2004.6.11 Akira Terashima, Professor
Faculty of Comprehensive Welfare, Urawa University
The number of national laws related to people with disabilities is 120 at least in Japan. Table 1 shows the main laws. Each national law has some regulations. Each local government also has its own laws and regulations. As the result there are many laws and regulations related to disabilities.
There are 4 main welfare laws related to persons with disabilities. Each law gives services to people with disabilities such as personal care, disability pension, disability allowance, tax deduction, barrier free transportation, assertive technology, communication services, etc
The Child Welfare Law (1947) protects the human rights of all (including disabled) children (under the age of 18) and aims at their healthy upbringing. Services like health examination and guidance on medical educational care, medical treatment, prosthetic appliances, specialized non-residential facilities and facilities for education and care, and public assistance institutions, etc. are provided for disabled children.
The Law for the Welfare of Physically Disabled Persons (1949) carries out necessary support in promoting independence and participation in society of physically disabled persons such as issuing of certification notebook, various counseling services, grant of prosthetic appliances, provision of technical aids, rehabilitation training, dispatch of sign language interpreter, provision of specialized facilities for nursing care and provision of place for living, etc.
The Law concerning Mental Health and Welfare for Mentally Disabled Persons (1950) provides necessary support for mentally disabled persons such as medical care and protection, promotion of social rehabilitation, and independent living and participation in society. It also aims to improve the mental health of the whole nation.
The Law for the Welfare of Intellectually Disabled Persons (1960) carries out necessary support in promoting independence and participation in society of intellectually disabled persons such as specialized counseling, various training for independence, dispatch of home helpers, day care and short stay programs, etc.
The Disabled Persons’ Fundamental law (1970) establishes the fundamental principles of measures for disabled persons and designates the responsibilities of the state, local public governments and the people.
2. Definitions of Persons with Disabilities in Japan
As each law has its own definition of disability on the basis of the purpose, there are many definitions of disability in Japan.
According to the Disabled Persons’ Fundamental Law which came into effect on 3 December 1993, “Disabled Persons” means persons whose daily life in society is substantially limited over the long term due to physical disability, intellectual disability or mental disability.
Besides this definition by the Disabled Persons’ Fundamental Law, each law has their own definition to provide the services for eligible persons.
- Physically Disabled Persons According to the Law for the Welfare of Physically Disabled Persons (1949), the physically disabled person means a person over 18 years of age who has physical disability which comes under one of those enumerated in the attached list, and who has received a Physical Disabled Person’s Certification Notebook from the governor of a local public body.
This law categorizes the physical disability into 6 grades.The grade is written on the physical disabled person’s certification notebook. The grade 1 is most severe. Table 2 shows the grades in detail. A physically disabled person can utilize the services offered on the bases of the law and other regulations with showing the note.
- Intellectually Disabled Persons The purpose of the Law for the Welfare of the Intellectually Disabled Persons is “to help intellectually disabled persons in their rehabilitation to give them necessary care, and thus to promote the welfare of intellectually disabled persons.” As the precise definition of intellectually disabled persons is not given by the Law, an general definition is used for practical use, that is “A Person with intellectual disability is a person who has an intellectual disability manifested during the developmental period (birth to 18 years of age) and displays functional deficits in skills for daily life which require supportive services.” The Intellectual Disabled Person’s Certification Notebook is also issued to persons with intellectual disabilities. The note is not the term of reference to utilize the services based on the law. It is issued for convenience.
The number of grade is from 2 to 4 , which each local government decide.
- Mentally Disabled Persons According to the Law concerning Mental Health and Welfare for Mentally Disabled Persons, Mentally Disabled Persons means those with schizophrenia, psychotic disorders due to psychoactive substance use, intellectual disability, personality disorders, and/or other mental disorders.”
The Mental Disabled Person’s Certification Notebook is issued based on this law. The note is not the term of reference to utilize the services based on the law. It is issued for convenience as same as the Intellectual Disabled Person’s Certification Notebook. This law categorizes 3 grades of certification.Grade 1 is most severe.
- Child with Disabilities
People under 18 years old is defined as Child by the Child Welfare Law. All the children are supported by the law, including disabled children.The definition of a disabled child is not prescribed by this law. The Physical Disabled Person’s Certification Notebook and/or the Intellectual Disabled Person’s Certification Notebook can be issued for a disabled child based on each law.
3. The Number of Disabled Persons in Japan
As mentioned above, there are 4 welfare laws related to disability, the Law for the Welfare of Physically Disabled Persons, the Law for the Welfare ofIntellectually Disabled Persons, the Law concerning Mental Health and Welfare for Mentally Disabled Persons and Child Welfare Law. There are some major surveys related to these welfare laws. According to these surveys and other related ones the total number of disabled persons in Japan is estimated to be 6,015,900, about 4.8% of total Japanese Population. Table 3 shows it.
- Physically Disabled Persons The Ministry of Health and Welfare(former Ministry of Health, Labor and Welfare) conducts the Survey of Actual Status of Physically Disabled Persons every five years since 1951.The purpose of the survey is to get the basic data which are required to promote measures for physically disabled persons by asking them about the kinds and degree of disabilities, disability causes, the real situation of daily life, whether using the community services such as home helpers, day services, and other services as assertive devices and prosthetic appliances, disability pension or other allowances, housing conditions and welfare and social services needs, etc. The recent 10th survey was conducted on June, 2001.
Table 4 shows the annual change in number of home-based people with physical disabilities by type.The number of internal disorder has been reported since 1970 as it was categorized as one physical disability in 1967 by theLaw for the Welfare of Physically Disabled Persons. The total number has been increasing for 50 years.
Although the number of people with motor impairment and people with internal disorder has been increased, the number of people with visual impairment and people with hearing impairment has been almost same since 1980s.The fact that the population of Japan has been becoming older is thought to be the reason. The elderly people would be disabled with motor function first. Once he/she gets the Physical Disabled Person’s Certification Notebook, he/she can utilize the services based on the Law for the Welfare of Physically Disabled Persons. And the sequela of internal disease such as diabetic mellitus makes the number of internal disorder increase. The morbidity rate of such degasses is higher for the elderly people.
Table 5 shows the number of home-based people with physical disabilities by age.61.8% of physically disabled persons is 65 years old and over.73.4% is 60 years old and over. Only 26.6% is under 60 years old.Table 5 also shows the changes in the ratio of physically disabled people by Age Group. 9.62% of people over 70 years old is disabled.
Table 6 shows the number of home-based people with disabilities by type and grade. The ratio of the number of people with grade 1 is higher than others. Especially the ratio of people with internal disorders with grade 1 is 56.6%. The ratio of people with Speech/hearing impairment with grade 1 is as low as 4.6% because there is no grade for them. Those people with grade 1 of speech/hearing impairment have multiple impairments such as both speech impairment and hearing impairment.
Table 7 shows the annual changes in the number of home-based children with physical disabilities by type of disability.
Although the number of children with physical disabilities has decreased for 25 years since 1965, it has been almost same for recent 10 years. Table 8 shows the number of children with physical disabilities by age.
- Intellectually Disabled Persons The Basic survey of the policy of the welfare of children/adults with intellectual disability has been also conducted almost every five years. The purpose of the survey is to obtain the basic data on the daily living situation and services needs of individuals with intellectual disability in order to establish well prepared public policies for intellectually disabled persons.
Table 9 shows the Number of children/adults with Intellectual disability by degree of Disability.Total number of children/adults with Intellectual disability is 441,100 which include both people living in homes and institutions. That is about 0.3% of total population of Japan.314,800 people with intellectual disability is living in homes and 126,300 people is living in institutions.
This high ratio of people living in institutions is one of the difference with other categories of disability. The ratio of children with very severe mantel retardation is 32.8%.
Table 10 shows the number of people with intellectual disability by age and sex. The ratio of elderly people is not so high compared with it of people with physical disabilities.
- Mentally Disabled Persons As for the mentally disabled persons, the Ministry of Health, Labor and Welfare has not conducted the survey. But we can get the data on the patients who are hospitalized in various hospitals through the Survey on Patients in Japan. The Mentally Disabled Persons’ Certificate System was started in 1995 and local government issues the Mental Disabled Person’s Certification Notebook. But the number of people with mental disability who applies for the Certificate are so small in number, partly because of the prejudice on mental disability, and partly because of the services for mentally disabled persons are not yet enough or varied.
Table 11 shows the annual change in the number of beds for psychiatric patients.
MHLW’s estimate the total number is almost 2,041 million.
4. Daily life of Persons with Disabilities in Japan
There are many services managed by each ministry of national government.The ministry of Health, Labor and Welfare is the main one which provides serves for Persons with disabilities.Other ministries such as the Ministry of Education, Culture, Sports, Science and Technology, the Ministry of Land, Infrastructure and Transport,the Ministry of Finance, even the Ministry of agriculture, Forestry and Fisheries has measures for people with disabilities.
There are two levels of local governments, prefecture and city, which provide their own services for people with disabilities adding to the services of national government. As the result, people utilize 3 kinds of governmental services.Table 12 shows an example of services distributed in a city of Tokyo.
In Japan all persons are included in public national health and pension insurance.The health insurance covers 70% of the cost of treatment received from medical facilities such as hospitals and clinics. National government covers the cost of some specified treatment such as corneal transplantation, artificial dialysis, pacemaker implantation for people with disabilities.And each local government covers the cost of general treatment for people with severe disabilities.
The severe disabled people of 20 yeas old and over can get disability pension in principle.Even a disabled person who acquired the disabilities before 20 yeas old can get basic disability pension when he/she reaches at 20 years old. People with severer disabilities can get Special Allowance for Disabled Persons.The parents or carerers who take care of children with disabilities get Rearing Allowance for Children. Each local government offers same kind of disability allowances.
In each community people with disability can utilize community services such as dispatch of home helpers, bathing service, home haircutting service, emergency short-term care, dispatch of guide helpers for the blind, loan of guide dogs for the blind, local newspaper in Braille and on tape, Braille transliteration and reading services, Braille library, dispatch of sign language interpreters, lending of subtitled videos, dispatch of note-taking helper, discount fares on public transportation, priority admission into public corporation housing, etc.
People with disabilities also gets reduction of income tax, resident tax, motor vehicle tax, private business tax, gift tax, inheritance tax, etc.