From Big Medical Encyclopedia

JAPAN — the state in East Asia, includes 4 large islands (Hokkaido, Honshu, Shikoku, Kyushu) and the numerous average and small islands adjoining them. Territory of 372,2 thousand sq.km, population of 119,3 million people (March, 1984). The capital — Tokyo (11 813 thousand inhabitants, July, 1984). Ofits. language — Japanese. In the administrative relation the country is divided into 47 prefectures and a governorship of Hokkaido.

Japan — constitutional monarchy. The legislature is carried out by the parliament consisting of the House of Representatives and chamber of the advisers having a term of office respectively 4 and 6 years. Executive power belongs to the cabinet, to-ry forms the prime minister.

Apprx. 3/4 territories of the country occupy heights and mountains (hl. obr. low and medium-to-high); lowlands are located certain sites along coasts. The climate is monsoonal, in the north moderated, in the southern part of the Japanese islands subtropical and tropical.

Japan — the advanced industrial and agrarian country. Takes the second place in the capitalist world after the USA on the volume of gross national product and industrial production. In economy 6 largest financial and industrial

groups dominate. The country is poor in natural resources, the industry uses import raw materials. Primary branches of the industry — ferrous metallurgy, radio electronics, shipbuilding, automotive industry, petrochemistry, etc. In agriculture small country land use prevails; 11,8% of land area are processed. The main page - x. culture — rice. Poultry farming, production of vegetables and fruit, fishery is developed.

Natural movement of the population. National structure I. it is homogeneous (St. 99% — Japanese). Average population density 320,5 people on

1 sq.km. More than 2/3 population live in the cities, and apprx. x / 2 the population of the country in megalopolises.

The main vital rates in 1970 — 1980 are presented in the table.

In Japan growth of number of the senior age groups is observed (65 years and are more senior) and their relative share among all population of this country (in 1970 — 7,06%, in 1980 — 9,4%) at simultaneous decrease in specific weight of the children's population (in 1970 — 24,03%, in 1980 — 23,6%) and absolute number been born (in 1970 — 1934 thousand, in 1980 — 1586 thousand). The average duration of the forthcoming life for men made 74,1 years, for women — 79,6 years (1981).

Incidence. The main problems of health care are connected with the observed postareniye of the population, prevalence of such noninfectious diseases as cardiovascular diseases, malignant new growths, diseases of a respiratory organs, etc. In structure of causes of death in 1981 the largest specific weight was made by diseases of the blood circulatory system (42,6%) and malignant new growths (23,1%). From inf. diseases flu, measles, whooping cough, scarlet fever, dysentery, tuberculosis most often meet (generally a pulmonary tuberculosis). Inf. diseases take the insignificant place in the general structure of causes of death.

A serious threat to health of the population is posed by air pollution by oxides of sulfur, nitrogen, photochemical oxidizers, pollution of lakes, rivers, contamination of foodstuff polyphenochlors. A number of diseases in I. it is integrated under the general name «the diseases connected with environmental pollution». In Japan carry to this group also the diseases developing owing to influence of pharmaceuticals.

Organization of health care. In Japan there is preferential insurance form of the organization of health care with the participation of the private capital and the state. The Ministry for Health and Social Welfare bears responsibility for the organization of primary prevention and treatment, improvement of state of environment, training, management of the national hospitals subordinated directly to the ministry, sanatoria and leper colonies, the organization and practical activities of highly specialized hospitals, medical aid in the remote districts, support of scientific research in the field of medicine, ensuring control of quality of medicines, control of drugs, the organization of rendering the social help to the population, health protection of children, aged, and also management of social insurance and provision of pensions. It incorporates a number of managements (statistics and information, public health care, hygiene of the environment, water supply and sanitation, medical care, social security, health protection, p; ety and families, social insurance, help to the victims of war, board of pharmacy) and social insurance Agency.

Specific actions within «The national development plan for the health care» developed by the Ministry for Health and Social Welfare will be organized at the level of each municipality by council of development of health care according to the available means (various in different areas) and depending on priority of the problems of health care, and also economic opportunities facing municipality.

In each prefecture and large municipalities there are public health departments, to-rye perform management of health care at the local level and direct work of the centers of health care created over all country (in 1981 there were 855 centers, from them 655 prefecture, 147 municipal and 53 in Tokyo).

The center of health care is «district administrative body» for the general management of health care in the prefecture (municipality), it performs also functions of extra medical lechebnokonsultativny medical institution and at the same time — sanitary epidemio - logical establishment. Doctors doctor books (including stomatologists), druggists, nurses, midwifes, sanitary inspection and epidemiological control specialists, etc. enter into staff of the center of health care. In direct subordination of the center of health care of medical institutions is not available, however it carries out in relation to them administrative and control and organizational and methodical functions on carrying out «state policy of health care» on the instructions of local bodies of health care. Activity of the center of health care is financed by local bodies of health care.

Each center of health care services from 10 thousand to 600 thousand inhabitants. As the centers of health care the general questions of the organization of fight against infectious, venereal, parasitic, chronic and other diseases, mental health care (social legal aid, control of drugs, etc.), motherhood and the childhood (the advisory help to pregnant women and nursing mothers, children, recommendations about care of children - the disabled person - mi, etc.), medicogenetic consultation, holding actions for hygiene of an oral cavity, to improvement of food, control of production and sale of meat and dairy products, holding actions for prevention of rage, control for a dignity enter. - a gigabyte. condition of residential and public buildings, hotels, theaters, movie theaters, laundry, hairdresser's and other subjects to household appointment, water handling and removals of garbage, cemeteries; control of state of environment; rendering the medico-social help, carrying out sanitary education, implementation of laboratory and diagnostic work, control of observance of the medical and sanitary and pharmaceutical legislation, collecting, analysis and publication of data of demographic and sanitary statistics.

Since the end of the 70th the organization of stations of health in the small settlements serviced by paramedical staff is begun. In recent years the network of the centers of strengthening of health began to develop, the main objective to-rykh consists in inspection of the addressed persons for the purpose of definition of their readiness to daily loadings on production and in life, developments of individual recommendations for an exercise stress, a diet, rest and ways of their performance.

Social insurance. V Ya. 9 systems of insurance work. Among them the largest are the state, national and assotsiatsionny systems of insurance. The state (government) system of insurance covers generally serving small and medium-sized enterprises and members of their families. The national system of insurance is under authority of local authorities and covers 50% of the population of the country, irrespective of an occupation and social accessory. The Assotsiatsionny system of insurance extends generally to employees of large enterprises. There is also independent system of insurance of seamen providing compensation of a certain share of expenses on medical service of seamen and members of their families. In the country there are also different types of the social help to patients, disabled people, aged, lonely and needy.

Such types of medical services as professional surveys, vaccination, obstetric aid, prosthetics, providing with optics, acupuncture are paid only at the expense of the patient; the most part of other expenses is compensated by this or that system of insurance. In 1978 direct expenses of patients made apprx. 11% of all expenses on medical service in the country. Because of chronic deficit of budgets and rapid growth of cost of medical care insurance systems cannot provide all insured persons with hospitalization and services of private medical practitioners.

Stationary medical aid. All medical institutions in I. are subdivided into 2 categories:

hospitals and clinics. In 1981 in the country there were 9224 medical institutions on 1 362 161 bed (115,7 beds on 10 Ltd companies of the population), including 8167 hospitals of the general profile (on 1 115 039 beds), 34 tubercular hospitals (on 3471 beds), 988 psychiatric BCs (on 230 753 beds), 16 leper colonies (on And 636 beds) and 19 infectious BCs (on 1262 beds). Private would make 83,4% of total number

of BC. The help at injuries (including neurosurgical) and according to vital indications is rendered by local points of acute management, the centers of emergency medical service, and also the centers of medical care at night and holidays. Besides, at a number of BC there are resuscitation centers working round the clock and accepting the patients directed from other medical institutions, and also addressed independently.

Extra hospital help. Extra hospital help to the population is given by preferential private medical practitioners in the general and specialized out-patient clinics («clinics»). Besides, there are small out-patient clinics for the coming patients at a number of hospitals which give medical and advisory help. The cost of these or those types of medical aid is determined by the special list approved by the Ministry for Health and Social Welfare.

Sanitary epid e m and about - logical service. At each prefecture or large municipality there is a medical and sanitary laboratory, edges exercises health control of various objects and will organize training of technicians-laboratory assistants.

Since 1971 in the country EPA functions. Name and content of work of healthcare institutions I. not completely correspond to the concepts accepted in the USSR (see Treatment and prevention facilities abroad).

Resorts. V Ya. there are popular seaside climatic resorts — Kimakura, Tigasa-ki, Oiso; mountain — Nicco, Karuidzava, Hutsimi; balneal — Beppu, Atami, Na sou, Yumoto, etc.

Health care workforce. In 1981 in the country 154 578 doctors (13,1 for 10 000 population), 52 369 stomatologists, 95 319 druggists, 25 538 midwifes, 285 378 nurses, etc. worked. Security of the population I. medical shots — one of the lowest among economically developed capitalist countries. This phenomenon is even more aggravated with their uneven distribution on districts of the country (apprx. 2,5 thousand settlements have no doctors at all).

Medical education. Training of doctors is conducted more than at 70 higher medical schools, in to-rye annually accept apprx. 8 thousand students, a course of 6 years. Enrollment in the higher medical schools is rigidly regulated by the quotas established by the Japanese medical association. The tuition fee at the higher medical schools is 2,5 times higher, than in technical colleges, and 3,5 times above, than in humanitarian. This situation reliably provides the privilege on medical education for few natives of the upper social groups. Specialization of doctors is carried out on the basis of the hospitals determined by the Ministry for Health and Social Welfare.

Medical science. Applied and basic scientific medical researches are conducted in the research in-ta subordinated to the Ministry for Health and Social Welfare (national in-you problems of the population, food, public health care, hospital management, health, mental health, a research of leprosy; National anticarcinogenic center, national centers of cardiovascular diseases and hygienic researches), and also in numerous research laboratories of pharmaceutical firms. At the prime minister there is a scientific council, in to-ry also representatives of medicine enter. Since 1956 the Academy of Sciences with department of natural sciences functions as independent body.

S. Kitasato's works on microbiology became world-famous; he for the first time received in pure form toxin of tetanus (1890); offered methods of an immunotherapy of this disease, opened the causative agent of plague (1894). Noticeable achievements in biology and medicine became release of adrenaline in a crystal look Takamin (J. Takamine, 1901), the description of elements Tavara who is carrying out systems of heart (S. Ta-wara, 1906). Yamagiva (To. Yamagi-wa) and Itikava (To. Ichikawa) carried out experimental induction of cancer tumors (1915, 1916). Large contribution to studying inf. diseases brought K. Shiga, R. Inada, etc., in the doctrine about diseases of kidneys — Masugi (M. of Masu-gi, 1933). S. Watanabe's researches on fight against leukoses and radiation defeats became widely known.

The table

the NATURAL MOVEMENT of the POPULATION of JAPAN In 1970 — 1980 (for 1000 the population)

the Bibliography: The sixth review of a condition of health care in the world of 1973 — 1977, the p. 2, page 568, M., 1981;

World health stati stics annual 1984, Geneva, 1984; World health statistics annual 1981, Infectious diseases, Geneva, 1981. M of H. Savelyev.