Global Environment

National Action Plan for Agenda 21 -Chap. 6

[Agenda 21] National Action Plan for Agenda 21


A) Meeting Primary Health Care Needs, Particularly in Rural Areas

There does not often exist a sufficient number of medical institutions in rural and mountainous areas to meet the needs of individual areas. Special attention should be paid to the maintenance and promotion of the health of workers in rural areas, due to special characteristics of their labor.

For this reason, comprehensive health-related measures that include special health examinations for the purpose of maintaining and improving the health of people living in rural areas are being taken.

Japan has been undertaking the following activities since 1984, and will continue to promote these activities.

Establishment of Rural Medical Examination Centers

In order to manage the health of people living in rural areas, rural medical examination centers have been established for the prevention of diseases indigenous to rural areas, as well as for the promotion of the overall health of people living in rural areas. At these centers, the health of people living in rural areas is examined, and related counseling is provided.

The following activities are conducted at these centers: (i) health examinations (special health examinations for diseases indigenous to rural areas, as well as general health examinations) (ii) guidance and the enhancement of public awareness regarding health management (distribution of pamphlets and other forms of literature) (iii) health counseling and guidance.

In order to conduct the above activities, rural medical examination centers are equipped with management divisions, medical examination divisions, counseling and guidance divisions, and most importantly, with vehicles for transporting people to and from their medical facilities. Special care is taken in establishing rural medical examination centers so that they will not overlap with activities conducted at local health centers in individual cities, towns and villages, and as of January 1993 there were a total of 14 rural medical centers throughout Japan.

Promoting Health Management and Guidance

Due to the characteristics of rural areas that tend to have a large administrative district with a decreasing population, there are some cases in which sufficient health management cannot be conducted by merely setting up facilities. Accordingly, remodeled microbuses are utilized to promote comprehensive health management and guidance activities.

The following activities are conducted through these vehicles, 79 of which are in use across Japan:

hygiene education (disseminating hygienic ideas)
health examinations (special health exams for diseases indigenous to rural areas)
health counseling and preparatory guidance

As regards the promotion of primary health care for the purpose of improving health and medical treatment in regional areas in developing countries, Japan will provide international technical cooperation by dispatching experts to these countries and receiving trainees from them.

As regards environmental sanitation, including drinking water, Japan will provide advice to developing countries concerning the formation of projects for facilities and equipment, and will develop and study appropriate technology that suits the circumstances of project areas.

Among measures devised from the viewpoint of improving the health of its people, Japan will give sufficient consideration to maintaining the health of people who live in rural areas.

6-B) Control of Communicable Diseases

Japan promotes measures to deal with contagious disease domestically, based on the Communicable Disease Prevention Law and the Preventive Vaccination Law.

Japan has provided cooperation technically and financially for Poliomyelitis eradication, the Expanded Programme on Immunization, the Global Programme on AIDS, the Special Programme for Research and Training in Tropical Diseases and the Diarrhea Disease Control Programme, all of which are conducted by the World Health Organization (WHO). Also, as regards measures against communicable diseases, Japan conducts international cooperation in such projects as control of tuberculosis and poliomyelitis, dispatch of experts and acceptance of trainees to and from other countries.

A big recent problem is that of AIDS. In addition to there being a sudden increase in the number of AIDS patients and people infected with HIV in Japan, the leading channel of infection has become that of heterosexual transmission.

Taking the above into account, Japan attaches importance to the implementation of the following activities:

(1) Japan will promote research and development of heat-stable and easy-to-use vaccines for developing countries in tropical regions.
Japan will financially and technically support the Children's Vaccines Initiative (CVI,) which is being internationally promoted by the World Health Organization (WHO).
Since 1993, Japan has worked on the technological development of vaccines corresponding to the Children's Vaccines Initiative (CVI).
In 1993, Japan greatly increased its budget for dealing with AIDS, concentrating on developing comprehensive anti-AIDS measures, including the dissemination of correct information, the improvement of medical examinations and the medical system, the improvement of systems for providing counseling and guidance, and the promotion of research and international cooperation.

6-C) Protecting Vulnerable Groups

With Japanese society aging at a pace unequaled anywhere in the world, it is forecast that at the beginning of the 21st century the elderly will make up 1/4 of the Japanese population. For this reason, in addition to establishing comprehensive measures to deal with caring for the elderly so as to appropriately meet the needs of the rapidly increasing number of elderly people, it is important for Japan to positively promote the health of elderly people as well as to provide the elderly with a fulfilling life. In response, the Government established the "Ten-Year Strategy to Promote Health Care and Welfare for the Aged" in 1989, and will continuously and intensively promote the measures given below.

As regards disability issues, the Government established the "New Long-Term Programme for Government Measures for Disabled Persons" in March 1993 and in order to further self-reliance among persons with disabilities and to enhance their participation in society, the Government will promote extensive measures in the following areas: public awareness, education and nurture, employment and work, health and medical services, and improvement of welfare and living environment.
Based on the spirit of the Constitution of Japan, Japan promotes measures of public aid in order to guarantee its people a minimum level of a healthy and cultural living standard.
Japan will make improvements in a variety of facilities such as social welfare facilities for people who are in need of some kind of aid in their everyday lives.
Japan will conduct health examinations and provides health guidance for pregnant women, nursing mothers, and infants to prevent and discover physical and mental disabilities at early stages.
Japan will enact a medical welfare policy that puts emphasis on preventive measures. For this purpose, Japan will take substantive measures through such means as health insurance, budgets, etc.
Japan will conduct international cooperation such as projects, dispatch of experts and acceptance of trainees in order to promote disease prevention and maternal and child health in developing countries.

6-D) Meeting the Urban Health Challenge

With brisk industrial and commercial activities in urban areas, there is concern over the deterioration of various aspects of the living environment, including the air and water, which accompany concentrations in population. Japan is presently devising a variety of pollution prevention and clean-up measures.

Japan attaches importance to the implementation of the following activities:

As regards the pollution of the atmosphere, Japan will promote the use of low-emission vehicles, and promote rationalization of distribution systems, as well as such environmental measures as those dealing with the flow of traffic. Japan will also further promote measures based on the Air Pollution Control Law, including the improvement of regulations on individual automobile exhaust, and particularly in regards to nitrogen oxides, and will additionally devise measures based on the newly established Automobile NOx Reduction Law.
As regards water quality, in addition to continuing the monitoring and measurement of the level of the quality of public water bodies, Japan will expand and reinforce environmental and effluent standards which concern the protection of human health, and promote the appropriate treatment of household waste water through sewerage and, depending on the local situation, "Gappei-Shori Johkasou" (water purifying tank to treat the waste water from toilets and miscellaneous household waste water). Japan will also assure the supply of clean water by improving advanced water purifying facilities and renovating decrepit facilities, including the removal of asbestos cement piping.
As regards soil pollution in urban areas, in order to achieve and maintain environmental soil quality standards, Japan will promote measures to deal with soil pollution, including the expansion and improvement of environmental quality standards, in addition to devising measures for providing guidance to businesses.
In addition to conducting technical cooperation in the field of drinking water, waste water and solid wastes, as well as education programmes on public health for trainees from developing countries, Japan will give advice to developing countries concerning the formation of projects for environmental sanitation systems of water supply, sewerage, solid waste management, etc. Japan will also continue to support the WHO Global Strategy for Health and Environment technically and financially.

6-E) Reducing Health Risks from Environmental Pollution and Hazards

Smoke, soot and wastewater emitted from plants had polluted the environment of Japan, mainly in the 1950s and 1960s. In particular, the pollution-related health damage caused serious social problems.

At present, although the situation of environmental pollution has been remarkably improved upon compared to that of the previous periods when health damage was caused, air pollution by nitrogen oxides, mainly in large cities, is as severe as it was in the past, and problems such as the pollution of water by hazardous substances need to be dealt with for the protection of human health.

Taking the above into account, Japan attaches importance to the implementation of the following activities:

Japan will conduct epidemiological research on the effect of nitrogen oxides on health, when necessary.
Japan will continue to make efforts to compensate the sufferers of pollution-related health damage based on the Law Concerning Compensation and Prevention of Pollution-Related Health Damage, which itself is based on the Polluter Pays Principle. Additionally, it will conduct activities for the prevention of chronic obstructively pulmonary diseases, provide health counseling to help people to recover from such diseases, and make available health examinations, functional training, and improved facilities and machinery. This will be funded by utilizing operation profits from a 50 billion-yen fund administered by the Pollution-Related Health Damage Compensation and Prevention Association. In addition to drawing up air-environment plans, as well as improving related facilities and machinery, Japan will conduct surveys and research for the prevention of health damage due to the effects of air pollution, as well as the dissemination of related information and training.
Japan will conduct long-term and continuous monitoring of air pollution and its effects on health by creating the "Environmental Health Surveillance System Regarding Air Pollution," aimed at discovering the effects of air pollution on health at an early stage and thereby preventing damage to health.
Japan will conduct monitoring and measurement of the conditions and levels of air pollution, and will release the results promptly every year. Also, in order to achieve and maintain environmental quality standards, Japan will continue to implement measures based on laws such as the Air Pollution Control Law. Concerning measures against Nitrogen Oxides in particular, Japan will promote various measures such as the automobile restrictions based on the Automobile NOx Reduction Law, while also strengthening the standards for the exhaust emission limits of individual vehicles.
Japan will make meteorological observations as well as air and meteorological forecasts in regions where there tends to be a lot of photochemical air pollution, and so contribute to countermeasures dealing with air pollution by local authorities (particularly countermeasures for dealing with photochemical air pollution).
Due to concerns regarding the effects on health from the increase in the amount of ultraviolet radiation as a consequence of the depletion of the ozone layer, Japan will implement measures to control the production of ozone depleting substances, as well as conduct observation on ultraviolet radiation levels and periodically announce these results. It will also conduct studies to determine the relationship between changes in the ozone layer and the amount of hazardous ultraviolet radiation that reaches the surface of the earth, and will promote surveys and research on the effects of ultraviolet radiation on health.
Japan has recently reviewed its health items for environmental water quality standards, both reinforcing and expanding them, and will continue to reinforce and expand all environmental quality standards. Japan also conducts surveillance and measurement of the pollution levels of public water bodies and ground water, and will announce these results promptly every year. Furthermore, Japan will reinforce effluent standards based on the Water Pollution Control Law. In order to achieve and maintain environmental quality standards for soil, Japan will expand and reinforce environmental quality standards for soil, and promote measures regarding soil pollution in addition to providing guidance to businesses.
As regards the registration of agricultural chemicals, based on the Agricultural Chemicals Regulation Law, Japan has established the standards for the registration of agricultural chemicals, taking into account their residue in crops and water pollution caused by their use. These standards aim to prevent damage to human health from residual agricultural chemicals before such damage can occur. In order to further improve and expand the standards, Japan will continue to accumulate basic knowledge of them through various types of surveys and research on agricultural chemicals. Japan will ensure safe and proper use of agricultural chemicals through the above standards. Furthermore, when registered agricultural chemicals are found out to be harmful to human health, Japan will restrict the use of such agricultural chemicals.
As regards substances which are not restricted by the current laws, Japan will conduct studies, monitoring and measurement on the sources of such substances, their densities, as well as their effects on health, and, when necessary, adopt appropriate management and measures for such substances.
As regards noise, Japan will further promote measures based on the Noise Regulation Law.

Ministry of the Environment Government of Japan

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