Three Towns, Three Forms of ‘Support’ Gradually Deteriorating

Iwakuni City has announced plans to abolish a medical facility. In Etajima City, there are plans to consolidate elementary and junior high schools into one each. In Fuchu City, a report on child abuse cases involving foster children pointed out a lack of collaboration.

The fields are healthcare, education, and welfare—each seems like a separate issue. However, when these three events are lined up, a common structure emerges. The population is declining, the number of caregivers is decreasing, and the systems are shrinking. And who will support the ‘last one’ left behind after this shrinkage, and through what system? None of the towns have an answer to this question yet.

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Iwakuni City ‘Asagiri no Sato’—A Quiet Conclusion for a Facility Without Doctors

Iwakuni City has indicated that the medical and nursing complex facility ‘Asagiri no Sato’ will be abolished by the end of the 2026 fiscal year. The direct reason is the difficulty in securing a full-time physician.

‘Asagiri no Sato’ has provided outpatient care and nursing services in a region away from the city center. For elderly residents with limited means of transportation, it represented ‘accessible healthcare.’ The closure of this facility means that for the residents living in that area—especially those with chronic illnesses who require regular visits—the foundation of their lives is being pulled away.

It is noteworthy that this closure is not a sudden event. In the medical area of eastern Yamaguchi Prefecture, which includes Iwakuni City, the number of doctors per 100,000 people has been consistently below the national average. The very structure supporting regional healthcare has been gradually deteriorating over a long period. The closure of the facility is merely the manifestation of this long-term decline.

The city plans to consider measures to secure alternative medical access in the future. However, specific transition plans and budget measures have not yet been announced. While the timing for closing the system is set, the contours of the next system remain unclear—this ‘blank period’ becomes the most anxious time for those on the ground.

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School Consolidation in Etajima City—The Day When Schools Will Be Reduced to One on the Island by 2037

In Etajima City, plans are underway to consolidate elementary schools, junior high schools, and compulsory education schools into one each by the fiscal year 2037.

The background to this is the acceleration of declining birth rates. The youth population (ages 0-14) in Etajima City continues to decrease, with the current number of children and students down by about 30% compared to ten years ago. It has become commonplace for the number of students in a single grade across multiple schools to fall below ten, and mixed-grade classes are not unusual. The consolidation is likely an unavoidable decision from the perspective of educational administration.

The problem is that schools are not just ‘places of education.’ Local elementary and junior high schools serve as disaster prevention hubs, centers for community events, and points of connection for parents. The disappearance of a school means that one reason for the community to ‘come together’ is lost.

The city’s policy of maintaining and improving the quality of education through consolidation has a certain rationality. By centralizing teacher assignments, the range of specialized instruction can expand, and interactions among children can diversify. However, the overall picture of specific burdens, such as increased commuting distances, school bus operating costs, and costs for school building renovations after consolidation, has not yet been sufficiently shared with the citizens.

The long timeline for the consolidation plan until the fiscal year 2037 is also somewhat concerning. Twelve years may seem like a grace period for carefully advancing the plan, but if the number of students continues to decline during that time, some schools may effectively ‘naturally disappear’ before consolidation. The question of which will move first—plans or reality—needs to be assessed.

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Foster Child Support in Fuchu City—What the Four Characters of ‘Lack of Collaboration’ Conceal

In Fuchu City, Hiroshima Prefecture, a case of abuse involving a one-year-old child placed as a foster child has occurred. A verification report created in response to this incident pointed out that there was insufficient information sharing and collaboration among the child consultation center, the city’s welfare department, and foster parent support organizations.

The most serious fact in this incident is that, despite multiple ‘opportunities for awareness’ existing within the system before the child was harmed, none of them led to a response. This is not a case of individual negligence. Each organization was operating within its own scope of work. However, there was no system in place to pick up the information that fell between the organizations.

Foster care is said to provide a more familial environment for children compared to institutional care, and the government is promoting an increase in the placement rate. However, a continuous support system for foster families after placement—regular visits, preventing foster parents’ isolation, and multi-faceted understanding of the child’s condition—requires manpower and budget. In small municipalities like Fuchu City, the placement of child welfare specialists is limited, and it is common for one person to handle multiple tasks.

The four characters ‘lack of collaboration’ may be accurate as a conclusion of the report. However, underlying this is a deeper structural issue: there is a shortage of personnel, time, and information infrastructure necessary to establish collaboration. A blueprint for the system exists; however, the components needed to operate according to that blueprint are not in place.

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A Common Structure Underlying the Three Events—’Shrinkage’ Transcends Fields

Iwakuni’s healthcare, Etajima’s education, and Fuchu’s welfare. These three events are occurring in different fields and different municipalities. However, the dynamics flowing beneath them are common.

The population decreases. Tax revenues decrease. Caregivers decrease. The relative cost of maintaining services increases. Eventually, decisions must be made to either ‘close’ or ‘integrate’ the system—this trend is the same across all fields and all towns.

Another commonality is that the decisions regarding shrinkage are made ‘by field.’ The closure of medical facilities is concluded within healthcare administration, school consolidation within educational administration, and the verification of foster child support within welfare administration. There is no perspective incorporated into the system to measure ‘how much support capacity remains in this town as a whole’ across fields.

An elderly person loses their primary care clinic, a grandchild’s school disappears, and the local monitoring network weakens—these are not separate policy issues, but rather events that occur simultaneously in one person’s life. What does the optimization of each field mean when viewed as a whole in the lives of residents? There is a lack of places within the current administrative structure to pose this question.

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What Does It Mean to Design Support for the ‘Last One’?

In regions where the population is declining, it is not realistic to maintain all services as they currently are. Everyone understands this. The issue is the design philosophy of what to preserve and how to reconnect when ‘shrinking.’

If medical facilities are closing, where will the residents in that area go next, and will transportation be secured? If schools are consolidated, who will take on the role of not just commuting but also the community’s ‘gathering function’? If collaboration in foster child support is lacking, how will the system for personnel and information that enables collaboration be redesigned?

Behind the decisions to ‘close’ and ‘integrate,’ is there a design for ‘reconnecting’? This will determine whether shrinkage becomes ‘withdrawal’ or ‘reorganization.’

Three towns, three events. In each of these places, there are individuals holding the fort at the edges of the system. Staff continuing to respond to the last patients at a facility without doctors, education committee officials listening to residents’ voices at explanation meetings for the consolidation plan, and welfare professionals trying to entrust children’s safety in the lines of verification reports.

When systems shrink, what remains in the end is human judgment. Therefore, it is essential to design a system that does not isolate the person making that judgment before the shrinkage occurs. Supporting the ‘last one’ means not isolating the person who supports the last one.