power plant accident.	B	[ .0 .1 .2 .3 .4 .8 .9 ]
						F	[ +0 + 1 +2 + 3 +4 + 8 ]
e545	Civil protection services, systems and policies
e5450	M	70	Retired	9 April, FM	We are encouraged by the officers who patrol regularly and ask us about our problems and complaints.	B	[ .0 .1 .2 .3 .4 .8 .9 ]
						F	[ +0 + 1 +2 + 3 +4 + 8 ]
e575	General social support services, systems and policies
e5750	M	72	-	20 March, AS	As I’m disabled, I use a wheelchair. So even if I can return, I can’t clean debris from my house on my own.	B	[ .0 .1 .2 .3 .4 .8 .9 ]
						F	[ +0 + 1 +2 + 3 +4 + 8 ]

Fourteen interviewees were selected from among 1,910 disaster victims. Their personal attributes, responses, category codes and qualifiers were listed.

¹ Category codes are the lowest subcategory codes.

² M: male; F: female.

³ The Asahi Shimbun (AS, national newspaper); Fukushima Minpo (FM, local newspaper).

⁴ Applicable words or phrases and qualifiers for the ICF category codes and their qualifiers are underlined.

⁵ E/M: extent/magnitude; P: performance; C: capacity; B: barrier; F: facilitator.

Table 7. Total number of main ideas based on interview responses.

Category of main ideas	AS^1		FM^2
	Main ideas	Percentage	Main ideas	Percentage
Self and Family member	570	55.5	457	51.8
Neighbour and Community	218	21.2	271	30.7
Administration and Government	95	9.3	60	6.8
Supplies and Facilities	39	3.8	16	1.8
Information	22	2.1	19	2.2
Rule and Procedure	5	0.5	0	0.0
Evacuation centre and Temporary housing	69	6.7	48	5.4
Others	9	0.9	12	1.4
Total	1,027	100.0	883	100.0

The interviewees were 1,910 disaster victims. The main ideas (themes) of their responses were classified into 8 categories.

¹ The Asahi Shimbun (AS, national newspaper).

² Fukushima Minpo (FM, local newspaper).

Table 8. Total number of strengths based on interview responses.

Parent category	Subcategory	Strengths	AS^1					FM^2	Total: AS + FM
			Iwate	Miyagi	Fukushima	Others	(Subtotal)	Fukushima
Resources	Family	Bonds	133	134	187	28	482	460	942
		Relationship	12	8	10	3	33	55	88
	Close people	Friends	13	17	20	1	51	23	74
		Acquaintances	0	1	2	0	3	2	5
		Peers	7	2	4	1	14	11	25
		Neighbours	4	22	4	4	34	3	37
		Pets	4	2	5	0	11	1	12
	Home	House	19	14	8	4	45	0	45
	Business	Shop, Office	6	1	1	1	9	1	10
		Clients	8	5	4	0	17	2	19
(Subtotal)			206	206	245	42	699	558	1,257
Natures	Character	Modesty	8	16	12	0	36	21	57
		Discipline	6	8	12	4	30	14	44
		Pride	4	3	2	0	9	1	10
		Positivity	4	3	2	0	9	48	57
		Introspection	8	5	6	2	21	5	26
		Independence	5	5	3	1	14	9	23
		Responsibility	8	11	6	1	26	7	33
		Vocation	8	4	2	0	14	4	18
		Leadership	3	2	0	1	6	4	10
	Contribution	Service	39	33	19	2	93	60	153
		Altruism	2	1	1	0	4	9	13
		Gratitude	4	1	7	0	12	12	24
		Piety	2	2	5	0	9	5	14
	Attitude	Sympathy	7	3	6	1	17	5	22
		Care	10	14	17	3	44	51	95
		Thanks	38	39	40	10	127	213	340
		Sociability	1	0	5	0	6	13	19
	Community	Hometown affection	53	39	51	11	154	54	208
		Righteous indignation	1	5	27	3	36	29	65
		Justice	0	2	7	0	9	1	10
(Subtotal)			211	196	230	39	676	565	1,241
Capabilities	Efforts	Diligence (worker)	73	66	62	18	219	67	286
		Diligence (student)	19	13	22	3	57	69	126
	Technique	Originality	2	4	1	0	7	1	8
	Incentive	Dream	9	5	4	0	18	1	19
(Subtotal)			103	88	89	21	301	138	439
Total			520	490	564	102	1,676	1,261	2,937
Without strengths			11	15	30	14	70	67	137

The interviewees were 1,910 disaster victims. Strengths (individual good traits and favourable environment) of their responses were hierarchically classified. Multiple strengths per response were allowed.

¹ The Asahi Shimbun (AS, national newspaper).

² Fukushima Minpo (FM, local newspaper).

WHO (World Health Organization). (2008). International Classification of Functioning, Disability and Health (ICF). ICF Manual. Geneva, Switzerland. https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health

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Data availability statement

Each newspaper interview article is available on the following newspaper publisher databases (written in Japanese): The Asahi Shimbun, http://www.asahi.com/information/db/; Fukushima Minpo, https://www.minpo.jp/cdrom). The ICF coding datasets produced by the author are not shared to maintain the privacy of interviewees.