Furthermore, in the private sector, groups such as the Okinawa Association of Parasitic Control, the Okinawa Public Health Association, and the Okinawa Mental Health Association, gave indirect support to public health administration,
and greatly contributed to the improvement of people's health and welfare.
(2) Public Health after the Reversion of Okinawa to Japan
After the reversion to Japan in 1972, health programs promoting mental and adult health, food sanitation and environmental sanitation services were conducted at the Health Centers and municipalities began preventive vaccination
as well as maternal and child health programs. Soon after this, with the enactment of the Measures for National Health Promotion and the Health and Medical Service Law for the Aged, municipalities were compelled to provide physical examinations, health consultation and health education. The Health Centers strived to give support to the structural maintenance of these programs.
Along with the enactment of the Community Health Law in 1994, and in answer to the diversification of health needs and the aging of the population in recent years, municipalities began conducting numerous health services, immediately accessible to the people. In addition, the Health Centers provide professional health services on mental health, incurable diseases, AIDS and other special services, as well as promoting surveys, research, data collection on regional health and compilation and application of the data.
2. Activities of Public Health Nurses / Health Counselors
With the opening of the Health Centers in 1951, 40 public health nurses were appointed, with a residency system being instituted at the time. This residency system in the community was effective in providing medical care to regions difficult to reach on the main island and outlying islands of the prefecture.
The activities of public health nurses improved the communities' medical health, especially in measures for tuberculosis control by providing in-home treatment and long-term care guidance as well as other measures for tuberculosis patients. In addition to this, public health nurses also provided maternal and child health consultation, guidance for infant care during home-visits and various other services as well.
With the reversion to Japan in 1972, the title of public health nurse was changed to health counselor, but the residency system remained. In the municipalities,
along with the expansion of health programs to improve health and health services for the aged, municipal health counselors were instituted in 1976. At present, 127 municipal and 153 prefectural health counselors share the responsibility of disease prevention and the promotion of health programs for people from birth until old age.
3. Infectious Disease Control
In order to overcome infectious diseases, the following measures have been put in place:
1) Early detection and sterilization of microbes to control sources of infection
2) Sterilization of water and extermination of the carrier bodies to control the route of infection
3) Preventive inoculation to control susceptibility
(1) Malaria
Before, during and after the war, Okinawa Prefecture experienced malaria as an endemic disease, centered around the Yaeyama and Miyako Islands. From 1945 to 1947, uncontrollable epidemics known as War Malaria occurred on the Yaeyama Islands. These were caused by the transfer of people to malaria infested sites, under an abnormal situation called war. During the first and second years after the war's end, many fell victim to the disease. According
to sources, in 1945 there were 16,884 patients, 3,674 of whom perished; 1946 saw 9,050 patients, 128 of whom passed away. This epidemic was temporarily
stopped by the evacuation of people from infested sites and careful planning by the Yaeyama Gunto Government. But the disease again raised its ugly head in 1949 as the infested sites became inhabited, this time by agricultural immigrants from the Okinawa main island.
The Ryukyu and U.S. Governments instituted the Wheeler Plan in 1957; the plan's major method for the suppression of malaria epidemics was the spraying and leaving of DDT residue indoors. As a result, no indigenous cases of malaria have been reported since 1962. In this manner, the endemic disease named malaria that had long hindered the improvement of Okinawan's quality of life, vanished. In 1978, during an Okinawa Prefectural Health Rally, a statement was read officially proclaiming the complete eradication of malaria.
(2) Filariasis (Heartworm Disease)
Sanitary science methods were used for a filariasis preclusion program started
in 1965 in which all citizens were given a microfilaria test as subjects in the night-time drawing of blood. Based on the test results, people with a positive reaction were given a dose of the effective prescription drug spatonin. In other areas, community organizations were formed throughout the prefecture, with many people participating to effectively promote this preclusion program. Besides testing and prescribing drugs, by thoroughly educating people on health issues and encouraging their participation, this program attained its anticipated goal in just 13 years. Its methods were highly rated by the World Health Organization (WHO) and were adopted as the standard method for filariasis preclusion. Filariasis disease, long scattered throughout Okinawa, was finally eradicated in 1980.
(3) Tuberculosis
Full scale measures for tuberculosis control in this prefecture were established
in 1951 with three health center locations using X-ray apparatus to detect the disease, followed up by public health nurses providing long-term care guidance for in-home patients. Three years later, the Health Centers conducted
medical treatment for in-home patients following guidelines set under the new Outline of Temporary Measures for Tuberculosis Prevention. From 1955 on, mobile group- examination vehicles were stationed in the Health Centers to facilitate early detection of tuberculosis in patients.
Furthermore, basic measures to control tuberculosis were established in 1956 under the Tuberculosis Prevention Law, with doctor's fees being paid by the taxpayer, thus reducing patients' financial burden.
Because medical institutions for tuberculosis control in Okinawa were few in number during this period, a program was started where patients were sent to mainland Japan for treatment. Around 3,000 patients received treatment
on the mainland until the program's end in 1983. At the same time, measures for tuberculosis control progressed in Okinawa with the technical support of mainland tuberculosis specialists. After reversion to Japan in 1972, a Committee for the Surveillance of Tuberculosis was set up, with the resulting
tuberculosis control measures still being applied today. Also, this prefecture
took the national lead in introducing short-term chemotherapy aimed at shortening
the treatment period for tuberculosis. As a result of the promotion of these measures, the current number of patients per year is one-ninth the number of patients in the tuberculosis rampant postwar years. The rate of contraction
of the disease is lower than the national average, with the prevalence rate also being lower.
(4) Hansen's Disease (Leprosy)
With the foundation of the Okinawa Leprosy Association in 1958, this prefecture
commenced with prevention activities for Hansen's disease, by increasing dermatological check-ups and reinforcing public education activities.
Based on outpatient trials and treatments of in-home patients at the Yaeyama Health Center in 1960, the then Government of the Ryukyus enacted the Leprosy Prevention Law in 1961. In-home patient care and the discharge of cured patients from leprosariums were also approved by the government. From 1967 to 1981, with the support of mainland Japanese medical specialists, steps were implemented for the early detection of the disease, including dermatological
check-ups of community residents, children and students at schools. Because of this thorough, early patient detection and treatment program, the number of new patients has declined from around 100 patients per year in the 1970s to around 5 patients per year from 1990.
4. Maternal and Child Health Measures
Maternal and child health measures in this prefecture began with the setting up of the Health Centers in 1951. Work was carried out with health guidance given to expectant and nursing mothers, and mothers of infants
and small children. At that time, medical personnel such as obstetricians and pediatricians were scarce and there was a lack of medical institutions. The general population's knowledge of hygiene was also low. Malnutrition affected infants and small children, illnesses were caused by infectious diseases, and the basic development of maternal and child health was insufficient.
Under the circumstances, guidance for mother and child through home-visits and counseling for expectant mothers, and for mothers with infants and small children were given by health counselors. In 1960, a maternal and child health handbook was systemized to guide early detection of pregnancy, post partum care and child development and was used to improve the health care of mothers and children. At present, all pregnant women receive this handbook to improve the health and welfare of all mothers and children.
Also, because nutritional guidance was regarded as important, a system was developed to foster the study of the physical development of infants and small children, to dispense nutritionally balanced powdered milk free of charge, and to introduce guidance to improve nutrition. Furthermore, research on pregnant women was conducted to establish a health examination system for mothers and children. Regulations concerning stillbirth notification, birth registration, and death notification were made stricter. At the same time, health examinations for pregnant women, infants and small children and health check-ups for three year olds were increased and improved.
Recently, the environment surrounding children has changed due to the progress
of urbanization, the increase of nuclear families, and the advancement of women's roles in society. Because of these changes, measures to ensure the mental health of children have become an important issue.
5. Measures for Improving Nutrition
Nutritional improvement measures in Okinawa commenced with an anemia prevention program for infants, small children and expectant mothers, instituted
right after the war when food was difficult to obtain. Around 1950, the program shifted toward activities aimed at the physical improvement of citizens,
with the main focus on school children. In 1967, the Nutrition Improvement Law was enacted. At the same time, a research survey of people's nutrition was commissioned to ascertain the health and diet conditions of people in the prefecture. Starting in 1970, the National Health Promotion Campaign has been developed throughout the country as a national policy. In this prefecture, "A Guide for Health Improvement of the Prefectural People "; was formulated based on nutrition, exercise and relaxation in accordance
with the research survey on people's nutrition in Okinawa. Based on the guide, a program for improvement of health and nutrition is under way, aiming to establish a healthy lifestyle that takes regional characteristics and people's diet into consideration.
6. International Medical Cooperation Project on Public Health
This prefecture, making the most of its public health experience in overcoming malaria, filaria, and other infectious diseases, is supporting the improvement of public health in developing countries through an international
medical cooperation project on public health. For five years since 1991, this prefecture has cooperated with the Japan International Cooperation Agency (JICA) and sent doctors and nurses to the Solomon Islands for the implementation of the Project for Promotion of Primary Health Care. Another public health improvement project called the Project of Public Health Improvement
(a three-year plan from 1996) has been implemented in Bolivia, with themain program being health service education activities focused on maternaland child health care.