Embed Size (px)
Citation preview
HIROSHIMA TO FUKUSHIMA AND
COVID-19:
A HISTORY OF JAPANESE HEALTHCARE
TOMOKO Y. STEEN, PH.D.
GEORGETOWN UNIVERSITY
MEDICAL CENTER
ACKNOWLEDGEMENT
The statements included in this
presentation are all based on my own
knowledge and research and do not reflect
or represent organizations that I am
affiliated with.
Japan’s healthcare system is shaped by a unique and complex history…
A JAPANESE NURSE PORTRAYED AS A 現代美人 (MODERN BEAUTY), PREPARES AN INJECTION FOR A PATIENT, CA. 1910
NATIONAL LIBRARY OF MEDICINE
HEALTH INSURANCE AND
QUALITY OF HEALTHCARE
UNIVERSAL HEALTH CARE AROUND THE WORLD
https://vignette.wikia.nocookie.net/liberapedia/images/9/94/Health.png/r
evision/latest?cb=20090404062422
JAPANESE HEALTH CARE: HEALTH
INSURANCE
• Since 1961 Japan has provided universal health
coverage, which allows access to preventive, curative
and rehabilitative services at an affordable cost.
• All residents of Japan (including non-citizens who have
establish residency in Japan) are required by the law to
have health insurance coverage.
• People without insurance through employers (“social
insurance”) can participate in a national health
insurance program administered by local governments.
JAPANESE HEALTH INSURANCE
The Japan’s statutory health insurance system (SHIS)
has two types of mandatory insurance and cover
98.3%; remaining 1.7% covered by the Public Social
Assistance Program.
1) employment-based plans (59% of the population)
2) residence-based insurance plans, which include:
a) Citizen Health Insurance plans for unemployed
or freelance individuals age 74 and under
(27% of the population).
b) Health Insurance for the Elderly plans, which
automatically cover all adults age 75 and older
(12.7% of the population).
*Low income category: disposable income $23,458
https://www.mhlw.go.jp/bunya/ir
youhoken/iryouhoken01/dl/01_e
ng.pdf
https://www.commonwealthfund.
org/international-health-policy-
center/countries/japan
http://www.ipss.go.jp/s-
info/e/ssj2014/006.html
COMPREHENSIVE MEDICINE
• Everyone is entitled to quality healthcare and is required to have a
health insurance.
• Costs of medical equipment and drug are strictly regulated by
Japanese government .
• Each of Japan’s prefectures (47) and regions has its own residence-
based insurance plan. There are more than 1,400 employment-
based plans.
• Doctors are assign to rural areas: formerly recent national medical
school graduates were required to spend time working in rural areas
for the first few years. (No longer required.)
• Each medical school now has a special category for educating
doctors to work in rural areas for 6-7 years after graduation--free
tuition.
• Federal and local governments agree on strategies to improve health
care in rural areas through telemedicine since 2007-telemedicine (D
to D or D to P), and other arrangements.
https://www.jmir.org/2020/1/e13649/
• Patients are free to select physicians or facilities of
their choice and cannot be denied coverage.
• Hospitals, by law, must be run as non-profits and be
managed by physicians.
• For-profit corporations are not allowed to own or
operate hospitals. Clinics must be owned and
operated by physicians.
JAPANESE HEALTH CARE: PATIENTS’
RIGHTS
• Brain and heart surgery: unique techniques are
developed
• Plastic and orthopedic surgery: techniques to fit its
population
• Pharmacy: combined use of western and Kampo
medicine
• Educational Programs on integrative and
complementary medicine at top medical schools
• Federal licensing (doctors, dentists, pharmacists)
rather than prefectural or regional license —
standards are high and consistent
JAPANESE HEALTH CARE:
SPECIALIZATION AND LICENSING
JAPANESE HEALTHCARE: INTEGRATION
Survey on the Current State of
Kampo Prescription Frequencies
by physicians.
Data retrieved from: 2011 Japan Kampo
Medicine Manufacturers Association
HISTORY OF MEDICINE IN JAPAN
UP TO THE MODERN PERIOD: (5TH CENTURY THROUGH 1868)
1. Traditional Kampo Medicine learned from China
2. Introduction of Dutch/German Medicine
ORIGIN OF KAMPO MEDICINEIN JAPAN
TRADITIONAL MEDICINE: KAMPO (漢方)
• Herbal medicine is introduced from China in
the 5th and 6th Century
• An independent Japanese school of Kampo was
established in the 1500s
• A shift to western medicine occurs toward the end
of the 1700s
• Prohibition of the use of Kampo during the early
modern period -- late 1800s
• Recent revival of Kampo medicine as mainstream
treatment
INTRODUCTION OF WESTERN-STYLE MEDICINE
• From Mid-1500s: Introduction of western medicine
from Portugal, Holland and Spain (Jesuit
Missionaries)
• Between 1639-1854: Japanese borders are closed
(sakoku鎖国). However, Nagasaki city remained
open to Holland, Portugal and China.
• Western medicine is introduced by Engelbert
Kaempfer, German naturalist and physician (1690-
1692) and by Philipp Franz von Balthasar Siebold
(German physician) during his stay in Nagasaki
(1823-1829).
WESTERN STYLE MEDICAL EDUCATION
• 1774 Kaitaishinsho 解体新書 Tāheru
Anatomia–first Japanese translation of
an anatomy book by Hiraga Gennai 平賀
源内
• 1854 First medical school was
established in Nagasaki - 長崎医学伝習
所（Nagasaki School of Medicine)
MODERN PERIOD:MEIJI RESTORATION,
SINO-JAPANESE WAR TO WWII (1868-1945)
3. Active introduction of German Medicine:
Study Abroad programs in Germany
4. Biological & Chemical weapons research
5. Atomic Bombs dropped on Hiroshima and
Nagasaki
MEIJI RESTORATION: MODERN JAPAN AND SCIENCE POLICY FROM 1868
• Wakon yosai (和魂洋才）—introduction of western talents (science, technology, medicine and other studies) while maintaining Japanese spirit
• Study abroad programs in Germany, France, England and the US
• Foreign teachers in Japan お抱え外国人講師
• Establishment of imperial universities 帝国大学
• Establishment of research institutes 理研
• Promotion of industries and innovation 殖産興業
• Industrial revolution 産業革命
WAR MEDICINE DURING WWII(WATER PURIFICATION UNIT 731)
• Epidemic prevention
• Bio-weapons development
• Human experiments
• Large-scale operations from Northern China to
Southeast Asia
ATOMIC BOMBS WERE DROPPED IN HIROSHIMA AND NAGASAKI
• First large-scale civilian casualties caused by nuclear
weapons
• Long terms effects of radiation
• Atomic Bomb Casualty Commission (ABCC) was
established – Life Span Studies & Children of
Atomic Bombs
• New health coverage, atomic bomb notebook
(Gembaku techo), Atomic Bomb Survivors
Support Law (hibakusha hogo hou被爆者保護法)
established by Japanese government (1957,
1968, 1994)
Atomic bombing of Hiroshima, OSTI.gov
POST WAR(1945-1989)
6. Allied Occupation Period
7. Industrial Growth Period
(高度成長期）
8. Pollution sickness (公害）
ALLIED OCCUPATION PERIOD
• Health reform under occupation - new
health policy
• Margaret Sanger’s visit: Abortion was
considered a eugenics act in the 1880s,
and then in 1931 as a women’s right. It
became legal in 1948, one of the first
countries to legalize abortion, but called
“Protection of Eugenics Act” 優生保護法
POST-OCCUPATION ECONOMIC GROWTH: ADVANCEMENT OF SCIENCE, TECHNOLOGY AND MEDICINE
• Scientists and doctors accepted
Fulbright Scholarships to study abroad
in the US & Europe
• Kōdo seicyo ki (高度成長期） -
high industrial development period
• 1910-1970: Itai-itai disease (Cadmium): Toyama 1955
• 1961: Yokkaichi asthma (Sulfur dioxide and nitrogen
dioxide): Yokkaichi-city in Mie 1972
• 1932-68: Minamata disease I (Mercury)
Chisso Chemical Factory in Kumamoto 1956
• 1964-65: Minamata disease II (Mercury) – Showa
Electric Works in Niigata 1965
______________________________
Citizen’s group pressured politicians to establish policies
for industrial regulation and factory safety
ECONOMIC GROWTH AND POLLUTION DISEASES
Drug Hazards 薬害
• The rapid development of pharmaceutical
industries and related companies resulted in
drug hazards
• 1956-62 Thalidomide: Birth defects
• 1980 Green Cross: HIV-tainted blood
products
• Citizen’s group pressured the Ministry of Public
Health to enact regulations薬事法/薬機法
(Pharmaceutical Affairs Law) 1874, 1917, 1960,
1973, 1985, 1997, 2014, 2019
• New regulations for clinical trials, quality control,
marketing and import (including cosmetics)
POST MODERN JAPAN(1990 – PRESENT)
9. The Lost Decade
10. Adaptation of European R&D Systems: Gender
Equality
11. An Aging Society
12. Disaster Medicine:
a. Great East Japan Earthquake and Fukushima
Nuclear Accident
b. Covid 19 (SARS-CoV-2) Management
JAPAN’S LOST DECADE AND MEDICAL COSTS
The Japanese Economy
“The unseen casualties of Japan’s lost
decades suffer in silence Politicians
who engage younger voters are few, so
the disgruntled stay unheard.“
in Financial Times By Sahoko Kaji
https://www.ft.com/content/042a592e-c283-11e4-
ad89-00144feab7de
Healthcare Expenditure/OECD, 2006
R&D BUDGET
• Social Principles of Human-Centric
Artificial Intelligence(AI)
• Moonshot Research and Development
Program
• Cross-Ministerial Strategic Innovation
Promotion Program
https://www8.cao.go.jp/cstp/english/
COUNCIL FOR SCIENCE,
TECHNOLOGY AND INNOVATION
ADVANCED TECHNOLOGY
• Cancer treatments
• Infectious diseases
• Public health & Immunization
• Drug development
• Organ transplants
• Regenerative medicine - aging
• AI and Robotics - aging, work force shortage
SHINYA YAMANAKA RECEIVES NOBEL PRIZE
The 2012 Nobel Prize in Physiology and
Medicine resulted in a large government funding
shift from all other basic research to iPS and
applied research/clinical research
TASUKU HINJO RECEIVESNOBEL PRIZE
The 2018 Nobel Prize in Physiology and Medicine
shared with James P. Allison "for their discovery of
cancer therapy by inhibition of negative immune
regulation.“
R&D BUDGET
• Cancer Immunotherapy
• iPS cell
• Nanotechnology
• Drug discovery
TECHNOLOGY TRANSFERS AND INTERNATIONAL SUPPORT
• R&D grants for developing countries
• Introduction of new technologies: technology
transfers
• Accepting science students from developing
countries to national universities and research
institutes - JST, JSPS
WOMEN IN SCIENCE & MEDICINE: POLICY
BENEFIT AND PROTECTIONS FOR WOMEN IN SCIENCE
• Women study abroad, 1871-73
• Reliable childcare by universities and
research facilities since 1940
• Equal opportunity laws: pay equality
established in 1985
After 2000,
• Flexibilities for research grant
• Post childcare grants for women scientists
• Partial/full parental leave with job security
GENDER EQUALITY BUREAU, CABINET OFFICE JST, JSPS
HTTP://WWW.GENDER.GO.JP/ENGLISH_CONTENTS/ABOUT_DANJO/WHITEPAPER/INDEX.HTML
AGING AND SUSTAINABLE MEDICINE
“JAPAN: SUPER-AGING SOCIETY PREPARING FOR THE FUTURE.”
The Gerontologist, Volume 51, Issue
4, August 2011, Pages 425–
432https://doi.org/10.1093/geront/
gnr067
NATIONAL CENTER FOR GERIATRICS AND GERONTOLOGY
Our mission is to dedicate ourselves to the
promotion of the physical and mental health of the
elderly, so that they can achieve life-long
independence, and the improvement of the health
and welfare of the people and society.
SUSTAINABLE HEALTH POLICY FOR AGING POPULATIONS
• Distance medicine
• Visiting nurse
• Assignment of younger doctors to
• rural areas
• AI and Robotics
• Need of geriatrics and holistic approach
DISASTER MANAGEMENT: SCIENCE AND HEALTH POLICY
DISASTER MANAGEMENT: SCIENCE & HEALTH POLICY
Fukushima Nuclear Accident
• Previously organized committee was not
contacted at the time of disaster
• No horizontal communication or agreement
among ministries
• Industry monopolies
• No centralized system of regulation such as
NRC in the US
FUKUSHIMA NUCLEAR ACCIDENT
Why does Japan have lower death rates from Covid19?
• Public Health: Controlling the amount of
virus circulating
• High subscription to mask wearing since
1918 pandemic flu
• Common practice of gargling
• Policy: Universal health care: preventive
care and early diagnostics
• Government Science Team: Contact tracing
and cluster managements since 2009
• Public Attitudes: Public compliance with
government orders
https://covid19japan.com/
• Key Preventive Measures started early (in March)
“Avoid Three Cs”:
• Closed spaces with poor ventilation
• Crowded places with many people
• Close contact settings such as face-to-face
conversations.
• Potential previous exposure to corona viruses
• Lower obesity rates
• More specialized and accurate testing zt the local
public health office (although less testing than
Korea or Taiwan)
Outbreak
Monitoring
Map 10/4/2020
Japan’s Low Death Rate…
2020 Annual Meeting ThemeUse of Emerging Technologies for Disaster Managements:
Cases of Nuclear Disaster and the COVID-19 Pandemic
Sponsored by
Biomedical Science Policy and Advocacy Program at Georgetown & DTRA
https://nssregistration.wixsite.com/nov2020
Annual Nuclear Security Summit at GeorgetownNovember 16th-18th, 2020
