The training course for public health center directors is one of the National Institute of Public Health (NIPH) training courses . This course is designed to help local government officials who do not meet the qualifications for public health center directors as stipulated in the Enforcement Order of the Community Health Law to meet the requirements for appointment. Over the past 20 years, a total of 360 people has taken the course. This training course has been conducted face-to-face, but it is now being conducted online due to the COVID-19 pandemic. This report aims to review the history of this training course and outline its prospects.

Objectives: This literature review aimed to explore the historical changes of basic education and continuous training after employment for public health nurses (PHNs) at the National Institute of Public Health (NIPH) to improve future human resource development.

Methods: We searched the published literatures using the search engine for the Web of the Japan Medical Abstracts Society, and manually for the Japanese journal for PHNs and the Journal of the NIPH. Additionally, we collected information regarding training programs which the NIPH provided through a memorial magazine, chronology, annual report of the NIPH, and achievements report of the Faculty of Public Health Nursing at the NIPH.

Results: The NIPH has provided two kinds of training programs for public health staff; one is the short-term training programs and the other is the long-term ones. Due to changes in social conditions, PHNs must constantly update their knowledge and skills to resolve community health needs accordingly. Since the enacting of the Public Health Nurse Regulations (Hokenfu kisoku), PHNs have consistently resolved the community health needs and developed healthcare systems and policies. Except for a period before World War II (WWII), the NIPH has consistently been responsible for providing a continuous educational program for PHNs to improve the practical level of PHNs with a national qualification. Additionally, the literature review showed that the NIPH had provided the training programs for the present and future leaders of PHNs.

Conclusion: The literature review showed that the NIPH provided continuous training courses for the human resource development of PHNs according to the change of era and health and life-related issues. In the future, we would forecast the community health needs and provide educational programs regarding their leadership development. Additionally, we would be needed to support the PHNs who have finished each educational course to conduct more effective human resource development at each local government.

The outbreak of coronavirus disease 2019 (hereafter, COVID-19) has caused complex health problems. Public health nurses (hereafter, PHNs) in Japan have provided not only patients but whole community with care and comfort under this harsh period collaborating with wide range of relevant professions like social workers (hereafter, SWs). The purpose of this paper is to describe the roles and education system of PHNs and introduce SWs as their collaborator.

As generalist, PHNs take charge of specific areas and provide all residents with health programs to promote their health condition and well-being There are four education ways to be a PHN. As human resource development, Ministry of Health, Labor, and Welfare launched the framework to develop PHNs' competency as “the Standard Career Ladder”. Also, there is a special training for infectious disease called Infectious disease Health Emergency Assistance Team (hereafter, IHEAT) which was established in 2021.

As one of PHNs' collaborators, SWs support diverse people to address life challenges and enhance wellbeing. Their core mandate is to promote social inclusion and social cohesion as similar as PHNs'. There are 12 ways to take national examination for SWs. The curriculum for SWs was amended to cover wide range of discipline in 2020 because of SWs' role expansion.

This paper introduced Japanese two public health workers but each country has its own values based on its history. Each country should enhance its own strength to attain the own goal –the common goal might be “no one left behind”.

Cooperation among many types of professionals is indispensable in health-related fields. The phrase, “team iryo (teamwork in healthcare),” which has already taken root at health, medical and welfare sites, began to be used frequently from the 1970’s. In 1975, a workshop titled “Teamwork for Doctors and Nurses at McMaster University” was held at the former National Institute of Health Service Management. Also in the field of public health, a multi-disciplinary practical course called “joint field training” was started at the former Institute of Public Health in 1961. In 2010, the “Committee for Promoting Teamwork in Healthcare” was established in the Ministry of Health, Labour and Welfare, and additional medical service fees for teamwork in healthcare started for nutrition support and respiratory care teams. In April of 2024, the limits to overtime work for doctors will be introduced as part of working practice reforms, so the promotion of cooperation among many types of professionals, such as task shifting/sharing, is essential, and a review of the existing systems is ongoing. At the same time, since the prevention of medical accidents is vital for medical personnel, team training is essential to ensure safe, efficient and effective patient care.

Rehabilitation needs have been globally increased and how to involve rehabilitation in the health care systems is important. There is a large number of rehabilitation professionals in Japan, and rehabilitation services is delivered for people who require rehabilitation in any clinical phase. We overviewed history of rehabilitation in Japan, especially focused on an aspect of the aging society.

The official history of rehabilitation professionals has begun with the enactment of Physical Therapists and Occupational Therapists Act in 1965. In 2000, the law for medical fees was renewed and a new ward of recovery rehabilitation was approved to open. More and more rehabilitation professionals have been required there. In the same year, the long-term care insurance system was established based on the principle of “support for independence.” Rehabilitation needs have grown under the system with further aging of the population.

Acute and recovery rehabilitation are mainly covered by medical insurance. There are payment systems of rehabilitation corresponding to certain major diseases such as cardiovascular, cerebrovascular, and musculoskeletal disease. Rehabilitation fee is applied for a fixed period differed by each disease ranging from 90 to 180 days. Provision of services is generally defined based on clinical evidence.

Long-term care insurance is covering rehabilitation for people in chronic conditions and long-term care needs. Therapist-led rehabilitation in this field is provided as three types of services: home visit, day care, and in-facility services. While Rehabilitation is mostly provided individually and directly under the medical systems, it varies under the long-term care systems. Functional training provided by non-rehabilitation professionals and collaborating with rehabilitation professionals are prescribed in addition to therapist-led rehabilitation. Although the systems have widely enabled older adults to receive the benefits of rehabilitation, there are still issues to be solved such as unclear applicable criteria and insufficient evidence of effective rehabilitation.

Rehabilitation is also delivered under the Community-based integrated care systems. Effective and efficient projects are created by municipalities following the regional characteristics under the systems, and rehabilitation professionals are involved in projects such as preventive population approach for healthy older adults. Rehabilitation professionals are starting to fulfill their responsibilities widely in the context of preventive care and support for independence in the community.

Through Japanese experiences and history to develop such rehabilitation services in the health care systems, we may learn lessons and get suggestions to apply to recent global initiatives on rehabilitation.

The UN Sustainable Development Goal 3 (SDG3) states to reduce by one third premature mortality from non-communicable diseases (NCD) through prevention and treatment and promote mental health and well-being by 2030. In addition, NCD control has become an important area in the Universal Health Coverage (UHC), including diabetes, hypertension, cardiovascular diseases and cerebrovascular diseases. This article outlines the national situation and challenges in non-communicable diseases in line with global trends.

Supplying drinking water with sufficient quality is essential for sustaining public health. The requirements on drinking water quality must be updated based on new evidence on chemical and biological risk factors. Providing accurate latest scientific knowledge required for such updates is one of the most important roles for the Area on Water Management (AWM), Department of Environmental Health, National Institute of Public Health (NIPH). In this article, the contributions of the NIPH to the drinking water quality management in Japan are reviewed. General aspects of drinking water quality management in Japan, including the history and the basic concept of the current drinking water quality standards (DWQSs), approaches for controlling pathogenic microorganisms, and activities for establishing water safety plans (WSPs) are overviewed. Recent water quality incidents and waterborne disease outbreaks are also explained. Then, the contributions of the AWM of NIPH to DWQSs are explained, with selected recent activities, i.e., setting allocation used in DWQSs based on exposure studies, a nationwide survey on water intake, selection of pesticides and other chemical substances to be included in DWQSs. Finally, the future perspectives on expected needs for our research and dissemination activities are provided."

Japan is among the countries with the highest occurrence of natural disasters worldwide and has a long history of addressing natural disasters. This paper outlines the public health practices related to natural disasters in Japan, focusing on the legislation for disaster management systems and relevant organizations to address the response to natural disasters, based on the legislation, and describes how the National Institute of Public Health (NIPH) contributes to the improvement of the public health practices that address natural disasters.

The “Disaster Relief Act,” which stipulates how to facilitate emergency rescue during the acute phase after a disaster, was enacted soon after World War II. Further, the “Disaster Countermeasures Basic Act,” which was enacted in 1961, forms the basis for a disaster management system, including the public health practice. Based on this act, the disaster management plan must be formulated by the national and local governments and other public institutions, including the National Hospital Organization, Japan Community Health care Organization, Japanese Red Cross Society, and Japan Medical Association. The “Basic Disaster Management Plan” prepared by the National Disaster Management Council is a comprehensive disaster management plan based on which other disaster management plans are formed. It has constantly been reviewed and revised based on the experiences from large-scale natural disasters, such as the Great Hanshin-Awaji Earthquake, the Great East Japan Earthquake, and the spread of the COVID-19 pandemic. In addition, the “Medical Care Act,” which ensures the medical care delivery system, and the “Community Health Act,” which guides the public health center and its health crisis management function, are also relevant to the public health practice for natural disasters.

In case of natural disasters, local governments, including prefectures and municipalities, are responsible for protecting the lives and health of residents. Further, prefectures struck by disasters should promptly request assistance from the national government or other local governments. However, if deemed urgently necessary, the national government may provide support even without requests from prefectures in disaster areas. The Disaster Medical Assistance Team (DMAT), Disaster Psychiatric Assistance Team (DPAT), and Disaster Health Emergency Assistance Team (DHEAT) offer substantial and effective support to affected local governments in public health practice. The DMAT has enough mobility to start working during the acute phase of a disaster, immediately after it occurs, provides medical care at disaster sites, and supports the medical treatment provided by hospitals in affected areas. Further, it coordinates wide area transportation and logistics. The DPAT supports psychiatric care and mental health services in affected areas. DHEAT supports the command and coordination of health crisis management in affected prefectures, establishes a health crisis management organization, develops a direction and coordination system, and coordinates the delivery of support by a healthcare team.

The NIPH contributes to the improvement of the public health practices related to natural disasters in Japan, from education and research aspects. Regarding education, the NIPH provides a three-month course to educate public health center directors and a short-term training program for health crisis management and contributes to the development of the knowledge and skills of professionals in the public health center and in the DHEAT, which play a central role in the public health practice related to natural disasters. ...

Objectives: The proportion of low birth weight (LBW: less than 2,500 g) infants in Japan is increasing consistently. Recent studies have suggested associations between intrauterine development including LBW and an increased risk of chronic diseases, such as obesity, diabetes, and cardiovascular diseases throughout adult life. Further nationwide quantitative analysis is required to clarify the factors that determine the increase in the proportion of LBW infants and the effect on future health outcomes. To address these important issues, we aimed to analyze the factors related to LBW using Vital Statistics of live births between 1980 and 2015 in Japan.

Methods: All birth registry data from 1980, 1985, 1990, 1995, 2000, 2005, 2010, and 2015 (n = 9,743,319), stored in Vital Statistics, a database maintained by the Ministry of Health, Labor, and Welfare of Japan including information from the national census, were analyzed using SAS statistical software version 9.4.

Results: Analysis of the national census in Japan from 1980 to 2015 revealed that the largest risk factor for LBW was an increase in early term birth at 37 gestational weeks. The population attributable risk proportion at 37 weeks showed a two-fold increase from 11% to 22% when adjusted for maternal age, sex, birth order, and number of fetuses. Thus, the gestational duration exhibited a stronger relationship with LBW infants than other evaluated pregnancy-related factors.

Conclusion: While multiple factors could be involved in the increase in the prevalence of LBW, early full-term birth, as likely determined by medical interventions for delivery, such as induction of labor and caesarean sections, constitutes an important factor affecting LBW. A more precise analysis of perinatal medicine for pregnant women is required to reduce the prevalence of LBW.

Objectives: The decision-making process for vaccination programs must be informed by cost-effectiveness analyses. This study was performed to quantify the medical expenditures for pneumococcal disease (PD) in Japan.

Methods: Surveillance data from the Japan Nosocomial Infections Surveillance program and insurance claims data were collected from community-acquired PD patients admitted to 29 hospitals in Japan. Patients with positive blood specimens were designated as having invasive PD (IPD). We estimated the medical expenditures incurred during the PD hospitalization episodes.

Results: The study sample comprised 1,358 PD patients from 28 hospitals between April 2015 and September 2017. Of these, 69 were IPD patients and 1,289 were non-IPD patients. The mean medical expenditures (standard deviation) for all PD patients, IPD patients, and non-IPD patients were estimated to be $6,610 ($13,133), $13,975 ($16,415), and $6,216 ($12,823), respectively.

Conclusion: This study is the first to quantify the medical expenditures for community-acquired PD in Japan.

Objectives: This study assessed the mortality rate trend of representative causes of death by marital status, every 5 years from 2000 to 2015, using Japan's Vital Statistics.

Methods: Japan's Vital Statistics and Census data of every 5 years from 2000 to 2015 were utilized. The mortality data included mortality rates of all-cause, tuberculosis, cancer, diabetes, heart disease, stroke, pneumonia, liver disease, renal failure, senility, unintentional injury, and suicide. The cancer mortality rates in all sites, stomach, colorectal, liver, gallbladder and extrahepatic bile duct, pancreas, lung, and breast cancer were also analyzed. Marital statuses classified into married, never-married, widowed, and divorced were utilized for analysis. Age-standardized mortality rates for each cause of death by marital status and the rate ratios of never-married, widowed, and divorced individuals compared with married individuals for the age-standardized mortality rates were calculated for each cause of death.

Results: The age-standardized mortality rates for married individuals were lower than those for other marital statuses irrespective of sex and years for most of the causes of death from 2000 to 2015. However, the degrees of decrease in age-standardized all-cause mortality rates were different based on marital statuses, with it being the largest in never-married individuals for both sexes. Alternatively, the divorced marital status had the worst prognosis in 2015 for both sexes. Moreover, tuberculosis and senility had the highest ratio for men and women, respectively, for the rate ratio of never-married individuals compared with married individuals. The ratios for cancer were relatively low compared to other causes of death.

Conclusions: During the analyzed periods, the disparity between the never-married and married individuals declined, and the social support for disease prevention and care is particularly needed for divorced individuals in the current time.