Public health centres in contemporary Japan

Abstract

As most readers will be aware, Japan made significant public health advances following the Second World War, such that the average life expectancyof its citizens is now thehighest in theworld; 86years forwomenand79years formen in2006. Theworkofpublic health professionals and the dissemination of effective primary health care represents an important part of this success story. In their Letter to the Editors, Hayasaka et al.2 commented on the decreasing number of public health centres (PHCs) in contemporary Japan. However, this may be an oversimplification of current events. The integration of PHCs in Yokohama City during 2007, for example, involved the amalgamation of 18 centres into one, although the new facility actually contained 18 branches. Hayasaka et al.2 also commented on a decreasing number of public health professionals now working in Japanese PHCs. However, this may only be part of the story, as statistics from the Japanese Nursing Association suggest that the number of public health nurses has been increasing since 1997, with approximately 47,000 in service in 2005. While Hayasaka et al. pointed out that PHCs were first established following promulgation of the 1947 Community Health Law, the origins of Japanese public health can be traced backmuch further than this. The first Japanese healthcare legislation was enacted in 1874, followed 1 year later by establishment of the Bureau of Public Health in 1875. The first Public Health Centre Act was introduced in 1937, before being amended in 1947 and again in 1994, when it became the Regional Health Act.5 This revised legislation was part of an overall restructuring process intended to delegate various PHC services to municipal health centres (MHCs). The number of MHCs has been increasing; in late 2005, there were 2692 MHCs in Japan.5 Despite somepotential caveats, the pointmadebyHayasaka et al. is still of vital importance. The Japanese success story in reducing disease and simultaneously raising the life expectancy of its citizens to record levels is no doubt a credit to its dedicated public health workforce. Similarly, the maintenance of high public health standards in Japanese society, as elsewhere, is critical as we enter a new era of potentially devastating epidemics, such as pandemic