Tomoko Tachibana*

1. Center for Public Health Informatics, National Institute of Public Health

^*Corresponding author: Tomoko Tachibana, MD, MPH, PhD, Mailing address: 2-3-6 Minami, Wako city, Saitama prefecture 351-0197, Japan

Keywords: universal Health Coverage (UHC), local comprehensive care system, community-based structure,paradigm shift, education of oppressed people.

Introduction

Japan has experience in building and maintaining universal health insurance. It has achieved the highest level of life expectancy and the lowest infant mortality rate in the world in the 60 years since the end of World War II. And, by the health care system centered on the universal health insurance system, Japan is also called the “world’s model of the UHC: Universal Health Coverage” [1].

On the other hand, in Japan, where the population is aging ahead of the rest of the world, by 2025 it will shift to a com- prehensive community care system [2]. In each region, various efforts are being promoted toward the realization of UHC that corresponds to the actual conditions of the region, that is, a “local symbiotic society”. In the model for promoting stroke measures (prevention, medical care, and welfare) in Osaka, preventive medical care is carried out in multiple layers in each region. As a result, low stroke rates and reduced annual national health care costs per capita have been observed in the intervention group [3,4, 5]. In Kitakyushu, community rehabilitation activities cen- tering on hospitals are being carried out, and expectations for social inclusion are increasing [6].

This paper first describes the paradigm shift necessary for public health from the viewpoint of Japan, which is also consid- ered to be the top runner of UHC. Then, I will introduce the case of Saitama, which is practicing “human resource development with collaborative power” toward the realization of a symbiotic society in a regional comprehensive care system. Based on those, this study has explored human resource development strategies for more effective operation of regional human resource devel- opment models.

Public health paradigm shift to achieve uhc-From a Japa- nese Perspective

In Japan, as a future vision for health care, “Healthcare 2035” has been formulated and published [7,8]. “Healthcare 2035” states that Japan’s health care should be the world’s lead- ing figure, and a message is sent to the world. “Healthcare 2035” has three visions [Table 1]. There are four missions: 1) Leading the world to health, 2) Lean health care, 3) Life design, 4) Leading (Leader of Global health).

Table 1. Three visions of "Healthcare 2035" [ref. 8]

Some of the events that have had a major impact on health systems in recent years include: 1) Globalization, 2) Explosion of health technologies, 3) Increasing Chronic Diseases, 3) De- mographic changes. As a result, “increasing medical expenses”, “changes in the relationship between health care providers and patients”, “changes in health problems with high priority”, and “health disparities” have occurred.

The elderly are now not necessarily a social burden, but rather an asset. Therefore, we should look for health care mea- sures that enable healthier and longer lives. In particular, Japan is at the top in terms of aging. However, Asian countries and other countries are also aging, and the speed is rather faster than Ja- pan. Japan has been aging since becoming a developed country, but many other developing countries are experiencing aging be- fore they develop. It is the sophistication of medical technology rather than the aging population that contributes to the surge in medical costs [9].

UHC is defined by WHO as follows:” Universal health cov- erage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”[9] UHC is not just about univer- sal health insurance.

In Japan, the universal insurance system was introduced in 1961, and at the same time, has achieved UHC for more than 50 years [8]. Many developing countries such as China, Vietnam, Indonesia, the Philippines, Ghana and African countries have learned from Japan’s experience and are helping to improve their own public health [10]. Each country will be required to develop a system of measures according to the actual situation of each country. All the essential functions of UHC exist in Jap- anese public health. From this, it could be said that “Fostering human resources capable of responding to the new public health paradigm”, “Community-based practice of participatory change education” and “Bridging the health gap” etc. can be cited as the direction required for Japanese public health.

Introducing practical examples of “human resource devel- opment with collaborative power” toward the realization of a symbiotic society

In recent years, a project for human resource development with highly collaborative solutions through multi-professional collaboration has been started and demonstrated in collaboration of four universities in Saitama Prefecture (Faculty of Medicine, Faculty of Pharmacy, Faculty of Nursing and Welfare, Faculty of Engineering) [11, 12]. This project is the 2012 Ministry of Education, Culture, Sports, Science and Technology inter-uni- versity collaborative education promotion project “Developing highly-professional professionals who support the lives of local residents in the Sai-no-kuni. It can be said that the prefecture has begun to move toward the realization of a community-based comprehensive care system and a symbiotic society for medical care, nursing care, and lifestyle support toward the 2025 issue.

The 2025 issue can be cited as the background of the proj- ect. In 2025, all baby boomers will be over 75 years old, and when faced with this, one in five residents will be over 75 years old. That is to say that we will enter a super-aging society that humankind has never experienced. Saitama prefecture, which is adjacent to Tokyo, has the highest growth rate of the population aged 75 and over from 2010 to 2025. On the other hand, Saitama Prefecture has the lowest number of nurses per 100,000 popula- tion in Japan. In general, demand for medical care and nursing care is expected to increase and diversify as the number of el- derly people increases. In the comprehensive community care system, medical care, nursing care, prevention, housing and liv- ing support must be provided socially, aiming for an area where everyone can live with peace of mind in a familiar area. Already, the problems of the current aging society are extremely complex. Therefore, it seems that approaching individual fields and prob- lems is reaching its limit, and the Ministry of Health, Labor and Welfare has begun efforts to “realize a symbiotic community”. This is a project to create a multi-functional base in the area for vertically split facilities such as facilities for the elderly and fa- cilities for the disabled. Along with the promotion of projects for the realization of a symbiotic society, the facilities that were vertically organized need to be shared with multiple functions. In addition, human resources for coping with multi-generation symbiosis/multi-function type must also have multiple functions. Therefore, in the future, it will be necessary to consider “com- mon qualification” as a human resource qualification necessary for building a community in harmony with the community.

Interprofessional education (IPE) [13] has begun to be newly started at four universities in Saitama that train health and medi- cal welfare professionals. The purpose is to cultivate a viewpoint that can support the lives of the residents of the coming aging so- ciety and to develop professionals who can work together. IPE is positioned according to the UK’s definition of CAIPE (Center of Advanced Interprofessional Education) as follows: “Profession- als from multiple disciplines learn together and learn from each other in the same place to improve collaboration and quality of care (CAIPE 2002)”. The introduction of IPE in undergraduate education in this project was verified as IPW: Inter Professional Working. Medical students who participated in the IPW train- ing understand the importance of professional cooperation, and report that they have improved their motivation and reflected on their daily lives. In addition, through practical training, he/ she became aware of the importance of seeing people as well as illnesses and the fact that he/she is a patient, including his/her life after discharge from the hospital. As an educational initia- tive to nurture medical personnel who can contribute to regional medical care, it is desirable to further deepen cooperation with the local community through IPW training and tackle problem solving on its own.

Aiming for a more effective regional human resource devel- opment

As of July 2020, the expansion of the COVID-19 pandemic poses a global threat. If we do not stop the spread of the global outbreak now, we will lose even more lives in the future and the declining global economy will not recover for a long time. The COVID-19 pandemic threat most afflicts the poor and vulnera- ble. UN Secretary-General Guterres pointed out on 6 July 2020 [14]: “The new coronavirus affects all countries and all people, but this impact and damage are equal. No, it exacerbates existing world inequalities and injustices”. At the same time, according to a UN report, around 71 million people are predicted to be ex- tremely poor in the world this year, and the poverty rate, which has been decreasing for the past 22 years, is expected to rise for the first time. It is necessary for the international community to work together to take measures so that it is not too late.

Japan, which is the top runner of UHC, has so far imple- mented vertical division of fields centered on the “facility mod- el”. In the future, though, it will be necessary to aim for the re- alization of a policy that “no gaps or breaks” in each region. In order to realize this, it is necessary to enhance the “community model” that is being sought by developing countries, and in the future, there must be a lot of mutual learning. “Approaches to the group” that public health has been good at so far will require more consideration for individuality. In order to aim for a society in which no one is left behind, it is necessary to listen to “voices that policy makers and planners had difficulty hearing”.

In behavioral science, “Empowerment” is defined as fol- lows: “For a person or group that is socially oppressed or put in a disadvantage, their unique abilities and focus on strengths and bring out your original strengths to help you control your life and environment”[15]. “Empowerment” spread during the 1980s when women’s rights movements flourished, and it was spread by Brazilian educator and philosopher Paul Freire (1921–1997). Empowerment is also defined as “each member of society and organization gains the necessary power for development and reform”. Freire noted, among other things, in the pedagogy of the oppressed, the low literacy rate and silent culture of northeastern Brazil in the 1960s. The culture of silence is the culture of peo- ple who have been oppressed, exploited, deprived of letters, and put into a quiet position in history. Based on his experience sup- porting the literacy learning of Brazilians, he laid the foundation for critical pedagogy and wrote the pedagogy of the oppressed [16,17]. The books spread to developing countries and is read all over the world. In order for Japan to approach a “group that is hard to reach the voice” in the future, it will be important to carefully explore the local demand, such as by utilizing the “ped- agogy of the oppressed”. In order to promote this, it seems that the use of “problem-solving education” recommended by Freire and the bidirectional exchange of human resources and informa- tion between Japan and developing countries will be required.

Acknowledgements

This research was supported by the 52nd Medical Grant, Taiju Life Welfare Foundation.

Disclosure of Interest

This research was supported by the Taiju Life Welfare Foun- dation’s 52nd Medical Grant, “Study on the Development and Evaluation of a Self-Management Program to Support the Social Life of Patients with Epilepsy after Stroke.”

For this study, none of the authors have a COI status to dis- close.

References

1. The World Bank. Speech by World Bank Group President Jim Yong Kim at the Government of Japan-World Bank Conference on Universal Health Coverage.

2. Ministry of Health, Labour and Welfare. Local comprehensive care system.

3. Iso H. Fasting and non-fasting triglycerides and risk of ischemic cardiovas- cular disease in Japanese men and women: the Circulatory Risk in Communities Study (CIRCS). Atherosclerosis. 2014;237:361-8.

4. Iso H. Public health human resource development for the next generation healthy society; co-creation between industry, academia and government. The 75th Annual Meeting of the Japanese Society of Public Health; Octo- ber 2016; Osaka. Japanese public health magazine. 2016; 63 (10 special appendices).

5. Kitamura A, Sankai T, Konishi M, et.al. Trends for stroke incidence, sever- ity, and prognosis in a rural community with a long-term stroke prevention program. Japan Public Security Journal Vol.51 No.1 p.3-12.

6. Hamamura A, Hamada T, Miyaoka H, et.al. Community-based rehabilita- tion activities centered on hospitals. Special issue: Rehabilitation in general hospitals. Comprehensive rehabilitation. 1982;10(11):971-9.

7. Miyata H. Japan’s vision for health care in 2035.Lancet 2015;385:2549-50.

8. Ministry of Health, Labour and Welfare. Health Care 2035 Recom- mendations.

9. World Health Organization. What is health financing for universal cover- age? Health financing.

10. Ministry of Health, Labour and Welfare. G7 Kobe Health Ministers’ Meet- ing.

11. Saitama Prefectural University. Sai-no-kuni cooperation development proj- ect.

12. Saitama Medical University. Interprofessional Education. Available at: http://www.saitama-med.ac.jp/chsc/ipe.html (2020-07-30)

13. CAIPE. CAIPE(2002) Interprofessional Education-Today, Yesterday and Tomorrow [Barr, H.] Higher Education Academy, Learning & Teaching Support Network for Health Sciences & Pracice, Occasional Paper 1.

14. United Nations. A Disability-Inclusive Response to COVID-19. MAY 2020.

15. Moriyama M. From Dialogue into Health Promotion & Education.

16. Freire P. Pedagogy of the Oppressed. London: Penguin;1996. ISBN- 10:978014037

17. Roberts P. Freire, P. (1988) Teachers as Cultural Workers: Letters to Those Who Dare Teach, Boulder, Westview Press, 100 pp., ISBN 0 81332314-5. Australian Journal if Teacher Education, 23(1). 304-5. Australian Journal of Teacher Education, 23(1).

Received: June09, 2020;
Accepted: July 20, 2020;
Published: July22, 2020.

To cite this article : Tachibana T.Explore Human Resource Development Strategies to Achieve UHC-How should the future comprehensive community care system be operated more effectively.Health Education and Public Health. 2020; 3:4.

© Tachibana T.2020.