Mini Review / Open Access

DOI: 10.31488 /heph.145

How to Develop the “Definition of Health in Mature Society” in Japan:through the Proposal of Practical Study to Effectively Support the “Independent Living”

Tomoko Tachibana*

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

*Corresponding author: Tomoko Tachibana, Center for Public Health Informatics, National Institute of Public Health2-3-6 Minami, Wako city, Saitama prefecture 351-0197, Japan Tel:+81-48-458-6206Fax: 　+81-48-469-0326

Abstract

In recent years, Japan is required to take measures against the declining birthrate and aging population, population decline, and increase in chronic diseases.Measures to realize a paradigm shift are needed to build a vibrant society that also contributes to sustainability and fiscal consolidation.In this study, we proposed a plan for a regional support model construction study of "independent living (IL) of chronic patients" for the realization of a symbiotic society and examined the significance of IL in the literature.In the proposed plan, the verification of the use of the current IC support system will be carried out by the parties concerned, through an expert study group, a national survey, and a field survey by local governments.IC can be regarded as a human right and targeting persons with disabilities among various chronic patients seemed appropriate in the light of historical circumstances.It was considered that the proposal of this study could be a reasonable and effective way to realize social life support to realize "promotion of IC" with a view to promoting a symbiotic society and SDGs.

Keywords: independent living (IL), chronic condition, self-management support, inclusive society, symbiotic society, disability, definition of health.

Introduction

In recent years, Japan has faced major demographic changes, such as an aging population and declining birthrate [1], and it is expected that health care needs will increase and diversify, and that necessary resources will increase in the future.However, the number of beneficiaries and benefit costs of the Japanese long-term care insurance system are increasing rapidly, which is a problem from the perspective of the sustainability of the system [2]. By accelerating the realization of a society in which people of all environments can play active roles in the region, it might be expected to contribute to the promotion of Japan's "100 million total active society policy [3] " and "local symbiotic society policy[4] ."

On the other hand, according to "Transition of budget for disability welfare services [5]," the budget amount for disability welfare services has increased about 2.8 times in 12 years since 2007.

There is a need for high-quality measures that can contribute to the “sustainable and better world [6]” based on the SDGs by 2030 and the “Japan 2035 [7].”In Japan, measures for persons with disabilities are promoted by the Cabinet Office as a symbiotic social policy [8,9].A symbiotic society is a society in which everyone, regardless of disabilities, can mutually respect and support each other's personality and individuality, in addition of recognizing each other's diverse ways of life.Therefore, in Japan, a policy to shift to a comprehensive integrated care system is being promoted by 2025[13,14].Hamamura et al. [15] have been developing community-based rehabilitation activities centered on hospitals, with the idea of true rehabilitation [16] and life reconstruction after discharge [17] as the philosophy of rehabilitation. The goal of the activity is “Being able to live a life like himself/herself” (as defined by the Japan Rehabilitation Hospital/Facilities Association) [18].For that purpose, "independent living (IL)" is necessary, and various factors are involved in the acquisition and maintenance of it, in addition to physical and mental health.For this reason, the relevant regional rehabilitation activities have been developed under the basic idea of "social inclusion", on the premise that the issues related to IC are the issues of the society as a whole and not individuals.

In recent years, many practitioners and researchers have been actively discussing the definition of WHO health [19,20,21].So far, we have published a proposal on "Definition of health for a mature society" through the study on construction of "Disability Registry (Database)" as a prognostic/outcome indicator [22].In other words, we insisted, in a "mature society" that aims for mature death by preventing premature death, a new policy based on the "New definition of health" might be needed.Then we proposed that in order to realize this, the infrastructure maintenance such as "medical/nursing/health and welfare database for injuries and disabilities" is needed.In the future, in addition to the development of medical bases in the region, it will be necessary to enhance the self-management measures to effectively support the home life of home patients in the community.

This study focuses on model-building research that effectively supports the community life of Chronic Patients living in the community.I propose a plan to realize the model-building study of effective support for local life By Selecting Personswith Disabilities from Chronic Patients as An Example. Next, from the perspective of social medicine, we will introduce the concept of IC based on a new perspective of rehabilitation, to verify the validity of the proposed plan. Both together, the purpose of this study is to propose appropriate and effective social life support measures in Japan, where the transition to a comprehensive regional care system is in progress.

Proposal of "Practical study on grasping the actual conditions of community life support for people with disabilities living in the community and effective support methods, and evaluation methods"

Study purpose

The purpose of this study is to contribute to the future operation of the IC support service created by the Revised Comprehensive Disability Support Law. In order to that, the introduction and operation status will be clarified, the actual conditions of persons with disabilities living alone, and the effective support method and evaluation method according to the state image will be established.

Necessity

In Japan, the revised Comprehensive Support for Persons with Disabilities Act was enacted in 2018, and a "new service (IC support) to support community life" was created. The subjects are those who used facility admission support and community life support, etc., and will provide consultations and advice for a smooth community life through regular patrol visits and occasional responses.Since two years have passed since the establishment of this service, it is necessary to understand the issues at the time of introduction, the operational status, etc., and to lead to the steady development of the system in the future.

Study content

In this study, we conduct national surveys (prefectures, municipalities/special wards), field surveys in local governments, and extract issues, operational status, points to be improved, etc. of introduction in each local government, and identify effective support methods and establish evaluation methods.Based on the issues clarified in the preceding studies [23,24,25,26], a survey will be conducted for persons in charge of local governments.[Table 1]

Table 1.

The goals for each year are as follows.

Fiscal 2020: Conduct a fact-finding survey of local governments nationwide to understand the actual conditions of persons with disabilities living alone.

Fiscal 2021: Conduct field surveys in local governments, and establish effective support methods and evaluation methods according to the state image.

Features and originality

  • Collaboration with local governments and related organizations

Promote study activities that make use of the network in the health and welfare fields established through research and training to date.

  • Proposals for measures that coordinate health and welfare

The principal investigator has experience in local administration (health center, etc.), medical field, and public health field, and connects the results of making policy proposals that lead to practice to this study.

  • Return to training

In addition to utilizing the results in measures, we will also utilize them in training for welfare office managers.

  • Understanding the overall picture of service status and detailed examples through national level surveys and field surveys

By conducting a fact-finding survey of persons with disabilities living alone at a nationwide level, the characteristics and variations of each municipality will be grasped, and detailed examples of individual cases will be investigated by field surveys in cooperating municipalities.

Expected results

Achievements directly reflected

  • Basic materials for improving the operation of the independence support service system will be created.

  • -Effective support methods and evaluation methods such as sharing of good cases and identification of promoting factors will be established.

Indirect utilization

  • Contribute to the preparation of future community-based welfare plans.

  • Contribute to the achievement of numerical targets for regional transition.

  • The results will be utilized in training for welfare office managers, persons in charge of operations of local governments, etc.

  • As a support for living ability, it will be a reference for withdrawal measures and life support for the elderly living alone.

Indirect ripple effect

  • It is expected to contribute to the realization of a "local symbiotic society", the cultivation of a culture of diversity acceptance in the region, and the increase of local resources (social capital).

Improvement of technical level:

  • Contribute to the improvement of human service technology.

Potential for other policy-significant study

  • It is expected to contribute to the achievement of Sustainable Development Goals (SDGs) and promote measures based on the Convention on the Rights of Persons with Disabilities.

Study plan and method

  1. Plan for the first year

    Conduct expert field study meetings, national surveys, and field surveys by local governments.

  2. Expert review meeting

    Organize a study group consisting of people with academic knowledge, local government staff, and NPO personnel. Discuss survey items, result analysis, effective support methods, and evaluation methods for understanding the actual conditions of persons with disabilities living alone.

A) National survey

Understanding the actual conditions of persons with disabilities living alone

Purpose of the survey: To clarify the actual situation of persons with disabilities living alone by clarifying the operational status, issues, etc., two years after the establishment of the "IC Assistance" system.

  • Examination of survey design and content: In order to identify the effective support method according to the state image by conducting a fact-finding survey at the national level, related factors (user image including disability support classification, service operation status) , Etc.) and conduct a survey centered on a large number of quantitative and statistical contents, using a questionnaire. The survey items are the issues before the creation of the system (image of people targeted for service, management of regular visits, system for occasional response, staffing, basic remuneration, addition, relationship with other services) (Ministry of Health, Labor and Welfare, Disability Welfare Service) Equal remuneration revision study team) and previous research.

  • Preparation of questions/questionnaire: At the expert review meeting, the details are decided at the review meeting (expert review meeting) with local government staff and NPO related persons.

  • Survey target: Local governments nationwide (prefectures, municipalities/special wards). Ask the department responsible for "IC Assistance" to cooperate with the survey. Coordination with local governments will be made by the representatives/partitioners as appropriate with their roles divided, and cooperation requests/ethical examination procedures will be collectively handled by the representatives.

# Create a “flash report (simple tabulation)” when the simple tabulation is completed. Using this as a reference, the results will be examined at an expert review meeting.

# Based on the results of the fact-finding surveys across the country, the details of the field survey for the next fiscal year will be examined by the expert review committee.

Field survey in local governments

Establishment of effective support method and its evaluation method according to the state image

Objective: To clarify the effective support method according to the state image in the municipalities/special wards and to establish the evaluation method.

  • Examination of survey design and content: In addition to the survey using the questionnaire, conduct an interview survey. The survey items will be based on the results of the national survey.

  • Creation of question text/questionnaire: Items such as operation record, service process, service user satisfaction, and regional characteristics are considered as items necessary for establishing evaluation methods for support. Details will be decided at the expert review meeting.

  • Survey target: Conduct field surveys in municipalities and special wards. It is intended for local government staff, NPO groups, businesses, and service users after consultation with the local government.

# Based on the survey results, create basic materials that contribute to the examination of effective support methods and evaluation methods that correspond to the state image.

Annual study plan

  • First year: Expert Committee, National Survey

  • Next year: Experts study group, field survey in local government, compilation of results

Study group structure

  • Principal Investigator:Responsible for overall management, cooperation with related organizations, and establishment of evaluation methods.

  • Researcher: In collaboration with the principal investigator, he will be in charge of analyzing survey results as a specialist in collaboration with related organizations, epidemiology and statistical surveys.

  • Research collaborators:

  • NPO groups (multiple groups in the Kanto suburbs such as Saitama prefecture)

    National Welfare Office Executive Committee

    National Health Center Directors' Association

    Other medical personnel, academic experts

Behavioral significance of "independent living (IL)"

Behavioral medicine is defined as an interdisciplinary discipline that integrates knowledge and technology related to social culture, psychosociety, behavior, and biomedicine [27].The knowledge and technology of behavioral medicine are used not only for understanding people's health and diseases, but also for prevention of diseases, promotion of health, elucidation of etiology, diagnosis, treatment, and rehabilitation.In recent years, based on behavioral science, geriatric behavioral science has been launched as a new elderly care science [28].

Osterwitz, Ingolf, in his book “A New Perspective on Rehabilitation[29],” defines the “independent life (IL)” of persons with disabilities” as follows:“They decide on their own daily schedule. They have the competence to tell the assistant how best to help them. They can choose how and where to live. They can develop a private living space and lifestyle. They have the right to friendship, love and sex. They have the right to work and to be paid for it.”The Japan Council on Independent Living Centers (JIL) positions independence (life) as "to be recognized as one person [30]." And they describe the IL as "Being able to Choose everything in one's life and live own life."

In recent years, the term Independent Living (IL) has been frequently used in Japan, mainly in the field of disability.Imaoka said that the IC movement has a history that has been the goal of the movement that has been developed by persons with disabilities who are difficult to be professionally independent in the United States themselves [31].The Ministry of Health, Labor and Welfare's independence support is now institutionalized and meticulously implemented according to the characteristics of various objects.There are various support projects for the independence support system for people living in poverty, and an independence support medical system for removing and reducing physical and mental disorders　[32,33]. Nagata [34] describes the concept of IL as follows:``Severely handicapped persons with an independence will choose and decide their own direction of life so that they can take responsibility for their own life, and, under self-reliant training and supportive support, very routinely Living in society, sharing joy and responsibility, and conducting family life and professional life [35-39].”The concept of IL is said to be composed and developed by the inclusion, fulfillment, and fulfillment of the three: 1) Physical Modification, 2) IL Rehabilitation, and 3) Consumer Rights.

As a disability welfare service for persons with disabilities living independently, services such as IC support and community settlement support are provided[40,41].Making an independent life possible is a fundamental human need [42] such as freedom of movement and communication. Therefore, it is necessary to consider the significance of IC in the future comprehensive community care system as an important element in realizing the SDGs and enhancing a symbiotic society.

Considerations /Summary

IC is considered a human right in developed countries such as Japan.From this, IC should be guaranteed to all people from the viewpoint of social medicine, regardless of the factors of health disparity.In addition, the history of the IC movement that occurred in the field of welfare for persons with disabilities and developed into various related fields was confirmed.In carrying out the "model construction study to effectively support the community life of chronic patients living in the community" in this study, it seemed appropriate to select "disabled people" from the chronic patients.

The development of assistive devices and AI has made it possible to make decisions in IC (IL) despite having severe disabilities and diseases[30].In Japan, IC is now becoming a natural human right of the people.The proposal of this study is only one plan, but if we aim to realize a symbiotic society and SDGs, the realization of an IC support environment should not be delayed any further.

Ueda [44] had discussed some theoretical issues that were raised in the 1981 International Year of Disability and thought to have a major impact on the future of rehabilitation medicine.Among them, “structural understanding of impairment, disability, handicap” has spread to a certain extent, and “expansion of the range of persons with disabilities/disabilities” has been institutionalized.However, it is difficult to reach a solution to some ideologically important problems such as “IC”.Therefore, in order to realize the solution by implementing the study plan proposed in this paper, the following two are considered necessary:(1)Presenting a "regional model" in collaboration with advanced local governments, etc., in anticipation of the future comprehensive local care system, (2)In order to be able to deal with various "individuals" in a finely tuned manner, the parties should take the initiative to build cooperation between public and private social capital.

The Hamamura's efforts[15] mentioned at the beginning of this article are community-building activities that hospitals carry out to support IC.Based on volunteer activities that provide skills and knowledge cultivated through their profession for social and public purposes, such as "pro bono activities [45]" Comprehensive activities are carried out at various levels.In that activity, "disability" is included as one of various chronic health problems, and a program that promotes "self-help", "mutual assistance", "cooperation", "network", etc. is adopted [46].In order for the elderly and people with disabilities to live in the area independently, local governments should be possible to effectively and efficiently collaborate with these activities that “promote activities for self-help and mutual assistance in the area.[47]”At the same time, it willbe needed that, (1)_Developing of regional models for regional development of inclusive and symbiotic societies centered on hospitals, and (2)_Developing of human resources development programs for local public health administration workers [48].I thought that grasping, realizing, and investigating issues in these current systems are the goals that should be pursued in the near future, and I put this as the outcomes of the proposed study plan in this paper.Through the realization of practical research that effectively supports "IC" as described above, I believe that the development of "the definition of a mature society" will lead to its diffusion together with the inclusive society and the symbiotic society.

Nakatani [49] looks at the next generation of public health and says, "The world of the 21st century is becoming healthier and richer as a whole." And he said, "The domestic and international health issues are similar."He added, "Japan's experience and health technology are extremely useful for countries that are late in confronting the aging tsunami (Silver Tsunami)."At the same time, he argues that if "Think globally, plan nationally and work individually" is practiced, "three ways good" can be realized for individuals, society, and the world.In addition, Nakatani cites six issues including "changes in disease structure" as "glocal issues," and "new health concepts" as "prospects from Japan for public health." So far, Japan's "Policies for Persons with Disabilities", has feeling of being addressed by "individual care" in the welfare field.

So far, the author has made the following three recommendations mainly in logical approaches as a public health infrastructure improvement that is considered necessary in the future: (1) Construction and use of a “Disability Registry Database (including various chronic health problems)” and improvement of information accessibility [19,48], (2) Discussion and Dissemination of the Definition of health for a mature society[19,47], and (3) Establishment of a quality self-management support system for people with chronic health problems[45,49].If the proposals in “(1)Construction and use of a Disability Registry Database and improvement of information accessibility” and “(3) Establishment of a quality self-management support system for people with chronic health problems” are considered “Planning nationally and Working individually,” and the proposals related to “(2) Discussion and Dissemination of the Definition of health for a mature society” are “Think globally,” then aiming to put those into practice will be the direction we should take in the future [50].It was considered that the proposal of this study could be a reasonable and effective realization method of social life support from the viewpoint of "promotion of IC" necessary for promotion of symbiotic society and SDGs.

Conflicts of Interest

The author has no financial conflicts of interest to disclose concerning the study.

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Received: April 07, 2020;
Accepted: May 12, 2020;
Published: May 14, 2020.

To cite this article : Tomoko TachibanaHow to Develop the "Definition of Health in Mature Society" in Japan: Through the Proposal of Practical Study to Effectively Support the " Independent Living" Health Education and Public Health. 2020; 3:3.

© Tomoko Tachibana.2020.