In this article, the history of the development and the current status and issues of the Health, Labour and Welfare Sciences Research Grants (HLWSRG) under the jurisdiction of the Ministry of Health, Labour and Welfare (MHLW), which supports health research policies and systems in Japan, are reviewed, and its future direction is also discussed.

The HLWSRG was initiated in 1951. The objectives of the HLWSRG are to ensure the science-based promotion of policies and to improve the technological level related to health and medical care, welfare, environmental sanitation, and occupational safety and health in Japan. The HLWSRG especially promotes “mission-oriented research” that can solve various problems by utilizing evidence obtained from research for the policies of the MHLW and by monitoring and evaluating the results of the policies through research.

Since the enactment of the Healthcare Policy in 2014 and the foundation of the Japan Agency for Medical Research and Development (AMED) in 2015, previous researches implemented by the HLWSRG were categorized into “policy research” and “practical research.” Policy research under the jurisdiction of the HLWSRG is aimed to conduct studies to establish scientific evidence for policymaking, studies on the promotion and assessment of policies, and the technological development of products other than drugs and medical devices, whereas practical research under the jurisdiction of AMED is aimed to elucidate pathogenesis and pathophysiology and to develop innovative diagnostic and treatment methods.

The HLWSRG consists of 27 research programs including medical ICT and artificial intelligence, global health, children, youth and families, cancer, cardiovascular diseases and diabetes mellitus, rare and intractable diseases, dementia, infectious diseases, occupational safety and health, food safety, regulatory science, health security control, etc. In FY2019, the budget of the HLWSRG was 8.90 billion yen, and the number of research projects was 644.

Each program is managed by the division of the MHLW that is in charge of the relevant policy. This enables the promotion of mission-oriented research, in which each division conducts its own research program to solve the problems identified in policy planning and implementation and utilizes the evidence obtained from the program for policymaking. On the other hands, the Health Sciences Council, which is an advisory body for the promotion of health research, and the Health Sciences Division of the MHLW, which carries out the comprehensive planning and coordination of health research, are established to improve the system of promoting the HLWSRG as a whole.

Japan has achieved universal health coverage in 1961. Although Japan's medical human resources are becoming sufficient in terms of quantity, there is a need to address the uneven distribution and to improve the quality of human resources. In recent years, there has been renewed interest in the role of public health personnel in responding to health crises such as disasters and emerging infectious diseases including the COVID-19 infection. Countries need to consider to build a tight network between public health and the healthcare delivery system, and also to establish a dual track health system utilizing limited human resources while maintaining normal medical care in response to medical emergencies.

Advancing medical technologies is one of the main reasons to increase medical expenditure. One possible way to consider efficiency is to evaluate cost effectiveness of medical technologies and make decisions upon the results. It is often described as health technology assessment, HTA. In Japan, introduction of HTA system was discussed since 2010. After 10 years of discussion, a new HTA system was established in 2019.

In the new HTA system, the manufacturer must submit the data first. The submitted analysis is reviewed and reanalyzed by academic analysis groups and is finalized by Center for Outcomes Research and Economic Evaluation for Health(C2H) at the National Institute of Public Health. Based on the manufacturer's submission and the C2H public analysis, the Expert Committee on Cost-Effectiveness Evaluation at the Central Social Insurance Medical Council (CSIMC) examines the scientific quality of the analysis and determines the most likely incremental cost effectiveness ratio (ICER) figure or range for the product in the appraisal process.

The target drugs and medical devices are principally selected when they are newly listed at the general assembly of CSIMC based on the predetermined selection criteria. The results of the evaluation will be used for reimbursement price adjustment, not for coverage decision. When ICER exceeds 5 million JPY per QALY, the price will be adjusted. For some diseases, such as rare or pediatric diseases and cancer, 7.5 million JPY per QALY will be used as threshold for price adjustment.

In order to implement full scale cost effectiveness evaluation, a new unit, “Center for Outcomes Research and Economic Evaluation for Health”, was established in 2018 at the National Institute of Public Health.

Using published literature, we described the historical transition of the contribution of the National Institute of Public Health (NIPH) to nutrition policies in Japan. We traced changes across five eras: 1) before World War II (1931–1938); 2) during World War II (1939–1946); 3) post-war reconstruction (1947–1960); 4) high economic growth and the asset price bubble (1960–1989); and 5) after the bubble: the Lehman shock and COVID-19 (1990–2020).

Before World War II, 1931–1938: Maternal and infant malnutrition and tuberculosis were leading health problems in this period. In 1937, the pre-war Public Health Center Act was enacted, tasking public health centers with providing guidance on nutrition improvement. In 1938, the Ministry of Health and Welfare (MoHW) was established in Japan, and the NIPH was set up to conduct training for public health personnel and perform research on public health matters. Urban and rural public health centers were established to provide on-site trainings.

During World War II, 1939–1946: Training for dietitians was conducted by the NIPH. The curriculum included lectures, hands-on practice, and on-site training in public health centers. Graduates conducted nutrition improvement activities in local governments. When the war intensified, the trainees collected 3-day dietary records for their families as on-site training. This method and the results became the basic material for the National Nutrition Survey, which has been conducted in Japan since the end of the war.

Post-war reconstruction, 1947–1960: The Nutrition Division was established within the MoHW, and the Dietitians Act was put forward. NIPH training was targeted to staff of model prefectural public health centers. Graduates informed the staff members of all public health centers in the prefecture of the training contents and played a key role in promoting nutritional measures at prefectural and municipal levels. In 1952, the Nutrition Improvement Act was enacted. NIPH training focused on creating a district for nutritional improvement practice that improved food habits by fostering community organizations, and research was conducted to evaluate the effect.

High economic growth and the asset price bubble, 1960–1989: The disease structure in Japan began to change in this period, and the Japanese diet shifted from the so-called Japanese dietary style to the Western dietary style. The MoHW formulated “National Health Promotion Countermeasures” to prevent lifestyle-related diseases. The policy enhanced health checkups and municipal health centers and secured public health nurse and dietitian manpower.　Therefore, at the NIPH, collaborative training programs involving multiple professions were conducted to clarify health problems and make recommendations using survey data, with the cooperation of the local government. The NIPH studied and established the curriculum of　Public Health Nutrition Course. Subsequently, nutrition in public health came to be known as “kosyu-eiyo” (public health nutrition).

After the bubble: the Lehman shock and COVID-19, 1990–2020: In 2001, the MoHW was merged with the Ministry of Labour and renamed the Ministry of Health, Labour and Welfare. “Health Japan 21” was formulated, and the Health Promotion Act was passed to replace the Nutrition Improvement Act. In 2002, the NIPH was established as a new institution. The NIPH was created by integrating the former Institute of Public Health, the former National Institute of Health Services Management, and part of the Department of Oral Science from the National Institute of Infectious Diseases. ...and more

In Japan, housing for older people is becoming an issue. This comes against the backdrop of a declining and aging population with a declining birthrate, and expected future increases in older single-person households and the demand for medical care for people aged 75 and over.

In Japan, there are several types of housing that cater to the condition of users, such as welfare facilities for the elderly requiring long-term care, fee-based homes for the elderly, and residences for elderly people with services, which have been increasing in recent years.

The residences for elderly people with services system was launched in October 2011, but with the remarkable increase in the number of such facilities, there is a need to evaluate their quality.

This paper summarizes residences for elderly people with services from the perspectives of living environment, functions, supply and location, improvement and assurance of service quality, appropriateness of service use, and future perspectives.

It is necessary to evaluate the quality of the functions of residences for elderly people with services. There are perspectives of structure, process, and outcome, and it will be important to establish a database for individuals to evaluate which kind of service is needed for which kind of residents and the results of matching them.

“The Work Style Reform Bill” was enacted on June 29, 2018, with proposed amendments to eight laws, including the Labor Standards Act. Since April 1, 2020, the bill has been applied to all cases except a few professionals including physicians, considering their current long working hours. The special committees on physicians' labor reform under the Ministry of Health, Labour and Welfare have reported that, behind the long working hours, aside from the issues of organizational management, there are additional issues, including insufficient functional differentiation/cooperation in the regional medical care provision system. The committees proposed three levels of overtime depending on the conditions of the individual physician and institution's roles in a community, which should be applied by 2024.

Objectives: The study examined the public health policies implemented after the Fukushima nuclear accident using the monitoring data on food.

Methods: The amount of radioactive material ingested was determined and converted into doses using the Japan National Health and Nutrition Survey and food radioactive concentration monitoring data sampled by each prefecture in June of each year between 2011 and 2019. The study also examined the effects of public health policies on the basis of the differences between (1) calculation using all food monitoring data in the absence of interventions and (2) application of the restriction.

Results: In June 2011, the median committed effective dose for adult males was estimated at 18.3 μSv (with regulation) in Fukushima Prefecture. The effect of food restriction was 42.2% for the population for intaking foods with median radiation dose (the median population) in Fukushima in 2011.

Conclusion: The effect of food restriction was 42.2% for the median population in Fukushima in 2011, which points to the effectiveness of public health mitigations.