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Integrating Medicine and Urban Planning,
Placemaking for the 21st century

The Planning Institute of Medicine Based Towns, the Organization for University Research Initiatives

In the earliest days of modern urban planning—from the late nineteenth century to the early twentieth century—urban planning and medicine had a close relationship. One priority of urban planning was establishing "public health" in urban areas, which at the time was facing urban congestion and pollution resulting from industrialization. As the economy grew in the 20th century, public health was maintained within the urban areas, and the fields of urban planning and medicine grew farther apart. Medical care became the role within the field of medicine and medical institutions, where as town development and urban planning became less involved with the field of medicine.

However as Japan's economy enters a period of low-growth and its society facing a declining aging population, urban living based on modern functional separation has suddenly become unrelated to economic efficiency, and even worse, it is presenting a threat to safe/secure living and health. Affluent urban-style living has led to an increase in lifestyle diseases associated with overeating and lack of exercise. In addition, individual-oriented lifestyles have led to breakdowns in communities, feelings of isolation and anxiety in regarding raising children. Also a soaring number of senior citizens living alone as well as solitary deaths and increase in medical costs are causing significant strain on public budgets. In order to suppress medical expenses, the government has set up a policy for encouraging senior citizens to die peacefully in their own homes rather than in a hospital. Prior to World War II, most people were born and ended their life at home, but after World War II, hospitals became the place where most people start and end their lives. The government is now attempting to restore this culture.

Professor Haruhiko Goto, Director of the Planning Institute of Medicine Based Town

With this societal demand, the need to “un-institutionalize medical care” and the innovative efforts in reconnecting the field of medicine and urban planning is called for. Currently Waseda University is participating in a number of innovative initiatives with Nara Medical University located in Kashihara City, Nara, as well as local NPOs and local government agencies affiliated with Kashihara City and Nara Prefecture. Waseda University’s center for promoting these initiatives is situated within “The Planning Institute of Medicine Based Town” (PIMBT), which was established as part of the Organization for University Research Initiatives in October 2015. We spoke with PIMBT Director, Professor Haruhiko Goto, Faculty of Science and Engineering, about the aforementioned initiatives.

Incorporating Medical Care into a Historical District

Photo 1: "Medicine-Based Town" : This book includes outcomes and visions from a two-year joint research conducted prior to the establishment of the PIMBT. (Hiroshi Hosoi & Haruhiko Goto, Suiyosha, 2014)

The MBT (Medicine-Based Town) initiative originates from the idea of "Indoor Environmental Medicine" advocated by Dr. Hiroshi Hosoi, President of Nara Medical University, which was introduced as a new discipline in 2005. This discipline is based on the idea of doing research on a concept of "preventing diseases and maintaining health with indoor environments" in the presence of medical evidence. This has resonated with Professor Goto, a researcher in the field of architectural/urban planning, specializing in landscape/community design. In 2008, Waseda University signed a comprehensive partnership agreement with the government of Nara Prefecture and Nara Medical University. With these partnerships in place, Nara Medical University invited Waseda University researchers from architecture and urban planning to participate in a research project on indoor environmental medicine carried out by Nara Medical University and Daiwa House Industry Co., Ltd. Through this research project, Dr. Hosoi and Professor Goto became acquainted with each other for the first time and started collaborating in 2012 (Photo 1).

"Waseda University does not have a medical school, and Nara Medical University is exclusively comprised of medical departments. These two universities could share values, complementing each other functionally, and collaborate in a fifty-fifty partnership. Dr. Hosoi saw a growing trend of indoor environmental medicine spurred by indoor elemental technologies such as intelligent toilets, but had a desire to incorporate indoor environmental medicine into towns’ development. For this reason we carried out investigative research on Kashihara City and its surrounding areas an initiative (Imai-cho Annex) geared to incorporate medicine, welfare and health in a historic district of Nara." −Professor Goto

Photo 2: Traditional townscape of Imai-cho:NHK's morning drama series “Asa ga Kita” was filmed in this location.

Imai-cho, located near Nara Medical University, is a district with an area of 17.4 hectares stretching about 600 meters east to west and about 310 meters north to south. Around 500 traditional buildings have been preserved in this area and is one of the largest Preservation Districts for Groups of Historic Buildings in Japan. Although 30,000 tourists visit Imai-cho annually, it has not been developed as a sightseeing destination. On the other hand, abandoned houses and vacant land caused by the declining aging population has become a social problem (Photo 2, Fig. 1). The Imai-cho Annex initiative aims to utilize such abandoned houses and unoccupied land as a base for medical care, welfare, as well as services that promote health and community activities. Various proposals such as a prevention center for senior citizens to become less dependent on nursing care, a general support center for the community, guest housing for overseas researchers at Nara Medical University, and dormitories for international students have been planned.

"Although it is difficult establish new medical centers due to laws and regulations, we intend to introduce various care centers into the community. These centers will not only promote wellness and preventive healthcare, but will also act as rehabilitation centers for patients recovering from health emergencies such as strokes, or a center supporting maternal/postpartum mothers. We believe senior citizens as well as expecting and nursing mothers can undergo checkups safely with peace of mind in these town centers, rather than at hospitals, which are rampant with disease. It is also believed that historic townscapes can help prevent and alleviate dementia. It is anticipated that being able to recall scenes from the liveliest period of their lives will have a positive effect on their brains." −Professor Goto

Figure 1: Location of Nara Medical University, Imai-cho and Imperial Mausoleum of Emperor Jimmu

Garnering Attention from Medical Societies

With the launch of the PIMBT, Waseda University intends to expand its efforts to other areas. Four new pillars for future research activities have been established. These include, (1) Setting up a home/town care system which does not depend on advanced medical treatment. (2) Securing a compact urban structure, which encourages people to go out on foot during the evening. (3) Appropriately managing open space in the suburbs where urbanization can be observed. (4) Creating a mechanism for partnership/collaboration with multiple entities in a community. In addition to researchers in architecture, urban planning and environmental design, researchers from the fields of community sports and public transportation from the Faculty of Science and Engineering, and researchers in the fields of town development and local communities from the Faculty of Social Sciences will be participating.

"Professor Morio Uzuki, a member of this research initiative, is familiar with town development in Germany and it is anticipated that he will shed light on overseas community education (such as Steiner education) and town development. We will also address spiritual care (creating motivation for living) for senior citizens and the QOD (Quality of Death) for the end-stages of ones life. For these issues, Professor Osamu Soda's laboratory, which has a good track record in research on citizen participation and community building, will make significant contributions." −Professor Goto

In further research and study, the charting of community records will be implemented, and the effect in reduction of medical expenses will be considered as an evaluative index. In the case of Kashihara City, it is estimated that annual medical expense will reach 430,000 yen per person in 2025, which was 320,000 yen in 2013. As a benchmark for the establishment of PIMBT, activities will be carried out to sustain the annual medical expenses per person in 2015.

The efforts in Imai-cho Annex will be used as a model for expanding into other areas in Nara. In districts with remains from the Kofun period, such as Asuka Village and Takatori Town, the integration of historical tourism with medical tourism will be attempted. Moreover, additional efforts will be made in regions that are commuter towns for people who work in Osaka, such as revitalizing new town developments which face issues regarding deteriorating buildings and aging community.

Figure 2: Establishing complementary relationships between town medical care and townscape.

In April 2015, The Medicine-Based Town Initiative was covered as a special program at the general meeting of the Japanese Association of Medical Sciences, which is held every four years, where Dr. Hosoi and Professor Goto, delivered lectures at the main site. This shows that the initiative attracted a great deal of attention within Medical Science. The initiative was also selected as a model project for community revitalization under the Japanese government's regional revitalization policy. Moreover, companies participating in joint research and projects gathered to launch the MBT consortium, kicking off with a symposium, which was held in January 2016 (Photo 3). One should not take eyes off the upcoming integrated movements of “Medicine” and “Urban Planning”.

Photo 3: MBT Consortium's Kickoff Symposium: A total of 630 people participated. 69 professors (including deputies) from Nara Medical University, sitting at long tables, responded to consultation and requests from 536 people from 293 companies.

Related links
Planning Institute of Medicine Based Town, Waseda University
Faculty of Science and Engineering, Waseda University
Faculty of Social Sciences, Waseda University