The outbreak of a pandemic of novel coronavirus infection (COVID-19) in Japan (hereafter referred to as the “coronavirus pandemic”) began in early 2020 and lasted for more than three years when it was classified as a ‘category 5 disease’ on May 8, 2023. Looking back over the past three years, various delays have been revealed in public health activities and in clinical, epidemiological, and basic research during emergencies in Japan. In the future, it will be important to establish and operate a research system for both normal times and emergencies. It is essential to secure surge capacity by training personnel during normal times and mobilizing them in an emergency. 　The National Institutes of Health Crisis Management (Kokuritsu Kenko-kikikanri Kenkyu-kikou ), so-called　Japan CDC, should be equipped with researchers in public and environmental health, epidemiology, behavioral　science, medical statistics, informatics, and health economics and communication, as well as researchers　in disaster medicine, medical and risk management, and risk management to conduct basic, clinical, epidemiological, and public health research and practice to deal with all hazards, with a focus on infectious diseases.　 The author participated in the research to clarify the long-term impact of coronavirus infection on medical care, including other diseases from the perspective of future measures against emerging infectious diseases. The survey was conducted in Yao City, Osaka Prefecture, Shinagawa Ward, Tokyo, and Sapporo City, Hokkaido, targeting 195,000 citizens aged 5-79 years, and received responses from over 53,000 people (valid response rate: 27.4%). The mean age was 45 for adults and 10 for children, with a male-to-female ratio of 4:6and 1:1, respectively. Among adults, 12% to 23% (waves 1-6: 23%, 4-6: 15%, 7: 12%) had lasting symptoms afterCOVID-19, which was 2 to 3 times higher than the 4% to 9% (waves 1-6: 9%, 4-6: 4%, 7: 6%) of uninfected persons who had similar symptoms for more than 2 months during the same period. Among children, 6% of infected persons (6% in both waves 1-7 and 4-6) had post-illness symptoms, 2 to 3 times higher than the 2% to 3% (waves1-7: 3%, 4-6: 2%) of uninfected persons who had similar symptoms for more than 2 months during the same period. These results are in general agreement with those reported from overseas.　 The Cabinet Agency for Infectious Disease Crisis Management and the National Institutes of Health Crisis Management were legislated to deal with possible large-scale health crises in the future, but the establishment and operation of these organizations are still an issue to be addressed. In particular, regarding the use of information during emergencies, it is necessary to proceed with the construction of a system, including the enactment of separate laws for the use of personal information during emergencies.

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Objectives　 This study applies the cross-sectional data of young carers in Japan and the international PANOC-YC20instrument to examine the relationship between family caregiving roles and the subjective cognitive and emotional responses of caring (both positive and negative) of young carers. We also compare our results with those of existing studies in European countries. Methods　 We conducted an internet survey of 816 young carers throughout Japan. The analysis used PANOC-YC20to calculate the positive and negative response scores in order to examine their relationships to caregiving, respectively. We classified young carers into general and high-risk groups based on those scores. In the analysis, we first tested the differences in the means of response scores for each dimension of family caring roles, and then applied OLS and Probit models to examine the relationship between the caregiving roles and the response scores, as well as the probability of being classified into the high-risk group. Results　 The average positive and negative response scores were 8.805 and 5.382 points, respectively, among the young carers. Based on these scores, 18.6% of young carers were in the high-risk group. According to the OLS analysis, we found significant changes in the response scores corresponding to the subject of care (care recipient), the burden of caregiving, external support utilization, the family’s economic situation, and the friendships of young carers. We also found significant changes in the probability of young carers being classified into the high-risk group depending on the subject of care and the family’s economic situation. Conclusion　 Based on the results of this study, we observed significant changes in both positive and negative responses of young carers depending on the burden of care and external support utilization. Furthermore, the family’economic situation and caregivers’ friendships also mattered in changes in their responses. However, manner of these changes differed when compared to those of previous studies in European countries. Based on the characteristics of the circumstances surrounding young carers in Japan, it is essential to explore ways of support that meet the actual needs of young carers and their families as social recognition and social support for young carers progress in the future.

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　The purpose of this paper is twofold. First, to determine the impact of the average daily walking time of the elderly on their health, taking into account reverse causality (endogeneity), and second, to discuss the policy implications of the obtained results from two perspectives: health policy and urban policy.　 The subjects were 10,058 elderly men and 10,601 women aged 65 years or older not certified for long term care who participated in the Health and Life Survey conducted by the Japan Gerontological Evaluation Study (JAGES) in 2019. The explained variable was the health-related quality of life score calculated from the EQ-5D-5L. To address endogeneity, analyses were conducted by using instrumental variables method. The instrumental variable was the number of parks and sidewalks suitable for exercise and walking within walking distance (roughly within 1 km). The results showed that when the average walking time increased by30 minutes, the health-related quality of life score increased by 0.124 (0.022) points for men and 0.160 (0.032)points for women. Taking these results into account the Minimum Clinically Important Difference (MID) score difference as a health status, we estimated the additional walking time to raise the health status by one step for each gender. We also estimated the impact of the additional walking time that raises the health status by one step on annual medical costs. The results of this study can also be interpreted as the impact on the health of the elderly, whose walking time increases as parks and sidewalks are improved and increase in number. It is expected that the results will be used as a guide for walking time in urban policies that take health into consideration, and will also be used in future health economic evaluations.

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