Progress in infant health in Okinawa, Japan

The infant mortality rate (IMR) and neonatal mortality rate (NMR) defined as the number of infant and newborn deaths per 1000 live births, respectively, are widely accepted as population indicators of the level of perinatal and postnatal health. Since the end of World War II, Japan has made substantial progress in reducing its IMR and NMR. This resulted from improving living standards and the provision of universal maternal and child health care (MCH) services. Okinawa, the island prefecture that is the furthest from mainland Japan, had the third highest IMR and the highest low-birth-weight rate (LBW) among all prefectures when its statistics were integrated into Japan in 1973. Even though the LBW rate in Okinawa has remained higher than the all-Japan average, Okinawa has shown a considerable improvement in IMR and NMR. The aim is to review the trends in IMR, NMR, and LBW in Japan and Okinawa and to discuss sociodemographic trends, economics, and the provision of health care services. The IMR and NMR in Okinawa decreased during that time from 14.8 to 2.4 and from 7.5 to 0.8, respectively. The LBW rate decreased until the mid-1980s, but since then it has increased to 11.5 (Okinawa) and 9.6 (Japan) in 2009. Okinawa's public health and primary health care model for infants has been very successful and may be applicable to child health in island nations of the Asia-Pacific region.