An editorial in The Lancet caught my attention earlier this summer and started me thinking about past visits to Japan and many encounters with Japanese public health nurses. The editorial by Richard Horton –  Offline: Japan’s Hidden Secret – refers to comments made at a global meeting by Dr. Hajime Inoue, an Assistant Minister in the Japanese Ministry of Health, Labour, and Welfare. Speaking at a side-event at the 2024 World Health Assembly, Dr. Inoue pointed out the impressive contributions of the country’s 53,000 public health nurses in achieving positive population health outcomes. I enjoyed reading the description of current public health nursing roles and the recognition given by The Lancet in sharing the successful model from Japan.

Early in my consulting career, I was asked if I would take on a role of coordinating a study tour to British Columbia for a group of nursing leaders from the Japanese Nursing Association (JNA). Their 1994 tour – funded by a grant to JNA by the Ministry of Health and Welfare – had the purpose of learning how health systems in various countries were embarking on health policy reforms. JNA sent groups to other countries during a two-year period and compiled reports from each tour. The study tours explored ways in which nurses were taking on new responsibilities in community health including home care.

Following the 1994 study tour, I received a lovely invitation from the JNA in 1995 to visit Japan to meet with nursing leaders including tour members as they worked on promoting new policies and roles in public health nursing and home care to meet changing demographics. It was a professional highlight and a great honour to serve as a consultant during two trips in 1995 and 1996. Connections made in that period led to further visits by Japanese colleagues to Canada as well as collaboration on documents and one journal publication. 

I was proud to be a co-author with three colleagues on an article published in Public Health Nursing in 1999 (25 years ago!). It was a rewarding collaborative effort to write the paper and to see it in print: Murashima, S., Hatono, Y.,  Whyte, N., & Asahara, K. (1999). Public Health Nursing in Japan: New Opportunities for Health Promotion. Public Health Nursing, 16 (2), 133-139.

As noted in our abstract, we outlined the history, organization, and new opportunities identified at that time:

“Major changes are taking place in public health nursing in Japan. These include significant developments in employment, education, and roles of public health nurses (PHNs). Demographic and economic factors have prompted the Japanese government to focus health service delivery on community-based care, particularly for the growing elderly population. Public health nurses are redefining their roles and are assuming important functions in planning, implementing, and evaluating community health programs for the elderly. Japanese PHNs are using a variety of health promotion strategies to initiate change at the local level. This article presents two case studies to highlight the leadership role of PHNs in creating new services that foster healthy communities” (Murashima et al., 1999, p. 133).

My later involvement involved visits to Japanese universities to conduct seminars with students and faculty and participation in two conferences. I met PHN leaders in their communities where they gave me tours of public health centres and described current successes and challenges.

Throughout these visits, I remember many interesting informal discussions, wonderful meals, and time to enjoy the beauty of Japan in both rural and urban areas. Above all, I remember the great kindness of the nurses and others in each place I visited.

As Richard Horton notes, “public health nurses evolved to be a unique comparative advantage enjoyed by Japan’s rapidly advancing health system” and asks why we are not sharing national experiences more widely (Horton, 2024, p. 2578). I agree fully and believe we need to continue to learn from policy and practice experiences in other countries.

By Nora Whyte – August 25, 2024

I acknowledge with respect that I live and work on the Unceded traditional territory of the K’òmoks First Nation.