Medical education in Japan has undergone dramatic changes, but nothing less than a paradigm change is required for the educational model for social medicine. In the 23 years since 1978, we have developed a community-based public health education program. The curriculum consists of a core of family health practice, student lectures, systematic teachers' lectures, participatory research on community health, and health policy-making. The community-based educational model was effective in developing students' active problem-based learning, abilities in health communication, and understanding of community needs as a biologic-psychologic-cultural-geographic complex; the empowerment of students and the community; and a comprehensive approach to the community care management which integrates health promotion and social welfare. We evaluated the community-based curriculum design, which exposes students to a wide variety of medical, social, and psychological problems in a community as a useful public health educational strategy.

We presented here an overview of the international innovation of public health and introduced our community-based educational practice of public health. We also reported it was effective for public health education to let students participate together with teachers in the cooperative movement developing healthy community and let them learn community dynamics, skills of participatory action research and the process of policy making. Today, the under-and post-graduate education of new public health will be effctively performed by participating in the practical healthy community project, which is performed cooperatively by communities, social resources and the university.

Although great changes have already been made to medical education in Japan, the public health system urgently requires a paradigm change in the educational model. Recently, changes in the concept of public health have been proposed as “New Public Health” based on the World Health Organization's Health Promotion Movement in developed countries. We defined the core concepts and basic theories of New Public Health and have evaluated the validity to New Public Health of the community-based public health education model used since 1978 at Shimane Medical University. We have also established an educational environment that supports the development and dissemination of the model.

The Japanese government's response to the recent discovery of dairy cows suffering from bovine spongiform encephalopathy (BSE) in this country was analyzed from the viewpoint of policy science with reference to the policy in the United Kingdom and other EU countries. The results of investigation into the causative agent (s) androutes of infection of BSE that affected a total of seven cows were reviewed and the points at issue during the course of the epidemiological survey were given. Despite repeated warnings from the UK, EU and WHO, adequate countermeasures were not taken by the government offices concerned-the Ministry of Agriculture, Forestry and Fishery and the Ministry of Health, Welfare and Labor. They failed to prevent the occurrence of BSE and the resultant panic among consumers. The present review brought to lighta lack of a sense of urgency and risk management system in the government, the moral hazard in the food industry and market, the blunder of the government officials and the absence of an adequate food safety surveillance system. At the same time, we presented some proposals as to what the future food safety policy should be.

Amid the swell of the tide of globarization and decentralization, the building of healthy cities and communities has become an increasingly important task of Japan’s health and welfare policy makers. In this article the international trends, results and problems of the healthy cities projects were reviewed with attention focused on the 3rd period (1998-2002) of the WHO healthy cities programs. The strategy and methodology, and the theory and practice of the development of healthy cities and communities were also proposed with stress placed on the need of the symbiotic collaboration between rural communities and urban communities from the viewpoint of policy science.
seconds ; Policy ; Science ; Methodology ; Community

A cluster of insulin resistance, dyslipidemia and hypertension has been labeled as a metabolic syndrome. Asians have a lower rate of obesity than Caucasians, but have recently become increasingly prone to obesity and the metabolic syndrome, especially in rural communities in Japan. Although weight loss has been considered to be effective for improvement of the metabolic syndrome, most data are based on studies in Western countries with only limited information derived from Japanese populations. We conducted a study of 188 subjects who participated in our interventional program for obesity based on health education and self-determination in 2000-2003. The intervention induced significant decreases in caloric intakes and increases in physical activity in the participants, and then resulted in a significant 1.3kg reduction in weight on the average. Weght-loss was significantly associated with indexes of obesity, values of total cholesterol, triglyceide and HDL cholesterol levels, but was not related with blood pressure and LDL cholesterol, which were significantly decreased by our intervention. Furthermore a simple regression analysis was carried out to verify whether weight loss and metabolic syndrome parameters were related. Weight loss was determinantsexplaining less than a total of 10% of the variance in triglyceride and total cholesterol for the participants. Future studies of weight loss for metabolic syndrome should incorporate Asian ethnic factors, such as dietary habits and genetic influences.
Syndrome ; Weight Loss ; Obesity ; Health education ; Metabolic