2020 Volume 69 Issue 1 Pages 14-24
Japan has experienced a dramatic decrease in the age-adjusted mortality rate from cerebrovascular disease, which previously was exceptionally high in the world. Such a dramatic change is thought to be due to changes in Japanese lifestyles, controlling of risk factors especially hypertension, and improvements in the medical care quality. These favorable changes have been further promoted since a series of National Health Promotion Measures began in 1978. Since then, the plan has been revised approximately every 10 years according to PDCA cycles. The first National Health Promotion Measures focused on implementation of health checkups, the establishment of municipal health centers, and the securing of manpower. The second National Health Promotion Measures called “Active 80 Health Plan” aimed to ensure that the people at the age of 80 could take care of themselves and participate in social activities, and was focused on physical exercise. The third National Health Promotion Measures, called “Health Japan 21” and started in fiscal year 2000, set numerical targets for 70 items in 9 fields (later increased to 80 items, including duplicated items) concerning lifestyle-related diseases and the improvement of lifestyles.
Based on the issues revealed in the evaluation of Health Japan 21 and subsequent discussion, the fourth National Health Promotion Measures called “Health Japan 21 (the second term)” covered new areas including the reduction of health disparities and improvement of the social environment. The midterm evaluation in 2018 showed that the extension of healthy life expectancy and reduction of health disparities that were the overall goals had improved significantly. However, there were several indicators that were unchanged or became worse. Issues to be prioritized in order to achieve the final evaluation target in 2022 were identified.
