The Ministry of Foreign Affairs of Japan

Article 12

1. Data Related to the Health Conditions of Citizens

Refer to WHO Regional Office for the Western Pacific, "Western Pacific Region Data Bank on Socioeconomic and Health Indicators, Dec. 1995."

2. Health Policy

(1) Prevention, treatment, and control of disease
(a) Infectious disease control
To prevent infectious diseases, countermeasures against the sources and paths of infection are implemented under the Infectious Disease Prevention Law. For example, physicians have an obligation to report cases of infectious diseases, medical examinations,confinement, and decontamination or disposal of contaminated articles. The routine and emergency preventative immunization against seven diseases such as poliomyelitis and diphtheria is implemented under the Prevention Vaccination Law.
As a result of these measures, the incidence of infectious diseases such as typhoid fever and paratyphoid fever has decreased to less than one twentieth of the level of the year in which the incidence of these diseases was highest after 1950. Poliomyelitis, in particular, has been virtually eliminated.
In order to prevent the invasion of pathogens which are not normally found in Japan, quarantine is implemented under the Quarantine Law.
The Government endeavors to prevent tuberculosis through health examinations,vaccination, prohibition of workers from engaging in certain occupations, and compulsory confinement and/or hospitalization. As a result of those measures, the number of newly registered tuberculosis cases per year has decreased to approximately 42,000.
Although the number of people who have contracted AIDS remains small in Japan, the number is steadily increasing. Based on the "AIDS Problem Countermeasures Outline" (as determined by the Cabinet Ministers' Conference on February 24, 1987; revised on March 19, 1992), the Government has been making efforts to prevent the possibility of AIDS contraction and to disseminate accurate information on AIDS.
(b) Prevention of chronic degenerative diseases
In accordance with the Law Concerning Health and Medical Services for the Aged,which came into force in February 1983, the Government provides health services to prevent circulatory diseases, cancer, and diabetes. These health services include health education, health consultation, health exams and various other services.
(c) Measures for the prevention of occupational diseases
In order to prevent occupational diseases, Japan has promoted various measures since 1953 through the formulation of Industrial Injury Prevention Programs. The 8th Industrial Injury Prevention Program (covering fiscal year 1993 through fiscal year 1997),has decided to take following measures:
(i) measures to prevent diseases caused by harmful materials such as toxic chemicals; and,
(ii) measure to prevent diseases caused by physical factors such as ionizing radiation and working conditions.
(2) Guarantee of adequate medical services
(a) Medical care supply system
Japan's medical care system has been arranged to ensure effective provision of high-quality and appropriate medical care which responds to the patient's physical and mental condition. As a result, the necessary number of beds and doctors has been secured throughout the nation.
Since fiscal year 1986, the prefectures have created and implemented medical plans in response to community conditions, in cooperation with those who are related to the medical care.
With regard to occupations related to medical care such as doctors and nurses, training and assurance of their quality are promoted through the nation's qualification systems. In addition, the Government makes efforts to enhance clinical training for licensed doctors as a means to foster the training of highly qualified doctors who can provide well-rounded treatment.
The Government provides necessary subsidies to hospitals providing unprofitable or advanced medical services such as those in remote rural areas and those providing emergency care, cancer treatment and treatment for children.
The Government has promoted various measures with a view to guaranteeing medical care for those living in remote areas based on annual plans since fiscal year 1956.For example, measures such as the provision of core hospitals and support hospitals for remote areas and clinics in remote areas, the maintenance of mobile clinics, the supply of doctors for remote areas, and the development of a patient transportation system, have been promoted.
In order to secure emergency medical services for local residents on holidays or at night, the Government has promoted the systematic construction of an initial, second and third emergency medical service system and an emergency medical information center since fiscal year 1977. In addition, the Government has made efforts to ensure proper medical service at first-aid scenes and during transportation of patients. For example, the system of emergency life-saving technician was introduced in fiscal year 1991.
Table 19 shows changes in the number of doctors, hospitals, and beds.

Table 19. Number of Doctors, Hospitals, and Beds
  1991 1992 1993 1994 1995
Doctors --- 219,704 --- 230,519 ---
(per 100,000 people) --- 176.5 --- 184.4 ---
Hospitals 10,066 9,963 9,844 9,731 9,606
(per 100,000 people) 8.1 8.0 7.9 7.8 7.7
Clinics 82,118 83,394 84,128 85,558 87,069
(per 100,000 people) 66.2 67.0 67.4 68.5 70.0
Hospital beds 1,685,589 1,686,696 1,680,952 1,677,041 1,699,951
(per 100,000 people) 1358.9 1353.3 1347.3 1341.3 1367.6
Clinic beds 271,780 270,618 265,083 262,273 259,245
(per 100,000 people) 219.1 217.4 212.5 209.8 208.6

(b) Medical care security system
Refer to the part under Article 9 in this report regarding the outline of the medical care insurance system. Every citizen receives benefits from one of these medical care insurance schemes. In this section, public medical care, which is another major medical care security system in Japan, is outlined as follows:
(i) Medical care assistance under the Daily Life Security Law
Medical assistance based on the Daily Life Security Law, Japan's public assistance law, includes the provision of hospitalization, health examinations, medication, injections, and surgical operations, for those who need such assistance due to their financial situation. Medical assistance benefits under medical care assistance are provided in accordance with the medical service guidelines of the National Health Insurance Law and the Law Concerning Health and Medical Services for the Aged. In this way, almost same medical care as provided by medical insurance is guaranteed.
(ii) Medical care assistance for intractable diseases
Under the General Plan Concerning Measures for Intractable Diseases which was enacted in 1972, the Government promotes extensive research projects on "intractable diseases" for which there are no really effective remedies at present, such as Bechet's Disease and Myasthenia Gravis. The Government subsidizes medical treatment to reduce the financial burden of the patient's medical care.
Moreover, with regard to chronic diseases that interrupt the growth of children and require a long period of treatment and high medical costs, medical care costs are subsidized in the form of remedy research projects to promote the establishment and dissemination of medical care.
(iii) Measures for public mental health and welfare for the mentally disabled
According to the law concerning mental health and welfare for the mentally disabled, the government pays the part of the medical expense for the patients hospitalized on orders of the prefectural governors and for the outpatients.
In Japan, the policy for mental health and welfare for the mentally disabled has been changing from the "system of hospitalization in mental hospital" to the "system of community care." In 1988, the Government enacted the Mental Health Law that superseded the existing Mental Hygiene Law to provide mentally disabled persons with more protection and rehabilitation. The Government amended this law in 1995 to improve measures for the welfare for the mentally disabled and the regional mental health, and to secure proper mental treatment, and thus changed the law's name to the "Law concerning Mental Health and Welfare for the Mentally Disabled."
As measures for the rehabilitation of the mentally disabled, the Government subsidizes the construction and management of rehabilitation institutions for the mentally disabled and provides the counseling by doctors and social workers at the health center and the center for mental health and welfare for the mentally disabled.
(iv) Medical care for tuberculosis
The Government implements measures, such as health examinations for the detection of the disease, vaccinations, the reporting of new cases, and medical care services, to prevent and treat tuberculosis, in accordance with the Tuberculosis Control Law. The number of newly registered tuberculosis patients in Japan has decreased year by year after the registration of new cases began in 1961.
(v) Medical care for persons with physical disabilities
In accordance with the Law for the Welfare of Physically Disabled Persons, medical care for rehabilitation is provided to improve vocational aptitudes and facilitate the everyday lives of those with physical disabilities by removing or reducing such disabilities.For children who suffer from physical disabilities or diseases that might cause disabilities if left untreated, medical care for children with potential disability is provided to the child, based on the Child Welfare Law, in cases where the elimination or reduction of the disability can be expected through treatment.
(vi) Others
In addition to the measures mentioned above, public medical care services include medical care for atomic bomb victims based on the Law Concerning Relief for Atomic Bomb Victims, and medical care for those with infectious diseases based on the Infectious Diseases Prevention Law.

(3) Health promotion
(a) National Health Promotion Movement
The Government has promoted the National Health Promotion Movement (The Active 80 Health Plan) since 1988 to establish healthy living practices in terms of nutrition, exercise, and rest, adding measures to take exercise and rest as a part of people's lives to existing measures to enhance people's lives.
(b) Medium and Long-term Plan Concerning Health Promotion and Disease Prevention
Medium and Long-term Plan Concerning Health Promotion and Disease Prevention, which aims to extend healthy life expectancy and improvement of QOL (Quality of Life), will be drawn up in the fiscal year of 1998 and 1999.
(c) Health services under the Law Concerning Health and Medical Services for the Aged
Under the Law Concerning Health and Medical Services for the Aged, which entered into force in February 1983, the Government provide those aged 40 and over with comprehensive health and medical services, including preventive care, medical treatment, and rehabilitation to ensure the health of the aged.
These medical services are provided based on First and Second Five-Year Programs. The Government inaugurated the third Health Service Program in 1992, which aims at a significant reduction of the death rate caused by the three major degenerative diseases, namely cancer, heart disease, and cerebral apoplexy, and of the number of bed-ridden elderly people. Medical services to this end have thus become even more effectively provided since then.
(d) Health services provided by medical insurance providers
Medical care insurance providers, such as health insurance providers, actively provide the necessary health services to maintain and improve the health of insured persons.These services include health education, health counseling, as well as health examinations.
(4) Improvement of environmental hygiene
(a) Waste disposal
Under the Waste Disposal and Public Hygiene Law, all solid and liquid waste, other than radioactive materials, are classified into two categories: industrial waste and general waste.
Municipal authorities (cities, towns, and villages) are responsible for the management and disposal of general waste, including human waste, and establish a general waste disposal plan for their respective area.
Although, in principle, the person or entity generating the industrial waste is responsible for the disposal and proper management of the waste, the prefectural governors draw up master plans for industrial waste management for the proper disposal of the waste.
All operations, such as collection, transportation, middle treatment and final disposal of waste, must comply with legal standards. The national government provides local governments with financial and technical assistance for the construction of general waste treatment and disposal facilities.
(b) Waterworks
Water utility companies which are authorized under the Waterworks Law supply water in conformity with the standards for drinking water quality set forth in the Law. Japan formed the "Fresh Water Program" in 1991, whose goal is to provide clean drinking water nationwide by the 21st century.
The Government subsidizes the construction and operation of waterworks such as area-wide water-supply systems, which tend to be exceptionally costly because of their nature and large scale.
(c) Sewerage
Under the Sewerage Act, local governments such as municipal authorities (cities, towns and villages) and prefectures are responsible for the construction and maintenance of sewerage facilities.
Sewers support environmental hygiene by draining waste water from households and industries quickly. The Sewerage Act prescribes that waste water should be treated by sewage purification plants to preserve the quality of public bodies of water.
Sewers also drain storm water and protect urban areas from being damaged by flooding.
The Government provides local governments with financial and technical assistance for the construction of sewerage facilities because the construction of sewers is expensive.
(5) Improvement of industrial sanitation
The Industrial Safety and Health Law, the Working Environment Measurement Law, and the Pneumoconiosis Law, and the rules based on these laws such as the Ordinance on Industrial Safety and Health, the Ordinance on the Prevention of Organic Solvent Poisoning, the Ordinance on the Prevention of Hazards due to Specified Chemical Substances, and the Ordinance on the Prevention of Anoxia were enacted in order to ensure the health of workers in the workplace and to establish suitable environmental working conditions.

3. International Assistance

International assistance in the health and medical field means assistance for basic human needs in developing countries and is defined as the core of the international cooperation provided by Japan. Japan contributes to human resources development mainly by technical cooperation such as dispatch of experts and the acceptance of trainees, and provides assistance for basic infrastructure through grant and loan aid. Japan also plays an active role in multinational cooperation, in cooperation with international organizations such as the WHO.

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