Since the statement by then Prime Minister Shinzo Abe in 2016, the development and application of artificial intelligence (AI) technologies in Japan has progressed rapidly. AI can be used and applied in several domains, of which health and medical care are among the most important and most emphasized. In this article, the history of the challenges to develop AI technologies in Japan is outlined and past achievements and future prospects for the research, development, and implementation of AI are reviewed and discussed, with a particular focus on the fields of health and medical care.

AI is clearly identified as one of the core technologies needed to promote science, technology, and innovation and to grow the economy of Japan. AI was first mentioned in the fifth phase of the “Science, Technology and Innovation Basic Plan,” in which AI was regarded as an important part of realizing “Society 5.0.” A specific vision for promoting the application of AI has then been presented in the “Integrated Innovation Strategy,” an annual action program for realizing this basic plan. Additionally, in an annual strategy that presents a comprehensive set of initiatives for economic growth, AI has been described as a key measure for economic growth and productivity improvement in Japan.

In the “Artificial Intelligence Technology Strategy,” which was formulated in 2017 by the Strategic Council for AI Technology, a council composed of three ministries (the Ministry of Education, Culture, Sports, Science and Technology, Ministry of Internal Affairs and Communications, and Ministry of Economy, Trade and Industry) relevant to AI, the priority areas specified included productivity, health, medical care, welfare, mobility, and information security. Subsequently, the “Social Principles of Human-Centric AI,” which were formulated in 2019, described ethics and other issues that should be considered in the utilization of AI. In line with this strategy and these principles, the first “AI Strategy” was developed in 2019 by the Cabinet Office, and a framework for promoting AI throughout the government, including all ministries, was established. In this strategy, key areas in which social implementation should be achieved were designated. These areas included health, medical care, long-term care, agriculture, national resilience, transportation infrastructure and logistics, regional revitalization (smart cities), and manufacturing.

Because health and medical care have been defined from the beginning as a priority area in which to promote the application of AI, the Ministry of Health, Labour and Welfare began its efforts on AI quite early and has taken on a leading role. The process chart for accelerating the development of AI in the field of health and medical care was released in 2020, and priority areas were identified, including genomic medicine; support for diagnostic imaging; support for diagnosis and treatment; drug discovery and development; long-term care and dementia; support for surgical procedures; prevention; infrastructure for the development of AI; and improvement in the efficiency of operations for reimbursing medical fees. Of these priority areas, diagnostic imaging is the most advanced because it has the largest number of related research projects, resulting in the completion of a database through collaboration among six related academic societies. With regard to other cases, the project to integrate data held by industry and academia on drug targets, efficacy, and toxicity and to build AI for drug discovery and the “AI Hospital System” project were conducted. The AI Hospital System aims at providing highly advanced medical services, improving the efficiency of medical care, reducing burden on medical personnel, and increasing the productivity of medical care.

In recent years, the various environments of mothers and children have changed significantly because of the declining birth rate, shift to nuclear families, and increasing employment rate of women. In Japan, subsidies for antenatal checkups and support have been provided so that expectant and nursing mothers can have and raise children with peace of mind. However, the importance of community care and support measures not only during pregnancy but also after birth has been pointed out. Furthermore, with the revision of the Child Welfare Act and the establishment of the Agency for Children and Families, it is expected that the system will be redeveloped and expanded with a focus on children, as well as improving the health and welfare of mothers.

With the world's aging population and the advent of a “super-aged, multi-death society” in which approximately 1.3 million people die each year, interest in end-of-life care is growing. Many academic societies have developed guidelines on how end-of-life care should be provided. In 2018, the Ministry of Health, Labour and Welfare revised its guidelines on end-of-life care for the first time in 11 years. The public has become increasingly interested in how to end one's own life, as in “end-of-life” activities, and there is a growing discussion about “desirable ways to die” and the corresponding medical treatment. Considerations regarding the kind of end-of-life care required and how medical and welfare professionals should approach patients and their families have emerged. Advances in medical technology have made it possible to prolong patients' lives; however, it is necessary to determine how we should respond when patients do not wish to prolong their lives. In such cases, options such as “euthanasia,” “death with dignity,” and “physician-assisted suicide” are available. However, there is conflict between the patient's preferred choice of dying (patient decision-making) and the medical professionals required to treat the patient.

Therefore, this paper summarizes the decisions made by medical professionals in cases in which ventilators and life-prolonging treatments were withheld or discontinued to respect the decisions of terminally ill patients and considers them in the context of legal arguments.

Japan is less advanced than other countries with regard to Voluntary Stopping of Eating and Drinking (VSED) at the end-of-life. Therefore, we will analyze these issues according to ethics, medical practice, and legislation and discuss how to advance knowledge about VSED in Japan, develop laws and guidelines, and formulate a code of ethics.

Water supply facilities that supply water to more than 100 residents or supply more than 20 m3 of water per day are called specified privately owned water supply systems (SPOWs). SPOWs and small water systems require proper maintenance and management at their facilities, especially small water systems including private drinking water wells, where many water quality incidents involving health hazards have occurred. Most water quality incidents in SPOWs occurred in facilities where the groundwater was used as raw water, requiring thorough water quality management by those who install SPOWs. In addition to recent water quality incidents associated with microbial contamination in drinking water storage tanks, the incident at a building of university hospital is introduced. In October 2021, methemoglobinemia developed in 10 of 17 infants in the neonatal intensive care unit of the university hospital. It was found that these infants had been fed milk that had been prepared in the kitchen within the building of university hospital. It was finally proved that the water was contaminated with nitrite contained in the anticorrosion agent used in the air-conditioning system due to cross-connection.

Given the changes in Japan's demographic structure, specifically the declining birthrate and aging population, as well as the declining working-age population that includes medical personnel, the construction of an efficient medical service system has become an urgent issue, necessitating the promotion of functional differentiation and cooperation of medical institutions. In order to promote such differentiation and cooperation the “Community Health Care Vision” is formulated based on estimates of the medical demand and number of beds required in FY2025 by medical care function (advanced acute phase, acute phase, convalescence phase, and chronic phase) in each region/community. Efforts in this direction began in all prefectures by 2017, until the COVID-19 outbreak in 2020 shifted the focus of medical institutions toward the infected. In December 2020, the Health Policy Bureau of the Ministry of Health, Labour and Welfare compiled the “Concept for building a future medical service system based on the novel coronavirus disease,” which includes ideas and means to advance the Vision. In March 2021, the Health Policy Bureau Notification, “How to advance the Community Health Care Vision” was issued, which stated that “The significance of functional differentiation of hospital beds and collaboration was recognized again, having faced the Covid-19 pandemic,” and as one of the three reforms in anticipation of the medical service system in 2040 (realization of optimal placement and cooperation of medical facilities; work style reform of doctors and medical staff; and effective measures against uneven distribution of doctors), continuous efforts are being made.

Even though the age of adulthood was lowered in Japan in April 2022, the minimal age of legal access (MLA) for tobacco products is maintained at 20 years, because the earlier the age of smoking initiation, the more likely one is at risk for tobacco-related diseases such as cancer and cardiovascular disease and the higher the risk of premature death and individuals with younger age of smoking initiation are considered more likely to have difficulty quitting cigarettes. The smoking prevalence among junior and senior high school students has significantly decreased, whereas that among those in their 20s are high, and the downward trend of smoking prevalence is slow. In contrast to the dramatic drop of smoking prevalence of junior and senior high school students, the downward trend is not significant.

Smokers have been reported to have a combination of lifestyle disorders, such as an unbalanced diet and lack of physical activity, compared with nonsmokers. Given that the smoking behavior and attitudes of family members, friends, and others around smokers may be related to the smoking behavior of young people, it seems important to avoid smoking and showing cigarettes around children as a countermeasure against social factors.

In Japan, the minimum age of adulthood and the MLA have been separated by this revision of the Civil Code. Considering the adverse health effects, raising the age from 20 years old to higher age should be considered a public health policy option. Comprehensive tobacco prevention and control programs should reduce the number of smokers and incidence of tobacco-related diseases and deaths.

Objectives: The purpose of this study was to determine the actual situation of conflicts as perceived by public health nurses (PHN's) managers working in Japanese local governments, it's effect on the performance of their managerial duties, and the factors that contribute to these conflicts.

Methods: We conducted a mail survey using a self-administered questionnaire on 384 PHN's managers in 14 prefectures selected by stratified random sampling. The questionnaire items covered the basic characteristics of respondents, conflict awareness, and conflict-handling style of PHN's managers. The analysis included descriptive statistics and a test of the difference in average scores A stepwise multiple regression analysis was conducted using the basic characteristics of respondents, conflict-handling styles as explanatory variables, and conflict awareness frequency as dependent variables. The study data were analyzed using IBM SPSS Ver. 25 statistical analysis software with a two-tailed significance level of <5%.

Results: Of 242 (63.0%) responses to the questionnaire received 223 (61.5%) were valid. A total of 51 respondents (21.6%) were aware of the high frequency of conflicts, while the mean proportion of all work occupied by the conflict-handling fraction was 24.3%. The most common style of dealing with conflicts was “understanding each other's ideas; integrating ” at 69 (29.2%), followed by “avoiding arguments; avoiding ” at 63 (26.7%), and “respecting each other's goals; integrating” at 48 (20.3%). Multiple regression analysis was used to examine the factors influencing the frequency of perceived conflict. The results showed a positive association with the percentage of work “managerial work fraction,” and a negative association with “the number of subordinate occupations,” ““integrating” of coping styles,” “superiors' occupation,” and “population size”.

Conclusion: Approximately 20% of PHN's managers frequently perceived conflicts in their job performance and 1/4 of their workload comprised dealing with them. The “integrating” style is considered a method that leads to a solution that is fully satisfactory to both parties in a cooperative manner.

It was suggested that the choice of a desirable coping style by PHN's managers may help in the performance of their duties.