Introduction

The Toyama Prefectural Government reorganized its public health and welfare system in July, 2002, expanding a new welfare division in the each of the main offices of the four Toyama prefectural health centers, including the Chubu Health Center. The Chubu Health and Welfare Center began providing better public service for the residents in cooperation with health and welfare division staff. Conversely, the three Toyama prefecture social welfare centers, Tobu, Chubu and Seibu Social Welfare Centers, were abolished after expansion of the welfare division in the four health centers.

The Kamiichi Health Center, later to become the Chubu Health Center, was established in 1940. At the time, Toyama had nine prefectural health centers. These were reorganized into four prefectural health centers and five branches in accordance with the Community Health Law of July 1998, which replaced the Health Center Law. The Chubu Health Center was one of those four Toyama prefectural health centers and was organized with its main office in Kamiichi Town and a branch office in Yatsuo Town. The Chubu Health Center managed the central Toyama district and consisted of 10 municipalities: 1 city (Namerikawa), 6 towns (Kamiichi, Tateyama, Oyama, Fuchu, Osawano and Yatsuo) and 3 villages (Funahashi, Yamada and Hosoiri).

Recently, there has been a growing call for municipal mergers in various regions to maintain and improve the quality of municipal public services and to increase efficiency in municipal administration. In our managing district, the above-mentioned 4 towns, Oyama, Fuchu, Osawano and Yatsuo and 2 villages, Yamada and Hosoiri, merged with Toyama city, and new Toyama city was born on April, 2005. As a result, the branch office in Yatsuo town was closed. Thus, Chubu Health Center’s managing district was reduced to only 4 municipalities: 1 city (Namerikawa), 2 towns (Kamiichi and Tateyama) and 1 village (Funahashi).

Our district reaches from mountainous areas to the plains and even to the seashore. Geographically, the mountainous area is home to beautiful Mt. Tateyama and Mt. Tsurugidake. These mountains are part of the Japan Alps, and are attractive to many climbers. The plains, called the Toyama Plains, are a fertile rice-producing area supported by the great Joganji River. Finally, the seashore area that faces the Toyama Bay is a fishing port where many delicious fish are caught. This area is especially well known for its sea-mirage viewing point and Firefly Squid production.

The population of our district is 87,809 people as of 2004. The percentage of those over 65-years old is 22.6%, and those less than 14-years old is 14.4%. Consequently there is a large elderly population and the number of children is decreasing.

The progression rate of the aging population with fewer children in Japan is increasing at a speed unprecedented in other nations. The number of bedridden elderly people has increased, and the period of the nursing care for them gets prolonged every year in proportion to the increase of the aging population. Therefore, the issue of nursing care is one of the greatest concerns of the citizens. For that reason, the Long-term Care Insurance Law was enacted and long-term care insurance was commenced in all municipalities throughout Japan in April 2000. Long-term care insurance was also initiated in 4 municipalities in our management district according to this law.

Furthermore, in Japan, there is a pressing issue in that the number of lifestyle-related disease patients and their deaths are increasing from year to year. Therefore, the Ministry of Health and Welfare established a framework of new health promotion measures emphasizing primary prevention, or the promotion of health and prevention of incidence, and set up the National Health Promotion Movement in 21^st Century (Health Japan 21) in 2000. This movement is expected to promote lifelong health and regional health.

Bird’s Eye View of the Organization of the Chubu Health and Welfare Center

Health and Welfare Center Director

 Health and Welfare Center Vice Directors (2)

 General Affairs and Planning Division 
  General Affairs and Medical Matters Section
  Statistical Analysis and Planning Section

 Welfare Division 

 Sanitation and Testing Division
Food Sanitation Section

Sanitary Testing, Environmental Sanitation and Pharmaceutical Affairs Section

 Health Service and Prevention Division
   Health and Care Service Section
   Prevention Section

Major Tasks of the Divisions and Sections

In our office, there are four divisions: the General Affairs and Planning Division, Welfare Division, Sanitation & Testing Division, and the Health Service & Prevention Division.

General Affairs & Planning Division

In the General Affairs & Planning Division, there are two sections: the General Affairs & Medical Matters Section, and the Statistical Analysis & Planning Section.

General Affairs & Medical Matters Section

This section deals with personnel, budget, medical affairs, paramedical license affairs and affairs of implementation of post-graduation training for second-year residents, etc.

Statistical Analysis & Planning Section

This section conducts statistical analysis of population trends, including death rates due to various types of diseases, and health promotion plans based on the results of these analysis and Health Japan 21.
The section also supports municipalities and volunteers by providing advice and information regarding long-term care insurance and health in the community.

Welfare Division

The main service provided by the Welfare Division is to supply necessary relief for indigents according to the Daily Life Protection Law. The division also provides loans with no/low rate interest for single mother families and widows to support themselves, allowing them to be independent. Also, in accordance with the Child Welfare Law, the division gives advice to single parent families regarding daily distresses related to child raising.

Sanitation & Testing Division

In the Sanitation & Testing Division, there are two sections: the Food Sanitation Section, and the Sanitary Testing, Environmental Sanitation and Pharmaceutical Affairs Section

Food Sanitation Section

This section deals with the sanitation guidance and surveillance of food shops and food processing industries (including mountain cabins in the Japan Alps), and conducts food poisoning preventative measures. Yet, in spite of the sanitation guidance and surveillance, there was one case of mass food poisoning in 2002 in our region: Lampteromyces japonicus was the cause.

In addition, ever since the occurrence of mass food poisoning by the Vero toxin-positive Echerichia coli infection incident that occurred in Osaka in 1996, special attention has been directed towards the prevention of mass infection. The sanitary conformity of food handling businesses, such as restaurants and cafes is also inspected upon their opening or renewal applications and licenses are granted provided they conform to the standards. After licensing, sanitary conditions are examined via sampling inspections, if necessary.

In viral gastroenteritis, Norovirus is the main etiological agent. There were many outbreaks at welfare facilities, schools and kindergarten in 2004/05 winter season. In our district, the outbreaks were observed at two welfare facilities. As the route of the transmission, 50% of the outbreaks were ascribed to foodborne transmission- consumption of raw oysters contaminated with noroviruses, 10% to person-to-person transmission, and 40% to unknown routes. There are no specific methods for preventing illnesses caused by these noroviruses. However, because of the extremely infectious nature of the agent, we recommend heat-treating oysters, careful hand-washing and proper disposal of contaminated material.

According to regulations, dog-owners must have their dogs registered. All dogs have to be vaccinated to prevent rabies, and all dogs in public places must be on a leash. Unleashed dogs may cause a nuisance to inhabitants, so a staff member is sent to capture them as soon as they are informed. In addition, if the owner of the loose dog can’t be located, an effort is made to find someone to adopt it.

Sanitary Testing, Environmental Sanitation and Pharmaceutical Affairs Section

This section performs bacteriological and chemical testing of foods, drinking water, swimming pool water, etc. In addition to these tests, the testing of the stools of workers in facilities that provide meals is also important. After the big mass infection incident caused by vero toxin positive O 157 E. coli that occurred in Osaka 1996, the Japanese Ministry of Health, and Welfare decided this test should be conducted every two weeks.

Environmental Sanitation & Pharmaceutical Affairs Section

This section works in narcotic control, environmental sanitation license affairs, and sanitation guidance and surveillance of hotels, barbershops, beauty parlors, public bathhouses, laundry mats, etc. They also give community lectures about intoxication from drugs and thinners.

Health Care Service & Prevention Division

This division includes the Health & Care Service Section, and the Prevention Section.

Health & Care Service Section

This section conducts health promotion and provides care services for some types of chronic diseases.

The progression rate of the aging population with fewer children in Japan is increasing at a speed unprecedented in other nations. As this is the same in our district, maternal and child health is very important. Health nurses go around to support the rearing of children, including infants with low body weight, low Apgar score infants, and babies with slow growth rates. They also respond to mothers with child-raising anxiety by giving guidance or advice. Meetings about child-raising and common pediatric diseases, such as atopic dermatitis, asthma, and obesity, are held as well, with pediatricians and volunteers of the maternal and child health promotion group.

The promotion of health for the elderly is also important. Center staff, municipalities, and volunteers campaign for the prevention of lifestyle-related diseases (e.g. cancer, diabetes mellitus, heart diseases, strokes, etc.) by encouraging people to improve their lifestyle and urging them to get tested for these diseases.

There are 45 incurable diseases (as of October 1, 2002) recognized by the Japanese Ministry of Health, Labor & Welfare, such as Parkinson’s Disease, amyotrophic lateral sclerosis, Behget's Disease, and systemic lupus erytematosus. Long-term treatment is unavoidable for patients with such diseases and many suffer not only physically but psychologically as well. Care services for these patients are essential. The section works to support patients by educating community volunteers on care techniques, thus increasing the quality of patients’ lives.

Welfare measures for people with mental disorders were improved in 1995 by an amendment to Mental Health Law called the Law on Mental Health and Welfare for People with Mental Disorders. The amendment stipulates that in order to promote mental health and welfare measures in the community, prefectures and municipalities shall publicize the significance of mental health and welfare, and provide counseling and guidance to people with mental disorders as well as their families.

To promote self-sufficiency and social participation among the mentally disabled in our region, two mental health and welfare promoting community associations and two community associations of families with mental disorders were established in our district. The volunteers in the community associations work to establish a comfortable and non-discriminating society for people with metal disorders and encourage their self-sufficiency and social participation. Additionally, rehabilitation is offered to them once every two weeks. The aim is to create a society in which all people, regardless of any disability, including mental disorders, can lead ordinary lives.

Prevention Section

This section works toward the prevention against many kinds of infections, such as tuberculosis, influenza, including highly pathogenic avian influenza, verotoxin positive E. coli, and HIV.

The prevention of tuberculosis is especially important because there was a time in Japan when tuberculosis was referred to as a “national disease.” Even now, tuberculosis patients are increasing in number, and the incidence occurrence rate in Toyama was 31.1 per hundred thousand people (32.4 nationally) in 1998. Thus, Sohei Miyashita, Minister of Japanese Health and Welfare declared a state of emergency concerning tuberculosis on July 26, 1999. Japanese doctors must now report an incidence of tuberculosis to the governor within 48 hours of diagnosis. Health conditions of people who have been in contact with the infected person are then examined in order to prevent a mass infection of tuberculosis. The reason for the recent high incidence of tuberculosis in Toyama is unknown, but it is speculated that it is related to the increase of aging people or lifestyle-related diseases, including diabetes mellitus and cancer. On the other hand, HIV/AIDS-patients are very rare in Toyama. Nevertheless, HIV tests are conducted free of charge once a week and there is a campaign against HIV infection for young people in the community.

The prevention of outbreaks of influenza is also important. Outbreaks of illness of variable extent and severity occur nearly every winter. Such outbreaks result in significant morbidity in the general population and an increase in mortality rates among certain high-risk, or immunocompromised, people, such as the elderly and infants, predominantly as a result of pulmonary complications of acute illness or encephalitis. Therefore, we recommend administration of influenza vaccinations to residents, and especially for the elderly. In order to increase the influenza vaccine coverage rates among the elderly, each municipality partially bears vaccination charges for the people over the age of 65.

Additionally, a new strain of coronavirus induced SARS was discovered in Asia in February, 2003. Outbreaks of SARS were very serious, but were brought to a successful resolution after about 7 months.
According to WHO reports, there were 8,422 cases and 916 deaths as of Aug. 7, 2003. As such, preventative measures against SARS have become vital in Toyama Prefecture, which is included in our managing district. We provide the following services against SARS: (1) Provision of information on SARS to the public through the Toyama Prefectural Government and our own web site, and (2) Advising travelers who may have been exposed to SARS and individuals who have returned from areas with SARS. As an additional service, in order to prevent the spread of infection, we transfer patients diagnosed as SARS-probable cases to official hospitals¹ designated as infectious hospital by the governor of Toyama Prefecture such as Toyama City Hospital.

¹ Toyama City Hospital,  Toyama Red Cross Hospital,  Toyama Prefectural Central Hospital,  Saiseikai Toyama Hospital,  Toyama Medical and Pharmaceutical University Hospital,  National Sanatorium Toyama Hospital,  Kamiichi General Hospital,  Koseiren Namerikawa Hospital

Conclusion

My staff and I are working toward the ultimate goal of creating a comfortable living environment. If you live in our managing district and have any questions, please contact us without hesitation.

Kazuyuki KATO, M.D., Ph.D.
Director of Chubu Health and Welfare Center