保健医療科学 2018 Vol.67 No.5 p.530－541
地方自治体における災害時の公衆衛生活動に対する準備状況の実態
＜報告＞
地方自治体における災害時の公衆衛生活動に対する準備状況の実態
―自治体種別による比較より―
松本珠実1, 2），遠藤智子3），池田和功4），簗場玲子5），相馬幸恵6），
清田千種7），森陽子8），谷戸典子9），青柳玲子10），宮崎美砂子11）
1）大阪市阿倍野区保健福祉センター
2）国立保健医療科学院生涯健康研究部
3）福島県保健福祉部
4）和歌山県橋本保健所
5）宮城県北部保健福祉事務所栗原地域事務所
6）新潟県糸魚川地域振興局健康福祉部
7）熊本市北区保健福祉部
8）茨城県下妻市保健福祉部
9）埼玉県狭山保健所
10）新潟市西区黒埼地域保健福祉センター
11）国立大学法人千葉大学大学院看護学研究科
The state of preparation for public health activities during disasters
in local govermments: Comparison by municipality type
Tamami Matsumoto 1, 2), Tomoko Endo 3), Kazunori Ikeda 4), Ryoko Yanaba 5), Yukie Soma 6),
Chigusa Kiyota 7), Yoko Mori 8), Noriko Yato 9), Reiko Aoyagi 10), Misako Miyazaki 11)
1) Public Health and Welfare Center, Abeno Ward, Osaka City
2) Department of Health Promotion, National Institute of Public Health
3) Social Health and Welfare Department, Fukushima Prefecture
4) Hashimoto Public Health Center, Wakayama Prefecture
5) Kurihara Public Health Center, Miyagi Prefecture
6) Itoigawa Public Health Center, Niigata Prefecture
7) Health and Welfare Department, Kita Ward, Kumamoto City
8) Health and Welfare Center, Shimotsuma City
9) Sayama Public Health Center, Saitama Prefecture
10) Kurosaki regional Public Health and Welfare Center, Nishi Ward, Niigata City
11) Graduate School of Nursing, Chiba University
抄録
目的：都道府県，保健所設置市，その他一般市町村別に，災害時の公衆衛生活動に対する準備状況の実態を明らかにするとともに，災害時の公衆衛生活動に関する訓練の実施と関連する準備項目を明らかにすることを目的とした．
方法：文献から平時の備えにより災害時の公衆衛生活動が促進されると報告されている項目を抽出し，それらの準備状況について，全国の都道府県，保健所設置市，その他一般市町村，保健所に配置されている統括的役割を担う保健師等を対象として郵送自記式アンケートを実施した．アンケートで得られたデータは都道府県及び都道府県型保健所，保健所設置市，一般市町村の 3 群に分類して実態を分析した．その後，自治体種別を調整した上で「災害時の公衆衛生活動に関する訓練実施の有無」を従属変数として多重ロジスティック回帰分析を行った．
結果：回答数は1,159件（回収率51.1％）であった．市町村では都道府県や保健所設置市と比較して，災害対策本部への保健医療部局の出席，マニュアルの作成，他部局や医師会等との連携，研修や訓練などの項目において実施割合が低かった．保健所設置市と市町村間で避難行動要支援者名簿の作成や管理状況に特に差はなかった．災害時の公衆衛生活動に関する訓練の実施については，保健医療活動チームからの応援を終了するタイミングの目安を決めていることや医師会・薬剤師会等が災害対策を話し合う場があること，研修への派遣など 9 項目との関連が明らかになった．
結論：市町村の災害時の公衆衛生活動に対する準備状況が遅れていることが明らかになった．災害時の公衆衛生活動に関する災害訓練の実施と関連ある準備項目は，関係機関との連携や受援体制の検討，研修の受講などであった．
キーワード：災害準備，公衆衛生活動，自治体種別，災害訓練
Abstract
Purposes: The purposes of this study are (a) to clarify the state of preparation for public health activities in times of disaster in terms of organizational framework setting, preparation of manuals, and other areas to be pursued by each local government: (i) prefectural governments, (ii) cities in which public health centers (PHC-established cities) are located, and (iii) other municipalities (cities, towns and villages); (b) to make clear what is in the preparation for the local government related to the “implementation of training on public health activities in the event of a disaster”.
Method: In published literature, the activity areas of which everyday preparation efforts would help actual public health services operate effectively in the event of disaster were chosen. In order to collect information on the progress of preparation in the identified areas, the questionnaire survey was prepared, covering supervisory public health nurses stationed in each local government—prefectures, PHC-established cities, and general municipalities, as well as those working at PHCs. The questionnaire was mailed to be completed by the public health nurses on their own. For analysis, responses were classified into three types by response source: (i) prefectural governments and prefectural PHCs, (ii) PHC-established cities, and (iii) other general municipalities. After an adjustment based on the type of the local government, multiple logistic regression analysis was conducted using the dependent variable of “whether training is carried out for public health activities in preparation for disasters or not.”
Results: A total of 1,159 answers were received (response rate: 51.1%). The general local governments showed a lower implementation ratio than prefectures and PHC-established cities in terms of (i) sending health care section personnel to disaster response headquarters, (ii) preparation of relevant manuals, (iii) cooperation with other sections in the organization or medical associations, and (iv) implementation of education and training. The PHC-established cities and general municipalities are almost the same in terms of the preparation and management status of those in need of support for evacuation. It has also been found
that the implementation of public health activity training in preparation for disasters is closely related to nine points, including (i) determination of the approximate timing of the termination of support from health and medical service teams, (ii) availability of opportunities for doctorsʼ organizations and pharmacistsʼ associations to discuss disaster relief measures, and (iii) dispatch of personnel to training sessions.
Conclusion: Preparedness in public health services for disasters is less progressed in other cities, towns, and villages than in other local entities. In the “implementation of training on public health activities in the event of a disaster”, preparations for disasters, such as “cooperation with related organizations”, “examination of the support system”, and “lectures” were related.
keywords: preparedness for disaster, public health services, type of local government, disaster drill (accepted for publication, 29th November 2018)
＜報告＞
連絡先：松本珠実
〒545-8501 大阪市阿倍野区文の里1-1-40
1-1-40, Fuminosato, Abeno-ku, Osaka 545-8501, Japan.
Tel: 06-6622-9968
E-mail: tam-matsumoto@city.osaka.lg.jp
［平成30年11月29日受理］