Matsuda_KYT Uni.PNC 1312 KKUws

Report
PNC 2103 ,Kyoto Univ. Japan,
Dec.11th, 2013
Area informatics in community
health policy & system
development to cope with
changing health needs in South
East Asia
Prof. Masami MATSUDA, Dr.H. Sc.,
Prof. of Public Health, Dep. of Health Nutrition,
Tokyo Kasei-gakuin University
The recent development process of community health policy & health
system change in Thailand show the position as the leading case of the
area informatics in health field in South East Asia. From the viewpoints of
health status & policy reports on global health such as in WHO (World
Health Organization: United Nations’ Technical Agency in Health
established in 1948), the current innovative programmer of TCNAP/RECAP
on community health, nursing & information system in Thailand will be
overviewed in the framework of international trend to understand the
meaning of those activities in world health. The overview of framework in
international health include such as 1.Primary Health Care in 1978 (AlmaAta Declaration) & Primary Health Care 2008 (The World Health Report
2008, PHC: Now more and ever, 1)universal coverage, 2)primary
care,3)public policy, and 4)leadership & government), 2.Health Promotion
in 1986 (Ottawa Charter), 3.NCDs (the Political Declaration on
Noncommunicable Diseases adopted by the UN General Assembly in 2011),
4.SDH (Rio Political Declaration at the World Conference on Social
Determinants of Health in October 2011 in Rio de Janeiro, Brazil &
Conceptual framework on Social determinants of health
inequities,2010:CSDH) ,5.Global health risks,2009(WHO) & GBD (Global
Burden of Disease) 2010 (Institute for Health Metrics and Evaluation).
The position of Data analysis and informatics in current
innovative health activities in South East Asia is on the frontline
in community health planning & policy implementation from the
health statistics in national level. The content of health data in
community include not only quantitative data but also
qualitative data and how to marge those data is the critical issue
in the actual field to cope with changing health needs such as
aging, lifestyle diseases, NCDs. The factors which affect health
policy change are the emerging four changes in population
structure & social environments, such as rapidly aging society,
epidemiological transition, risk behaviors & economic crises.
The current health activities of TCNAP in Thailand are ample
examples of the five sectors (1.Community empowerment,
2.Health literacy and health behavior, 3.Strengthening health
systems, 4.Partnerships and intersectoral action, 5.Building
capacity for health promotion) of the 7th Global Conference on
Health Promotion, Kenya, 2009.
Change of Community & health issue
in 40 years
• Disease structure (DM,
hypertension, cancer)
• Lifestyle(obesity)
• Economic development
• (4C: Car, Cooler, Calar TV,
Computer)
• Autonomy in local
government
• Information revolutionpersonal computer
• Educational level
•
•
•
•
Globalization
Loan, increasing debt
Aging
Disabilities: ICF
(International
Classification of
Functioning, Disability and
Health)May,2001(WH
O),1980 WHO(ICIDH),
ICD(International Statistical
Classification of Diseases) to
Health &
• Indicators from death rate
to DALY
PHC in 1978-2000
• Health: infectious diseases (Diarrhea, TB, AIDS)
• Development: occupational training, water supply,
etc.
• Information: IEC
• Participation: to Care provision such as
VHV(health volunteer )
• GIS: nothing
• Equipment in community: few telephone, no
computer,
• Manpower: PHC worker but no RN/NP
Development of Nursing Practitioner and Community Nurse in Thailand
Sources of Fund
Started the bachelor
degree program
Needed students to
diagnosed and
screening to work in
rural but no
competent teacher
Lacked of Community
Nurse who could provide
screening and treatment
1970
Primary Health Care
(Until 2000)
Universal coverage scheme
(2001-2007)
1979
1980-1981
1984 1988 1990
Established th 3rdEstablished the 1 year
Established th 2rdformal program 6
st
Started the 6 M course for th 1 formal program 6 m.
m for ER-NP for
NP course under formal
eye-NP program, by
Faculty of
physician
Program to train
a physician from the
Medicine,
authorities at nurses at the
Dept. of Ophthal. in
Ramathibodi Hosp,
Ramathibodi Department of Public
collaboration with
Mahidol Uni.
School of
Health Nursing,
Dept. of Nursing, Stopped th
Nursing, Mahidol Faculty of Public
st
Faculty of Medicine,1 - formal
University
Health, Mahidol
Ramathibodi Hosp.,program
University
training
Mahidol Uni.
activities
Faculty
members and
Produced and entitled
nursing staff =
the ‘Public Health Nurse
4 NPs
Practitioner Program”
The National Health
Needed more
Care Reform and the
CN belonging
Universal Health Care
to community
To comply
Coverage System was
with the
implemented , demanded
regulations of
NP in PCU = 15,000 prs.
government.
Program of
Nursing of
Needed more
Thailand
Community
institutes to
Economic
students
produce NP
crisis/IMF
started at
FON/KKU
Demanded on
Neonatal NP
Not enough doctor
specialists
to meet the needs
Demanded on ER
of the people and
NP to be able to
lacked of skill
manage cases
nurses to screen
Demographic
and provide basic
impact of the
Tx to eyes pts NP’s performances
were unacceptability HIV/AIDS
epidemic
by the physicians.
1977
Health Security
(2007-2013)
Produced 12
groups
(apprx.10-15
nurses/gr.)
Apprx. 700
people
produced
totally
Produced
ER-NP
Established th
4rd- formal
program 4 m
for Neonatal-NP
to work on
growth,
development,
overall health
of newborns
Produced
Neonatal-NP
1997 2001
2002
MoPH released
regulations for
NPs to provide
treatment
legally.
First group of
selected
students by
community
learned at
FON/KKU
Th 3rdformal
program
reduced to 4
m for ER-NP
The Thailand
Nursing and
Midwifery
Council (TNMC)
took the lead in
responding to
4 m for ERthis need.
NP course
2004
National Health Security
office , Thailand signed
MOU with TNMC to
produce NP 10 yrs to
response the needs at PC
level
Asean
Economic
Community
2005 2007 2008-2014
Expanded to
Local Admin.
Org.+ private
sector for funded
selected students
Be a NOC
model.
Other 26 NU
institutes apply
this idea.
?? Merging of
Health Funds
Able to produce
the undergrade CN
apporx .
20prs./yrs. To
return to their
communities
2015
Nursing institues in
Thailand provided 4
m. NP course and 2
Yrs. for Advance
nursing practice
(APN) -a master
degree
Able to produce NP
1000 prs/ yr and
APN of community
250 prs/ yr
Sources: Khanitta Nuntaboot, 2007; Somchit Hanucharunkul,2007
タイの保健システム発展の外的・内的要因
The Ottawa charter for
Health Promotion
•
•
•
1986
Economic crisis
Thai Royal
election/politic
al party’s
interest
Demanded on
decentralized
1999
Bangkok charter for
health promotion
Health Risk
/Health demands
The Nairobi charter for
health promotion
Public
Health
Ministry
Policy
Constitution of
Kingdom of
Thailand
2001
2005
2007
2008
2009
Her Royal highness
Princess Sirasm, Royal
Consort of His Royal
highness Crown Prince
Mahavagiralongkorn
Ministry of Social
Development and
Human Security Policy
2010
2012
School Health Policy
Healthy
Thailand’
policy
地方分権化
の開始(市町
の自治権)
ユニーバル・ヘル
ス(国民皆保険)
制度の開始
Oral Health Promotion
Saiyairak project
Millennium Development
Goal
タイヘルス・プロ
モーション財団
の設立
国民保健法
参考 Khanitta Nuntaboot
タイの保健システム発展の外的(図上)
・内的(図下)要因(1986-2013)
オタワ憲章・ヘル
ス・プロモーショ
ン(HP)
ミレニアム開発
目標
ナイロビ
憲章HP
バンコク
憲章HP
経済危機
1986
1999
地方
分権
化の
開始:
市町
の自
治権
2001
2005
憲
法
改
ユニー 正
バル・
ヘルス
(国民
皆保険
)制度
の開始
タイヘ
ルス・
プロモ
ーショ
ン財団
の設立
健
康
タイ
政
策
2007
国
民
保
健
法
参考 Khanitta Nuntaboot
2008
2009
公
衆
衛
生
省
政
策
の
革
新
2010
社
会
保
障
省
の
新
政
策
2012
王
立
健
康
増
進
プ
ロ
ジ
ェ
ク
ト
タイの Nursing Practitioner と地域看護師の発展過程
Primary Health Care
(Until 2000)
学部の看護
教育開始
1970
NP
の
養
成
開
始
1977
保
健
師
NP
NPの質が
問題化
1979
眼
科
NP
HIV/AIDS
の広
がり
1980-1981
NP
の
養
成
700
名
で
停
止
救
急
ERNP
の
養
成
1984
1988 1990
新
生
児
NP
の
養
成
IMF
経
済
危
機
Universal coverage scheme
(2001-2007)
Health Security
(2007-2013)
NP / PCU が
15,000名必要
1997 2001
公衆
衛生
省NP
の治
療を
許可
2002
コンケン
大で
地域
NP
養成
2004 2005 2007 2008-2014
学部
の地
域看
護強
化
年間
1000 人
のNP と
250 人
の地域
APN
Advance
nursing
practice
参照: Khanitta Nuntaboot, 2007; Somchit Hanucharunkul,2007
TCNAP in 2009-2012
• Health: lifestyle diseases (DM ,hypertension,
cancer),Aging, disability
• Development: economic development (from bicycle to
car in local area) etc.
• Information: information system
• Participation: in all revel of decision making (from data
collection, analysis, policy)
• GIS: challenging
• Equipment in community: mobile telephone, computer,
camera,PHC unit(curative care & preventive care)
• Manpower: RN,NP
Comparison of TCNAP with PHC
PHC in 1978-2000
TCNAP in 2009-2012
• Health: infectious disease
• Development: occupational
training, water supply, etc.
• Information: IEC
• Participation: to Care provision
such as VHV(health volunteer )
• GIS: nothing
• Equipment in community: few
telephone, no computer
• Manpower: PHC worker but
no RN/NP
•
•
•
•
•
•
•
Health: lifestyle diseases
(DM ,hypertension, cancer), Aging,
disability
Development: economic development
(from bicycle to car in local area) etc.
Information: information system
Participation: in all revel of decision
making (from data collection, analysis,
policy)
GIS: challenging
Equipment in community: mobile
telephone, computer, camera, PHC
unit(curative care & preventive care)
Manpower: RN,NP
Change the health & welfare system with rapidly
aging society What
is the factor to change
the role of PHNs & health system ?
1. Population structure(Aging)
2. Disease structure (cause of death,
communicable diseases, NCDs)
3. Risk factors(life style )
4. Economic conditions
Community data base in health promotion policy
making with Multi-sectoral Collaboration &
Multi-stakeholders Partnership
量 Quantity Data 質 Quality Data
(work place, public health
insurance, community,
school)
個
Individual
集団/地域
Population/
Community
Health Risks
(smoking)
Meaning of Life, Mental
Health, Terminal Care
(Clinical)
Utilize the Epidemiological
Community Assessment
Indicators in Community
(People, PHNs,
level (Death Rate, Prevalence
Nutritionists, MD)
Rate …)
Integrate Individual &
Community in Healthy
Life Expectancy
Social Capital
Leading causes of attributable global mortality and burden of
disease, 2004 (WHO)
Attributable Mortality
Attributable DALYs
%
%
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
High blood pressure
12.8
Tobacco use
8.7
High blood glucose
5.8
Physical inactivity
5.5
Overweight and obesity
4.8
High cholesterol
4.5
Unsafe sex
4.0
Alcohol use
3.8
Childhood underweight
3.8
Indoor smoke from solid fuels 3.3
59 million total global deaths in 2004
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Childhood underweight
5.9
Unsafe sex
4.6
Alcohol use
4.5
Unsafe water, sanitation, hygiene
4.2
High blood pressure
3.7
Tobacco use
3.7
Suboptimal breastfeeding 2.9
High blood glucose
2.7
Indoor smoke from solid fuels 2.7
Overweight and obesity
2.3
1.5 billion total global DALYs in 2004
GBD2010
Nature of Change
• Quantitative change (such as 10 % to 15% increase,
50 % to 35 % decrease)
• Qualitative change(epidemiological transition,
health transition, population transition)
• Speed( low, high, very high)
• Aging (Slow Speed: Quantity, Quality: Europe)
•
(High Speed: Japan, Asia, other countries)
• Age: 0,5,10,15,20,30,40,50,60,70
•
: 0,5,20,40
Globalization of unstable- welfare state
such as Japan which is rapidly Aging
society with family collapse
There are four types of welfare states in sociology.
Japanese health & welfare system is a mixture of four welfare states.
1.Libertarian type(Market system) : US, Canada, Australia
In Japan; Fee- for Service in medical care mixed with social insurance
2.Beveridge-libertarian type (National minimum) : UK
In Japan; Welfare system for child care, elderly care, disability care
3.Social insurance type : Germany, France, Italy
In Japan; National Medical Care Insurance from 1965
National Care Insurance for aged from 2000
4.Scandinavian type (De-commercialization of labour with maternity leave,
parental leave & educational leave) : Sweden, Denmark, Finland, Norway
In Japan; ???
(Esping-Andersen, The three worlds of welfare capitalism, Polity press, 1990)
(Kenichi Tominaga, Welfare state in social change, p156-157, Chuokouron-shinsha, 2001 in Japanese)
Socio-economic condition
and population aging
1947; Social Right (Beveridge-libertarian )
in the new constitution of article 25
1950’; Priority is recovery of economy
(Libertarian )
1961 ; National health insurance and
pension system
(toward Beveridge-libertarian type)
1973 ; Starting point of welfare state
(strengthen Beveridge-libertarian type)
(Matsuda in Tokyo University)
1982 ; budget cut(Libertarian)
(Matsuda in Graduate school of Tokyo Univ.
& in Mahidol U.,Thailand)
1989-2000; Gold plan for the Aged and care
insurance scheme for the Aged requiring
nursing care
(Scandinavian type or Social insurance type)
(Matsuda in RITB & U.Shizuoka)
2001-2013; Libertarian with budget cut
(Matsuda in U.Shizuoka, Care of my mother,
in U. Kasei-gakuin)
(K. Tominaga, Welfare state in social change, p182-196,
Chuokouron-shinsha,2001 in Japanese)
Rapidly Aging Society-speed of Aging
2-4 times ( 7%→14% Japan 25 years、Europe, US 45~115 years
10%→20% Japan 21 years、Europe, US 43~ 86 years)
7% to 14%
10% to 20%
canada
USA
Italy
France
Japan
Rapidly Aging Society-Japan as a Model of Countries
in Asia, Latin America & Eastern Europe in future
Japan
Japan
USA,EU
Thailand,Korea,Singapore
,China,Indonesia
How to cope with Rapidly Aging
Society like Japan
1. Do not rely on the western model of aging society
but try to create own activities based on each
community settings.
2. Change the target of health & welfare services from
the longevity of life to healthy life expectancy plus
QOL(Quality of Life).(Development of New data
system)
3. Putting together the experiences of PHC (TB control,
MCH) into NCDs prevention with emphasis on health
promotion with academic society: JAHWP.(Reform
Health & Welfare System and Society)
Policies influencing health promotion scheme in Thailand
The Ottawa charter for
Health Promotion
•
•
•
•
Economic crisis
Thai Royal
election/politic
al party’s
interest
Demanded on
decentralized
1986
Bangkok charter for
health promotion
Health Risk
/Health demands
•
•
Increasing
prevalence of
chronic illness
Changing
demographics of
aging adults
Risk Behavior i.e.
smoking Alc.
Drinking,
Changing diet
habit and unsafe
sex practices
Constitution of
Kingdom of
Thailand
2001
1999
Establishment of the
ThaiHealth Promotion
Foundation as a HP
funding mechanism
Public
Health
Ministry
Policy
Thai Royal Government Policy
Statement
2005
Launching of the
Universal Health
Coverage Scheme
Embraces the
principle and
direction of health
promotion
The Nairobi charter for
health promotion
2007
2008
Ministry of Social
Development and
Human Security Policy
2009
2010
2012
School Health Policy
Healthy
Thailand’
policy
National Health Act
Oral Health Promotion
Saiyairak project
Decentralization
started
Decentralization to
LAO (Authorities
and fund)
• Sub- district
fund allocation
• Control social
determinants to
health
• Welfare to
population
Her Royal highness
Princess Sirasm, Royal
Consort of His Royal
highness Crown Prince
Mahavagiralongkorn
Millennium Development
Goal
Cost USD 2 billion
for health
promotion
activities a year
•
•
•
•
•
Largest aerobic
display
Against drunk
driving and
controls on
tobacco
Thailand is
committed to
reducing
substance
•
Draws upon a 2 percent surcharge
levied on alcohol and tobacco excise
tax, approximately USD 50-60 million a
year
ThaiHealth funds programs
health
risks/issues such as alcohol, tobacco,
accidents, exercise, as well as area or
setting based programs, for example,
school, work place, community, and
programs that target specific population
groups such as the youth, the elderly,
Muslim community
Open grants program invites proposals
from all kinds of organizations/groups
interested in launching HP initiatives
Embraces the principle of human
rights and key principles of the
Ottawa Charter in 2005. It is a
result of five years of extensive
public dialogues on important
health issues that enhanced public
awareness and nation wide
networking on health promotion
•
•
•
•
•
•
•
•
•
•
•
•
Breast feeding policy
Baby friendly hospital
Mother-Child policy
Child care center/ Kindergarten
Teenage health promotion
( Pregnant, Youth council from
school-to-University)
Healthy working place
Woman Health (Violence, CA
screening)
Health promotion
The "3 Generations Weave
Family Love” Center
Elderly people club
Accident and Emergency
prevention
National institute of Emergency
medicine/Disaster management
GBD2010
GBD2010
GBD2010
Role of public health
• Policy, quality assurance, evaluation(ABM)
• traditional public health practitioners and
institutions are reaching out (or could reach
out) to the public through social media.
"Public Health 2.0" is used to describe public
health research that uses data gathered from
social networking sites, search engine queries,
cell phones, or other technologies.(Wiki)
Brief History; PHN Role(3)
• Contemporary roles
–
–
–
–
Community Developer
Facilitator of self-health promoter/self-help
Resource Manager
Policy Formulator
• Remarkable topics today : lifestyle disease, frail elderly
– Community level activities
– Health problems of the growing elderly population, so on
– PHNs are using a variety of health promotion strategies
• The role of PHN has become bigger and bigger in Japan.
Feb. 5th 2009Katsumasa Ota
New role of head PHN in Shizuoka government for
the policy in health promotion (Eguchi A.)
 Several key health promotion concepts were identified in various health
promotion initiatives.
 The mindsets in PHNs’ activities became the driving force behind the initiatives.
 In the development of health promotion initiatives, PHNs work proactively in
order to understand the opinions and concerns of both municipalities and
residents through a variety of channels.
 By observing both the overall picture and disparities in health status in different
areas, prefectural PHNs supported the “visualization” of processes involved in
and results produced by initiatives undertaken by its municipalities, while also
promoting the “visualization” of reliable health information.
 PHNs created an administrative system for ensuring the effectiveness of
initiatives.
 Advancing community development through win-win partnership that exceeds
the boundaries of health sector appears to be linked to positive participation in
health promotion by both individuals and private corporations.
Box 1: Disability-adjusted life years (DALYs)
DALYs are a common currency by which deaths at different ages and
disability may be measured. One DALY can be thought of as one lost year of
“healthy” life, and the burden of disease can be thought of as a
measurement of the gap between current health status and an ideal
situation where everyone lives into old age, free of disease and disability.
DALYs for a disease or injury are calculated as the sum of the years of life lost
due to premature mortality (YLL) in the population and the years lost due to
disability (YLD) for incident cases of the disease or injury. YLL are calculated
from the number of deaths at each age multiplied by a global standard life
expectancy of the age at which death occurs. YLD for a particular cause in a
particular time period are estimated as follows:
YLD = number of incident cases in that period × average duration of the
disease × disability weight
The disability weight reflects the severity of the disease on a scale from 0
(perfect health) to 1 (death). The disability weights used for global burden of
disease DALY estimates are listed elsewhere (6).
In the standard DALYs in recent WHO reports, calculations of YLD used an
additional 3% time discounting and non-uniform age weights that give less
weight to years lived at young and older ages (7). Using discounting and age
weights, a death in infancy corresponds to 33 DALYs, and deaths at ages 5–20
years to around 36 DALYs.
Development of Healthy Japan 21st
–National & Regional/Local Level
(A.Eguchi)
Achievements of Healthy Japan 21st
(1st Stage :2000-2012)
1.National Level: Decrease the Smoking Rate of
Male from 50 % to 35 %
(still high)
2.National Level: Decrease the Suicide
Population from over 30000 per year to under
of it in 2012 (-1997 over 20000, increased
during 1998-2011 over 30000)
3.Local Level: Average Prefecture of Shizuoka in
any health & welfare outcomes became No.1
in healthy life expectancy in 2012(Male 71.68
years, Female 75.32 years)
Empower local city & town using area data on
Smoking & heart disease-A Case of Shizuoka- (A.Eguchi)
JAHWP compare with TCNAP;Community Strengthening Actions
1. Technical Team
2. Management Team
3. Communication Team
4. Mayor/Administrator
Team
Health : (1) Health care
(2) Social Health Determinant
Systems/Civil groups
(SOJO method; Iwanaga)
Management of
effective Initiatives &
Actions
Multi-sectoral
Collaboration
HFA21Japan,9 HPP,130 Targets
7 HPP
Healthy Public Policy
(84 proposals)
TCNAP (1)
RECAP
Shimane;
GIS-Social
capital
(Shiwaku,
Hamano)
Multi-stakeholders
Partnership
HP 10 Acts/law
(Nishimoto)
1.
2.
3.
4.
5.
Disaster management
Learning & Education
Welfare
Health Care
Environment & natural
resources management
6. Food security & organic
agriculture
7. Governance in administration
of local government
Case;
1.Shizuoka
Prefecture
(Eguchi,et
al)
2.Hachioji
city
(Noyama)
Outcomes &
Impacts of initiatives &
actions
1. Alcohol Consumption 2. Smoking 3. Accident
4. Healthy Food (Shokuiku;eating education)
5. Physical Activity(100ys old Ikiiki; Horikawa) 6. Health Care
(Economics, Politics) 7. Health Investment (Inequality & social divide)
8. Disaster management (Kobe,Fukushima) (Climate & Nuclear disasters)Etc.
Evaluation of
HFA21Japan
8+ Impacts
of Health
Development of TCNAP
Knowledge from
research findings
•Co m m u n i t y P r o b l e m s
• Ta r g e t P o p u l a t i o n
2012-13
•Na t u r a l r e c o u r s e s m a na g e m e n t
• Ac t i v i t i e s a n d p r o b l e m s o l v i n g
process
Community problems & issues
• social capitals
• 4 groups of community
data
1. Baseline data
• healthy tambons 2. Problems
• community health system 3. Systems
strengthening
development
• knowledge management for
4. Outputs, outcomes,
impacts
healthy tambons
•involving parties
• innovations for health care and
•assessment tools
services at primary level
•supportive systems
• students trainings
•Trainings of students for nurses of the
community project
Development of
• community based research
TCNAP2
TCNAP1
•R e l a t e d o r g a n i z a ti o n
•C o m m u n i t y s ys t e m s m a n a g e m e n t
• M o d e l o r g u i d oe nl i nmee c h a n i s m
C o m m u n i t y s y s t e m s m a n af go er mseys
nttems strengthening
2012-13
TCNAP3
•He a l t h s t a t u s
•Outcomes of community
s ys t e m s s t r e n g t h e n i n g
•Impacts on human
Outcomes
conditions that affect health
of c o m m u n i t y s y s t e m s s t r e n gatnh de nwi negl l b e i n g
2013-14
TCNAP
RECAP
TCNAP4
community data base system
Civil Public
Local
society sectors Chiefs &government
chairs
groups
Nuntaboot, 2012
JAHWP compare with TCNAP;Community Strengthening Actions
TCNAP (2)
1997
(1978-1986-1997)
Creating
1. development of SOJO(Prof.Iwanaga) with research
funds
from
MOHW
and
many
local
area
practices.(national & over country)
2.
Development
of
healthy
of
public
city module/kit
health
in
manpower
4. Development of GN model(Prof.Maruchi) (central)
5. Citizen participation in community health &
welfare of intractable diseases & mental health
(Yanak,Yadokari-no-sato)(Saitama)
society of
health &
(Prof.Arai) (North)
(Ishikawa,Tokinkyo)(Tokyo),
Japanese
academic
Shimane Pref.(Prof.Yamane)(West)
3. Development
the
welfare
policy
(JAHWP)
1. Technical Team
2. Management Team
3. Communication Team
4. Mayor/Administrator
Team
Pre-JAHWP projects of Health promotion in Japan
RECAP
Tambon
Health : (1) Health care
(2) Social Health Determinant
Shimane;GISSocial capital
(SOJO method;
(Shiwaku,
Iwanaga)
Hamano)
Integrate
Management of
into Platform
effective
Initiatives &
Actions
TCNAP (3)
HFA21Japan,9 HPP,130 Targets
7 HPP
Healthy Public Policy
(84 proposals)
TCNAP (1)
Systems/Civil groups
HP 10 Acts/law
(Nishimoto)
1. Disaster
management
2. Learning &
Education
3. Welfare
4. Health Care
5. Environment &
natural
resources
management
6. Food security &
organic
agriculture
7. Governance in
administration
of local
government
Case;
1.Shizuoka
Prefecture
(Eguchi,et
al)
2.Hachioji
city
(Noyama)
Outcomes &
TCNAP (4)
1. Alcohol Consumption 2. Smoking
3. Accident
4. Healthy Food (Shokuiku;eating
education) 5. Physical Activity(100ys old Ikiiki; Horikawa)
6. Health Care 7. Health Investment 8. Disaster management
(Kobe,Fukushima)Etc.
Impacts of initiatives &
actions
Evaluation of
HFA21Japan
8+ Impacts
of Health
PHN:Role in the past
Health Systems in Transition Kozo Tatara, Etsuji Okamoto,WHO,2009
Health education
For improvements in community involvement, it is essential to provide
opportunities for residents to obtain information about health planning
promoted in their community. This has yet to be fully implemented in Japan,
although residents may have had such opportunities in the various actions for
health education organized by public health nurses in their community.
Reduction
Long life expectancy in Japan is largely the result of a reduction in infant
mortality and deaths from TB and cerebrovascular diseases. The recent
decline in deaths from cerebrovascular diseases reflects the strong network
of community activities, with an important role of public health nurses (Tatara
et al., 1984).
Brief History; PHN Role(1) (truncated)
• The first PHN activities started in 1920.
– Prevalence of Tuberculosis; prevalence rate 223.7
– Main role; prevention and visiting care for TB
patients, school nursing, et. al
• The systemized education of PHN began
– 1928 ; Japan Red-Cross
– 1930 ; Japan Saint-luke’s Nursing School, so on.
• PHN Act was established in 1941.
– To promote health condition of the candidate for
soldiers by the governmental request.
Feb. 5th 2009Katsumasa Ota
Brief History; PHN Role(2)
• After WW-II
– Japanese health condition in general; so terrible
– The American General Head Quarter GHQ re-organized
Japanese nursing system and unified the legislation of
nurse, PHN and midwife into one ACT..
– The conventional role of the PHN:
• cutting off vicious circle of poverty and disease
• prevention of disease
• supporting the effort of self-improvement by residents, et. al.
• An episode of the PHN in those days
– PHNs completed successfully to give the poliomyelitis
vaccine to 13 million children within a month in 1955.
– This resulted in big contribution for termination of
poliomyelitis in Japan, afterwards.
Feb. 5th 2009Katsumasa Ota
Education System for Nurses
4-year
Univ/Col
BScN
Program
RN
3-year RN
School
Diploma
Program
MW
1-year PHN
Course
PHN
1-year MW
Course
MW
2-year RN School
(JH grads need min. 3-year
clinical exp.)
High School
Junior High
RN
PHN
2-year LPN
School
LPN
Feb. 5th
2009Katsumasa Ota
GBD2010

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