On March 28, 2023, two faculty members and 10 students at Kyoto University School of Public Health visited Nabari City, Mie Prefecture, together with the two officers from WHO Western Pacific Regional Office (WHO/WPRO) and researchers from Brunei and Cambodia. The purpose of this field visit was to visit the sites where Nabari city conduct various exemplary activities related to healthy aging. Nabari city created “Welfare Utopia Plan” in 2003 and since then, they set the goal “to realize an inclusive society where all residents can participate and help mutually, regardless of age, gender, disability or sickness”.

In the morning, we visited Nabari City municipal government office and had a warm welcome greeting from the Mayor Mr. Kitagawa, and Vice Mayor Mr. Nakamura of Nabari City. After that, we received explanations from the officers of Nabari City regarding various activities carried out in Nabari City, related to healthy aging.

In Nabari City, in all districts, they created spaces called “Community Health Rooms (CHRs) (Machi no Hoken Shitsu in Japanese)”. Citizens of Nabari City can visit CHRs anytime and talk with the public health nurse about their problems or daily concerns, in a relaxing atmosphere. The venue is named after a school health room (hoken-shitsu in Japanese). In every school in Japan, there is hoken-shitsu, so Japanese people are familiar with this system. Citizens of all ages can visit CHRs and ask for help when in need.

Another interesting activity unique to Nabari city was “stay-home diary” This is a program of exchanging diaries. Among those who wish to participate in this program, three citizens of Nabari city are randomly assigned to form a group to circulate a notebook where each member can write anything about his/her daily thoughts as a diary. Each member bring the diary to the CHRs. This activity also helps prevent isolation of citizens and finds people with physical and mental health challenges.

We also heard about the training program of link workers for social prescribing in Mie prefecture. They conducted an online training program to train the specialists who can act as a link worker to connect citizens with various resources in the communities. In this online training program, Prof. Naoki Kondo of Kyoto University School of Public Health was one of the instructors. In 2022, the Nabari city carried out this online training to those who are engaged in interpersonal support in Mie prefecture, and about 100 people participated in this training session.

In the afternoon, we visited Nabari City Town Development Council and Community Development Organization Head Office called “Nabari Otagai-san”.

In Nabari City Town Development Council, they form various committees voluntarily by involving citizens of Nabari and come up with ideas to improve the conditions of the people in the community. As a results of collaboration and discussion, such initiatives as holding community festivals, conducting support programs for people with disabilities, activities for mothers to support child rearing, and children’s cafeteria are organized. We heard about how they came up with the ideas for the creation of these mechanisms.

In Nabari Otagai-san, they coordinate paid volunteer who does various help activities such as moving furniture, pruning garden trees, helping with house cleaning, and simple carpentry. This is a sustainable program where the volunteers are paid to do the activities. This activity is valued highly.

Lastly, we visited the Hashimoto clinic in Nabari City, where they conduct unique initiatives of combining art and health. In the walls of the clinic waiting space as well as consultation rooms, they paint in color the sceneries and designs that would bring peace and comfort to the patients while the patients stay there. We received explanations of the reason for starting this activity and an overview.

Overall, Kyoto University School of Public Health faculty and students learned a lot from this field visit. It is hoped that the lessons learned from this visit will serve as an impetus to further promote collaboration between citizens and governments related to healthy aging and ongoing efforts to strengthen research in Japan and other countries around the world.

Below are the impressions from the students who participate in this field visit:

我非常感谢能够有此次机会访问名张市。此次访问我学习到了如何通过多方的协作去构建一个不仅仅对老年人友好，甚至让社区里每一个人都能受惠的社区，并且深切感受到了居民为社区付出的努力。比如在社区里开展的一系列志愿活动推进跨世代之间的互动，让我觉得每一个人都能够受到帮助。

‘I am very grateful for this opportunity to visit Nabari. During this visit, I learned how to build a community that is not only friendly to the elderly, but also benefits everyone in the community through the cooperation of various parties, and deeply felt the efforts made by the residents for the community. And seeing how volunteering in a community promotes intergenerational interaction has taught me how community comprehensive support can benefit every resident.’ (KUSPH Student from China)

Overall, the visit to Nabari City was informative and enlightening. The international medical school students gained a deeper understanding of the city’s efforts to promote healthy longevity and an aging society, as well as the challenges faced by the local community. The visit provided valuable insights into the role of government, nonprofit organizations, and medical facilities in promoting healthy aging and the importance of community engagement in achieving this goal. The Hashimoto General Clinic’s use of art in their professional settings was particularly inspiring and demonstrated the potential of creative solutions in improving patients’ overall health and wellbeing. (KUSPH Student from Iran)

有償ボランティアである「なばりおたがいさん」の活動が特に印象的だった。高齢者の方々が自らの役割をこなし、お互いを支えあいながら生活している。地域の人々が高齢者になっても、持続可能な取り組みとして続いていくことが期待できる。これは介護保険でカバーできない内容を必要とする人や独居や高齢者世帯の方々にとって必要なサービスであり、全国に広がるべき活動だと感じた。

The activities of “Nabari Otagaisan,” a paid volunteer group, were particularly impressive. Older people are performing their roles and supporting each other in their daily lives. It is expected that this will continue as a sustainable initiative even after local people become elderly. This is a necessary service for those who need something not covered by long-term care insurance, for those who live alone or in elderly households, and I hope it spreads throughout the country. (KUSPH Japanese Student)

Nabari shahriga sayohat chog‘ida men Yapon xalqi qanchalik buyuk ekanligini yana bir bor anglab yetdim. Albatta, biz sog’lom qarishning bir qancha jihatlari bilan tanishdik, lekin men hatto keksa ko’ngillilar ham jamiyatda bir-birlarini qo’llab-quvvatlash tizimida juda aktiv qatnashishidan hayratda qoldim.  Shu jumladan, maxsus Salomatlik xonalari Nabari shahri sog’liqni saqlash tizimida o’ta muhim ahamiyatga ega ekanligiga guvoh boldim va biz ham buni o’rganishimiz va o’z shahrimizda tadbiq etishimiz kerak ekanligini angladim.  Shunday qilib, men Nabariy sayohatidan katta zavq oldim va ko’p narsalarni o’rgandim.

During the Nabari city trip, I realized once again how Japanese nation great is. Of course, we became familiar with several aspects of healthy ageing, but I really surprised about the voluntary system for supporting each other within the community even by elderly volunteers. And I found that the health rooms are one of the significant impacts on the health system of Nabari which we must learn and implement in our city. So, I enjoyed and learned a lot in the Nabari trip. Thank you very much again for the opportunity to join. (KUSPH Student from Uzbekistan)

ผมขอแสดงความยินดีกับเมืองนาบาริที่สามารถสร้างเมืองแห่งสุขภาวะ ความสำเร็จที่เกิดนี้เกิดจากพลังความเข้มแข็งของชุมชนที่อยากจะพัฒนาคุณภาพชีวิตของชาวเมืองให้ดี และการวาดภาพฝันของเมืองนั้นไม่ได้เกิดขึ้นเพียงเฉพาะคนในชุมชนและหน่วยงานด้านสาธารณสุขในพื้นที่ แต่การมีภาคเครือข่ายจากหลายภาคส่วนรวมไปถึงสถาบันการศึกษาจนการจัดการสุขภาพชุมชนอย่างยั่งยืน  อีกทั้งการสร้างเสริมสุขภาพไม่จำเป็นต้องเฉพาะการออกกำลังกายหรือให้สุขศึกษา แต่รวมไปการสร้างสิ่งแวดล้อมที่เอื้อต่อสุขภาพที่ดี การมีกิจกรรมร่วมกันระหว่างวัย หรือกิจกรรมจิตอาสา 

I would like to congratulate Nabari City, which can create a healthy city for all. The key to success is the power of community. The future image of the town was created not only by local residents and the health sector but also with multisectoral collaboration, including support from researchers. This collaborative synergy leads to sustainable community health management. In addition, it showed that health promotion activities are not limited to only exercise and health education. But building healthy community environments, intergenerational activities, or volunteer activities should also be implemented. (KUSPH Student from Thailand)

今回名張を訪れ、助け合う社会の温もりを感じ、”地域”の持つ可能性の広さを学びました。都市部にいると電子的な手段に頼りがちですが、時代をあえて遡り、みんなが生まれ育った町・文化に基づく方法を取った方が深い繋がりが生まれかもしれないと思いました。今後も機会があれば地域を訪れ対話を行い、より良い社会づくりに携わりたいと思います。

Visiting Nabari on this trip, I felt the warmth of a society where people help each other and learned about the wide possibilities of “community”. In urban areas, we tend to rely on electronic means, but I thought that it might be better to go back in time and use methods based on the town and culture where we were all born and raised to create a deeper connection with others. If I have the opportunity, I would like to continue to visit local communities and engage in dialogues to create a good society. (KUSPH Japanese Student)

社会的処方を含めた地域共生社会の取組を伺い、良い意味で“支援”らしくない、“緩く優しい繋がり”が張り巡らされているように感じました。取組からエッセンスを抽出して、他地域で取組を進める際の参考・ヒントとなるのではないかなと感じました。ご説明、ご案内くださった名張市の皆様に、心より感謝いたします。ありがとうございました。

Listening to the efforts of local symbiotic society including social prescription, I felt that there is a “lenient and gentle connection” that is different from “support” in a positive sense. We hope to extract the essence from these initiatives and use them as a reference or hint for promoting initiatives in other regions. We would like to express our sincere appreciation to the people of Nabari City for their explanation and guidance. Thank you so much. (KUSPH Japanese Student)

Community interventions are not new to me as I myself have been part of such initiatives in my home country (Philippines) both as an organizer and implementer. However, I still have a lot to learn in terms of how such programs are designed and implemented at a larger scale and from the perspective of health policy makers. In particular, I have always been curious about sustainability, which is what struck me the most after the visit. It was extremely inspiring to see how volunteerism and a genuine desire to contribute to society drove forward and brought about favorable outcomes in Nabari city. I have  always assumed that monetary compensation and employment are the main keys to sustainability of such interventions, but through this trip, I realized how limited that perspective was. After the visit, I am left with a number of questions: I want to understand what sort of things lead to this kind of attitude towards community health interventions and foster this kind of behavior in other settings. What enables these mechanisms and which barriers need to be addressed? How do we ensure that older adults, regardless of their social status, are able to benefit from these initiatives? Hopefully, I will be able to answer these as I pursue my studies. (KUSPH Student from the Philippines)