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The following article of mine was carried on the December 2008 edition of “Mainichi Forum” in the section titled “Views”.

A “Community PTA Anyone Can Participate” at elementary school can improve regional unity ? Academics and college students should volunteer

Family health is important for individual health, while community health is necessary for family health. This is the basic idea I have strongly advocated as the chairman of the government’s New Health Frontier Strategy Conference when we compiled a report called the “New Health Frontier Strategy” last April.

The report identifies among its top priorities health of children, women, and the working-age population and increasing the healthy life expectancy of the elderly. What I stressed in particular is to review the role of family and strengthen regional communities in order to promote health with a focus on preventive measures. Increased urbanization, nuclearization of families, the declining birth rate and the advance of women’s role in society is making it increasingly difficult to pass knowledge and skills forward to the next generation in domestic life and child rearing, as well as culture and tradition. The weakened family is now on the brink of collapse. As a result, some young parents don’t know what to do when their child’s temperature suddenly goes up and rush to emergency rooms. The fundamental problem is that basic skills to raise children are not being passed on due to the collapse of family.

Just as a firm root and trunk are necessary for strong branches and leaves to grow on a tree, vibrant families and regional communities are important to be at the foundation of sound individual health policies. Discussions that lack such a broad vision will result in lousy policies.

In urban society, it is important for regional communities to complement weaknesses in families. In Japanese communities, however, a sense of unity is unfortunately diminishing both in cities and rural areas. A disconnected community puts people at big risk if anything should happen. On the other hand, a unified community creates a greater chance for neighbors to notice when something is wrong with an elderly person living alone. There is also more cooperation when disasters strike. Developing a strong community is essential in nurturing family bonds.

In Europe people have traditionally gathered at public spaces in their districts or local churches where they share their beliefs. We, however, don’t have such places in Japan today. So, I would like to propose the use of the 22,000 elementary schools around the country as community gathering places. Schools are usually located in areas that are relatively easy for anyone to reach because children as young as first graders commute. They can serve as centers of community where elders, young people and mothers in the area can congregate at their free time. This can take off heavy responsibilities placed on teachers, giving them more time to focus on teaching classes because the people who have gathered can look after the children too. Schools will in essence have a running “Community PTA Anyone Can Participate”. If a child becomes sick the mother can seek advice from other mothers on what to do, or may be able to find somebody they met there to look after the child. Naturally people may talk about their doctors of preference, and this will result in local physicians becoming part of the community too. Local governments can provide mini-bus services going around the district picking people up and delivering them to school. They should also support voluntary community activities that continue on the weekends.

Inside this community, many adults will be looking after the children’s well-being and food. Some elderly people may even scold kids at school for not eating breakfast in the morning. Having this kind of relationship with other community members is important for young boys and girls, especially since there’s a recent increase in children who have never been scolded before. Even outside of school, there will naturally be more people calling out to the kids on the streets. This will help improve their attitudes and behavior because they will be conscious that others are watching them. Parents can feel safe to leave their children at school until around 6 pm, knowing that they will have a wide variety of things to do such as study, read, exercise and play under the supervision of many adults. It will also give teachers more time to focus on their work and may improve their relations with parents.

A sense of unity can contribute to preventive care

Women(and men) who have grown up in nuclear families don’t have much contact with their siblings or grandparents and hardly have any experience in holding babies or lulling them to sleep until they get married and have children themselves. These women can receive support and a sense of security from the community, as many people will try to help them on a daily basis when they see that they are pregnant. This will contribute to developing a brighter society. Separately, people in the community can help each other by casually sharing episodes like how they quit smoking or overcame the Metabolic Syndrome through exercising. In this way, adequate preventive care will be promoted in the community not through a top-down government policy, but through a sense of togetherness.

There are nearly 500 public health offices nationwide, but a sense of unity seems to develop more in areas where their staff or nurses actively reach out to the community. So, it is important for members of these facilities to interact with local residents on a daily basis.

Another point I have advocated is for university faculty and staff members and graduate and college students to volunteer at local elementary, junior high or high schools for about 20 hours a year (including weekends). By teaching alongside school teachers, graduate students and university faculty can develop confidence in their specialty areas while learning how to teach children. Another incentive for graduate and college students to volunteer would be to offer them teaching certificates. Many students may develop a desire to become teachers after volunteering at the schools. The education arena could change dramatically if a system is implemented to hire such people as teachers, even if they are in their 30s. Such flexible work styles and career paths would also strengthen the school-based regional community. Centers of community like those at elementary schools can also be set up at junior high and high schools, kindergartens, facilities for the elderly, and hospitals. Local governments should support such programs that will help form communities that anyone can participate.

There is a movement that is likely to positively influence the formation of regional communities. It is called social entrepreneurship and is spreading around the world. One example in Japan is a non-profit organization called Florence that supports working women. It is a day-care center specifically for sick children and operates on a membership fee which amounts to several hundred dollars a year. The center has a registered person from the local community look after a child who falls sick or, in some cases, dispatches a local doctor to their homes. This bottom-up style of management is a “social business,” and the founder is called a “social entrepreneur.”

Communities are not imposed from above by local governments, but we create them. In Japan we need to form local communities where people of different generations can interact, or else the lack of connection in both urban and rural areas could lead to the country’s collapse. So, it is “Back to Basics” in both public health and medical care. I would like to emphasize again that all health policies should be based on underlying principles that will create community health and revitalize family strength.