[Rethinking public health administration for foreign residents: Perspectives from the frontline]

In recent years, responding to foreign residents has become an important issue in the Japanese public health administration, and various guidelines and multilingual materials have been developed. From the perspective of institutional ethnography, this study examines the administrative realities constituted by the Guide for Assisting Foreign Residents at Public Health Administration Counters and multilingual administrative documents. Specifically, the analysis examined consultation scenes, items to be checked, classification terms, and procedures for recording and referral in the documents, focusing on how foreign residents' experiences are organized as objects of administrative practice. The analysis shows that these documents function as support tools and practical devices that translate the diverse lives of foreign residents into administrative attributes, such as residence status and ability to pay, and reconstitute them as objects that can be processed institutionally. Furthermore, discourses of care, such as attentive listening and trust building, are positioned as conditions for smoothly carrying out administrative practices, including the continuation of treatment and the collection of information. Here, asymmetry can be observed: while difficulties in providing support are attributed to the cultural backgrounds of foreign residents, the structural barriers of the administrative system are pushed into the background. Therefore, what is needed is not to make people unfamiliar with the system adapt to existing administrative practices but to reorganize the system itself in light of diverse living conditions and barriers to access. Multilingualization, too, should be repositioned not as a means of administratively ordering foreign residents but as a practice through which the system itself becomes capable of responding to people with diverse backgrounds.