Rikuzentakata’s 15-Year Practice of Designing Relationships Offers New Questions for Urban Elder Care

On May 14, 2026, Shunsuke Mitsui, chair of certified NPO SET, spoke at the Urban Nursing, Elder Care, Medical and Related Services Collaboration Study Group. He reported on 15 years of practice accumulated in Rikuzentakata, Iwate Prefecture, to medical and welfare professionals from Tokyo, Nagoya, and Osaka. After the presentation, Yoshinori Fujiwara of the Tokyo Metropolitan Institute for Geriatrics and Gerontology said, “It is not about building communities for preventive care, but about preventive care existing within community building. This reaffirmed that reversal in thinking.” It was a day when the “design of relationships” fostered in a small town facing ongoing population decline reached professionals in large cities confronting rapid aging. Rikuzentakata’s practice has shown a reversal: it is not that relationships are lost because the population declines, but that a community can withstand population decline because relationships exist. This question was brought into discussions among experts working on elder care in urban settings. The study group, under the theme “Community-based services: the current state and future of small-scale multifunctional care, nursing small-scale multifunctional care, dementia group homes, and related services,” explored how multidisciplinary collaboration can help older adults continue living in the communities where they have long resided. Mitsui presented Rikuzentakata’s model, which has nurtured connections through exchanges between young people from outside the region and local residents. Its activities include career education for about 1,300 junior and senior high school students in Iwate Prefecture, week-long stay programs joined by about 1,500 university students, hosting about 17,000 school trip students, and exchange programs involving about 3,000 local residents each year. Behind these numbers is the steady work of carefully building relationships that do not end after a single encounter. Some migrants have also taken root locally as assembly members, traditional performing arts practitioners, and entrepreneurs. In the Q&A session after the talk, participants actively discussed the potential for linking SET’s activities with preventive care and comprehensive community support programs. Fujiwara pointed out that comprehensive programs, especially comprehensive support projects, have a high degree of flexibility and available budget frameworks, yet are not being fully utilized due to a lack of ideas. He said SET’s exchange programs could be positioned as preventive care initiatives, and that mobility support could potentially be implemented as a home-visit type service. Mitsui shared that SET’s current point of contact is the exchange and settlement section under commerce, industry, and tourism, and that ties with welfare departments are still limited. At the same time, SET already has some collaboration with local welfare commissioners. “Going forward, we would like to challenge ourselves to collaborate with comprehensive programs,” he said. The discussion highlighted the possibility that relationships in which young people and residents mutually influence each other’s lives, rather than a one-way relationship between supporter and supported, may help sustain everyday security beyond the reach of formal systems. SET is currently expanding its model across multiple municipalities in Iwate Prefecture and aims to systematize it so that other organizations can carry out similar initiatives. In 2026, SET also plans to publish a book compiling 15 years of practice and philosophy. The question that “preventive care exists within community building” is not limited to Rikuzentakata. Whether in cities or rural areas, how we foster relationships in which people connect and care about one another may already have answers lying dormant in our own communities. Those interested in SET’s practice are encouraged to visit Rikuzentakata and see these relationships firsthand. The question raised from a depopulated area has quietly begun to move forward, with the potential to change urban community-based integrated care. SET’s mission is “to turn each person’s ‘I want to do it’ into ‘I did it,’ and create Good Change for Japan’s future.” Since the Great East Japan Earthquake in 2011, SET has built systems centered in Iwate Prefecture where young people and residents learn together. Through school trip homestays, programs for university students and working adults, and community-building activities, young people take part in everyday life in local communities and develop lasting relationships with residents. In fiscal 2024, more than 5,000 people participated. SET now operates not only in Iwate but across multiple regions. By simultaneously supporting young people’s growth and local vitality, SET works toward sustainable community building grounded in the relationships between people and places. It has twice received the Prime Minister’s Award and has won many other awards. Organization overview: Certified specified nonprofit corporation SET. Address: 52-6 Yamada, Hirota-cho, Rikuzentakata, Iwate Prefecture. Chair: Shunsuke Mitsui. Established: March 12, 2011; incorporated: June 18, 2013; certified: October 16, 2025. Official website: https://www. poset.o g. Official Instagram: https://www.i stag am.com/_ poset/?hl=ja. Official podcast Spotify: https://x.gd/wh4Lo, Amazon Music: https://x.gd/TjRP0. Media inquiries: Public relations, set.fo japa @ poset.com, Tel: 0192-47-5747.