『保健医療科学』 保健医療科学 2025 Vol.74 No.5 p.426-434（2025年12月）
特集：公衆衛生看護の未来 ―持続可能な地域保健への挑戦
＜解説＞
地域保健・医療・福祉の未来
尾島俊之
浜松医科大学健康社会医学講座
The future of public health, medical care, and welfare in communities
OJIMA Toshiyuki
Department of Community Heath and Preventive Medicine, Hamamatsu University School of Medicine
＜抄録＞
地域における保健・医療・福祉の未来についてまとめた．日本では，急速な人口減少と高齢化が進む一方で，喫煙率や食塩摂取量の低下等により健康寿命は延伸してきた．しかし，身体活動の低下，男性における肥満の増加，孤独・社会的孤立の深刻化といった課題も進行している．さらに，気候変動に伴う災害，感染症，経済財政危機に関連する複合的な健康リスクも存在する．
これらの変化に対応するためには，健康格差の縮小，自治体間の共同，地域資源の発掘・育成・活躍，兼業の機会拡大などが重要な方向性となる．特に，配慮有る普遍的対策やライフコースアプローチといった戦略は，健康格差に対処するために重要である．
今後の地域保健・医療・福祉活動においては，決められた手段をこなす活動よりも，目的や目標を指向した取り組みを推進し，PDCAサイクルやOODAループによる効率的・効果的な活動を行うことが求められる．縦割りや「支え手・受け手」という従来の関係を超えて，互いに支え合う地域共生社会の推進が不可欠である．
地区活動に関しては，NPO，民間企業，共通の関心を持つコミュニティなどと連携し，市町村や都道府県といったより広い範囲での取り組みを進める必要がある．自治体同士の共同事業や，市町村・都道府県間による相互支援の推進も重要である．情報通信技術の活用については，定型的な事務の効率化に加えて，関係者間の情報共有，人工知能の活用，オンラインによる保健指導などへと取り組みを広げていくことが求められる．
これらの取り組みを通じて，困難な状況があっても，住民の健康と幸福が向上することを期待したい．
キーワード：保健医療福祉，人口減少，健康寿命，地域共生社会，健康危機管理
Abstract
This paper presents a perspective on the future of public health, medical care, and welfare in communities. In Japan, while rapid population decline and aging are progressing, health expectancy has been extended due to decreases in smoking rates and salt intake. However, challenges exist, such as reduced physical activity, increased obesity among men, and the growing problems of loneliness and social isolation.Moreover, there are multiple health risks associated with climate change–induced disasters, infectious diseases, and fiscal and economic crises. To respond to these changes, key directions include reducing health disparities, strengthening inter-municipal collaboration, identifying, fostering, and mobilizing community resources, and expanding opportunities for multiple jobs and side work. In particular, strategies such as proportionate universalism and the life course approach are important for addressing health inequalities. In future public health, medical, and welfare activities in communities, it will be important to pursue purposeand goal-oriented actions rather than merely means-driven ones, and to conduct efficient and effective operations using PDCA cycle and OODA loops. Promoting a community of mutual support (regional symbiotic society) that transcends conventional divisions such as vertical silos or providers versus recipients is essential. Regarding community-based activities, it is necessary to promote initiatives on a broader scale̶such as at the municipal or prefectural level̶in collaboration with nonprofit organizations, private enterprises, and communities sharing similar interests. Joint projects among local governments and mutual support initiatives between municipalities and prefectures should also be promoted. In terms of information and communication technology (ICT) utilization, efforts should extend beyond routine administrative tasks to include information sharing among stakeholders, the use of artificial intelligence, and online systems for health guidance. Through these initiatives, it is hoped that society will overcome difficulties and sustainably ensure peopleʼs health and well-being.
keywords : public health, medical care, welfare, population decline, health expectancy, regional symbiotic society, health security