ACQ Vol 12 No 3 2010

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 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 system (MEXT, n.d.). Health policies

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.

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

145

ACQ Volume 12, Number 3 2010

www.speechpathologyaustralia.org.au