Chapter 1: Basic Concepts

Part 1: Features of Sukoyaka Family 21

Sukoyaka Family 21 sets our vision, offering major initiatives for the health care of parents and children in the 21^st century. It is a national campaign, which is to be promoted by the various parties and organizations concerned in one single body.

This project has two significant aspects. First, it is a measure aimed at addressing the declining birth rate and improving the household and community environment in which people can give birth to their children without anxiety and raise them comfortably; it is also part of the Health Japan 21, which is a national health enhancement campaign aimed at realizing healthy and lively people in an aging society with fewer children.

Although its primary target will be the health care of mothers and children, this project was named "Sukoyaka Family 21" because it aims to create a society in which fathers, grandfathers and grandmothers as well as mothers and children can live in good health.

We will execute this national campaign over a ten-year period from 2001 until 2010. In the interim year of 2005, we will assess the implementation status and re-address issues as necessary.

Part 2: Basic standpoints of Sukoyaka Family 21

As a result of continued efforts of the parties concerned, various indicators of maternal and child health show that Japan is already at the top level globally in the 20th century. Based on such results, we decided to focus on the following four basic standpoints before devising major initiatives for maternal and child health in the 21^st century:

(1)	Make further efforts to ensure that the maternal and child health standard achieved in the 20th century is not lowered (maintenance of maternal and child health systems both qualitatively and quantitatively, etc.);
(2)	Overcome issues that we failed to solve in the 20th century at an early stage (achievement of the world's highest level for infant mortality rate by accident, maternal mortality rate, vaccination rate, etc.);
(3)	Tackle new issues which appeared towards the end of the 20th century and which are expected to become more serious in the 21st century (health care for adolescents, anxiety about child rearing and the psychological development of children, stepping up measures for child abuse, etc.); and
(4)	Search out issues to be worked on based on totally new concepts or methods, while taking into account new values and international trends. [These include application of health promotion ideas and methods, promotion of supported medical practices or Evidence Based Medicine (EBM), improvement in medical and educational environments for children suffering from chronic diseases and handicapped children, improvement in the environment from pregnancy until childbirth and coordination among health care, medical services, welfare, education, and labor measures, etc].

Part 3: Issues Agreed for Sukoyaka Family 21

The following four major agenda items have been agreed based on the basic standpoints mentioned in the preceding section, and will be worked on in the 21^st century:

(1)	Stepping up health care measures and promoting health care education for the adolescents;
(2)	Assuring safety and comfort during pregnancy and childbirth, and supporting for infertility ;
(3)	Maintaining and improving the standards of child health care and medical service; and
(4)	Promoting trouble-free mental development of children and alleviating anxiety about child rearing.

In Chapter 2, we discuss "recognition of problems," "direction of the initiatives," and "specific initiatives" for each agenda item.

Under "recognition of problems," we present our views on the present status of the issues concerned and the reasons for selecting the items as major agenda items, and under "direction of initiatives," we present the basic direction and framework for actual implementation. In "specific initiatives" we set our proposals in concrete terms based on the above two items. Such specific initiatives, however, do not necessarily guarantee the feasibility of the respective agenda items, but they have been strictly chosen as solutions, which are expected to contribute to solving the problem and in each respective agenda item. Although the respective agenda items may not necessarily be described in a uniform manner due to the varying nature and content of each issue, we placed importance on their practicability in line with the objectives mentioned above. We anticipate that concerned parties will, where possible, use our proposals as a reference when implementing voluntary initiatives and in addressing respective agenda items.

It should be noted, however, that issues not included in the above four agenda items are not insignificant. We have carefully selected these major agenda items as the focused target of the national campaign to prevent our activities resulting in Christmas-tree type initiatives. We therefore handed over the issue of child dental health and child nutrition to the section of Health Japan 21 concerning the prevention of lifestyle-related illness, and did not discuss measures for individual disease, such as atopy. We expect that concerned parties will continue to work steadily on the major issues that are not included in the Sukoyaka Family 21, but are nonetheless important.

Part 4: Promotion measures for Sukoyaka Family 21

1.Basic concept

In promoting the national campaign Sukoyaka Family 21, we decided to select health promotion as our basic concept.

The concept of heath promotion, as proposed at the International Conference of WHO held in Ottawa in 1986, is a public health strategy which is to be developed under the two pillar items; 1) increasing the ability of individuals to improve their own health and prevent disease based on their own judgment and to control disorders and chronic diseases; and 2) developing an environment that supports good health.

While existing health education tends to consider "health" as its ultimate objective, health promotion is characterized by its ultimate objective of "improvement in Quality of Life ('QOL')," positioning health as "a resource for living a better life."

Promotion of trouble-free mental development for children and alleviation of child-rearing anxiety

The figure illustrates differences in ideas between existing health education and health promotion in the field of maternal and child health. Existing health education aimed at "safety of pregnancy/childbirth and proper child rearing," focuses on the detail of professionals' advice to mothers. Health promotion, on the other hand, is designed to support mothers and children so that they can lead "rich lives", while mothers grow as human beings through pregnancy, childbirth, and child rearing. At the same time, it is intended to encourage people in the community or society to join in pushing the ball of "child development," thereby making the slope more gradual. In achieving this, "to increase the ability of individuals to improve their own health and prevent disease based on their own judgment, and to control disorders and chronic diseases" which is one of the pillar items of health promotion. Initiatives to make the slope more gradual relate to another pillar, the development of an environment that supports good health.

2.Promotion measures for Sukoyaka Family 21

To achieve every single goal set out in Sukoyaka Family 21, we need contributions from citizens as well as the organizations and parties involved in health care, medical services, welfare, education, and labor services from their respective positions. On the basis of the afore-mentioned basic concept of health promotion, we have devised the following three policies for the development of Sukoyaka Family 21 as a national campaign:

(1)	Encourage voluntary activities by clarifying the contents of initiatives that can be taken by the parties and organizations involved;
(2)	Set up a Promotion Council for Sukoyaka Family 21 that will operate as a central liaison and coordinator for the activities of different organizations; and
(3)	Set objectives by clarifying the activity period and specific issues to be achieved.

Chapter 3 illustrates ways in which citizens, local public entities, government, specialized agencies and commercial organizations can contribute to each agenda item. In order to effectively coordinate and promote the initiatives, we also propose to establish a central promotion council for Sukoyaka Family 21, which can put together activity plans and monitor the progress reports of the parties concerned. In addition, we also need to present our objectives clearly, which will help to clarify the activity period and specific issues to be achieved before launching the national campaign.