Nursing in Japan

Socioeconomic situation

Japan is an advanced developed country, as shown by its G8/G20 membership. However, since the financial crisis in September 2008, Japan's economy has drastically deteriorated under the global economic crisis. Japan's real GDP growth rates have been negative since 2008. In addition, reflecting the severe employment situation since the financial crisis, the placement rates of university graduates in FY2009 was 60.8% showing the biggest point loss since the start of these surveys.

[References]
Annual Report on the Japanese Economy and Public Finance 2010-Strong Economic Growth Achieved through Demand Creation-July 2010, Cabinet Office.
White Paper on the Labour Economy 2010, Ministry of Health, Labour and Welfare (MHLW)
Key Economic Indicators, September 2010, International Economy Division, Economic Affairs Bureau, Ministry of Foreign Affairs

Transition of population

Japan's population is 127.51 million as of October 1, 2009, accounting for approximately 1.9% of the world's population.

After the birthrate declined around the end of World War II, Japan's population showed an increase, experiencing two baby booms in 1947-49 and 1971¬-74. However, the population increase/decrease rate has been showing a decrease since 2005.

Since around 1970, the elderly population has been increasing dramatically. The proportion of the population aged 65-year or older to the total population was 20.2% in 2005 and will reach 40.5% in 2055. In contrast, the proportion of the population under 15 will decline from 13.8% in 2005 to 8.4% in 2055. Japan will see further aging society with fewer children in the future.

[References]
Health and Welfare Statistics Association (2009) Annual Statistical Report of National Health Conditions, Journal of Health and Welfare Statistics, 56 (9) , 512.

Figure1:Population Pyramid (as of October 1, 2009)

[Source] Current Population Estimates as of October 1, 2009, Statistics Bureau, Ministry of Internal Affairs and Communications

Health situation and trend

Japan's health situation has continuously improved in all health-related statistics, such as the average life expectancy of men is 79.59-year and that of women 86.44-year, while the infant mortality rate is 2.4 as of 2009.

Concerning the birth trend in Japan, the birthrate (per 1,000 population) hovered in the 30s from the Meiji period (1868) through the beginning of the Showa period (1920s). Immediately after the World War II, an increase in marriages triggered the first baby boom with high birthrates. However, after its peak in 1950, the birthrate declined rapidly. Those who were born during the first baby boom reached their childrearing age, showing a temporary increase in the birthrate during the second baby boom in 1971-74. Since then, however, the birthrate has remained at a low level with some fluctuations.1),2)

[References]
Vital Statistics in JAPAN 2007, MHLW
1) Annual transition of Comprehensive Vital Statistics in JAPAN, MHLW
2) White Paper on Birthrate-Declining Society2004, Cabinet Offi ce

Figure2:Vital statistics overview

[source]Monthly Report of Vital Statistics: (Preliminary annual figures) 2008, Statistics and Information Department, Minister's Secretariat , MHLW

Figure3:Transition of fertility and mortality rates

Figure4：Transition of infant mortality rates and total fertility rates

Figure5：Transition of mortality rates by the major cause of death

[Source] Vital Statistics in Japan 2009, MHLW (Figure 3, 4, 5)
Vital Statistics in JAPAN- Annual transition of death rate by major cause of death, MHLW(Figure 5)

The total fertility rate was 3.65 in the 1950s, but has declined to 1.37 in 2009. This has many possible causes. In addition to lower neonatal and infant mortality rates due to advancement in health care, the decline in the 80s can be attributed to the trend toward delayed marriage and increase in unmarried people and in the 90s can be attributed to a change in the number of children per couple. The average age of mothers giving birth to their first child was 25.7-year in 1965 and 1975, and risen to 29.7-year in 2009.3)

Although the mortality rate (crude deaths per 1,000 population) in Japan had hovered at the 20s around the Meiji period (1868-1912), it declined to 16 in 1941. After the War, the rate showed a continuous downward trend, reaching the lowest point of 6.0 in 1982. However, this rate has been showing an upward trend with the aging population and was 9.1 in 2009.4)

The major cause of death was pneumonia until the Meiji period, then it changed to tuberculosis(TB). From the latter 1950s deaths from TB greatly decreased and the causes of death in Japan shifted significantly from communicable diseases to non-communicable diseases. Since 1958, malignant neoplasms, heart disease and cerebral vascular disease have formed the three major causes of death, and currently account for approximately 60% of all deaths. Under these circumstances, measures to prevent non-communicable disease are being stressed.

Although the number of deaths due to communicable diseases has been reduced, there are still some issues like HIV/AIDS, TB and hepatitis.

Though prevalence rate of TB (per 100, 000 population) reached below the 20s level in 2007 for the first time to show a continuous downward trend, Japan is a country with a medium tuberculosis epidemic in the world. Among the patients with persistent viral hepatitis, 1.1-1.4 million are estimated to have type B and 2.0-2.4 million type C. It has become a issue since the time of infection can hardly be identified and the infection is often asymptomatic, patients who have not received treatment at an appropriate time can easily develop cirrhosis or liver cancer. In addition, the number of people with mental problems has also been increasing due to the stress of a severe work environment, including overwork, in modern Japanese society.

Among the in- and outpatient rates by age group (per 100, 000 population), the rate of people aged 75 or older is the highest by far. The patient survey estimates in 2008 showed that persons aged 65 or older accounted for over 60% of inpatients and 40% of outpatients.

[References]
3) Annual Paper on National Lifestyle 2005, Cabinet Offi ce
4)Vital Statistics in JAPAN - Annual transition of death and death rate 1899-2008, MHLW

Figure6：Transition of patient estimates by age group
(inpatient)

(outpatient)

[source] Survey on Patients 2008, MHLW