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Alumni Dispatches

Hideyasu Aoyama

MD, PhD, MPH ’69

Moving Public Health Forward in Japan 

Hideyasu AoyamaIs Japan a Developing Nation in Terms of Public Health?

In fact, Japan is a developing nation when it comes to public health, although almost all national health statistics indicate high levels of health, such as the longest life expectancy at birth and the lowest neonatal and infant mortalities in the world. Japan is the first Asian country to introduce social insurance measures, and now the entire population is covered by a national health insurance scheme. Total medical cost per GDP and per capita are lower than in other developed countries.

Japan was defeated in World War II, and the nation was demoralized by the destruction and damage that occurred during the war. But the rapid improvement in health indicators such as the mortality rate from tuberculosis and infant death had already begun in postwar years 1945 to 1960, and high levels of health were supported by rapid economic growth in the 1970s.

There is a strange relationship that I have observed between health indicators and public health in Japan. First of all, I have to point out that Japan is a strongly centralized, bureaucratic nation. Japan has endeavored to catch up with western developed countries since Meiji Restoration began the modern era in 1868, after about 200 years of feudalism (the Edo era). An alliance among a powerful emperor, ambitious young men and mercantile capitalists destroyed the feudal systems. The new leaders of the central government were eager to introduce various new systems from western developed countries.

In medicine, Japan followed Chinese traditions until the Meiji restoration. In 1870 the central government decided to adopt the German systems of health care and medical education, and these systems have been maintained until now, although the entire national system was innovated by the strong powerful General Headquarters of occupation forces at the end of the World War II. Introduction of American medicine to the entire health care system has not resulted in innovating the medical education system at all, with the exception of establishing public health departments at the medical schools.

The local health authority services are provided by community health centers and managed by local governments cooperating with volunteers from professional associations such as medical and dental associations, pharmacies, nurses, nutritionists and so on, who work on maternal and child health, health examination, food hygiene and also relief for refugees from disasters like the big earthquake in 1995. In the legal system of community health practices, Health Center Law was enforced in 1937 and was revised in1947 and 1994. Health Promotion Law was enforced in 2002.

In Japanese medical education, undergraduate courses at medical schools have been managed by the Ministry of Education and postgraduate clinical training has been managed by the Ministry of Health, and all continuing medical education has been managed by various academic societies closely connected with professors of the medical schools.

The Rockefeller Foundation donated an institute of public health and two health centers to Japan (Ministry of Health) in 1937. But these wonderful gifts have not been helpful in bringing public health to medical schools. Many departments of public health were established at the medical schools in 1960s, but many old associate professors in department of Hygiene engaged in providing medical students with traditional Hygiene. Also, a few active young teachers who studied public health at a school of public health in the U.S. were eager to provide medical students with public health education after being promoted to professor at a medical school.

The Japanese Association of Directors of Public Health has discussed establishing a new school of public health by organizing some departments of public health at medical schools and the national institute of public health, but the plan has not been realized due to bureaucratic factionalism between the Ministry of Health and the Ministry of Education. I have proposed to establish a new postgraduate course of International Health at our medical school with strong support from the Ministry of Education as a chairman of a national committee on medical education in 1994, but it resulted in very little support from the president and the highest-level faculty at our university. Very few professors at medical school are interested in public health, because they are all specialists in their own field.

The International Clinical Research Program, which leads to a doctorate, and the International Health Care Program, which leads to a master’s degree, were born in April 2008. These programs are supported by the Ministry of Health and also the Ministry of Education as among the most important proposals of Okayama University.

I would like to expect that our long great dream became a reality at last with a wide range of many helpful supporters, and that Japan will be one of the developed countries in terms of public health in the near future.

Hideyasu Aoyama is a professor emeritus at Okayama Medical School , a visiting professor at Okayama University, and also the former president of Kochi Women's University. He is an honorary member of the Japanese Society of Public Health,Occupational Health and Hygiene.

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