The origin of public health nurses in Japan is the end of the 19th century. In the world, health visitors had already begun their activities in UK. Around the same time that home-visit nursing was spreading in the United States through settlements, home-visit nursing began in Japan with the cooperation of the American missionary Perry.
In the early 1900s, nurses began to provide public health guidance and environmental improvement in factories and schools; in 1926, the name “public health nurse” was used for the first time as a professional position to provide infant health checkups and childcare counseling; in 1937, the Public Health Center Law was enacted and public health nurses were specified as employees. After World War II, the public health system was reorganized under the policy of GHQ, and this system has remained largely unchanged to the present.
Education for public health nurses began in 1928 at the Japanese Red Cross Society under the influence of foreign countries such as the U.K. In 1941, the Public Health Nurse Ordinance defined the qualifications of public health nurses, and in 1948, the laws for public health nurses, midwives, and nurses were consolidated into the Act on Public Health Nurse, Midwife, and Nurse.
Employment Location of Public Health Nurses in Japan
The number of employed public health nurses in 2020 is 55,595 (44.1 per 100,000 population) nationwide and increasing. The majority of public health nurses work in public administration (73%). Public health nurses working in public administration are largely divided into those working in prefectures and those working in municipalities. The roles of public health nurses are divided between Prefectural Health Centers and Municipal Health Centers (large cities take on the roles of both Prefectural Health Centers and Municipal Health Centers). Prefectural Health Centers mainly deal with health crises and difficult health issues such as infectious diseases, mental illness, and intractable diseases. Municipal Health Centers deal with health issues at each stage of life, such as parent-child health, adult health, and elderly health. Many health services, such as maternal and child health and elderly health, are now provided by municipalities, and the number of public health nurses working in municipalities is increasing.
Public health nurses work in a variety of places, including private companies, schools, medical institutions, and long-term care insurance facilities, as well as government agencies. Public health nurses support all people from cradle to grave, from the healthy to those with illnesses and disabilities.
To become a public health nurse, one must have passed the national nursing examination. Education for public health nurses is provided at universities, first-year junior colleges and training schools, and graduate master’s programs. Most students receive their education at universities, but graduate education is also increasing. The content of basic nursing education has increased to 102 credits due to the 2020 revision of the designation regulations, which increased the number of credits for “community and home nursing” and other courses. Basic public health nurse education is now 31 credits and the educational content has increased.
Recent Health Issues and Public Health Nurse Activities in Japan
1. Parent-child health
Issues related to children such as child abuse, child poverty, and young carers are becoming more common. Parents also face various difficulties such as older childbirth and postpartum depression. Public health nurses at Municipal Health Center provide seamless support from the time of pregnancy and abuse prevention. They interview basically all pregnant women from the time of pregnancy notification and identify those who need support. Support is provided from the time of pregnancy to the postpartum period. After childbirth, public health nurses or other staff visit everyone by 4 months; they conduct checkups at 4 months, 1.5 years old, and 3 years old to check on the child’s development and provide support for parental care. Immunizations and childcare classes are also offered.
From school age onward, school nurses play a central role in providing health support for children. If necessary, they provide support in cooperation with administrative public health nurses.
2. Adult health
Laborer health checkups are conducted annually and include a screening called stress check to ascertain mental health; at age 40, health checkups specific to metabolic syndrome begin. Public health nurses working in companies provide health support for laborer. Public health nurses at Municipal Health Centers provide health support to those who are self-employed or receiving public assistance.
3. Health Care for the Elderly
Japan has the world’s longest life expectancy and is now a super-aged society due to the declining birthrate and aging population. The year 2040, when the generation born during the second baby boom will be 65 years old or older, is known as the “2040 problem,” and it is said that problems such as increased social security costs and a decrease in the working population will arise. Already, phenomena such as the elderly caring for each other and those with dementia are occurring. The core institution for health care for the elderly is the Comprehensive Community Care Center. Public health nurses, social workers, and care managers work together to address these issues. Community-based Integrated Care System has been established. In that system, public health nurses take methods that suit the actual conditions of the area so that people can live in their familiar neighborhoods until the end of their lives within their daily life sphere. The system is designed to support people’s life in the community through cooperation among the fields of medical care and nursing, nursing care and rehabilitation, health and welfare services, residents’ organizations, and housing, and is to be created in each community.
4. Infectious diseases
In COVID-19, public health nurses at the Prefectural Health Centers took the lead in organizing the response to infected people in the community. It was a difficult situation, with many working nights and holidays. In addition, since tuberculosis is common in Japan, public health nurses provided support for the completion of treatment.
5. Mental health
Prefectural Health Centers are mainly involved in crisis intervention and handling difficult cases. Since Japan has more psychiatric beds than any other country in the world, public health nurses also provide discharge support for hospitalized patients. Municipalities provide counseling and welfare services for living and social reintegration to those who are basically stable.
6. Intractable diseases
Prefectural Health Centers receive application procedures for medical subsidies for people with intractable diseases. Then, public health nurses begin to provide support to those who need it. In particular, those with neurological intractable diseases gradually become physically immobile and require a lot of medical support. Public health nurses provide care management and coordinate services. They also provide support in cooperation with hospitals.
Written by Masako Kageyama, Ph.D.
Chair, International Committee, Japan Academy of Public Health Nursing