The Japanese school health system can be traced back to the promulgation of the school system in 1872, when its major aim was to implement measures to prevent schools from serving as a medium for the transmission of prevalent infectious diseases such as smallpox and cholera. In 1898, an imperial ordinance was issued to place school doctors in public schools. Since then, school doctors have played a central role in school healthcare. In more recent years, we have seen rapid changes in social and living environments, and these changes have been accompanied by a wide spectrum of new health issues including mental health problems and the onset of lifestylerelated diseases at younger ages. The cooperation of specialists from a variety of medical fields as well as health education and health management that provides a firm basis for lifelong health in schoolchildren are necessary and will become an integral part of the role assigned to school doctors in the future.