Public health practices to address natural disasters in Japan

TAKEMURA Shinji 1, 2)

1) Department of Health Policy and Technology Assessment, National Institute of Public Health
2) Program Officer, Research Program on Health Security Control, Health, Labour and Welfare Sciences Research Grants

Abstract
　Japan is among the countries with the highest occurrence of natural disasters worldwide and has a long history of addressing natural disasters. This paper outlines the public health practices related to natural disasters in Japan, focusing on the legislation for disaster management systems and relevant organizations to address the response to natural disasters, based on the legislation, and describes how the National Institute of Public Health (NIPH) contributes to the improvement of the public health practices that address natural disasters.
　The “Disaster Relief Act,” which stipulates how to facilitate emergency rescue during the acute phase after a disaster, was enacted soon after World War II. Further, the “Disaster Countermeasures Basic Act,” which was enacted in 1961, forms the basis for a disaster management system, including the public health practice. Based on this act, the disaster management plan must be formulated by the national and local governments and other public institutions, including the National Hospital Organization, Japan Community Health care Organization, Japanese Red Cross Society, and Japan Medical Association. The “Basic Disaster Management Plan” prepared by the National Disaster Management Council is a comprehensive disaster management plan based on which other disaster management plans are formed. It has constantly been reviewed and revised based on the experiences from large-scale natural disasters, such as the Great Hanshin-Awaji Earthquake, the Great East Japan Earthquake, and the spread of the COVID-19 pandemic. In addition, the “Medical Care Act,” which ensures the medical care delivery system, and the “Community Health Act,” which guides the public health center and its health crisis management function, are also relevant to the public health practice for natural disasters.
In case of natural disasters, local governments, including prefectures and municipalities, are responsible for protecting the lives and health of residents. Further, prefectures struck by disasters should promptly request assistance from the national government or other local governments. However, if deemed urgently necessary, the national government may provide support even without requests from prefectures in disaster areas. The Disaster Medical Assistance Team (DMAT), Disaster Psychiatric Assistance Team (DPAT), and Disaster Health Emergency Assistance Team (DHEAT) offer substantial and effective support to affect- ed local governments in public health practice. The DMAT has enough mobility to start working during the acute phase of a disaster, immediately after it occurs, provides medical care at disaster sites, and supports the medical treatment provided by hospitals in affected areas. Further, it coordinates wide area transportation and logistics. The DPAT supports psychiatric care and mental health services in affected areas. DHEAT supports the command and coordination of health crisis management in affected prefectures, establishes a　health crisis management organization, develops a direction and coordination system, and coordinates the delivery of support by a healthcare team.
　The NIPH contributes to the improvement of the public health practices related to natural disasters in Japan, from education and research aspects. Regarding education, the NIPH provides a three-month course to educate public health center directors and a short-term training program for health crisis management and contributes to the development of the knowledge and skills of professionals in the public health center and in the DHEAT, which play a central role in the public health practice related to natural disasters. Regarding research, the NIPH, as a research institute, conducts many research projects related to the health crisis management, including the response to natural disasters, and supports and enhances them as a funding agency for the Research Program on Health Security Control of the Health, Labour and Welfare Sciences Research Grants. The findings of these research have been used to develop and revise activity guidelines, develop human resources, and enhance the quality of activities for public health centers, DHEAT, DMAT, and DPAT.

keywords : natural disaster, health crisis management, public health center, Disaster Medical Assistance Team (DMAT), Disaster Health Emergency Assistance Team (DHEAT)

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