社会医学研究．第 36 巻 1 号．Bulletin of Social Medicine, Vol.36(1)2019

総説

A role of public health center on the health promotion in Japan
本邦の健康増進における保健所の役割
HASEGAWA Takashi1) , FUJIKAWA Mariko2)
長谷川

卓志 、藤川

眞理子

1)

2)

1) Chiba Prefectural University of Health Sciences
2) Ichihara Public Health Center, Ichihara, Chiba
1) 千葉県保健医療大学
2) 千葉県市原保健所
Summary
To date, public health centers have functioned as front-line institutions for public health maintenance/promotion incommunities. With a shift of disease structure from infectious diseases such as tuberculosis to metabolic syndrome and otherlifestyle-related diseases, reflecting lifestyle changes, as well as internationalization and aging with a decreasing birth rate, theirroles have also changed. As the Community Health Act replaced the Public Health Act in 1994, their leadership has strengthened
as bases for community-based integrated health promotion, which manage further complicating health and environmental
problems using their specialties. This paper outlines the transitions of public health centers from their establishment before
World War II, roles, and services, and observes the current status and challenges of health promotion, including the managementof health risks and development of social capital as a resource for resident-centered healthcare.
抄録
保健所は地域の中で、公衆衛生の第一線の機関としての役割を担ってきた。結核など感染症が猖獗を極めた時代

から、国際化、少子高齢化やメタボリック症候群など生活習慣病を中心とする時代へと疾病構造の移り変わりにつれてその役割は変わってきた。平成 6 年には保健所法から地域保健法へと変わり、ますます複雑化する健康、環境問題に対処可能な高い専門性をもった広域的な拠点として地域の健康増進に指導的な地位を得るに至った。本文では、戦前の保健所の設置から現在の保健所までその役割、業務を歴史的に俯瞰すると同時に、健康危機管理、住民
中心の健康資源としてのソーシャル・キャピタルの醸成が課題となっている今日の健康増進について考察したものである。
Keywords: Community Health Act, public health centers, professional liaison, health risk management
キーワード：地域保健法、保健所、専門職連携、健康危機管理

Introduction

problems using their specialties. This paper outlines theOver many years, public health centers have functioned

transitions of public health centers from their establishment

as front-line institutions for public health maintenance/

before World War II to their current status to develop future

promotion in communities. With a shift of disease structure

perspectives on these institutions3).
1. Services provided by public health centersfrom infectious diseases represented by tuberculosis toobesity and other lifestyle-related diseases, reflecting

Public health centers are public front-line institutions

lifestyle changes, as well as internationalization and aging

supporting community residents’ health, as specified

with a decreasing birth rate, their roles have also changed.

in the Community Health Act, and they provide healthAs the Community Health Act replaced the Public Healthservices that require specialized skills. They are located

Act in 1994, their leadership has strengthened as basesin prefectures, government ordinance-designated and corefor community-based integrated health promotion, whichcities, cities approved to establish public health centers,

manage further complicating health and environmental

and special wards. The Community Health Act specifies− 91 −

社会医学研究．第 36 巻 1 号．Bulletin of Social Medicine, Vol.36(1)2019

basic guidelines on community health measures, such as

following functions: 1) specialized and technical services tothe establishment of public health centers, and basic items

manage mental disorders, intractable diseases, and AIDS, 2)

related to community health promotion. It aims to contributethe collection, classification, and utilization of information,

to the maintenance and promotion of community residents’3) surveillance and research, 4) support for municipalities, 5)

health by ensuring the appropriate implementation of these

health risk management, and 6) planning and investigations.

1)measures in communities . Services provided by public

As an example of these measures, approaches to utilize rain

health centers are mainly classified into 2 categories:

water in Sumida-ku, Tokyo were presented7). It was a beturepersonal and objective health services, involving differentof public health center. In 2014, a new law to promote rain

types of professionals. The following sections summarize

water usage was enacted8). As reports on the enhancement

the past development of public health centers, and discussof functions in objective health services are rare, attention

their future directionality.

should be paid to future trends in this area.

2. Circumstances that led to the establishment ofpublic health centers
In April 1937, when the original Public Health Act
was enacted, 187 public health centers were established
as institutions to provide health consultation services forgeneral citizens2). These centers were defined as bases forthe provision of necessary guidance to improve citizens’

The Community Health Act specifies that public healthphysical fitness3). In January 1938, the Ministry of Healthcenters should manage affairs related to the following

and Welfare was organized to promote citizens’ physicalitems1): 1) the enhancement of hygiene awareness, 2) vital

fitness and welfare. Since that time, it has been in charge ofstatistics, 3) improvement of the nutritional status and foodadministration regarding matters of public health, including

hygiene, 4) housing, water supply, sewerage, waste disposal,

the management of affairs related to public health centers4).

cleaning, and other environmental hygiene systems, 5)

3. Establishment of the new Public Health Act

medical and pharmaceutical affairs, 6) public healthnurses, 7) improvement and promotion of public healthcare

after World War II
2)

In 1947, the Public Health Act was enacted . Under theguidance of Colonel Crawford F. Sams leading the General
Headquarters (GHQ), the following items were incorporated
into the new act: 1) the enhancement of hygiene awareness,
2) vital statistics, 3) improvement of the nutritional status
and food/beverage hygiene, 4) housing, water supply,
sewerage, waste disposal, cleaning, and other environmental
hygiene systems, 5) public health nurses, 6) improvement
and promotion of public healthcare services, 7) maternal,
infant, and elderly hygiene, 8) dental hygiene, 9) testing andexamination for hygiene maintenance, 10) prevention of
tuberculosis and venereal, epidemic, and other diseases, and11) promotion of public health in rural areas. The GHQ also
defined the public health center in Suginami-ku, Tokyo as amodel, which was followed by the opening of model public

services, 8) maternal, infant, and elderly hygiene, 9) dental
hygiene, 10) mental health, 11) healthcare for patients withintractable or specific diseases that require long-term care,12) prevention of AIDS, tuberculosis, venereal, epidemic,
and other diseases, 13) testing and examination forhygiene maintenance, and 14) management of other affairs
to maintain and promote community residents’ health.
Professionals providing personal health services include:
medical doctors, dentists, public health nurses (nurses),registered dieticians, nutritionists, radiological/medical
technologists, dental hygienists, and physical/occupational
therapists. In some municipalities, consultants specializing
in mental health and welfare are in charge of mental healthservices. In such a situation, it may also be necessary topromptly establish environments and systems for thesedifferent types of professionals to participate in activities forhealth centers throughout Japan.
4. The Community Health Act and public healthcenters
The Community Health Act was enacted in 1997 1-3).
The Basic Guidelines for Promotion of Community Health
Measures (1994)7) emphasize the necessity of enhancing thehealth promotion/maintenance from equal standpoints.
In contrast, objective health services cover thefollowing areas, mainly involving veterinarians andpharmacists: 1) the improvement of the nutritional status
and food hygiene and the licensing of cooks/confectionery− 92 −

社会医学研究．第 36 巻 1 号．Bulletin of Social Medicine, Vol.36(1)2019

hygiene specialists, 2) approval, audits, and observation of

aspects of personal health services, technical and financial

food manufacturing, cooking, and sales facilities, wholesale

support from the government is needed: promoting themarkets, and facilities providing meals for groups (suchcollection, classification, and utilization of information

as restaurants), 3) food-related complaint management

regarding mental health, intractable disease/AIDS

and consultation services, the laboratory testing of foods,

management, food and environmental hygiene, andcontainers, and packages, receipt of reports on foodmedical and pharmaceutical affairs as bases for integrated

poisoning from physicians, surveys on such events, andaudits and examination; extensively collecting, managing,awareness-enhancing activities to prevent them, 4) receipt

analyzing, and providing information related to healthcare,of applications related to housing, water supply, sewerage,

medicine, and welfare; promoting surveillance, research,waste disposal, cleaning, and other environmental hygiene

and studies focusing on community residents’ daily lives;

systems, waterworks, and other public water systems,

and collecting, classifying, utilizing, examining, andexamination and guidance on these issues, and river, well,studying information. The act also specifies that the centersand pool water quality examination, 5) countermeasures

should establish systems to adopt appropriate health-related

against environmental pollutions, 6) operating permission,

measures as institutions managing healthcare and medical

observation, and guidance for beauty salons, barber shops,

affairs in communities, such as preventing health risks,cleaning service providers, hotels, entertainment centers,

ensuring sufficient medical services in each community, andand public baths, 7) management and euthanasia of wildorganizing health risk management systems. They should

dogs and stray cats and finding new owners for these

also develop systems to systematically collect healthcare-animals, 8) management of medical and pharmaceutical

related and medical information in each community daily,

affairs and receipt of applications for licensing from

including on holidays and during the night-time.

medical professionals, 9) approval for/registration of

In addition to these roles, public health centers also

those selling pharmaceutical products and poisonous/

carry out the following duties to promote associations withdeleterious substances, 10) approval for the establishment

medical, care, and welfare measures: 1) actively supportingof hospitals, clinics, treatment places, and pharmacies andthe establishment of liaison among medical institutions andcomplaint management, and 11) medical audits and on-site

fairly and impartially coordinating through collaboration

examination for medical institutions based on the Medical

and cooperation with community-based medical associations

Service Act.

and 2) identifying, assessing, analyzing, and disclosing

Health centers located in municipalities provide

health-related issues in each jurisdiction ward. In the casepersonal health services. These centers are facilities thatof prefectural public health centers, they should also:

comprehensively provide health services for community

1) strengthen community-based integrated care systems

residents from mothers and children to the elderly. The

through collaboration among medical institutions and among

Medical Service Act defines municipal health centers

medical, care, and welfare services to manage patientsas “facilities to execute businesses necessary to provide

during acute, recovery, and maintenance periods, 2) promoteresidents with services, including health examinations andinformation-sharing with municipalities in each jurisdiction

guidance, medical examination, other community-based

ward and community health measures through multi-layer

activities, health promotion/maintenance, and health risk

collaboration, and 3) coordinating with care and welfare

management”. Based on this, health centers function as

measures.
6. Health risk management

bases for resident-led health promotion/maintenance.
5. Systematization of public health centers6-1. Definition

According to the Basic Guidelines for Promotion

According to the Basic Guidelines for Health Crisisof Community Health Measures4-6), public health centers

Management established by the Ministry of Health, Labour,

should develop their scales, facilities, and equipment

and Welfare in 20019), health risk management is “a category

while considering the characteristics of each communityof services to prevent health damage due to pharmaceuticalto strengthen their functions as integrated, specialized,

products, food poisoning, infectious diseases, drinking

and technical bases for community health promotion/water, or other causes that threaten citizens’ lives, health,maintenance. In this respect, particularly in the following

or safety and the spread of such events, and treat persons− 93 −

社会医学研究．第 36 巻 1 号．Bulletin of Social Medicine, Vol.36(1)2019

suffering from them under the jurisdiction of the Ministry of

the communities they have long lived in, it is necessary

Health, Labour, and Welfare”.

to ensure sufficient healthcare, medical, and welfare

6-2. Roles

functions in each community. The re-examination of

On examining the Basic Guidelines for Community

conventional systems to provide medical/care services

Health Crisis Management (2001) in terms of community-

is also indispensable as a challenge in developing a

based health risk management, the Public Health Act was

new community, covering infrastructures, such as re-revised as the Community Health Act in 1994 to establish

organizing multiple communities as a “compact city” to

new community health systems. However, this wascomprehensively support residents’ daily activities throughfollowed by the frequent occurrence of health problems

housing, companionship, observation, and other services.

in communities, indicating the necessity of reviewing the

Deliberations upon social capital and health have justroles of healthcare and hygiene sections in community-

started in Japan10), which is facing globally unprecedented

based health risk management. To address such a situation,

aging, and the consequent necessity of not only promoting

the Basic Guidelines for Promotion of Community Healthindividual measures, but also developing social capital

Measures (established by the Ministry of Health and Welfare

through resident organizations’ activities. Residents,

in December 1994 as Notification No. 374) were revised inin addition to each type of professionals, should fully

March 2000, specifying basic community health measures,

understand this and adopt appropriate actions.

including community-based health risk management. These
guidelines (No. 143) emphasize the necessity of creating

Conclusion

manuals for local public bodies to appropriately perform

Since the revision of the Public Health Act as thehealth risk management, with public health centers as

Community Health Act, public health centers’ roles haveintegrated, specialized, and technical bases for community

been redefined, and their functions have been enhanced

health promotion/maintenance also playing a central role into date. Based on the new Community Health Act tocommunity-based health risk management.

improve 6 items in communities, plans were developed,

6-3. Activities

according to their situations, and this was effective toThus, public health centers are defined as bases forresolve problems at that time. However, in personal healthcommunity-based health risk management to address healthservices, new challenges in integrating healthcare, medical,

problems that have frequently occurred over these years. As

and welfare services, represented by community-based

administrative institutions managing healthcare-related andintegrated support and health risk management, have been

medical affairs in communities, they are charged with theidentified. With the Tokyo Olympic/Paralympic Gamestask of leading health risk management through activities,

around the corner, internationalization, countermeasures

such as normal audits, while coordinating the activities ofagainst newly emerging infectious diseases and other healthcommunity-based medical institutions and municipal healthrisks, and smoking should be simultaneously addressed.

centers, and establishing systems to provide necessary

In food environments, there are also a number of issues toservices for residents. The roles they are expected to play

be addressed under the leadership of public health centers.

include: ensuring sufficient medical services for victims,

To adopt HACCP (Hazard Analysis Critical Control

clarifying causes, preventing the spread of health damage,

Point) as a food safety management measure, a revision

providing mental care for disaster victims (e.g., healthof the Food Sanitation Act is currently being considered.

management and countermeasures against PTSD), andHACCP adoption has already been made obligatory in some

adopting special measures for persons with disabilities,

advanced countries, suggesting the necessity of promptly

children, the elderly, and other disaster-vulnerable groups.

establishing international-level hygiene management

7. Social capitalsystems in Japan.

The revised Basic Guidelines for Promotion ofCommunity Health Measures No. 464 6) newly mention

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