ACQ Vol 12 No 3 2010

43 / 56

ACQ Volume 12, Number 3 2010 145
rehabilitation soon after the onset of disease or after surgery
were ranked mainly by the staff size and qualifications, and
received recognition accordingly in the medical service
fee system in 2000. Also, “long-term care insurance” was
established in 2000, in an effort to deal with the needs of the
increasing number of elderly persons who need assistance
in daily living after their acute and sub-acute medical
conditions are treated. Health policy-makers also focus on
the prevention of diseases, dementia, and other age-related
problems to keep the population as healthy and active as
possible.
Korean persons constitute 55%, followed by those from
Brazil (14%) and the Philippines (9.5%) (Ministry of Justice,
2010). English is taught as the first foreign language in public
high schools from 7th grade (age 12). Recently primary
schools have begun introducing English to their pupils in the
name of “international cultural experience”.
Education
The Japanese school year (as well as the fiscal year) runs
from April to March. Compulsory education for persons of
Japanese nationality is provided for 9 years from 6 to 15
years of age. This consists of 6 years of primary school and
3 years of junior high school. Almost 98% of 15-year-olds
enter senior high school and 50% of high school graduates
go on to college (Ministry of Education, Culture, Sports,
Science and Technology (MEXT)), 2008) .
For students with disabilities, what is termed “special
needs education” is offered. This provision was first
implemented in 2007 throughout the country. Depending on
the nature and severity of their disabilities, these students
receive their education in resource rooms or special classes
in regular schools, or in schools named “schools for special
needs education”. Unlike the previous special schools that
each specialised in one kind of disability, schools for special
needs education can accept students with any of several
types of disability and so can meet the needs of children
with multiple disabilities. Children with developmental
disabilities without obvious intellectual impairment (learning
disabilities including developmental dyslexia and dysgraphia,
ADHD, etc.) used to be excluded from the previous special
education system, but an increasing number of them are
now receiving support under the special needs education
system (MEXT, n.d.).
Health policies
The major causes of death are lifestyle-related diseases
including cancer, heart disease and stroke. There is a low
infant mortality rate and long average life expectancy, despite
the relatively small number of medical staff (per 1,000
persons): 2.24 doctors, 0.78 dentists, 2.10 pharmacists,
10.37 nurses (Ministry of Health, Labour and Welfare, 2008a,
2008b), 0.65 physical therapists (PTs) (Japanese Physical
Therapists Association (JPTA), 2010a), 0.37 occupational
therapists (OTs) (Japanese Association of Occupational
Therapists (JAOT), 2010) and 0.14 speech-language-hearing
therapists (SLHTs) (Japanese Association of Speech-
Language-Hearing Therapists (JAS), personal
communication, 2010). The nation-wide shortage of medical
staff and their uneven distribution have gained much
attention recently. Some medical schools increased
enrolment or have given preference to local residents to
replenish the future supply of doctors.
Since 1961, all residents of Japanese nationality join either
the Health Insurance Union or the National Health Insurance
program. With the rapidly ageing society, medical and
other social security expenditures are growing. In order to
control the cost and maintain the universal health insurance
program, the insurance premium paid by employers and
contributions paid by individuals have both increased.
The mean length of hospitalisation has been shortened
by allowing hospitals with shorter average length of stay
to collect higher fees. In order to maximise the outcomes
of rehabilitation, intensive rehabilitation wards that start
History of the speech therapy
profession
The history of speech therapy in Japan can be traced back
more than 50 years. In 1958, the National Training Center for
the Deaf, which later became the National Center for Speech
and Hearing Disorders, was established to treat people with
problems in hearing, voice, speech and language. In 1971,
the first educational program for speech and hearing
specialists was established at the National Rehabilitation
Center for Persons with Disabilities near Tokyo, where 20
students per year with college degrees received a one-year
intensive training.
Although the need for a national licence for speech
therapists to work in medical settings was recognised
quite early, it was not until the end of 1997 that the licence
law was finally passed. This was 32 years behind the
law for physical therapists and occupational therapists.
The first national examination was given in 1999 and
recognised 4,003 “speech-language-hearing therapists”, or
gengochoukakushi, which is the Japanese name for these
licensed professionals. The licence bears the signature of the
Minister of Health, Labour and Welfare.
In January 2000, the Japanese Association of Speech-
Language-Hearing Therapists , a national professional and
scientific association, was established. It has just celebrated
its 10th anniversary and currently has 9,086 members. As
of March 2010, there are 17,315 SLHTs. The gender ratio is
19% male and 81% female, the percentage of females being
much higher than for PTs and OTs. There are 64 accredited