JNA's challenge
to strengthen UHC in Japan andenhance nursing capacity in the community:from the perspective of public health nurses, midwives, and nurses

Introduction
Japanese Nursing Association
President Hiroe TAKAHASHI

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Nursing professionals are essential to achieving UHC
Nursing professionals…

⚫account for half of all health workforce.
⚫understand the needs of people & communities, being closest to them.
⚫are significantly involved in prevention activities and health promotion.
The WHO and UN also point out that the cost for the healthworkforce is not a financial burden, but a profitable investmentthat can be a path to economic growth.

3© 2022 Japanese Nursing Association

Achievement of UHC in Japan
 In Japan, universal health insurance since 1961 realized one of the three elements of UHC, "providing (medical) services
to all (X-axis in the figure)" (100% of the population is covered by medical insurance).
 After that, UHC in the medical field was almost achieved in 1973 by expanding covered services and reducing the copayment.
 Thereafter, the "social security system," which adds health and public health, long-term care/welfare, public assistance,
etc. to the system of medical insurance, has functioned as a safety net that supports the healthy lives of people.
Achievement and development of universal health insurance (comparison of pre-1961, 1961, and 1973)

Reducepatient copayment

Expandservice
coverage(3) Z-axis:
What is theratio of copayment?

Expand thenumber of people
coveredPre-1961 condition(2) Y-Axis: Which services
are covered?
(1) X-Axis: Who is covered?
(Source) Prepared by the author. The concept of the cube diagram is fromthe World Health Report 2010.

© 2022 Japanese Nursing Association[Source] Kenji Shimazaki, The essence of universal health insurancein Japan - What and how we should communicate about Japaneseexperience - Research Report Symposium on International Medical
Research and Development Expenses in FY 2014 (Issue No. 26,
Designation 1), "Medical security system - Utilizing Japaneseexperience for UHC support in developing countries" July 16, 2015Report4Underlying challenges faced in sustaining UHC
Aging rates among G7 nations（Population ages 65 and above (% of total population))
30.0

25.0

20.0

15.0

10.0

5.00.0

CanadaGermany

FranceUnited KingdomItaly

JapanUnited StatesWorld

Social issues looking ahead to 2040
Further progress of the declining birthrate,super-aging, and declining population••

between the rich and poor)•

Qualitative changes in the elderly population

Decrease in production-age population
Economic imbalance among generations (GapAging of the elderly population (30% of elderlypeople aged 85 years and older)••

Impoverishment (aging of the employment ice-agegeneration)
Isolation (40% of elderly households are singlehouseholds)

Expansion of health inequality

Weakening of local government/life functions

•
•
•
•

Intergenerational
Between men and womenGap between the rich and the poor
Differences in knowledge quantity and quality••

Decrease in population + urban hollowing
Dispersed and scattered population© 2022 Japanese Nursing Association6

Current system of providing health, medical care, and welfare services in Japan and recognition of issues
From the viewpoint of maintaining UHC into the future⚫ Current medical and welfare services in Japan are mainly provided after the onset of disease⚫ Intervention is insufficient for health promotion and disease prevention from the time when still healthy⚫ Intervention is insufficient for those who are not connected to necessary supports (e.g., those with social/economic factors,
those indifferent to their health)⚫ Following up is necessary for those who may fall through the gap in the system

Insufficient intervention
It is necessary to strengthen health promotion,disease prevention, and interventions for
those not connected to necessary supports
Healthy

At a risk ofdeveloping disease

Return to a healthy state

Current Focus of Health, Medical
Care, and Welfare in Japan
Much social security expenses and medical
resources/personnel are invested
Disease onset/
start of treatment

Recuperation

Disease developed but not
yet seen by a doctor

Nursing professionals who can understand patients from the perspective of both medical careand daily life, and perform coordination functions including social background, family andrelated institutions, are expected to play an active role!
© 2022 Japanese Nursing Association7