Creating a Healthy Community Led by
Public Health Nurses
Sachi SAKATA
Department of Health Promotion Policy , Public Health Nurse Division
Japanese Nursing Association

Faculty Disclosure✓ No, nothing to disclose
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Other(please specify)© 2023 Japanese Nursing Association2

Characteristics of Public Health Nurse in Japan
Public Health Nurse(PHN) - a national qualification≪1941：Public Health Nurses Ordinance enacted≫≪1948: Act on Public Health Nurses, Midwives, and Nurses enacted≫
Public Health Nurse is• a person who has acquired a license from the Minister of Health,Labour and Welfare to use the title of ‘Public Health Nurse’ andprovides health guidance as a profession.
• ‘Public Health Nurse is an exclusive title’.
© 2023 Japanese Nursing Association3

Characteristics of Public Health Nurse in Japan
Over 70% of Public Health Nurses work in local governments≪1937: Public Health Center Act enacted≫
Establishment of health centers and stipulated their role→ 1947
Public health centers strengthened as frontline institutions for public healthwith integrating administrative functions

Public Health Nurses work “in” and “into” the community
as public health professionals© 2023 Japanese Nursing Association4

Historical Changes of Health Issues and Measures in Japan
Child poverty
Chain of poverty
Balancing work and medical treatment
Occupational health
Collaboration in the community and workplace

Dementia, cancer and disease control measures
Health promotion

Dispatch of Disaster Health
Emergency Assistance TeamSocial security for all generations
Strengthening measures for NCDs
Strengthening health promotion measures
Healthy life expectancy extension
Establishment and promotion ofcommunity-based Integrated care systems

Health and welfare services for the elderly

Health care and welfare measures for persons with disabilities

Building care system and support
for persons with mental disorders

Establishment of a parenting generation
integrated support centers

Maternal and child health

COVID-19
response/measures

Infectious disease
1941

1950s

1960s

Enactment of the Public Health Nurses Regulations

1970s

1980s

1990s

2000s

the 2010s(integration of all sectors)

Health emergency management

Towards a mutually-supportive community

Disparities

52020s - present.
© 2023 Japanese Nursing Association

Role of Public Health Nurse in Health Issues and Measures
Point
1

Developing a series of activities that are appropriate to the times
building on the activities that have been implemented so far

Point
2

Confronting complex and diverse health challenges adapting
subjects and content of activities in response to social change

Point
3

With enactment of new or amended schemes,
PHNs work with diverse changes in their own functions

Contributing to the realisation of a mutually-supportive community(UHC achieved and sustained)© 2023 Japanese Nursing Association

6

“Guidance on Health Activities by PHNs in Communities”~ Basic Direction of Public Health Nurse’s Activities ~（1） Implement a PDCA cycle based on community assessment（2） Expand viewpoints and activities from individual issues to community issues（3） Emphasize preventive intervention（4） Strengthen activities grounded in community-based activities（5） Promote a system of area-based responsibility（6） Promote healthy community development in accordance with local characteristics（7） Coordinate and collaborate on cross-departmental public health activities（8） Establish community care systems（9） Establish and implement various health care and welfare service plans（10） Develop human resources
Source: Health Service Bureau Notification No. 0419-1, 19 April 2013. Notification of the Director-General of the Health Service Bureau, Ministry of Health, Labour and© 2023 Japanese Nursing Association
Welfare: ”Health activities of Public Health Nurses in local communities”.

7Locations of Public Health Nurse activities
Prefecture
HealthHealth &welfare

Planning &Coordination Long-term
Welfareinsurance
Health &welfare
MedicalMain officeLong-term
insurance

Healthinsurance
Workers’
healthChild guidancecenter

Public health center

Mental health &welfare center

Cooperation and Collaboration
for the same local area
Municipal
Municipal (city, town)
health center
HealthHealth &welfare

Long-term
Welfare insuranceChild healthsupportcenter

HealthWelfare

Health &welfare

WelfareofficeMedicalMain officeLong-term
Healthinsurance
insurance
Workers’
healthCommunity
general supportcenter

Child welfare
institution© 2023 Japanese Nursing Association

8

Role of Prefectural/Municipal Public Health Nurses
Role of Prefectural Public Health Nurses:‘Creating a wide-area system and environmental improvement'
Role of Municipal Public Health Nurses:‘Creation and effective implementation of a system suited to the community'
Grasping the actual situation: Clarification of health issues

Development and implementation ofhealth care and welfare service plans

Cooperation and coordination

Training (skill development)

Provision of public health services

Prepared by the Japanese Nursing Association based on Health Service Bureau Notification No. 0419-1, April 19, 2013, a Notification of the DirectorGeneral of the Health Service Bureau, Ministry of Health, Labour and Welfare

Evaluation© 2023 Japanese Nursing Association9

Changing Social Needs & Health Challenges towards 2040
• Low birthrate and ageing society• Declining population in an extraordinary level (shortage of health care personnel)• Risk of vulnerability of health center functions due to decentralization,municipal mergers, and consolidation of health centers• Health inequities (disparities between regions and social classes)
Young carerChild poverty
Elderly Care by the Elderly
Health emergency management (burden on vulnerable groups) etc…
© 2023 Japanese Nursing Association10

Current Challenges for Public Health Nurses•

expansion and promotion work of the policy development, health support
projects, and care system establishment•

Increase in the number of eligible people in need of direct health care services•

Increase in administrative work related to health emergency management•Recruitment and development of human resources- Effective health activities with limited human resources- Division of roles and cooperation between Public Health Nurses working inprefectures, health centers and municipalities- Improving the visibility and quality of Public Health Nurses' expertise- Development of postgraduate education for basic Public Health Nurse education© 2023 Japanese Nursing Association11

Demonstration of Competencies as Public Health Nurses
Solving individual problems withviewing them as community- andpopulation-wide issues, seeking toachieve “organizational solutions”

Do I have aclear view of
the area I’m
Are there any in charge of?
hidden healthissues?

To analyze and assess
community health issues
quantitatively and qualitatively
Are there
people inneed?

Visualize the issues ofinvisible issues, andleading to solutions

Able to reflect the voices ofcommunity resources invarious plans and policies

Can see and know
local individuals andstakeholders
Collaborate with multiple
professions and organizations

Combine various approaches
home visits, area organization activities,
health education, health counseling© 2023 Japanese Nursing Association12Future State of Public Health Nurses as a Profession
Acting as leaders/providers of healthactivities that contribute to effective
health policy in the community

Working with responsibility,mission and pride in directly
identifying and taking action toaddress local health issues

Providing high quality health activities to all citizens
Creation of healthy communities (achieving and sustaining of UHC)
© 2023 Japanese Nursing Association13