In 2025, we will face not only economic issues, with social security finances coming under increasing pressure, but also a greater problem in the anticipated shortages of staffing and material in the medical, nursing, and public health communities. Specifically, the construction of a new public health and welfare system that encompasses everything from disease prevention through caregiver services and that can therefore support an elderly society will be a central theme of 2025. Because the composition of the Japanese population will be transfigured by its increasing age, the issues that will be confronted in the area of public health and welfare, which are practical and not academic fields, will change considerably in response. It will therefore be essential to adopt approaches that are fundamentally different from those that have been adopted in the past when we formulate measures to combat threats to public health such as dementia, cancer, frailty and sarcopenia, and lifestyle diseases.

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The Japanese population is set to continue aging at an accelerated pace, which will result in increasing shortages of preventive and therapeutic medical care and nursing goods and services.Seven years have passed since the introduction of the "Specific Health Checkups and Specific Health Guidance" system that was established as a measure to prevent lifestyle diseases. Whether or not the effectiveness of the health guidance provided under this system has been sustained was evaluated over time in local residents. It was found that the effectiveness of the health guidance persisted significantly over 6 years."The construction of an integrated system" will be important to the effort to provide preventive health care services in the future. Two good examples of such a system are described below. Through the year 2025, Saitama prefecture will see the highest percentage increase in the nation in the number of its citizens 75 years or more years of age. Saitama decided to place a special emphasis on diabetic nephritis, and in October 2014 launched an initiative to prevent diabetic nephritis from becoming serious. Saitama's system, which closely integrates preventive and therapeutic health care services, is functioning well. This is the only prefectural-level initiative that has been launched to date in Japan, and it is hoped that its methodology will spread in the future. Meanwhile, the town of Kora in Shiga prefecture has been conducting preventive health care activities that are intended to minimize the number of new patients requiring dialysis. A key feature of these activities is close cooperation between primary care physician and specialists, with government public health nurses acting as a bridge to facilitate said cooperation.The sharing of useful information and the formation of relationships of trust among local health care stakeholders, and the construction of a truly integrated system, will be urgently needed in the future.

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The baby boomer generation will enter the 75 and over age group in 2025. This demographic change, accompanied by the transformation of Japanese family structure, will drastically increase people's needs for health and social care while diminish financial resources available for them. This situation is called "the year 2025 problem." To tackle the year 2025 problem, it is necessary to construct an efficient care system. To realize this, Japanese national government has encouraged local governments to build a community-based integrated care system that is based on multidisciplinary and cross-sectoral collaboration. Nonetheless, the approaches for building such an integrated care system vary across regions and communities, and are somewhat chaotic. It is necessary to identify the phase of system building in which each of the approaches and efforts are, is placed, and then to organize the problems and tasks for the project based on multidisciplinary and cross-sectoral collaboration. Therefore, this report outlines the framework for each phase of the process of building a community-based integrated care system by local governments. Subsequently, using results of a survey of local governments, the present situation and problems in building a system based on this framework are identified. Further, in light of the importance of internalizing an outcome evaluation structure for building this system, the challenges Japan presently faces are discussed by referring to the international developments in the evaluation of care. Finally, a plan of action is proposed for the next five years in order to solve the challenges identified in this report.

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Health inequalities in the individual and regional level becomes even greater health issue in 2025. Public health nursing personnel need to be fostered over the next 5 years in order to equip them to deal with it. This paper discusses the approaches to do the same in light of current conditions and issues.By 2025, public health nursing should fulfill 3 roles: (1) increasing the health literacy of individuals; (2) producing "facilitators" to promote self-help and mutual assistance in the community, based on the concept of health promotion; and (3) creating frameworks to support systems, e.g., creating and implementing care systems in the community.Two approaches are proposed for fostering public health nursing personnel over the next 5 years: to develop practical proficiency, and to foster leaders in public health nursing. Public health nursing will in turn develop through practices based on evidence, systemic thinking, introspection, community empowerment, and collaboration among different professions.Personnel can be fostered by helping them gain proficiency (practical knowledge), establishing systems for on-the-job training, coordination with universities, and supporting public health nurses at public health centers to meet the expectations of local municipalities. Methodologies for fostering personnel need to be established so that they can attain the required level of proficiency.

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"Residence," in the context of the community-based integrated care system, has been likened to a flowerpot that is needed to grow a plant, which, in this case, "medical care", "long-term care" and "living support and preventive care". For the promotion of a community-based integrated care system, " suitable residence that has been established as the foundation of life, where the elderly people can live within one's hope and means" is a prerequisite.However, there is no sufficient discussion on how to establish residences for the elderly. Although the home ownership rate of the elderly is more than 80%, the construction of housing for the elderly with life support services is the only specific senior housing policy. Therefore, it is necessary to discuss how the elderly live at home.There are different types of residences for the elderly, from homes to senior facilities. With the promotion of home care and medical services, the functions and roles of residences for the elderly have changed. Until now, housing has been viewed in terms of a personal space. However, there has been an increase in the population of elderly people living with the help of external services, such as long-term care services. Therefore, it is necessary to allow outsiders to enter the residence to provide services, or to restrict the time to receive such services. In order to promote home care and end-of-life care, it is necessary to study and verify the functions of housing, as it would differ from those of conventional housing.While the maintenance of housing is important, there are some problems in the "life style" of the elderly. The authors' observation on sole households of the late elderly revealed, issues concerning the living environment, such as narrowing of the daily living space, leaving a bed unmade, the use of portable toilets at night, and ensuring warmth by layering clothing due to the non-use of heating appliance. One aspect of support and care for them is to prvide them the "power to develop their own living environment," which would help the elderly be self-reliant. Consequently, awareness and support regarding "how to live" is necessary for the elderly.

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In Japan, about 30% of the population is expected to comprise of elderly people by 2025. Therefore, there is a sense of anxiety regarding the rapid increase in social security expenditure, such as on care and medical costs. As a part of governmental efforts to cope with such a phenomenon, we are structuring community-based integrated care systems. This counterplan aims to provide integrated care systems with collaboration among occupations and organizations. However, such integration is viewed differently.This paper aimed to understand the issue of gintegration h in structuring community-based integrated care systems and to suggest measures to promote the same. Findings revealed that it is important to structure community-based care systems integrated to the level of coordination which is second stage of integration. It was concluded that, to solve the issue, it was necessary to 1) clarify confusions and provide appropriate information, 2) develop methods to promote coordination in the integrated-level community-based care systems, and 3) develop requisite human resources.

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In the symposium "The role of public health in solving the 2025 problem: A symposium by the National Institute of Public Health (NIPH)," at the 74th Annual Meeting of the Japanese Society of Public Health, three topics were discussed by five speakers and an audience of more than 100 participants after the presentations.Regarding the first topic, "What other problem could surface by 2025?", opinions such as the shortage of human resources for healthcare and long-term care, and the increase of disparity among local governments were expressed.With regard to the second topic, "What should be done by the government and/or health care professionals?", opinions such as actions for integrated social inclusion, integration of several sets of individual health data along the life course, and understanding the awareness of lay people about the ageing society were reported.In terms of the last topic, "What is the role of NIPH in solving the problems?", options such as the development of evaluation indicators that would be useful for healthcare/long-term care activities on the frontline, the execution of research that directs the long-term policy perspectives, and human resource development in various settings were pointed out.After the annual meeting, the research plan for the next ten years was discussed by the speakers and chairpersons. A study on managing the PDCA(Plan, Do, Check, and Act) cycle in inter-sectoral and integrated care services in the community was proposed as a research topic of common interest.

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Purpose: In recent years, in response to the chronicity of disease or injury, a paradigm shift from the conventional "cure-seeking medical care" to "care-seeking medical care" has been desired in the health care system of Japan. Trauma is viewed as a condition that requires "care-seeking medical care" with reference to tertiary prevention, that is, prevention of deterioration of the functional, psychological and social quality of life (QOL) in patients with sequelae or disabilities. Epidemiological evidence in regard to prevention is important as the scientific basis for the formulation of disability welfare policies, but is still severely lacking in Japan. In this study, an opinion survey was conducted aimed at exploring the means for building epidemiological evidence for the prevention of trauma, including traumatic brain injury (TBI), from the viewpoint of the promotion of welfare policies for disabled persons.Methods: An opinion survey (questionnaire and interview) was carried out regarding a collaborative database project (DBP) for the long-term follow-up of trauma patients. Answers obtained from 29 trauma healthcare professionals (physicians: 93.1%) were analyzed.Results and Discussion: Most of the responders answered that a collaborative DBP for the long-term follow up of trauma patients would be meaningful (87.5%). In addition, many opinions indicating concrete and urgent problems, such as "therapeutic limits have been reached due to the rapid increase in the number of elderly patients with TBI from non-traffic accidents" in the field of neurosurgery, "longterm outcome and evaluation of initial treatment from the point of view of a patient's ability to reintegrate into society," "frequency of higher brain dysfunction after TBI and neurological prognosis," "cooperative network for trauma care" and "post traumatic stress disorder (PTSD)." Therefore, it was considered appropriate and reasonable to start the project on TBI, to be used as a model of a collaborative DBP for the long-term follow up of trauma patients. To proceed with the construction of the "collaborative DBP for the long-term follow up of trauma patients (e.g., TBI)" in the future, the following comments made by the participants in the free-entry column appear to be important to keep in mind: "co-management with a regional cooperation system," "link to existing DB [e.g., Japan Trauma Data Bank (JTDB), Japan Neurotrauma Data Bank (JNTDB) ]," "recommendations for the prevention of TBI in the society and the necessity for the development of countermeasures" and "large-scale DBs for other conditions, such as chronic diseases."Significance of the study: The significance of the present study lies in the fact that a necessary preliminary survey has been conducted, aimed at the realization of a paradigm shift from "providercentered care" to "patient-centered and value-based care," with reference to the promotion of development of disability welfare policies.

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Objective: Hemodialysis usually uses a water treatment system (hereinafter referred to as "RO system") for producing water for hemodialysis from tap water or ground water. This report makes clear the behavior of removing radioactive substances in a RO system which measures the concentration of radioactive substances from the equipped filter(s) in a RO system and from RO treated water, after the Great East Japan Earthquake, the Fukushima Daiichi nuclear power plant disaster of the Tokyo Electric Power Corporation.Method: To measure the concentration of radioactive substances of filters in a first generation RO system (RO membrane is one-step type) used one year from the nuclear accident and in the third generation RO system (RO membrane is two-step type) and treated water after the nuclear accident. Measurement period of the first generation type was one time at the disposal of filters and the third generation type was four times in every three months (one year one month). During the period, it is April, 2013 from March, 2012.Results: Radioactive cesium was detected in all pre-filters and RO membranes of first generation and third generation. However, from the second stage RO membrane of the third generation RO system radioactive substances were not detected, and also from the RO treated water radioactive substances were not detected.Conclusion: RO system could remove radioactive substances by equipped filters and radioactive substances were remove in treated water used for hemodialysis.

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Objective: We modeled the flow from patients occur util hospitalized for evaluating the nighttime secondary emergency system using an agent based approach. Additionally, from scenario analysis, we analyzed that how nighttime hospital scheduling influence on the transport time of emergency patients and the number of patients transported to medical institutions.Methods: We developed a model using Agent Based Modeling and validated it adopting the nighttime rotation system in multiple scenarios, to demonstrate the utility of the model in the real world.Results: (1) In areas that assumes the rural area, the number of emergency patients transported to the main hospital in this area were large whether the nighttime rotation system is used or not. Additionally, hospitals which are located in the populous region can be reduced the burden by adopting the nighttime rotation system though the number of doctors who are on night duty is not so big. (2) In areas that assumes the urban area, the number of emergency patients transported to hospitals which have a large number of doctors who are on night duty is large if the area do not use the nighttime rotation system. Otherwise, if the area use the nighttime rotation system, the burden of hospitals which accepted a large number of emergency patients without enough doctors became small. (3) In areas that assumes the depopulated region, emergency patients were transported to all of the medial institutions whether the area used the nighttime rotation system or not. Compare with result(1) and (2), we found that when an area adopts the nighttime rotation system, transportation time of emergency patients will be shorten in result(1) and (2), but not in result(3). (4) From result(3) , there is no big advantage of using the nighttime rotation system. So, we improve the nighttime rotation system and confirm the advantage of using the nighttime rotation system.Conclusions: In this study, we demonstrated the utility of the model we developed. In future, it is important to enhance the validity of the model. To do this, it is difficult to validate only by public data, open data reported data and so on. We think it is necessary to ask medical experts for their opinion and collaboration about our model to improve and validate.

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