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We examined the associations between prefectural health status of children and sanitation infrastructure, medical care services and socioeconomic status in Japan during 1955-2000. Four indicators of child health status: infant mortality rate (IMR), Ascaris lumbricoides prevalence and height and weight of elementary school children, and five prefectural social indicators: water supply, sewerage, number of physicians, income and women's education, were calculated over five-year intervals and examined by correlation and panel data analyses. Associations between paediatric health and five social indicators were significant (p<0.001) until 1970. After adjustment for income or education, water supply diffusion rate showed a significantly negative association with IMR until the 1980s. A significantly positive correlation was observed between the number of physician and paediatric health from 1955-70 after adjustment for income. Water supply development showed a positive association with paediatric health after adjustment for economic or educational impact during the phases of rapid and steady economic growth, while medical care showed a positive correlation with paediatric health after adjustment for income during only the phase of rapid economic growth. Relationships between child health status and social indicators have changed over time with stage of economic development.

Critical contribution of sanitation infrastructure and primary medical care to child health status in Japan from 1955 to 2000.