Professor Hiroshi Okada

School of Pharmacy, Wakayama Medical University

Dr Okada is a professor at the School of Pharmacy, Wakayama Medical University, and a researcher specializing in public health, epidemiology, and social pharmacy. In particular, he continues to conduct research on the management of diabetes and hypertension by pharmacists in community pharmacies and on the effectiveness of health promotion.

He is also a founding member of the Western Pacific region of the UNICEF-FIP UNITWIN project on pharmacy education. He also specializes in health care quality and patient safety, and is a member of the Society's International Committee and Patient and Public Engagement Committee.

Good Practice and evidences on innovative aspects of community-based preventive services and healthcare delivery

OKADA, Hiroshi

Community pharmacies are easily accessible and are located between places where local residents live and medical facilities such as hospitals and clinics. People can consult with a pharmacist, a health care professional, at the pharmacy without an appointment when they have health concerns or worries.

Japan's aging population has already exceeded 30%, making it a super-aging society. With health and care resources in short supply, pharmacists have become an important practice, not only in pharmacotherapy, but also in supporting people living with illness.

In this presentation, I will present case reports of pharmacists' practices at home and support for people with cognitive disabilities in Japan, as well as results of a study on the impact of improvements on patient outcomes for people with diabetes and hypertension in the pharmacy.

Mihi Ratima PhD

Director, Taumata Associates, Te Hāwera, Aotearoa New Zealand

Dr Mihi Ratima (Ngāti Awa, Whakatōhea) is a Director of Taumata Associates, an indigenous public health consultancy located on the papakāinga (Māori co-housing development) where she and her husband have raised their children in a Māori culturally immersive environment.

Mihi is a former Associate Professor (Māori health) at AUT University, Harkness Fellow at Brigham and Women’s Hospital and Harvard University, WHO analyst and Fulbright Scholar with the Native American Diabetes Project. Her research focusses on health equity and indigenous health promotion. Mihi was the recipient of the inaugural Health Research Council of New Zealand Senior Research Fellowship for prominent leaders in Māori health and was an editor of ‘Promoting Health in Aotearoa New Zealand’, the first comprehensive text on health promotion in Aotearoa New Zealand.

A rural community-led intervention for health equity – Indigenous New Zealand experiences

RATIMA, Mihi

Māori are the indigenous peoples of New Zealand. British colonisation in the 1800s decimated Māori communities. Colonisation undermined Māori ways of seeing the world, robbed communities of their lands and resources, and eroded secure identity – the interlocking foundations of indigenous wellbeing. Ongoing colonialism drives the wide inequities in health outcomes today. There are pervasive inequities in access to and quality of hospital and health services for Māori.

Māori communities are outraged at health system inequities, exacerbated by the new National Party-led coalition government disestablishment of Te Aka Whaiora Māori Health Authority. The independent statutory government entity was set up in 2022 by the previous Labour-led government and charged with managing Māori health outcomes. Māori are protesting the undermining of rights enshrined in the 1840 constitutional document the Treaty of Waitangi, an agreement between Māori chiefs and the British Crown guaranteeing Māori rights to equity and the Government’s right to govern. A 19 November nationwide protest will take their message to the steps of parliament.

For decades Māori have fought to take control of health service provision to our own communities. The view is that we know what works for our own people and should be resourced to provide solutions grounded in our own worldviews and leveraging the strengths of our communities. Recent decades have seen a proliferation of Māori community-based health promotion initiatives.

We have investigated case studies of Māori health promotion interventions, currently in education, language revitalisation, housing and health, and with a lifecourse orientation. This presentation focuses on a case study of the Te Kaha Medical Centre, a remote rural health service in a high deprivation Māori community. Using the Centre’s experience during the Covid pandemic, in which 98% full course vaccination coverage was achieved months before other communities, we highlight success factors that the Centre continues to practice and that underpin their Māori health equity efforts. These success factors are consistent with health promotion principles and relevant to health promoting hospitals and health services that seek to contribute to health equity in their own communities.

Dr Kazuya Yui

Saku Central Hospital, Koumi Branch, Japan
Japan Association of Rural Medicine

Dr Kazuya Yui is a managing director and a physician of the Koumi Branch of Saku Central Hospital. The hospital has been pivotal in providing quality healthcare services and health promotion activities in a rural part of Nagano prefecture in Japan. It is well known for its leading role in improving rural and community medicine.

While addressing the ongoing demographic transition of urbanization and ageing as both a hospital manager and a primary care physician at the forefront, Dr Yui also serves as a committee member of the Japan Association of Rural Medicine (JARM) and a board member of a national non-profit organization promoting community care, to extend his expertise to strengthen the contribution of hospitals in health promotion in rural and remote areas.

Getting among farmers – reflecting on the roles of HPH from the perspective of rural healthcare in Japan

YUI, Kazuya

Saku Central Hospital (SCH) is renowned for its pioneering role in agricultural medicine and rural health in Japan under the exceptional leadership of Dr. Toshikazu Wakatsuki (1910-2006) with the slogan "Getting among farmers". Post-war rural Japan was impoverished, and many farmers could not access adequate medical care.

SCH proactively engaged in outreach activities aimed at health equity in these rural areas from an early stage. These included unique health promotion activities such as educational drama performances by hospital staff  and hospital festivals (opening the hospital to the general public to host exhibitions on hygine and health). The mobile health check-up activities in remote areas eventually developed into comprehensive village health screening programs, demonstrating the effectiveness of early detection in improving population health. SCH actively collaborated with public health nurses from local municipalities and community health volunteers on these community activities outside the hospital. Creating healthy communities through resident autonomy was a precursor to what is now known as Primary Health Care, and remains a significant approach today.

While the migration from rural to urban areas enabled Japan's rapid economic growth post-war, it has now become a super-aged society with the longest life expectancy in the world. Urban areas have now become overpopulated, aged, with many deaths, some of whom are dying alone, which have become a social issue. On the other hand, in rural areas, the decline in the number of children and women of childbearing age is pronounced, and there are many regions where their future sustainability is at risk. Today in Japan, widening disparities and poverty, along with the significant increase in social security costs, have raised concerns about the sustainability of the medical and long-term care insurance systems. Given these various challenges to ensuring health equity, this presentation discusses how SCH has tried and will address these issues as an HPH.