Journal of the National Institute of Public Health2012 Vol.61 No.2 p.96−103

Topic：Issues and international trends towards the community-based integrated care system in Japan＜Review＞
Challenges and opportunities in the development of the communitybased integrated care system in Japan: Significance of social capital
within community-based integrated care system
Takako TSUTSUI
Research Managing Director, National Institute of Public Health
Abstract
In April 2005, the cabinet council formulated basic policies for the reactivation of communities in Japan through the Local
Revitalization Act. The council, while promoting the implementation of social networks and investing in human resources,
stipulated the need to stimulate the social capital inherent to each community. Meanwhile, the Ministry of Education, Culture,
Sports, Sciences and Technology (MEXT) as well as the Ministry of Economy, Trade and Industry (METI) also examined thepossibility of supporting social capital. It was at the same time that the long-term care insurance system was reformed.
This reform promoted the implementation of a “community-based integrated care system,” but no mention was made ofsocial capital. However, as the design of the system was a task delegated to each local government and considering that somegovernments put social capital at the core of the system, some leave it out of consideration, and some others try to cultivate asocial capital adapted to the Japanese situation, significant differences between local governments in the design of the system
can be expected.
The diffusion of a concept such as social capital, which describes various dimensions outside market mechanisms andmonetary exchanges, probably had some influence on the design of community-based integrated care systems.
The purpose of this paper is to determine what definition and conception of social capital could be relevant for the
management and implementation of community-based integrated care systems. The current state of research in the UnitedStates and in Japan is also summarized, and the reasons explaining the growing interest in social capital from the World Bankand the OECD are clarified.
keywords: community-based integrated care system, social capital, local government, community(accepted for publication, 11th April 2012)

Ⅰ．Introduction
The Social Policy Bureau of the Cabinet Office examined
the relationship between social capital and civil activities
and tried to grasp social capital quantitatively [1]. In recent
years, research institutes from various ministries have also
started to conduct research on social capital.
In April 2005, the cabinet council formulated basic
policies [2] for the reactivation of communities in Japanthrough the Local Revitalization Act. The council, while
promoting the implementation of social networks andinvesting in human resources, stipulated the need tostimulate the social capital inherent to each community.
Various reasons could explain this decision. For example,
the shift towards an information-based society and theaging of the population have led to the fear that citizens
may be less and less inclined to transcend their respective
social positions to actively help each other. Moreover, basedon the view that fostering and strengthening relations

2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
T e l: 048-458-6111
Fax: 048-458-6715
E-mail: tsutsui@niph.go.jp

96

J. Natl. Inst. Public Health, 61（2）: 2012

Challenges and opportunities in the development of the community-based integrated care system in Japanbetween people within a community will lead to a more
fulfilled and peaceful life, the tasks of increasing the social
capital and resolving various policy issues started to be
seen as two faces of the same coin and as related processes
that needed to be addressed.
The Ministry of Education, Culture, Sports, Science andTechnology (MEXT), in the “Research paper on the future
information technology strategy [3]” of March 2005,
described the conditions for building a society that values
lifelong learning and stated that: “It is necessary to
implement measures for lifelong learning according to the
new concept of public sphere with the three different levels
mentioned below. By implementing such measures, it
seems possible to increase social capital”.
The Ministry of Economy, Trade and Industry (METI),in the chapter “Paradigm of the manufacturing industry inharmony with the twenty first century [4]” of the “National
manufacturing strategy” report of November 2005,
described a socio-economic system for relations between
companies and argued for the need to accumulate, in thisrelational space, a social capital for human networks that
supported trustful relationships.
The Cabinet Secretary also published a paper in
February 2006 entitled “Public policies for therevitalization of communities [5]” (revision). The firstparagraph (“Promoting networks and developing humanresources”) of chapter one (“Promoting and supporting
innovations and wisdom”) describes local companies,
educational institutions, public institutions, and variousorganizations as leaders for the promotion of communities.
These various organizations include non-profit organizations(NPOs) created for a specific purpose, such as welfare or
urban development, as well as all the associations involved
with community activities. The paper recommends
reactivating those organizations, clarifying the purpose ofeach leader within the community, and planning a system ofgoals to achieve within a given period and according to acommon theme important to the community. With thispaper, the Cabinet Secretary clearly considered thefunction of mutual help within a community as social capital.
Reports from the two ministries mentioned previously
also suggested the need to improve and accumulate social
capital. METI, when speaking of accumulating social
capital, clearly believes that social capital can be grasped
quantitatively. However, MEXT suggests, throughexpressions such as “improvement of social capital,” that it
is a functional capability.
Those documents from the ministries and from the
Cabinet Secretary show how the term “social capital” canbe understood and used differently, even on the same
governmental level.

This lack of a clear definition and the ambiguous use of
the words did not stop MEXT from using widely, along withthe mass media and politicians, the catchphrase “a new
public sphere” as if it were a completely different and newarea of social security.
After the 1990s, the Ministry of Health, Labour andWelfare (MHLW) recognized the need [6] to change
the traditional local community by introducing
community healthcare and community welfare through theimplementation of the Long-Term Care Insurance System
in 2000. This system was designed to allow elderly persons
in need of care to live and stay longer at home and was used
as a trump card that could substitute for the old system ofself-care and mutual help.
However, the Long-Term Care Insurance Act was revisedin 2006 to create a system that not only simply focuses onhome care but on community care by implementing
community-based integrated care centers and building new
living environments. Because this revision and the interest
from the ministries towards social capital started at thesame period, it seems likely that the improvement or theaccumulation of social capital was also evoked when thecommunity-based integrated care system was designed.
However, as the system was designed to be a task
delegated to each local government and considering thatsome governments put social capital at the core of thesystem, some leave it out of consideration, and some others
try to encourage a form of social capital that has been
adapted to the Japanese situation, significant differences
can be seen between local governments.
The purpose of this paper is to investigate the meaningthat social capital may have in the context of a communitybased integrated care system. In the process, after
revealing a fallacy that tends to occur in research on social
capital, this paper also suggests a new way of consideringsocial capital that may be more relevant when designingand managing a community-based integrated care system.

Ⅱ．Worldwide growing interest in social capitaland current state of research in Japan
1. Context behind the growing interest in social
capitalSince 2000, the growing worldwide interest in social
capital (including in Japan, where it has been acknowledged
as part of “a new public sphere”) has been clearly linked
with a notable decline of the United States. The economiccrisis that followed the terrorist attacks on the UnitedStates as well as the shift in the industrial structure
seriously deteriorated the public service spirit and the faithof the middle class in social stability. This explains the need

J. Natl. Inst. Public Health, 61（2）: 201297

Takako TSUTSUI

for a major overhaul in the United States.
This decline in the United States that led to the growinginterest in social capital goes along with a decline in social
democracy and of the welfare state in many European
countries.
The deterioration of social capital in America started after
the oil shock of the 1970s and the large-scale downsizing
strategies of companies. These events weakened the middle
class, which is at the core of social capital, andsubsequently led to the deterioration of local communities.
Social capital can be seen as a favorable means toincrease the public service spirit and to dispel distrust
towards the market, or as “a concept that includes various
dimensions outside market mechanisms and monetary
exchanges that influence economic performance [7]”. The
important part here is that the economy is influenced byelements outside the market.
According to Sato Hiroshi, those elements outside themarket became the center of attention for the following
reason: “As globalization and the gap between rich and poor
kept expanding, even the World Bank, as a lending financial
institution, had to be involved in not only economic but alsosocial development and poverty reduction plans. However,in order to expand the role of the institution without
entirely reforming its organizational principles, ‘it wasnecessary to demonstrate that social development could
contribute to economic development […] and to make thatpossible, social capital seemed to be the most appropriate
concept [8].’”This explanation originally applied to the World Bank but
is also valid when trying to explain the growing interest insocial capital in general: the context behind this growinginterest is the failure of policies promoting an almighty
market and structural adjustment policies.
2. Current state of research on social capital in Japan
Japan has taken examples from the United States in many
disciplines on a conceptual and theoretical level, including
in areas of social sciences such as economics, development
studies, politics, and policy sciences [9, 10].
In recent years, some experimental studies have also
been conducted in Japan [1, 11]. The Cabinet Officeconducted two generic surveys on social capital entitled:“Social capital: creating a virtuous circle of richrelationships and civic activities (2003) [1]” and “Research
paper on social capital and the revitalization of communities(2005) [12]”.
Much research focuses on the relationship betweensocial capital and the health of the population. In the field of
public health and social epidemiology, a particular interest
has been shown in social capital, which is already98

acknowledged as one of the social factors influencing
health conditions [13, 14]. The hypothesis according towhich health conditions are positively influenced by social
capital is frequently tested on a national and local level
through various indicators [15, 18].
In Japan also, research results show that residents ofcommunities with a high social capital are more likely to behealthy [19, 20]. These studies discuss how indicators suchas “trust”, “interpersonal relations” and “social inclusion”
have a spillover effect and influence each other. Those
three indicators have been combined and used as proxies toestimate the social capital of each municipality of Japan.
The standardization and the calculation of those indicators
on a local level revealed the correlation between them andconfirmed the spillover effect between their component
elements [1, 12].
As an attempt to understand why Japanese people had
the longest life expectancy in the world, Ichiro Kawachicompared Japan and the United States and found that eventhough the United States was above Japan in terms of grossdomestic product (GDP), rate of healthcare expenditures
over GDP, disposable income, house size, smoking rate,alcohol consumption rate, and hereditary components,
Japanese people still had a longer life expectancy than
Americans. After hypothesizing that the reason could bethat there is more economic disparity in the United States
and that Japan has a higher level of social cohesion in theworkplace and in communities, research was conducted toprove empirically that people living in communities withhigh social capital and low economic disparity were more
likely to be healthy [21, 22].
Similarly, Kondo has been carrying out group researchand has conducted a series of surveys since 2003 with
32,891 elderly persons in 15 municipalities (in threedifferent prefectures but mainly in Aichi prefecture)through self-reported questionnaires sent by mail andinvestigating: “Subjective feelings of healthiness”, “Drinking
and smoking history”, “Length of education”, “Equivalentoutcome”, “Existence or non-existence of a disease
currently treated”, “Administrated medication”, “Fallhistory”, “Force of mastication”, “BMI”, “Auditory
disorders”, “Visual impairment”, “Elimination disorders”,“Tendency to depression”, “Sleep-related information”,“Average walking hours per day”, “Frequency of going out”,“Relationship with friends”, “Social Support”, “Social
integration”, “Work”, “Engagement in domestic work” and“Proxies of social capital” (including questions such as: “Do
you trust people in general?”). The results from this study
also indicated that people in communities with high social
capital are more likely to be healthy [14, 23, 24].
Moreover, the possibility of introducing the concept of

J. Natl. Inst. Public Health, 61（2）: 2012

Challenges and opportunities in the development of the community-based integrated care system in Japansocial capital in the field of community healthcare andespecially in health promotion activities involving residents
has been debated [25] because the comprehension of thenature and quantity of social capital that may enhancecoordination between various organizations is crucial for
those activities. From a similar point of view, it has been
pointed out that grasping the quantity of social capital incommunities is beneficial for health promotion activities [26].
In the field of health promotion activities involving
residents, the activities of searching for a leader in thecommunity, promoting collaboration between organizations
and building trustful relationships within networks are now
described in terms of assessment and development of social
capital. This shift has allowed for former community
healthcare activities conducted for example by publichealth nurses to be considered as activities for thedevelopment of social capital and has led to greater publicrecognition of those activities.
The meaning and importance of those activities used tobe hard to grasp and communicate, but using the concept ofsocial capital helped to describe outcomes in a new way [27]and revealed the formerly tacit competence of people andpublic health nurses working in the community. From thispoint, social capital started to evolve as a sort of omnipotent
tool.
The importation of indicators of social capital in the fieldof public health in Japan made it possible to take into
consideration various public health activities alreadyconducted and their results. This means that the use of
those indicators was just an attempt to make apparent theoutcomes for this type of activity.
Most of the research mentioned above came to theconclusion that people in communities with a high social
capital show better health performance. Thus, those studies
revealed a correlation between some health indicators andthe civic culture underpinning communities, currently
rephrased as “social capital”.
Putnam’s research on social capital was originally basedon civil society and the civic culture of modern European
countries. Thus, the method used to grasp social capital
may not apply directly in the Japanese context.
However, even though the civic culture and the social
communities may be different in Japan, recent research on
Japan has still been able to measure, at least partially, thesame social mechanisms (networks, norms, trust) that
Putnam aims to measure and which are supposed toincrease the efficiency of society and the collaboration
between people.
Currently, many studies are still at the stage ofestablishing relationships between health indicators andindicators of social capital. Thus, very few studies arefocusing on how to improve or accumulate social capital.
It may also be interesting to discuss the quality of social
capital in future research in Japan.

Ⅲ．Relationship between social capital andcommunity-based integrated care
The fact that the Cabinet Office chose to support
comprehensive studies on social capital tends to prove that,in Japan also, social capital was created to overcome thefailure of policies promoting an almighty market andstructural adjustment policies.
Bourdieu defines three forms of capital: economical,
social and cultural. Moreover, he suggests that economic
capital is at the root of the two other types of capital. He
also argues that labor time is the key to convert one form ofcapital to another. To make this transformation, it isnecessary to take into consideration both the labor time
accumulated in the form of capital and the labor timeneeded to shift from one type to another. For example, toconvert economic capital to social capital, it is necessary to
produce unpaid work such as “paying attention, taking care,and being thoughtful”. Even though this may be considered
as a loss from a strictly economic point of view, social
exchange theory considers it as a long-term and profitable
investment.
The theory of Bourdieu seems relevant to explain thetype of social capital that the MHLW is trying to promote in
the community-based integrated care system. According tothis theory, it can be said that the long-term care insurance
system has succeeded in transforming unpaid work such as
the “taking care” part of “paying attention, taking care, andbeing thoughtful” activities to paid work, or economic
capital, by creating a market for this activity.
The remaining “paying attention and being thoughtful”
activities, which clearly used to belong to social capital
before 2006, are also being converted to economic capitalthrough the implementation of “housekeeping and daily life
assistance services”.
The time when the MHLW had to take a position on thecommunity-based integrated care system coincided withrequests from many researchers and citizens’ organizations
to cover those services by long-term care insurance [28].
The decision made by Japan to transform some social
capital to economic capital was greatly influenced by thedecision to respond or not respond to this request.
However, the MHLW did not make a long-term andprofitable “investment” as defined by Bourdieu. Ever since
Putnam’s work was reported, there has been no doubt thatthe bond between individuals and between groups, within afamily or a community, and which is built on trust,

J. Natl. Inst. Public Health, 61（2）: 201299

Takako TSUTSUI

networks, and social connections (which defines social
capital) is a social resource. The relevance of this resourcefor economic output is also undeniable.
Social capital used to be considered as a precious andinvisible resource in Japan, but recent research andgovernmental surveys are clearly trying to make thisresource more apparent. Even though a full understandingof social capital is probably not possible or even relevant,
implementing such a concept has enabled greater
recognition of the value of social capital.
The MHLW introduced the concept of community-based
integrated care when planning the paradigm shift from“care by society” to “care by community” [29]. In otherwords, it was used to described the shift from a system
where care is provided by the entire society to a systemthat allows care to be provided at a local level.
However, it is important to distinguish “community-basedcare” from the “community-based care system” that the
government implemented and whose main purpose is toenable users to remain at home (in the community) byproviding medical treatment and care services.
Reports on community-based care published in 2008 [30]and 2009 [31] describe four levels of care provision (selfcare, mutual care, social solidarity care and governmentalcare) along with the slogan: “From care by society to careby community”. These reports emphasize the idea thatformal and informal care provided through the long-termcare insurance system (social solidarity care) have replacedor supplemented the informal care (mutual care) provided
in communities through networks or by family members.
Originally, the four levels of care provision (self-care,mutual care, social solidarity care and governmental care)
were designed based on the principle of subsidiarity, which
underpinned citizens' groups in modern Europe and consist
in taking decisions at the smallest level possible andallowing intervention from a higher level only when it was
not possible to do otherwise. In other words, this principle
specifies the role and order of intervention of individuals,
associations and regional policies.
However, no order of intervention was specified for thefour levels of care designed by Japan, especially for mutualcare and social solidarity care, which just happen
to be between self-care and governmental care (public
assistance) [32].
Currently, the coordination and management of those
two levels of care are important topics in the developmentof the community-based integrated care system in Japan.
Concretely, not only the capacity of mutual care of thecommunity and the capacity of social solidarity care of thelong term-care insurance have been reviewed, but theoperation manual (March 2003) for community-based100

integrated care centers states that: “it is necessary todesign a community-based integrated care system thatenables an organized management of the various social
resources, formal and informal, of the community” [33]. A
fallacy that generally occurs is to consider those informalsocial resources as social capital and thus to consider acommunity-based integrated care system as a structured
social capital system.
However, even though social capital undeniably plays a
key role in the smooth running of the system, thecommunity-based integrated care system only integrates
medical treatment and other care services and is called assuch because of the way it is provided, that is, within acommunity. Nevertheless, social capital is crucial because it
is, as Uzawa would say, the “soft part” created by smooth
human relationships that allows the “hard part”, that is “thesocial common capital”, to be used efficiently.
Bourdieu noticed in regard to groups of experts that theowners of the means of production only need economic
capital to obtain machines, but to use them they must haveaccess to embodied cultural capital, either in person or byproxies such as engineers. As those executives andengineers are not the possessors of the means of
production and only sell the services of making themachines work, they can be classified among thedominated groups. However, they can also be classified
among the dominant group because they draw their profits
from the use of a particular form of capital, that is, theircultural capital. From this, Bourdieu makes the interestingobservation that the collective strength of the holders ofcultural capital would tend to increase along with thecultural capital incorporated in the means of production.
If this principle applies to the smooth humanrelationships incorporated with social capital, then one
issue that research on social capital should deal with isfinding out if there are techniques that could increase thisfluidity and whether there are groups of specialists who
actually possess those techniques.

Ⅳ．Conclusion
From an international point of view, the community-based
integrated care system developed in Japan is an attempt
to bring together integrated care and community-basedcare [32]. Incentives through the long-term care andmedical fee system already promoted collaboration between
healthcare facilities and community-based long-term careservices, and the new reform of the system in 2012 willreinforce this integration of care.
Many studies conducted in advanced countries that have
tried to assess the efficiency of integrated care systems

J. Natl. Inst. Public Health, 61（2）: 2012

Challenges and opportunities in the development of the community-based integrated care system in Japan

have pointed out the fragmentation of care systems and thelack of integration between primary care (private
practitioners) and secondary care (hospitals). Recent
studies naturally consider communication between involved
parties as an important criterion [34] that is greatly
influenced by the quantity of social capital.
Another field on which many studies focus on is theanalysis of networks between individuals. Basically, suchstudies are an attempt to measure the link and relationships
between people and organizations.
Specifically, those studies are trying to reveal who is
speaking to whom and who isn't, who is at the center of the
network, who is deciding the agenda, if people are banding
together or not, and if there is cohesion or “cracks” in the
network. For example, the studies by Wiktorowicz [35] andHolmesland [36] measure the degree of social interaction
and investigate the possibility of estimating the value of
networks and social capital.
The importance of social, economic and environmental
factors has been recognized since the 1970s, and current
approaches taken in studies on social capital are quite
diverse [37, 38]. It has been suggested that social factorsthat have an impact on those factors, including politicalmeasures (for example, housing allowances, means oftransport, home-delivered meals), may have an evengreater impact on health than healthcare systems,
individual decisions and lifestyles [39].
Concretely, evidence from organizations involved inpublic health suggests that low-income individuals andfamilies have a lower life expectancy, regardless of thecause, and are at higher risk for mental, social and physicalissues than people in high-income communities [39, 40].
There is little doubt that this evidence triggered thegrowing interest in social capital.
This was the justification that specialists from the
medical field needed in order to plead for more support tobe given to individuals and communities--support thattranscends the framework of medical and clinical services.
Measuring social capital was the means that could allow theefficiency of this new type of support to be estimated.
Thus, when considering the significance of social capitalin the community-based integrated care system, it is crucial
that the Cabinet Office and other researcher remember thisfact and avoid the mistake of assuming that communities inJapan can substitute for mutual help and are some sort ofgemeinschaft, in which mutual help is supposedly very
active.
Communities in Japan are certainly imbued with a civic
culture in a modern European sense and, fortunately, some
active members of the community have developed a real“habit of heart”. This social capital is now needed by thecommunity-based integrated care system of Japan and thus,
it is necessary to investigate methods to accumulate anduse this precious resource without waste.

Reference[1] Heisei 14 nendo naikakufu itaku chosa. Social capital:
Pursuing the virtuous circle of rich relationships andcitizen participation. Tokyo: Kokuritsu insatsukyoku;
2003. (In Japanese)
Available from:https://www.npo-homepage.go.jp/data/report9_1.html[2] Shusho Kantei. Policy for the revitalization ofcommunities. Cabinet Decision, March 22nd 2005. (InJapanese)
Available from:www.kantei.go.jp/jp/singi/tiikisaisei/housin.pdf[3] Heisei 18 nenhan monbukagaku hakusho. Increasing
learning opportunities of each citizens (In Japanese).
Available from:http://www.mext.go.jp/b_menu/hakusho/html/hpab
200601/002/011/008.htm[4] Monozukuri seisaku kondankai. Strategic vision for the
manufacturing industry of Japan. November 2011. p.2325.
Available from:http://www.meti.go.jp/report/data/g51128a01j.pdf[5] Naikaku kanbo chiiki saisei suishinshitsu. Partiallyreforming the policy for the revitalization ofcommunities. Kakugi kettei an, February 2005. (InJapanese)[6] Takegawa S. Scheme for community welfare. Yuhikaku
aruma; 2005. p.15-24. (In Japanese)[7] Sato K. Mutual help and social capital: potential of theconcept. Nihon Boeki Shinkokai, Ajia keizai kenkyujo;
2001: 5. (In Japanese)[8] Id. 2001: 4.
[9] Kage R. Reviewing research on social capital: the threesocial capital defined by the American Sociological
Association. Hougaku ronso. 2002; 151(3):101-119. (InJapanese)[10] Kokusai kyoryoku jigyodann kokusai kyoryokusougou
kenshujo. Social capitaland international collaboration:
aiming for results to keep going. Tokyo: Kokusai
kyoryoku jigyodann kokusai kyoryokusougou kenshujo;
2002. (In Japanese)[11] Sakamoto H. Can local governments be reactivated?
From social capital to civic power. Kokyo seisaku
kenkyu. 2005; 5 :141-153. (In Japanese)[12] Naikakufu keizai shakai sogo kenkyujo. Reviewing
research on social capital and the revitalization of

J. Natl. Inst. Public Health, 61（2）: 2012101

Takako TSUTSUI

communities. 2005. (In Japanese)[13] Subramania SV, Kawachi I, Kennedy BP. Does the state
you live in make a difference? Multilevel analysis ofself-rated health in the US. Social Science & Medicine
2001; 53: 9-19.
[14] Kondo K. A society of health disparities: what may
erode heart and health. Tokyo: Igaku shoin; 2005. (InJapanese)[15] Islam MK, Merlo J, Kawachi I, et al. Social capital andhealth: does egalitarianism matter? A literature review.
International Journal for Equity in Health. 2006; 5: 3.
[16] Lochner KA, Kawachi I, Brennan RT, et al. Social
capital and neighborhood mortality rates in Chicago.
Social Science & Medicine. 2003; 56: 1797-1805.
[17] Veenstra G. Social capital and health (plus wealth,
income inequality and regional health governance).
Social Science & Medicine. 2002; 54: 849-868.
[18] Mohan J, Twigg L, Barnard S, et al. Social capital,
geography and health: a small-area analysis forEngland. Social Science & Medicine. 2005; 60: 12671283.
[19] Ichida Y, Yoshikawa G, Hirai H, et al. Research on
multilevel analysis of elderly person’s health and social
capital. Data from 9,248 elderly persons living in the 28
district of Chita Hanto. Noson keikaku ronbun shu.
2005; 7: 277-282. (In Japanese)[20] Fujisawa Y, Hamano T, Koyabu A. Effect of the social
capital at a local level on the subjective sense of healthof the population. Kosei no shihyo. 2007; 54: 18-23. (InJapanese)[21] Kawachi I, Kennedy PB. Is inequality bad for our
Health. Nihon hyoronsha; 2008. p.3-4. (In Japanese)[22] Kawachi I, Subramanian SV, Kim D. Health and social
capital. Nihon hyoronsha; 2008. (In Japanese)[23] Kondo K, et al. “A society of health disparities”-Large
scale socio-epidemiologic survey on prevention careservices. Igaku shoin; 2007.
[24] Kondo K. Essay for the integration of social
development knowledge and policy science on elderlycare. Fukushi shakai kaihatsugaku no kouchiku.
Minerva shobo; 2005. p.69. (In Japanese)[25] Yuasa M, Nishida M, Nakahara T. Examining the
introduction of health promotion activities according to
the concept of social capital. Nihon koshu eisei zasshi.
2006; 53: 465-470. (In Japanese)[26] Matsuoka H. Healthy Japan 21 and social capital.
Shimoda Tomohisa ed.Heisei 18 nendo chiiiki hokensogo suishin jigyo “Kenko Nihon 21” chiho keikaku
suishin?hyoka jigyo hokusho. Tokyo: Nihon koshu
eisei kyokai, 2007. p.69-77. (In Japanese)[27] Hanibushi T, Murata Y, Ichida Y, Hirai H, Kondo K.

102

Local evaluation of social capital by health nurses.
Nihon koshu eisei zasshi. 2008; 55(10): 716-723. (InJapanese)[28] Okifuji N. Does the Long-Term Insurance protect theelderly population? Iwanami Tokyo: Shoten; 2010. p.3142. (In Japanese)[29] Tsutsui T. The future of community-based integrated
care system -From care by society to care bycommunity-. Hoken iryo kagaku. 2009; 58(2): 84-89. (InJapanese)[30] Heisei 20 nendo rojin hoken kenko suishinto jigyo.
Report of 2008 from the research team on communitybased integrated care - Organizing points of controversy
for the future reviews. Mitsubishi UFJ risachi
konsarutingu kabushiki kaisha, 2009. (In Japanese)
Available from:http://www.mhlw.go.jp/houdou/2009/05/h0522-1.html[31] Heisei 21 nendo rojin hoken kenko suishinto jigyo,
Report of 2009 from the research team on communitybased integrated care. Mitsubishi UFJ risachi
konsarutingu kabushiki kaisha, 2010. (In Japanese)[32] Tsutsui T, Matushige T, Otaga M, Morikawa M. From
‘care by family’ to ‘care by society’ and ‘care in local
communities’: switching to a small government by theshift of long-term care provision. ISA world congressof Sociology; 11-17 July 2010; Gothenburg, Sweden,
contribution paper.
[33] Chojushakai kaihatsu senta. Manual for communitybased integrated care centers, 2010.
Available from:http://www.nenrin.or.jp/chiiki/sonota/manual.html[34] Leinchsering K. Developing integrated health andsocial care services for older persons in Europe.
International Journal of Integrated Care. 2004; 4: e01e15.
[35] Wiktorowicz M, Fleury M-J, Adair C, Lesage A,
Goldner E, Peters S. Mental health network
governance: comparative analysis across Canadianregions. International Journal of Integrated Care. 2010
October 26; 10. [serial online]
Available from: http://www.ijic.org/[36] Holmesland A, Seikkula J, Nilsen Ø, Hopfenbeck M,
Arnkil T. Open dialogues in social networks:
professional identity and transdisciplinary collaboration.
International Journal of Integrated Care 2010
September 16; 10. [serial online]
Available from: http://www.ijic.org/[37] Evans RM, Barer M, and Marmor T. Why are somepeople healthy and others not? The determinants ofhealth of populations. New York: Aldine de Gruyter;
1994.

J. Natl. Inst. Public Health, 61（2）: 2012

Challenges and opportunities in the development of the community-based integrated care system in Japan[38] Evans RG, Stoddart GL. Producing health, consuming
health care. Soc Sci Med. 1990; 31(12): 1347-1363.
[39] Wilkinson RG. Unhealthy societies: The Afflictions ofInequality. London: Routledge, 1996.
[40] Smith GD, Wentworth D, Neaton JD, Stamler R,

Stamler J. Socioeconomic differentials in mortality risk
among men screened for the Multiple Risk Factor
Intervention Trial: II. Black men. Am J Public Health.
1996; 86: 497-504.

抄録
２
０
０
５（平成１７）年４月，地域再生法に基づく，地域再生基本方針が閣議決定され，地域再生のためのひとづくり・人材ネットワークづくりの促進の中で，地域固有のソーシャル・キャピタルを活性化することが明記され，経済産業省，文部化科学省でもソーシャル・キャピタルの検討がなされ，時期を同じくして，介護保険制度の改正もなされた．
この介護保険法の改正では，「地域包括ケアシステム」の創設が謳われたが，ここにソーシャル・キャピタルが言及されることはなかった．しかし，地域包括ケアシステムの構築は，各自治体が実施する事業であることから，このシステムを構築する際に，日本的な意味でソーシャル・キャピタルを意識した自治体と本来の意味でのソーシャル・キャピタルを基礎として実行した自治体と，全くこれを考慮しなかった自治体では，そのシステムの有り様は大きく異なったものと予想される．
すなわち，ソーシャル・キャピタルを市場メカニズムの外から，あるいは貨幣価値の交換関係以外の側面から影響を与える個々の機能を言い表す概念として用いたことは，「地域包括ケアシステム」の構築には，少なからず影響を与えたことが予想される．
このような背景をふまえ，本稿では，今後の地域包括ケアシステムの整備や運営において，このソーシャル・キャピタル
をどのように定義し，これを，どのように考えていくべきかを論述した．また現在のソーシャル・キャピタル研究の現状について，アメリカや日本の状況をまとめ，とくに国際機関である世界銀行やOECDがソーシャル・キャピタルに関心をもった理由についても言及した．

J. Natl. Inst. Public Health, 61（2）: 2012103