In Japan, the public health center (Hokenjo) has greatly contributed, as the frontline authority of public health, to improve the health of local residents since 1937. The National Institute of Public Health (NIPH) has also continuously implemented education and training of Hokenjo personnel. This paper outlines the activities performed by Hokenjo, and describes how the NIPH will contribute to Hokenjo and the public health system of Japan.

The Community Health Act established in 1994, which is an amendment of the Public Health Center Act of 1947, has formed the framework for municipalities to provide public health services that affect the daily lives of local residents and the Hokenjo provide broad-based public health services, public health services requiring specialized technologies, and services requiring collaboration of various healthcare professionals.

The Hokenjo is established by local governments, which include prefectures, designated cities, core cities, special wards in Tokyo Prefecture, etc. As of April 1, 2019, the number of Hokenjo is 359 in 47 prefectures and 113 in 107 cities and special wards, a total of 472. The number has continued to decrease gradually and was almost halved during the past 30 years.

Hokenjo performs a wide range of services related to the health of local residents, from personal health services to environmental health services, including vital statistics, nutrition improvement and food sanitation, environmental sanitation, medical and pharmaceutical affairs, public health nursing, public medical services, maternal and child health and health for the elderly, dental health, mental health, medical care and social support for patients with intractable/rare diseases, the prevention of HIV/AIDS, tuberculosis, sexually transmitted diseases, and other infectious diseases, hygiene inspections and examination, etc. In addition, since 1994, Hokenjo has been providing new services, including healthy community development, public health services requiring specialized technologies, collection, proper organization, and utilization of information, survey and research, support for municipalities (in the case of Hokenjo in prefectures), health crisis management, planning and coordinating. The function of health crisis management in particular was significantly developed.

The personnel at Hokenjo consist mainly of the public health center director, medical doctors, dentists, pharmacists, veterinarians, public health nurses, midwives, nurses, clinical radiologic technologists, clinical laboratory technologists, registered dietitians, dietitians, dental hygienists, statisticians, etc. The number of Hokenjo personnel dereased from 34,680 in 1989 to 27,902 in 2017. Although the number of public health nurses, pharmacists, veterinarians, and registered dietitians have increased slightly, the number of medical doctors, including public health center directors, has been decreasing.

The main education and training programs that the NIPH provides for Hokenjo personnel are “professional education program” and “short-term training program.” As for the former, the 3-month course to educate candidates of public health center directors has produced approximately 20 graduates who have the highquality competency suitable for public health center director every year, even while the numbers of Hokenjo and medical doctors in Hokenjo have been decreasing. Furthermore, in the short-term training programs with a duration of 2 to 28 days intended to have trainees acquire the latest knowledge and skills in public health practice, the NIPH has quickly responded to newly emerging health issues including health crisis management and various needs of local governments, has planned and conducted high-quality programs suitable for them, and has developed many relevant human resources, 　

View PDF for the rest of the abstract.

View full abstract

Japan has experienced a dramatic decrease in the age-adjusted mortality rate from cerebrovascular disease, which previously was exceptionally high in the world. Such a dramatic change is thought to be due to changes in Japanese lifestyles, controlling of risk factors especially hypertension, and improvements in the medical care quality. These favorable changes have been further promoted since a series of National Health Promotion Measures began in 1978. Since then, the plan has been revised approximately every 10 years according to PDCA cycles. The first National Health Promotion Measures focused on implementation of health checkups, the establishment of municipal health centers, and the securing of manpower. The second National Health Promotion Measures called “Active 80 Health Plan” aimed to ensure that the people at the age of 80 could take care of themselves and participate in social activities, and was focused on physical exercise. The third National Health Promotion Measures, called “Health Japan 21” and started in fiscal year 2000, set numerical targets for 70 items in 9 fields (later increased to 80 items, including duplicated items) concerning lifestyle-related diseases and the improvement of lifestyles.

Based on the issues revealed in the evaluation of Health Japan 21 and subsequent discussion, the fourth National Health Promotion Measures called “Health Japan 21 (the second term)” covered new areas including the reduction of health disparities and improvement of the social environment. The midterm evaluation in 2018 showed that the extension of healthy life expectancy and reduction of health disparities that were the overall goals had improved significantly. However, there were several indicators that were unchanged or became worse. Issues to be prioritized in order to achieve the final evaluation target in 2022 were identified.

View full abstract

Natural disasters have increased in recent years. Although a physical infrastructure is important to reduce disaster damage, it has its limits. It has been pointed out that attention should be paid to the social infrastructure. In this paper, we focus on social capital, which is attracting attention as a social infrastructure that is one of the social determinants of health, and give an overview of its impact on disaster-affected areas. Various studies have shown that a region with rich social capital recovers its social and physical environment, including local infrastructure, community and individual health, faster. Social support, social participation, and informal social controls provided by social capital also improve disaster preparedness and resilience of individuals and the community before a disaster occurs. However, social capital also has a negative side. While paying attention to the negative aspects, the creation of social capital during normal times will contribute to disaster mitigation.

View full abstract

Universal health coverage (UHC) is the core driver of SDG 3. However, UHC cannot be attained unless health services are accessible, affordable and acceptable and financial risk protection systems are in place.

Currently, there are few mutual learning platforms to share experiences and exchange ideas or best practices among countries tackling similar challenges on the pathway to UHC. At the same time, there are significant lessons from the various aspects of Japan's experience in achieving and maintaining UHC that are of growing interest globally. In this paper, we analyze the contribution of the National Institute of Public Health (NIPH) in supporting UHC around the world through the annual training course supported by the Japan International Cooperation Agency (JICA), “Strengthening social health protection towards UHC.” We present lessons learned from this training course over the past few years and discuss what works for whom under what context to make progress towards UHC.

The course participants learned about Japan's experiences in establishing and maintaining UHC and presented their own proposal (Discussion Notes) for implementing solutions to move forward to achieve UHC in their context. We hope that they will be able to contribute to the strengthening of social health protection to achieve UHC in all of their countries.

View full abstract

Efforts to improve the management of medical incidents have derived from two main perspectives, namely, the promotion of patient safety and quality improvement, and the strategic management of organizational crisis. These two streams have produced different sets of policies and endeavors, although they are sometimes closely interrelated and supplementary. Around the turn of the century, promotion of medical safety came to focus mainly on systemic failures, institutional learning, risk communication, and a safety culture, which resulted in a shift away from risk management toward safety management, and then from safety management to a safety culture and (service/ treatment) quality management.

Although a crisis management perspective has thus moved away from being the central topic of public policy, its importance undoubtedly remains. With increased expectations of medical services, as well as lawsuits, effective management of health crises is called for, more than ever, and healthcare organizations and professionals should be sufficiently prepared to address these events. Depending on the phase of a crisis (i.e., before, during. and after a crisis), a set of actions is required, along with advanced planning and coordination. Basic principles for risk and crisis management should be applied to the management of medical incidents, which in turn improves patient safety. In addition, communications play a key part in this regard. Advance plans (for preparation, response, and recovery) are especially imperative, aside from efforts to prevent medical incidents.

This article first presents the basic components of crisis management, along with the promotion of patient safety, with a focus on communications. It then introduces recent policies regarding safety promotion, as well as efforts to manage the crises caused by medical incidents in Japan.

View full abstract

Japan has adopted the universal health insurance system, in which a detailed, single list of fee points is used to evaluate every claim, regardless of type of insurance. The great success of “Rececom” (i.e., an abbreviation for “receipt computer”) in managing electronic medical claims, which was developed ahead of the world, may also have represented a significant factor in hindering the spread of electronic medical records systems in the personal computer era. Over time, departmental information systems became linked to computerized provider order entry systems, and data exchange over networks became practical. Nevertheless, interoperability between medical information systems became a problem that was impossible to ignore. In the 1980s, a non-profit organization, HL7 International, was established in the United States to create and disseminate international standards for medical information systems. Subsequently, the Japanese Association of Healthcare Information Systems Industry (JAHIS) was established in 1994, and the Association for Medical Informatics and JAHIS founded the HL7 Japan in 1998. JAHIS and HL7 Japan have since led the development of medical information standards in Japan. In 2001, the Healthcare Information System Review Committee announced a “Grand Design for computerization in the medical field,” and MHLW promoted the spread of electronic medical record systems and the development of medical information standards. HELICS, which is an incorporated association of academic societies and industries involved in the provision of health information, was established in 2007. HELICS evaluates proposal to determine whether they should be accepted as proposals for the national standards in Japan. Specific health checkups and specific health guidance are an initiative unique to Japan, drawing worldwide attention as a measure to counter lifestyle-related diseases that are increasing in developed countries. The HL7 CDA document specification is available regarding specific health checkups, and checkup institutions must create and submit checkup reports that conform to the defined specification. The Pharmaceuticals and Medical Devices Agency (PMDA) has three responsibilities: “Relief Service for Adverse Health Effects,” “Review,” and “Post-marketing Safety Measures.” To achieve efficient review and cross-sectional analysis, PMDA requires clinical trial data to be submitted in accordance with the Clinical Data Interchange Standards Consortium (CDISC) standard. Consistent with HELICS proposals, standardization will be promoted principally in accordance with HL7 V2.x and CDA. In addition, the Fast Healthcare Interoperability Resources may be used to develop new medical applications in areas not profiled in these HL7 2.x and CDA related standards in Japan.

View full abstract

The law for environmental health in buildings (LEHB) was enacted in1970. It was believed that sick building syndrome could be prevented by LEHB in the1970's. The recent studies showed that the rate of sick building syndrome in offices is not low. One of the factors in this nonconformity rate of indoor air environment is thought to be energy saving in buildings since the 1990's. In this report, the authors showed the state of indoor air environment in specific buildings and the characteristics of the inspection of these buildings by the health centers of local governments. The results showed that though the owner of specific buildings are obligated to follow the law of environmental health in buildings, the nonconformity rates with indoor air environment are increasing and the risk of sick building syndrome may also be increasing. It is clear that some improvement must be done as soon as possible to avoid an architectural health crisis such as sick building syndrome and indoor infections like influenza, etc

View full abstract

Objectives: To analyze the current status of smoking cessation promoted by dental clinics in Japan and to investigate the issues faced in promoting tobacco control measures through interprofessional collaboration.

Methods: A questionnaire survey on smoking cessation was conducted from October to November 2018. Of the 1,020 dental clinics that were sent the questionnaire, 406 responded (response rate: 40.0%). Of these, the 400 valid responses were included in the analysis set. The analysis consisted of basic tabulation and bivariate and multivariate analyses based on the status of collaboration. The significance level was set to below 5%.

Results: 91.5% of the respondents be aware of the current smoking status of patients, and 69.8% had performed examinations for smoking cessation during treatment for periodontal disease. 46.3% of them responded that there are problems with supporting smoking cessation, and that the most common problem (67.0%) was “smoking cessation is not included in the reimbursement of medical fees”. Meanwhile, 30.8% of the dental clinics were not doing anything in particular regarding education on smoking cessation, and 34.6% of those admitted to having problems with promoting cessation, stating the reason to be “inadequate smoking cessation skills.” Only 11.8% were promoting smoking cessation in collaboration with areas other than dentistry, while 91.5% were enforcing outpatient visits for smoking cessation treatment as well as collaborating with physicians.

Conclusions: The findings suggested that only a few dental clinics are supporting smoking cessation in collaboration with areas other than dentistry. They also demonstrated the need for education for dental healthcare personnel to improve their skills related to smoking cessation efforts.

View full abstract