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Section 4. Promoting Lifelong Health and Regional Health

1. Health Promotion and Measures against Lifestyle-Related Diseases

(1) National Health Promotion Movement in the 21st Century (Healthy Japan 21)

An international comparison shows that many of the indicators representing the health standard of Japanese people are favorable. Japan, however, has yet to solve many problems to make the coming age of fewer children and older society healthy and vigorous. Such problems include yearly increases in the number of lifestyle-related disease patients and their deaths, which are accompanied by yearly increases in national health expenditure.

The term "lifestyle-related disease" was introduced in response to the proposal by the Council on Public Health (December 1996, opinion offering), replacing the traditional name of "adult disease". This new term represents a concept of "a group of diseases whose symptomatic appearance and progress are affected by living practices including eating, exercising, rest, smoking, and drinking".

The Ministry of Health and Welfare has executed a variety of measures under the "Second-Phase Measures for National Health Promotion (Active 80 Health Plan)" (launched in fiscal 1988), which follows the "First-Phase Measures for National Health Promotion" (fiscal 1978 to fiscal 1988). These measures have contributed to a certain degree to disease prevention and health promotion of nationals, leading to a higher ratio of people receiving health examinations and improvement of facilities such as municipal health centers. They, however, had some problems, as well, as they did not present clear standards including numerical targets, making it difficult to evaluate the achievements. In the meantime, it has become more important to promote measures through mutual cooperation among experts in health, medical treatment and welfare sectors as well as among ministries and government agencies, for promoting health measures that cover the whole life of each individual.

Because of this, a framework of new health promotion measures emphasizing "primary prevention", or the promotion of health and prevention of incidence, is to be established, which will replace traditional efforts giving priority to "secondary prevention" aiming at early detection and early treatment. In the concrete, efforts for the formulation of a "National Health Promotion Movement in the 21st Century (Healthy Japan 21)" is currently under way. Under the campaign, particular areas that are going to be important for health and medical care of nationals will be selected and concrete numerical targets will be set, which will function as the indicators of health and medical treatment.

The basic idea of the Healthy Japan 21 is to promote people's health comprehensively through a decrease in premature death, the extension of the period during which people can live without suffering dementia or being bed-ridden (healthy life span), and so forth, in order to realize a society where all the nationals can live a healthy and happy life. The Ministry of Health and Welfare intends to launch measures to promote people's health according to the program in 2000, which are to be completed in 2010.

The plan is to be established by the end of 1999 and announced in January 2000. During the process of formulating the plan, opinion of related people will be widely collected through regional public hearings, etc.

(2) Promoting measures against lifestyle-related diseases

The measures against lifestyle-related diseases give priority to "primary prevention", or the promotion of health and prevention of incidence.

In November 1997, a survey was conducted to find out the actualities of diabetes - one of the most serious health problems for the public. The survey revealed that the number of people who were strongly suspected of suffering diabetes was 6.9 million, while the number including the people with undeniable possibility of suffering the disease reached as many as 13.7 million. This means that the possibility of diabetes cannot be denied in about one out of seven adults. The survey also showed that many of the people with very high possibility of suffering diabetes are, or were in the past, corpulent. Thus, it proved that the correction of living practices, such as eating and exercising habits, was important for preventing the incidence and progress of diabetes (non-insulin dependent diabetes mellitus). Because of this, even more detailed analyses will be made, whose results will be notified to professionals engaged in health and medical care services, as well as to the public at large.

Cerebral apoplexy is another serious problem in terms of its influence upon the society as well as medical expenses and needed long-term care, because the disease is a major cause for deaths in Japan and represents 40% of the causes making people bed-ridden. Comprehensive measures to be taken are currently under consideration, based upon sufficient understanding of the actualities of the disease. The measures will cover the establishment of an appropriate medical care system for patients at an acute stage, human resource training, and study schemes, giving priority to preventive measures.

The National Nutrition Survey, which is executed every year to understand the actual intake of food, nutrients, etc. by nationals, is under revision aiming to prevent lifestyle-related diseases. "Recommended Daily Allowances of Nutrition for the Japanese People", which sets forth the standards for appropriate intake of each nutrient, is also being revised for the same purpose. As for the National Nutrition Survey, it has become necessary to revise the details in order that we can understand living practices at large?including eating habits?together with health and nutritious conditions of people, which provide information necessary for disease prevention (June 1998: Report on "Discussion Meeting on Ideal Features of National Nutrition Survey in the 21st Century"). As for the "Recommended Daily Allowances of Nutrition for the Japanese People," preparations are under way for the "6th revision" to expand the variety of subject nutrients and introduce measures against excessive intake in addition to trditional measures against the prevention of deficiency diseases based upon scientific grounding. In the meantime, nutritionists and managerial nutritionists are expected to manage not only meals, which they have traditionally managed, but also "people," as experts of nutrition. Accordingly, they are required to have more advanced expertise in nutritious guidance for the prevention and treatment of diseases (June 1998: "Discussion Meeting upon Ideal Features of Managerial Nutritionists in the 21st Century").

Based upon these, respective parties concerned are considering necessary measures including the revision of the current system, striving for sufficient adjustments.

(3) Measures against smoking

1 Actualities of measures against smoking
In 1995, the Council on Public Health announced a "Report by Tobacco Action Program Committee", which now functions as a foundation for comprehensive measures against tobacco. Upon this foundation are three pillars - the "preventing minors from smoking, the "improving the environment to eliminate or reduce the adverse effects of passive smoking (separating smokers from nonsmokers)", and "providing support to help smokers stop smoking and reduce tobacco consumption (no smoking/ moderate smoking)". Accordingly, measures against smoking, particularly the diffusion of right knowledge upon smoking and health, have been implemented to encourage business entities, etc. to introduce spontaneous efforts for anti-smoking measures. As for smoking separation at public places and work sites, in particular, the Ministry of Health and Welfare, Ministry of Labor, National Personnel Authority, and Tokyo Metropolitan Government have presented guiding principles, respectively, for the promotion of establishment of environment for smoking separation. The tobacco industry, as well, is promoting efforts including the midnight suspension of operation of automatic tobacco vending machines (1996) and the revision of advertisement standards (advertisement of tobacco brands through electric waves has been spontaneously controlled since April 1998).
Despite such efforts, new smoking problems have surfaced recently, such as a high smoking rate among young people (particularly women), increased tobacco consumption, and an increase in deaths due to tobacco-related diseases accompanied by increased medical expenses. In the meantime, measures against smoking in other nations have shown changes, as knowledge of tobacco influence grew deeper internationally, including the relation between smoking habit and nicotine dependence, risks of tobacco smoke including carcinogenicity, and impacts upon health of popularization of lower-tar tobacco.
Under such circumstances, it has become necessary in Japan as well to introduce more appropriate measures, and a "The Committee on Tobacco Control for the 21st Century" was held in February 1998. The discussion results of the meeting were announced in the "Summary of Discussions" in August of the same year.
2 Future measures against smoking
The Ministry of Health and Welfare regards tobacco measures as one of the important themes in public health, partly for the prevention of lifestyle-related diseases. Accordingly, the ministry will execute a variety of measures in succession. Measures to be executed include a survey upon smoking and health problems (fiscal 1998 and 1999), the preparation of a report summarizing the latest scientific knowledge upon tobacco and health both at home and abroad (fiscal 1998), an analysis of ingredients of tobacco smoke (fiscal 1999) and the establishment of information offering system concerning tobacco and health (fiscal 1999).
2. Health Support for Women Throughout Their Lives

The introduction of the concept of reproductive health/rights aims at the establishment of health widely for women throughout their life. This mainly concerns the right of self-decision as to whether they deliver babies or not and if they do, how many children they are going to have. The right is increasingly and internationally recognized as one of the rights of women.

As for health measures for women, "Health Support Project for Women throughout Their Lives" is currently under way, under which health education and consultation are provided in consideration with health conditions unique to women. At the same time, consultation about sexual troubles of young people at puberty, health checkups and sanitary guidance for pregnant women, the establishment of a system for perinatal medical care, etc. are being promoted.

A comprehensive approach is required for the health support for women. For that reason, "Study Group on the Health Support Project for Women throughout Their Lives" was organized in May 1998, in which current measures are evaluated and the direction of future measures are discussed.

3. Community Health Measures

As for community health measures, the Law on the Enactment of Related Laws to Reinforce Community Health Measures was enacted in June 1994. It was then agreed that the municipal, prefectural and national governments would fulfill their respective roles under the scheme.

Measures under the scheme have been implemented in compliance with the "Basic Guidelines on the Promotion of Community Health Measures" that were set in December 1994. Nonetheless, the social situation have changed drastically since the setting of the guidelines by now, giving rise to new problems concerning community health measures.

Because of this, a "Discussion Meeting on Community Health Problems" has been held to consider the revision of basic guidelines concerning the promotion of community health measures. The following matters are currently being discussed at the discussion meeting.

1 Some of the cabinet order-designated cities have a health center in each administrative district, and others have one integrated health center for the whole city. Under such circumstances, how should we consider the ideal features of health centers in cabinet order-designated cities?
2 Many disasters and criminal cases that directly affect the lives and health of community residents have occurred, including the Great Hanshin/Awaji Earthquake and the recent case of poison mixing in curry in Wakayama Prefecture. What roles should organizations in charge of community health, such as health centers and local health laboratories, play in case of surfacing of such health risks?
3 What roles should community health measures play for the long-term care insurance system that is to be introduced in fiscal 2000?

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