The Pacific coast of the Tohoku region of Japan experiences repeated tsunamis, with the most recent events having occurred in 1896, 1933, 1960, and 2011. These events have caused large loss of life and damage throughout the coastal region. There is uncertainty about the degree to which seawalls reduce deaths and building damage during tsunamis in Japan. On the one hand they provide physical protection against tsunamis as long as they are not overtopped and do not fail. On the other hand, the presence of a seawall may induce a false sense of security, encouraging additional development behind the seawall and reducing evacuation rates during an event. We analyze municipality-level and sub-municipality-level data on the impacts of the 1896, 1933, 1960, and 2011 tsunamis, finding that seawalls larger than 5 m in height generally have served a protective role in these past events, reducing both death rates and the damage rates of residential buildings. However, seawalls smaller than 5 m in height appear to have encouraged development in vulnerable areas and exacerbated damage. We also find that the extent of flooding is a critical factor in estimating both death rates and building damage rates, suggesting that additional measures, such as multiple lines of defense and elevating topography, may have significant benefits in reducing the impacts of tsunamis. Moreover, the area of coastal forests was found to be inversely related to death and destruction rates, indicating that forests either mitigated the impacts of these tsunamis, or displaced development that would otherwise have been damaged.