With aging of the population and the epidemiological transition from communicable to non-communicable diseases, rehabilitation needs have been increasing globally. In Japan, the provision of rehabilitation services to children, adults, and older people with disabilities has gradually expanded as related laws, policies, and systems were established since the end of the World Wars. This paper summarizes the multi-layered system for providing rehabilitation services in Japan. The main frameworks for providing rehabilitation are the medical insurance system, the long-term care insurance system for older people, and the disability welfare system. Although users of rehabilitation services are required to pay a co-payment based on their income, these systems cover most of the costs. Under the medical insurance system, rehabilitation is provided by rehabilitation professionals. Recovery rehabilitation wards have provided intensive and specialized rehabilitation from acute to recovery phase, especially for non-communicable diseases such as cerebrovascular diseases, musculoskeletal diseases, and cardiovascular diseases. The long-term care insurance system has provided rehabilitation for older people who are certified as requiring long-term care. Welfare services include vocational rehabilitation for persons with disabilities as well as functional training. Furthermore, long-term developmental support is provided to children with disabilities living in the community. Training for rehabilitation professionals began in 1965 for physical and occupational therapists, followed by speech-language-hearing therapists in 1997. Educational programs for training professionals are primarily conducted at the undergraduate level, with the curriculum determined under the supervision of the Ministry of Health, Labor and Welfare and the Ministry of Education, Culture, Sports, Science and Technology, in consideration of the needs of the social situation. After graduating from training schools or universities, they are required to pass a national examination to obtain national licenses, which helps to ensure the quality of the workforce. Current policies are taking the direction of promoting community living and social participation for older people, and adults and children with disabilities, and rehabilitation plays an important role in this regard. Related systems have been continuously improved through revisions to respond to the changing social needs of the times, which ensures an appropriate allocation of the workforce and a maximization of the performance of their professional responsibilities.

In 2008, the International Labor Organization reported on decent work (i.e., work that is fulfilling and humane), which has been promoted by the Ministry of Health, Labor and Welfare in Japan. To support the employment of people with disabilities (PWDs), a new system and training program will be launched. We would like to provide an opportunity for mutual study, through dissemination to the world, the status and prospects of employment support for PWDs in Japan, including human resource development. In Japan, a number of employment support measures have been implemented for PWDs, based on the Act on Employment Promotion of PWDs, including the “Employment rate system for PWDs” and “Payment system for employment of PWDs,” “Measures to reduce economic burden,” and “Vocational rehabilitation.” Although the various systems have been successful, and work opportunities for PWDs have been expanding, there are some types of employment that deviate from the philosophy of employment of PWDs, such as proxy companies. In addition, there are also PWDs who are unable to transition from welfare to employment due to “protection.” In addition, the “market-principle” was introduced, which emphasized efficiency without consideration of the PWDs' wishes, since the Law to Support the Independence of PWDs was launched. Employment Choice Support (ECS) in 2025, based on the Act on Comprehensive Support for PWDs may represent an opportunity to solve these problems. Supporters obtain correct knowledge and improve their skills by “Basic Training” or training for ECS supporters. From FY2025, both welfare and employment supporters are required to complete “basic training,” which enables participants to acquire basic knowledge and skills, including the purpose and philosophy of employment support, pre-employment and post-employment support, support for companies, and cooperation with related organizations. Due to the diversity of supporters in the employment and welfare fields, hierarchical training is provided according to expertise and years of experience. After October 2025, prior to using welfare employment, PWDs are generally required to use ECS, which enables them to make self-selection in cooperation with professional supporters. The method of employment assessment, which is a core ECS skill, assumes knowledge and skills such as basic principles, the employment support process, and cooperation with related organizations. Supporters engaged in ECS are required to complete basic training, followed by an ECS Supporter Training Course. While views on disabilities and support differ worldwide, it is necessary to create a society where all persons can work with authenticity, irrespective of age or region. There is a need to cultivate human resource development that supports such authenticity.

The “Law Concerning Support for Children with Medical Care and Their Families” was enacted by the Japanese Diet on June 11, 2021. The challenges surrounding children requiring phlegm suctioning and tube feeding first gained attention in the context of school education in 1988. Since then, the Ministry of Education, Culture, Sports, Science and Technology (MEXT) and the Ministry of Health, Labour and Welfare (MHLW) have implemented various measures to address these issues. These efforts include clarifying the legal interpretation of non-medical personnel performing such acts, authorizing specific procedures under the revised Social Worker and Care Worker Law, and distinguishing acts that are not fundamentally considered medical. This study examines the historical development of these measures, identifies challenges regarding community integration for children with medical care needs, and discusses potential future directions.

Nutrition forms the foundation of individual health and well-being and is a critical component of sustainable development and economic growth. At the Tokyo Nutrition for Growth Summit 2021, the Tokyo Compact on Global Nutrition for Growth was issued to promote policies to achieve the World Health Assembly's Global Nutrition Goal 2025, the United Nations Decade of Action for Nutrition (2016?2025), and the Sustainable Development Goals, with the goal of “eradicating all forms of malnutrition.” In line with this declaration, the Government of Japan has committed to advancing inclusive nutrition policies domestically. Against the social backdrop of an aging population, efforts to address the protein-energy malnutrition of older adults and promote enjoyment of eating have accelerated. As part of these initiatives, Nutrition Care and Management (NCM) based on multidisciplinary collaboration among medical institutions, long-term care facilities, and facilities for individuals with disabilities has been introduced and promoted. This paper summarizes the philosophy of NCM and the development of its institutional design within the medical insurance, long-term care insurance, and disability welfare service systems. We also discuss the outcomes of research on the nutritional status of older adults and patients and the health and economic effects of nutritional care as background for the introduction of NCM. A significant milestone was the 2000 revision of the Dietitians Act, which expanded registered dietitians' responsibilities and highlighted nutrition management services for patients, enhancing insurance services of NCM. Furthermore, in the aging society, strengthening medical and long-term care coordination within community-based comprehensive care systems and developing skilled professionals for NCM are important issues. Japan's initiatives in these areas offer valuable insights for designing and implementing nutrition policies in other aging societies globally.

Japan's demographic structure is changing dramatically. Due to an increase in the number of older adults, there is a growing need for acute medical and long-term care services. As a result, even after completion of treatment in acute care facilities, patients who have difficulty living independently may be transferred to long-term care facilities, facing the risk of developing pneumonia and other acute illnesses that require hospitalization at an acute care facility. If a patient in a long-term facility experiences a fall or another medical safety event, they must be promptly diagnosed and treated at an acute care facility. Consequently, collaboration between acute medical and long-term care is essential, and the Japanese Ministry of Health, Labor and Welfare is promoting various initiatives to address this issue. The medical service fee, revised every two years, and the long-term care fee, revised every three years, will be used to achieve this goal. June 2024 presented a rare, once-every-six-year opportunity for these fees to be revised simultaneously, enabling the implementation of policies to promote coordination between acute medical care and long-term care. However, a significant challenge is the decline in the working-age population, which must be addressed. The details are presented in this study.

This article aims to present an outline of the history of health policies related to sexuality in Japan, focusing on challenges to improve women’' health and welfare, and to discuss the future policy directions from the perspective of the diversity of sexuality. Measures to improve women’' health had focused on their specific situations and roles. To protect “maternity,” public assistance has been available for many years , for pregnant women and mothers experiencing poverty, and the Maternal and Child Health Act introduced measures to promote the health of all pregnant and nursing women. These measures were promoted in a way that maternity was integral to the child. Before World War II, the primary measure against sexually transmitted diseases was the control of “prostitutes,” followed by a shift to control of the general public after abolishing the licensed prostitution system and enacting the Anti-Prostitution Act. Furthermore, measures aimed to protect and reform women engaged in prostitution, with the scope of protection and support later expanded to “women with difficult problems.” Measures to protect “working women,” including restrictions on overtime, holidays, and late-night work, were first initiated at factories and then extended to all workplaces. Although these restrictions were abolished under the Act on Equal Opportunity and Treatment between Men and Women in Employment, working women’' health, particularly maternal health, continues to be considered. After the concept of reproductive health/rights was proposed in 1996, measures to support women’' health throughout their lives, including adolescence, pregnancy and childbirth, menopause, and old age, were clearly defined as part of both gender equality policy and health policy. The specific measures include support for those seeking infertility treatments, public awareness such as “Women’' Health Week” and the “HealthCareLab” website, preconception care, gender-specific medicine, FemTech, Gendered Innovations, solutions to period poverty, and research and development. In 2003, the first legislation related to sexual diversity in Japan was promulgated, and in 2023, the Act on Promoting Public Understanding of Diversity in Sexual Orientation and Gender Identity was implemented. Except for measures against AIDS and supporting women with difficult problems, measures to address health problems related to diversity in sexual orientations and gender identities have not progressed adequately. To develop health policies that take sexual diversity into account, it is necessary to identify in detail the health status and problems of people with diverse sexualities and to define the ideal of health for each sexuality.

Purpose: The 2019 novel coronavirus (COVID-19) pandemic has reshaped our lives and communities. In the medical field, primary care providers were required to continue providing medical and long-term care despite the global shortage of protective equipment against the progressing infection. How did frontline primary care facility administrators experience the COVID-19 pandemic? Were they required to change our attitude and behavior during the COVID-19 pandemic? Methods: To explore this, we conducted a semi-structured interview survey. Four researchers interviewed the administrators of 20 clinics (7 general practitioner clinics and 13 dental clinics) and 11 long-term care services (7 visiting nurse home services and 4 resident long-term care and home help services) in Japan. We conducted interviews with administrators either face-to-face or using remote communication devices. The interview results were analyzed using a qualitative descriptive approach. Results: We interviewed 31 primary care facility administrators and found three attitude categories: (1) self-awareness of being responsible for the business site, (2) self-awareness of contributing to the community through medical care, (3) self-awareness for respecting the life of each local resident. Further, we found five behavior categories: (1) Taking action to protect the staff, (2) taking Measures to safeguard the facility, (3) establishing and implementing infection control policies, (4) ensuring service continuity and community service, and (5) collaborating in community infection control efforts. Conclusions: Frontline administrators of primary care facilities displayed strong transformational leadership during the COVID-19 pandemic.