Currently, occupational health faces increasingly diverse and complex challenges (such as rising mental health issues, an aging workforce, and increasing female employment rates), yet occupational health initiatives in small and medium-sized enterprises (SMEs) remain highly inadequate. To change this situation, healthcare and legal professionals in the field should begin with what they can do themselves (for example, mental health measures, harassment prevention, commitment to workplace improvement, support for balancing disability and work, distinguishing between reasonable accommodations and labor management, and preventing health problems caused by long working hours). In doing so, we should better utilize services from existing organizations, such as Regional Occupational Health Centers, while also leveraging the networks of this society. Additionally, to secure adequate personnel, it is necessary to reconsider the division of roles and positioning (redistribution of resources) of occupational physicians, occupational health nurses, and others.

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To effectively promote and maintain workers' health, it is necessary to accurately respond to changes in the work environment while considering the existing occupational health systems and frameworks. As occupational health challenges become increasingly complex due to environmental changes, a clear distribution of roles among stakeholders becomes essential. This paper discusses recent topics including mental health measures, support for balancing treatment and work, chemical substance management, and revision to general health examinations. The role and expectations of occupational health are expected to remain significant in the future.

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This moot court case examines the handling of a company’s sick leave order and the employee’s subsequent return-to-work request, where the employee developed adjustment disorder and was suspected of having neurodevelopmental disorder. Lawyers and physicians representing both the employee and employer discussed key issues including whether the cause for sick had been resolved, and whether sufficient efforts had been made by both the employee towards recovery and the company towards avoiding dismissal. Through this discussion, it was reaffirmed that the field of occupational health law offers numerous opportunities for intervention before disputes escalate to litigation requiring binary outcomes. This requires essential collaboration among labor management professionals, occupational health specialists, and various other disciplines.

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The speaker delivered an unscripted presentation about his life story and 60-year career in medical practice. A Q&A session followed, during which the speaker answered questions from the audience. The following is a summary of the presentation and subsequent discussion, preserved as closely as possible in the speaker’s original conversational style.

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Currently, workplaces face various health challenges, including mental health issues and an increasing number of elderly workers. However, in small and medium-sized enterprises (SMEs), occupational health activities remain insufficient. To address this situation, various measures were proposed, such as promoting greater utilization of existing systems like Regional Occupational Health Centers, leveraging the Occupational Health Activity Promotion Grant System through Organizations, enabling local primary care physicians to support small-scale workplaces in the community, enhancing coordination between occupational physicians and occupational health nurses, reinforcing corporate training directive systems, and introducing a certification system to evaluate contractors' workforce structures and occupational safety and health initiatives. The Ministry of Health, Labour and Welfare (MHLW) has positioned small-scale workplace measures within the 14th Industrial Accident Prevention Plan, and it is essential to steadily advance these initiatives while considering the above proposals.

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Japan faces projected population decline due to accelerating low birthrate and aging demographics. Additionally, work style reforms are being actively implemented. To sustain socioeconomic stability, workplaces are increasingly required to strengthen their efforts in ensuring workers’ safety and health beyond current standards. The Ministry of Health, Labour and Welfare is actively promoting worker health protection measures under the Industrial Safety and Health Act.

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Although approximately 60% of all workers are employed in small-scale workplaces with fewer than 50 employees, these establishments have insufficient occupational health systems and require external support. In regional areas facing population decline and shortages of specialists such as occupational physicians, Comprehensive Occupational Health Support Centers and Regional Occupational Health Centers are serving as hubs connecting various local professionals and organizations, aiming to develop services tailored to regional circumstances.

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Although small and medium-sized enterprises (SMEs) have higher rate of occupational accidents that would warrant stricter regulations, regulatory requirements have instead have been relaxed due to their limited resources. Despite the implementation of technical and financial support measures through the Workers’ Accident Compensation Insurance Special Account, these interventions have shown limited effectiveness. Initiatives such as guidance and advice from experienced accident prevention advisors, as well as tax incentive systems for companies actively engaging in occupational health and safety, failed to yield meaningful results and were subsequently discontinued. Similarly, the public “Safety Project,” which publishes information on companies’ proactive safety initiatives, has struggled to attract a sufficient number of participants. Therefore, potential measures to address these challenges include: 1) Strengthening and expanding the mandatory training system for occupational health and safety officers in companies where occupational accidents or health impairments occur. 2) Introducing a framework that requires clients to evaluate the workforce and occupational health and safety measures of contractors, supported by a certification system. 3) Developing AI-based systems to provide occupational health and safety information. 4) Supporting venture businesses in building management resources such as personnel, capital, offices, and clients, while implementing policies to ensure proper health and safety management. In any case, as business stability in SMEs is closely linked to occupational health and safety, it is essential to promote management support and occupational health and safety policies in parallel.

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From the perspective of researching measures to promote occupational health in small and medium-sized enterprises after practicing as an occupational health nurse, it is believed that multi-professional team collaboration is especially important in small and medium-sized enterprises without a dedicated occupational physician. In particular, the establishment and promotion of a new support model and the creation of a social infrastructure with occupational health nurses at the forefront are considered urgent issues, as occupational health nurses are close supporters of companies and employees, have a wide range of support capabilities covering both physical and mental aspects, and possess a coordinating function that links various professionals, including occupational physicians.

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Occupational health challenges in regional cities include a higher proportion of small and micro enterprises compared to metropolitan areas, resulting in many workplaces being exempt from the requirement to appoint occupational physicians and health managers, along with insufficient understanding among employers. Through examining the case of Miyagi Prefecture as a regional area, this paper analyzes the current status and challenges of occupational health in workplaces across local municipalities and introduces successful examples of collaboration between occupational physicians and Certified Social Insurance and Labor Consultants as a solution strategy, emphasizing the importance of further promoting such partnerships.

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Disparities in transportation infrastructure and external occupational health resources between metropolitan and regional cities, stigma toward mental illness, and differences in resources and commitment levels between large corporations and small/medium-sized enterprises are believed to affect workers’ health. These factors are also important from the perspective of social determinants of health (SDH). Occupational physicians play a role in proposing and implementing measures tailored to company size and regional circumstances to promote employee health and productivity improvement. The active involvement of part-time occupational physicians is particularly important in regional areas.

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Supporting employees in regional areas faces challenges such as limited access to healthcare resources and headquarters’ messages that may not align with local conditions. Furthermore, when locations are distant from headquarters, it becomes difficult to implement and establish compliance with corporate rules thoroughly. To address these challenges, it is essential to consider region-specific needs and circumstances while developing unique approaches and ensuring rule compliance. Occupational health activities tailored to regional characteristics contribute to employee safety and health promotion, as well as corporate development.

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The Work Style Reform-Related Laws strengthen the authority of occupational physicians by enhancing their neutrality and independence and clarifying the specific recommendation procedures, thereby ensuring their ability to prevent work-related deaths, including karoshi (death from overwork). With five years having passed since the implementation of the Work Style Reform-Related Laws, it is time to evaluate their effectiveness in improving workers’ health management. This symposium addresses current challenges and explores future directions for occupational health activities.

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Work style reform should aim not only to address excessive working hours but also to create workplaces where diverse talent can thrive. While regulations on overtime work limits have shown some effectiveness, the adoption of rest interval systems and enhancement of occupational health services remain limited in small and medium-sized enterprises, leading to health disparities. As work style reforms also increase managerial workload, enhanced collaboration with occupational physicians becomes increasingly important.

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The ‘Enhancement of Occupational Health Physician and Occupational Health Services Functions’ was incorporated as part of the‘ Work Style Reform’ but after five years, no assessment of its outcomes has been publicly released. Given the continuous increase in work-related mental health disorder claims even after the implementation of these measures, it is difficult to conclude that the reforms have been effective. It is presumed that this is due to the lack of outcome indicators set at the time of policy implementation, and the insufficient problem-solving mindset among occupational health professionals.

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This symposium was organized to explore the legal and practical challenges in ensuring adequate disconnection from work, from the perspectives of occupational fatigue research, labor law, and personnel management. Focusing specifically on the “right to disconnect” and “rest intervals between shifts,” the symposium aimed to examine the future direction of working time regulations. This paper presents summaries of the presentations and the subsequent discussion.

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This paper examines both the benefits and challenges of the “work interval system” and the “right to disconnect from work” as emerging countermeasures against overwork in terms of occupational fatigue research. These discussions suggest that the effectiveness of new overwork prevention measures in Japan would be limited without considering the characteristics of local workplaces.

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Among working time regulations in the Labor Standards Act, maximum working hours limits and minimum rest time requirements are the provisions that effectively contribute to worker health protection. Regulations addressing both working time and rest periods are most effective for health protection. This paper proposes revision to rest day regulation and introducing minimum rest period between shifts regulation as approaches strengthen minimum rest time requirements. Regarding the “right to disconnect”, approaches from work-life balance and workplace harassment perspectives should be considered. Workplace-level initiatives are particularly important in this context.

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This study examines how workers define the boundaries of working time by setting aside legal definitions established by labor laws and case law precedents and instead investigating the actual behaviors of workers in the workplace and how they interpret these activities. Based on these findings, recommendations are made for future approaches to working time management.

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Recently, in occupational health practice, it has been recognized that alongside employers’ duty of care, workers’ own responsibility for self-care is important in ensuring mental health in the workplace. This symposium aimed to promote these efforts by both employers and employees through a legal theoretical analysis of the duty of care and self-care obligations, reporting on the mental health care and education approaches outlined in administrative guidelines, and practices in the workplace, followed by discussions involving legal and occupational health professionals.

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This article summarizes the symposium ‘Legal Challenges in Occupational Health for Telework’ held at the 4th Academic Conference of the Japan Association of Occupational Health Law. Human resources professionals, occupational physicians, occupational health nurses, and attorneys participated as symposiasts, each raising issues they consider important in promoting telework. In the latter half of the symposium, specific cases were presented, and countermeasures and challenges were discussed with audience participation. This symposium provided a valuable opportunity to consider ‘new ways of working.’

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Multiple job holding contributes to workers’ income enhancement and career development while serving as an effective means to address labor shortages. However, work hours exceeding statutory limits increase the risk of karoshi (death from overwork), necessitating the continued aggregation of total working hours across multiple jobs. On the other hand, aggregating working hours for overtime pay calculations across multiple jobs presents significant challenges. Consequently, eliminating this aggregation requirement for overtime pay purposes has been proposed, while maintaining it for health management purposes. Based on the Industrial Safety and Health Act provisions, when a worker’s total hours across multiple jobs exceed certain thresholds, the primary employer should be obligated to implement health protection measures. Through multifaceted discussions, the symposium emphasized the importance of working time management and health protection measures in multiple job settings.

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The prohibition of discrimination against persons with disabilities and the mandating of reasonable accommodations are rooted in the goal of realizing an inclusive society where individuals are respected regardless of illness or disability. However, in many workplaces, appropriate accommodations based on the needs of individuals with health conditions are not adequately provided. This suggests an understanding gap exists between these individuals and their workplace. To improve this situation, it is important for individuals with health conditions and their workplaces to deepen mutual understanding through careful, ongoing dialogue. This symposium focused on mental and developmental disabilities, with attorneys supporting affected individuals, employment support professionals from various positions, and physicians sharing their insights and experiences to explore possible solutions.

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This paper provides a concise report of the outcomes from the symposium ‘Legal Issues and Challenges in Supporting the Balance Between Treatment and Work’ held at the 4th Academic Conference of the Japan Association of Occupational Health Law, as compiled by the chairpersons and presenters. Through two cases - one involving physical illness and one involving mental health conditions - this symposium first identified practical challenges in the workplace. From a legal perspective, it discussed the legal basis and scope of ‘accommodations’ and the handling of health information. From a medical perspective, it examined the position of treatment-work balance support within the healthcare system and the practical roles and challenges of medical opinions regarding work accommodations.

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On April 1, 2024 (Reiwa 6), a new legal framework for chemical substance regulation based on autonomous management was introduced. How will the above revision affect the responsibilities of employers? In what cases will businesses be found to have failed in their autonomous management? Taking awareness of the issues in practice as a starting point, we deepened the discussion, taking into account the foreseeability of employers in relation to SDS and the position of experts and workers.

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Regarding responses to employees suspected of having developmental disorders, from an occupational health perspective, attending physicians face limitations in gathering information solely from the employee. Therefore, information sharing and collaboration with occupational physicians are crucial. Occupational physicians are expected to fulfill a mediating role by facilitating dialogue and applying their assessment of pathological factors to implement reasonable workplace accommodations, thereby helping workers better adapt to their jobs. Additionally, implementing trial work periods can be beneficial. From a legal perspective, the court ruling in this case determined that treating symptoms suspected to be related to a developmental disorder as grounds for automatic resignation, rather than as a reason for a leave of absence, constitutes an attempt to circumvent the abuse of dismissal rights doctrine. However, considering the purpose of the leave of absence system, this case should be handled as a dismissal based on a lack of ability or behavioral grounds under the abuse of dismissal rights doctrine after the employee’s reinstatement. Nevertheless, in cases such as this one, where distinguishing between an illness and underlying characteristics is not straightforward, some experts suggest that provisions in work regulations regarding reinstatement requirements should be reconsidered, necessitating further examination in the future.

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This paper aims to examine how return-to-work assessment criteria should be considered using the Sharp NEC Display Solutions case as material, while also analyzing the scope of the judgment in light of the case’s specific characteristics. While the judgment that deemed automatic termination upon completion of the leave period illegal by emphasizing the worker’s illness is theoretically sound, challenges remain from a case-specific perspective. Due to the unique circumstances of this case, the scope of this judgment should be interpreted as extremely limited.

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This paper summarizes key points from the author’s presentation at the Joint Society Symposium 1 (with the Japanese Society of Occupational Mental Health) titled “Analysis of the Sharp NEC Display Solutions Case,” held during the 4th Annual Conference of the Japan Association of Occupational Health Law. The paper examines the scope of the court decision and return-to-work assessment criteria from the three perspectives; (i) the relationship between recovery from mental illness and the risk of relapse/recurrence; (ii) employer discretion in designing leave-of-absence policies; and (iii) the relationship between leave-of-absence systems and the doctrine of abuse of dismissal rights.

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Through analysis of this case, from the perspective of conflict prevention, we examined potential interventions by occupational physicians and occupational health staff, presenting three key points regarding their roles. The three key points are: 1) Assessing illness severity and utilizing this assessment in case management through collaboration with related stakeholders. 2) Acting as an intermediary role in labor-management dialogue regarding case evaluation and reasonable accommodation considerations. 3) Facilitating behavioral changes in workers through interventions based on behavioral science principles.

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In return-to-work cases following mental health-related leave, discrepancies often arise between workplace and treating physician assessments. This discrepancy arises because treating physicians focus on symptom improvement, while workplaces emphasize work capability, leading to conflicting assessments of return-to-work readiness. Therefore, effective return-to-work support requires collaboration between treating physicians and occupational health staff, as well as the establishment of a comprehensive multidisciplinary support system. Particularly in cases where neurodevelopmental disorders are suspected, careful assessment and phased return-to-work support are essential.

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This is the fourth in a series of symposium examining controversial occupational stress factors that courts have either recognized or rejected as excessive workload or illegal. Through multidisciplinary discussion, the symposium analyzed these factors and explored potential solutions. This session examined the Toyota Labor Standards Inspection Office Chief Case （Nagoya High Court decision, September 16, 2021, Nagoya District Court decision, July 29, 2020）, with presentations focusing on workers’ compensation, harassment, and intensive work patterns.

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This report examines 57 cases of overwork-related deaths and suicides （26 cases of cerebro/cardiovascular diseases and 31 cases of mental disorders and suicide known as “Karoshi/Karojisatsu”） among physicians in Japan officially recognized as work-related between 2010 and 2020, along with landmark legal cases that significantly influenced the review of physicians' working conditions. It also highlights key aspects of the work-style reforms for physicians, including the introduction of overtime limits implemented for sustainable healthcare system reform, and discusses expectations for occupational health in medical institutions. A growing number of cases involve young physicians, especially residents, suffering from mental health issues and suicide—reflecting the unsustainable workloads and extended hours imposed on hospital doctors. Since the 1990s, there has been a succession of lawsuits questioning the labor status of physicians and the duty of hospitals to ensure safety and health in the workplace. The growing social awareness of working conditions and the overtime work limits to be implemented in April 2024 represent not only an institutional turning point in addressing physicians' health issues but also a crucial opportunity to reconstruct occupational health systems in medical institutions. It is necessary to develop and revise support systems that reflect the realities of clinical practice.

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The physician work style reforms system implemented in 2024 is expected to address various issues concerning physician overwork in Japan. The promotion of interprofessional collaboration and task shifting/sharing represents one of the key solutions. To achieve successful physician work style reform, it is essential to gain public understanding that reducing physician workload leads to improved healthcare quality, while implementing policy approaches including regional healthcare planning and addressing physician maldistribution.

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This case study examines workplace harassment that occurred among staff members at a long-term care facility. This case addresses multiple issues including harassment prevention, management of mental health problems in workplaces without occupational health staff, and the appropriateness of harassment investigations and disciplinary measures. The harassment victim has taken sick leave due to mental health problems, filed for workers’ compensation, prepared legal action, and has not yet returned to work. The perpetrator has filed a labor tribunal claim following disciplinary dismissal. This case examines how Labor and Social Security Specialists (Shakai Hoken Roumushi) can effectively engage in such cases for prevention, appropriate follow-up measures, and cooperation with occupational health services. The analysis explores legally sound responses considering workers’ compensation, labor tribunal proceedings, and civil litigation.

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This symposium explored collaboration between primary care physicians, who are often the first point of contact for drivers’ health concerns, and occupational physicians in making fitness-for-work determinations in the trucking industry, which faces multiple challenges. The discussion featured attorneys representing both employer and employee perspectives, focusing on determining whether or not a person is able to work in case of sleep apnea syndrome – a condition where symptoms and diagnoses can be ambiguous and require individualized approaches.

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The “Takao Method,” which emphasizes the main principle of the labor contract that “the workplace is a place to work” and requires employees on leave to “return to their original jobs,” is essentially designed to be operated through thorough “dialogue” between labor and management. In this session, prompted by questions from an occupational physician, a lawyer and a Certified Social Insurance and Labor Consultant who advise on the Takao Method, a psychiatrist recently involved in its implementation, and a human resources manager with years of practical experience presented on the authentic application and significance of the Takao Method. The presentation was followed by a discussion incorporating questions and perspectives from the audience.

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Currently, many qualifications are linked to occupational health and safety in Japan, but except for occupational physicians and a limited number of qualified professionals with certain backgrounds, most do not earn sufficient income to live comfortably. To address this issue, reports were presented from occupational safety and health consultants, occupational hygienist, social insurance and labor attorneys, public health nurses, and psychological professionals engaged in occupational health and safety activities. They were asked to share: (1) their experiences of success and failure (2) individual and policy challenges, (3) strategies to overcome these challenges, and (4) the significance of their qualifications and whether those qualifications are essential for occupational health and safety work. In conclusion, while some professions require legal policy support, such as stricter penalties, there were opinions that the development of policies emphasizing autonomous risk management could promote the utilization of specialists. There were also views that self-help efforts are necessary, based on accurately recognizing the characteristics (differentiating elements) of one’s profession, precisely identifying the needs of client companies, and exploring these needs in depth. Additionally, the necessity of collaboration between professions and across regional and occupational boundaries was pointed out.

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This symposium aims to examine, through specific practical examples, how the knowledge gained from this society contributes to improving problem-solving capabilities in occupational health. Through the speakers’ presentations, it was demonstrated that the educational and training activities of this society not only facilitate the acquisition of legal knowledge but also promote interdisciplinary collaboration, enhance the ability to address workplace issues, and contribute to the career advancement of individual professionals.

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The legal knowledge and key points of legal response that independent occupational health professionals should master were discussed with four experts, providing a comprehensive overview. This topic was explored from diverse perspectives: the chairperson of the training committee of this Society for Occupational Health and Law, the director of research on roles and competencies required of occupational health nurses, a currently active professional with long experience as an independent occupational health nurse, and a lawyer who has interviewed independent occupational health professionals. Through this discussion, ‘Six Legal Areas Faced by Independent Occupational Health Professionals were identified.’

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The first report introduced the actual situation of damage during natural disasters and during recovery and reconstruction phases, using the Noto Peninsula earthquake as an example. In addition, the role that occupational health staff should play in preventing and mitigating damage caused by natural disasters was clarified according to each stage: during the disaster occurrence, recovery, and reconstruction. The second report, using labor court cases as material, identified legal measures to prevent and mitigate damage caused by natural disasters (e.g., the duty of care for safety), and explained the challenges in proving the foreseeability of disasters. Furthermore, when considering the issue of compensation for damages caused by natural disasters, the report highlighted the challenge of proving a causal relationship between natural disasters and the development of mental illness.

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Workers are exposed to various safety and health risks in the event of natural disasters. This report examines preventive measures to mitigate health hazards and the duty of care to ensure worker safety. The report also highlights the importance and limitations of preventive measures before disasters occur. Furthermore, it proposes establishing the right to refuse to work or evacuate as autonomous rights of workers. Regarding workers’ compensation after disasters, while there is a trend toward more flexible application of the system, the report highlights the challenges of proving a causal relationship between natural disasters and mental disorders. It also addresses the difficulties in compensating workers engaged in restoration and reconstruction work who were not directly affected by the disaster.

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This paper examines the impact of Industry 4.0 (I4.0) technological innovations on occupational health and safety (OHS) and explores appropriate regulatory approaches based on a literature review. While I4.0, with its introduction of autonomous robots powered by AI, is expected to improve operational efficiency and reduce risks, it also brings new risks—especially psychosocial risks—and regulatory challenges. Under I4.0, traditional rules are insufficient as regulations struggle to keep pace with technological evolution. A co-regulation framework is needed, where programmers and manufacturers are entrusted with risk management responsibilities. Additionally, health monitoring through wearable technologies, risk prediction using big data, and appropriate—not merely reinforced—data management to safeguard privacy are critical requirements. In conclusion, OHS regulations should be preventive and flexible, balancing the need to avoid hindering technological development while fully leveraging the benefits of new technologies. This requires establishing guidelines and safety nets that facilitate innovation. It is also necessary to adopt and enforce the principle of assigning risk management responsibilities to those capable of predicting and managing risks (broadly defined risk creators). This principle extends risk prevention responsibilities to designers, manufacturers, platforms, and clients commissioning work in part. Notably, clients should ensure that contractors have the capacity to perform work safely and sustainably. Finally, addressing psychosocial risks requires an approach that emphasizes compatibility between individuals and organizations, as well as alignment of skills and values.

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In conjunction with the government’s work style reform policies, seafarers’ health management measures have been introduced, including the implementation of occupational physicians. From the perspectives of various experts, this report discusses: 1. Health problems and karoshi (death from overwork) among seafarers, 2. Seafarer health in Ishinomaki, Miyagi Prefecture, where there is a large seafarer population, 3. The current state of occupational physicians for seafarers following amendments to the Seafarers Act, 4. The actual conditions of occupational physicians for seafarers, and 5. A proposal for the “Kasaoka Model” program for small and medium-sized shipping companies.

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Over the past half-century, the annual number of deaths in Japan has consistently increased, and further growth is anticipated in the future. While the forms of mourning for the deceased are highly dependent on regional culture and folk customs of the residents, it is believed that the scale of Japan's funeral industry and the number of people engaged in it will continue to show an increasing trend due to the rise in the number of deaths. With the advent of a mass-death society, the number of workers engaged in duties involving corpse handling and interaction with bereaved families is expected to increase. Regarding occupational safety and health in the funeral industry, which lacks a notification and approval system, it is crucial to address issues concerning infection control measures. The industry also faces challenges such as insufficient refrigeration facilities in mortuaries, and awareness of dry ice handling and ventilation. Together with heavy lifting and transportation, chemical substance exposure, mental health measures, and other concerns, this study extracts various occupational health challenges specific to the funeral industry as suggested by the overview of a nationwide survey conducted by a Ministry of Health, Labour and Welfare research group, and presents directions toward the development of standard guidelines focusing particularly on infection control and indoor environment measures.

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Workers in the funeral service industry face many health and safety risks. This paper reviews occupational health and safety policies in the funeral service industry in Japan and the United States. Although neither country has a law that specifically covers the funeral service industry, the United States has established an education and licensing system for funeral directors and other professionals, and states and private organizations are working to ensure OSHA compliance. In Japan, it is important to recognize funeral service workers as essential workers and to implement occupational safety and health measures for them.

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