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Public Health Centers in Japan and Their Response to COVID-19

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Public Health Centers in Japan and Their Response to COVID-19 2021/7/6 Hokkaido Reproducing all or any part of the contents is prohibited. 47 Prefectures of Japan 1. Hokkaido Chugoku Chubu 20 Designated cities 31. Tottori 15. Niigata 32. Shimane 16. Toyama Most of them are along Public Health Centers in Japan 33. Okayama 17. Ishikawa Tohoku 34. Hiroshima 18. Fukui 2. Aomori Japan’s Pacific coastal belt. 35. Yamaguchi Kansai 19. Yamanashi 3. Iwate 24. Mie 20. Nagano 4. Miyagi and their response to COVID-19: 5. Akita 25. Shiga 21. Gifu Shikoku 26. Kyōto 22. Shizuoka 6. Yamagata 36. Tokushima 27. Ōsaka 23. Aichi 7. Fukushima An overview 37. Kagawa 28. Hyōgo Kanto 38. Ehime 29. Nara 8. Ibaraki 39. Kōchi 30. Wakayama 9. Tochigi Kyushu 10. Gunma 40. Fukuoka 11. Saitama 41. Saga 12. Chiba Akihiro YOMO, M.D., M.Trop.Paed. 42. Nagasaki 13. Tōkyō 43. Kumamoto 14. Kanagawa 44. Ōita 45. Miyazaki Director, Fukui Public Health Center 46. Kagoshima https://www.nippon.com/ja/japan- Fukui Prefecture, Japan 47. Okinawa data/h00854/?cx_recs_click=true 2 https://commons.wikimedia.org/wiki/File:Regions_and_Prefectures_of_Japan.svg The structure of territorial governance in Japan (May, 2021) Administration institutes of public health programs in Japan Ministry of Health, Central Government Labor & Welfare Tokyo Metropolitan Bureau of Social Welfare Dept. of Health, Prefectures (46) Government (TMG) & Public Health, Tokyo Prefectures (46) Prefectural Public HCs Municipalities (1747) Special Cabinet Other Special Designated Cabinet Designated Core Towns Villages Core cities wards in order cities Cities wards cities order cities Other Cities Towns Villages cities (20) cities (60) (743) (189) Public HCs Tokyo (23) (5) (707) Public HCs Public HCs Public HCs Population Municipal Municipal Municipal Municipal Municipal Municipal Municipal more than more than HC HC HC HC HC HC HC 3 500,000 200,000 4 1 2021/7/6 PublicPublic Health Health Centers Centers The Community Health Act MunicipalMunicipal Health Health Centers Centers was amended in 1995. The director is a medical doctor. Headed by a general office staff or a public health nurse. Plan, supervise, evaluate and implement health programs Provide community-oriented health services directly to the residents at responsible area. Year• Growth monitoring 1994 2000 2006 2020 in the municipals. Prefectures(46＋Tokyo) 625 460 396 355 -270 • • Issuing MCH Handbook In 1995, the authority was transferred from Public Public Health Health Centers Centers. Health education Designated cities(20) 124 70 73 26 -98 • Improvement of nutrition Core cities(60)• Health checkups0 27 for 36 adults60 +60 • Growth & development monitoring • Improvement of food hygiene Cities of cabinet• Health order(5) advice45 11 7 5 -40 • Issuing Maternal & Child Health Handbook Tokyo’s 23 wards 53 26 23 23 -30 • • Environmental health • Immunization Health checkups for adults TOTAL 847 594 535 469 -378 • Health advice • Mental health • Arrangement of immunization program • Registration of intractable diseases • Control of infectious diseases; VCT for HIV, TB-DOTS, etc. No role on the infectious disease control. 5 6 Stuffs https://www.nippon.com/en/japan-data/h01044/ Public Health Centers Municipal Health Centers • Medical doctor(s) • ± Dentist • Veterinarian (animal doctor) • Pharmacists • Public Health Nurses • Public Health Nurses • National registered dietitian • ± National registered dietitian • Radiological technician Pneumonia • ± Laboratory technician • Dental hygienist • ± Dental hygienist • General office staffs • General office staffs 7 8 2 2021/7/6 Beds for TB and for Designated Infectious Diseases have been (Classification by Infectious Diseases Control Law) decreasing year by year. Data: https://www.mhlw.go.jp/toukei/list/79-1a.html 70000 1700000 Ebola haemorrhagic fever(HF); Crimean-Congo HF; smallpox; South American HF; Class I plague; Marburg virus disease; Lassa fever 60000 1650000 acute poliomyelitis; tuberculosis; diphtheria; severe acute respiratory syndrome; Class II 50000 1600000 Middle East respiratory syndrome; specified avian influenza cholera; shigellosis; enterohaemorrhagic Escherichia coli infection; Class III 40000 1550000 typhoid fever; paratyphoid fever hepatitis E; hepatitis A; yellow fever; Q fever; rabies; anthrax; avian influenza 30000 1500000 Class IV (excluding specified avian influenza); botulism; malaria; tularaemia; etc. 20000 1450000 Seasonal influenza; viral hepatitis (excluding hepatitis E and A); cryptosporidiosis; 1867 Beds Class V acquired immunodeficiency syndrome (AIDS); genital chlamydia infection; syphilis; 10000 1400000 measles; methicillin-resistant Staphylococcus aureus infection; etc. a Novel Influenza Infection, etc. 0 1350000 Designated Infectious Disease COVID-19 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011 2014 2017 2020 New Infectious Disease 9 Beds for Designated Infectious Diseases Beds for TB Hospital Beds 10 Preventive health services Curative medical services Number of Hospitals which may Free of charge Payment Fee-for-service system accept COVID-19 cases (a survey) Tax Resources Health insurance + copayment No. of Public sector Suppliers Public < Private facilities hospitals PublicPublic health Health centers Centers (468) Public Private MunicipalMunicipal Healthhealth Centers centers (2,457) Hospitals (1,575) (6,725) Public Health Laboratories Clinics (4,509) (98,107) https://www.mhlw.go.jp/stf/covid-19/kokunainohasseijoukyou.html Hospital beds 13.2/1,000 population Unacceptable Acceptable, Governmental Number of testing day of PCR Number per National Institute of top of 35 OECD countries Acceptable, Other public Public Health Laboratories Private Laboratories Acceptable, Private Infectious Diseases Percentage Univ. Hospitals & Clinics Physicians 2.4/1,000 population Quarantine stations below average of OECD 12 https://www.mhlw.go.jp/content/ 10800000/000726034.pdf 11 Governmental Other public Private 3 2021/7/6 Advantages to be classified as a “Designated Infectious Disease” Disadvantages to be classified as a “Designated Infectious Disease” 1.Public Health Centers request a confirmed patient to be hospitalized to prevent the spread of the disease. 1. Designated Hospitals face with the heavy workload. The outbreak soon expanded over the capacity of those Hospitals. 2. Patients are hospitalized in Designated Hospitals, and the other facilities may decrease the risk of infection. Number of beds for Designated Diseases are only 1,867 Payment 3. The prefecture must pay the expenses for medical services. 2. Other hospitals and clinics may loosen their guard, or tighten their guard too much to see patients with fever. 4. Physicians must quickly notify the cases to Public Health Centers , and the governments easily track the spread of the virus. 3. Human rights of the patients are more or less limited. 5.Public Health Centers request the close contacts to stay home and report their health conditions during the incubation period. 13 14 Cumulative cases per 1 million population (Jun 6,2021) Population (million, 2020) 47.Okinawa 1.47 Apr 15 - Jun 13 (or 20), 2021 Jun 21 - July 11(extended?), 2021 13. Tokyo 14.06 27. Osasa 8.84 1. Hokkaido 5.23 28. Hyogo 5.47 Emergency 14. Kanagawa 9.24 declared 40. Fukuoka 5.14 23. Aichi 7.55 26. Kyoto 2.58 Quasi-emergency 11. Saitama 7.35 declared 12. Chiba 6.29 29. Nara 1.33 The declaration 21. Gihu 1.98 10. Gunma 1.94 cancelled 33. Okayama 1.89 34. Hiroshima 2.80 4. Miyagi 2.30 25. Shiga 1.41 43. Kumamoto 1.74 (23 Pref.) 18. Fukui 0.77 3. Iwate 1.21 31. Tottori 0.55 32. Shimane 0.67 https://upload.wikimedia.org/wikipedia/commons 5. Akita 0.96 /thumb/6/69/Japan_Population_density_map.svg/ 600px-Japan_Population_density_map.svg.png 15 16 0 2000 4000 6000 8000 10000 12000 14000 4 2021/7/6 Emergency Quasi-emergency Number of people staying on the 7 busy streets in Tokyo, March 7, 2020 - Jun 26, 2021 (Priority Preventative Measures) 10-12PM 8-10PM Number of new cases per week Stage 3, when there are risks of Criteria for Stage 4, the worst level on the scale. infections spreading and a growing People No.of declaration Reducing casesweek No.of per Emergency Emergency strain on medical systems. business Emergency hours Prime Minister apply the steps to an Governors apply the steps to selected Target area entire prefecture. cities and towns. Restaurants are asked to barred from Governors Serving alcohol is allowed to do so serving alcohol. requests or until 7 p.m. Not only shorter business hours, orders Only shorter business hours. (shut by 8 p.m.) restaurant (shut by 8 p.m.). but also store closures. & bars Fines up to 300,000 yen Penalties Fines up to 200,000 yen ($1,800) Limited to 5,000 or half of a venue’s Spectators at Same as under a state of emergency capacity, whichever is smaller. major events Refrain from unnecessary and non- Year 2020 | 2021 For citizens Same as under a state of emergency 18 urgent outings. 17 https://www.igakuken.or.jp/r-info/monitoring.html PublicPublic Health Health Centers Centers Prefecture-wide coordination is often better than cope with markedly increased workload by… coordination by Public HCs in their responsible area. • Fukui Prefectural Admission Coordinate Center find a proper • reducing or postponing non-urgent health programs. hospital in the entire prefecture according to the severity of cases. eg. Nutrition programs National Nutrition Survey • Fukui prefectural Call Center receives all the telephone call from Registration of intractable diseases; automatic renewal the entire prefecture and find a proper PCR test clinic. VCT sessions for HIV • Bureau of Social
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