A nuclear meltdown is a localized concern. It's small potatoes compared to an all out nuclear exchange.
For example, failure to restore cooling to the Fukushima pools could have necessitated the evacuation of 35MM people.
http://scienceandglobalsecurity.org/archive/sgs24vonhippel.p...
Even in a pure-counterforce exchange that avoided targeting population centers, the resulting damage to infrastructure could result in the denial of current urban centers to habitation for many decades.