Journal of the National Institute of Public Health
Online ISSN : 2432-0722
Print ISSN : 1347-6459
ISSN-L : 1347-6459
Topics
Considering dental health policy using a logic model and the PDCA cycle
Jun AIDA, Satomi SHIMADA, Sayo MASUKO
Author information
Keywords: Health Japan 21 (Phase 3), Basic Matters on the Promotion of Dental and Oral Health, logic model, population approach, PDCA cycle
JOURNAL FREE ACCESS FULL-TEXT HTML

2024 Volume 73 Issue 5 Pages 359-368

Details
Download PDF (2875K)
Download citation RIS

(compatible with EndNote, Reference Manager, ProCite, RefWorks)

BIB TEX

(compatible with BibDesk, LaTeX)

Text
How to download citation
Contact us
Abstract

我が国の健康政策「健康日本21」は，目標値を設定し，その達成を目指すものである．令和6年度から「健康日本21（第三次）」と，これに足並みをそろえて歯科分野では「歯科口腔保健の推進に関する基本的事項」が改正，「歯・口腔の健康づくりプラン」が開始されている．これらの政策では健康の社会的決定要因の概念が取り入れられ，社会環境を考慮しながら，健康寿命の延伸と健康格差の縮小が最上位の目標に設定されている．そしてこの目標の実現のために，ロジックモデルがつくられ，個別の施策や健康目標の相対的な位置関係が階層的に提示されている．さらに施策をその介入効果や介入の性質によって区分けしたアクションプランが示されている．アクションプランにおいては，従来よく行われている健康教育だけでなく，社会環境の影響を考慮し，環境を整える施策やインセンティブやデフォルトの変更を重視した施策も考慮するなど，より実効性に富んだ施策が分かりやすく分類されている．なお，どのような施策が健康格差を縮小または拡大するかについては注意が必要である．健康教室や健診においては，健康意識が高い者ほど参加が多く，リスクの高い人々が参加しないという，いわゆる「逆転するケア（予防）の法則」がしばしば現場の課題となっている．このため，健康格差を縮小するポピュレーションアプローチである「配慮ある普遍的アプローチ」が求められ，歯科においては学校でのフッ化物洗口などが有効とされている．個別の施策を実施していく上では，計画，実行，評価，改善の順にPDCAサイクルを回していくことが求められている．PDCAサイクルを活用するためには，「80歳で20歯以上の自分の歯を有する者の割合」といった短期間での改善が難しい項目を目標値に設定するのではなく，実行や改善が見えやすいアウトプットや中間アウトカムを利用することが近年の流れとなっている．最後に，目標値のみにとらわれると，近年の高齢化に伴う歯が少ない人々の増加や，他の疾患と比較した際のう蝕や歯周病の医療ニーズの多さが見落とされることがある．医科における施策や，WHOの口腔保健の決議にみられる国際的な流れと同様に，日本の歯科界においても，目標値の限界を理解し，必要に応じて他の指標にも目を向ける必要があるだろう． Japan’s national health policy, “Health Japan 21” is a program that sets target indicators and strives for their achievement. Starting from fiscal year 2024, “Health Japan 21 (Phase 3)” and its counterparts in the dental field, the revised “Basic Matters on the Promotion of Dental and Oral Health” and “Oral Health Promotion Plan” have commenced. These policies incorporate the concept of social determinants of health, setting the extension of healthy life expectancy and the reduction of health inequalities as their highest-level objectives, while taking into account the social environment. Logic models have been developed which hierarchically present the relative positions of individual measures and health goals. Furthermore, an action plan has been introduced, which categorizes the measures based on their nature and effectiveness. This action plan emphasizes not only traditional health education, but also more practical measures that consider the impact of the social environment, such as policies aimed at improving the environment and changing incentives or defaults. It is crucial, however, to carefully consider which measures may reduce or exacerbate health inequalities. For example, in health education and check-up programs, individuals with higher health awareness tend to participate more, while those at higher risk do not, presenting the challenge of the so-called “inverse care (prevention) law.” Thus, a “proportionate universalism” approach, which is a population strategy aimed at reducing health inequities, is required. In the dental field, school-based fluoride mouth rinsing programs have been identified as an effective proportionate universalism approach. The implementation of individual measures necessitates the use of the PDCA cycle (Plan-Do-Check-Act) cycle. In utilizing the PDCA cycle, rather than setting target indicators that are difficult to improve in the short term, such as the percentage of individuals retaining 20 or more teeth at age 80, the recent trend is to focus on utilizing outputs and intermediate outcomes that provide more visible evidence of progress regarding execution and improvement. Lastly, an excessive focus on target indicators alone may overlook certain trends, such as an increase in individuals with fewer teeth due to aging, and the high dental treatment needs for dental caries and periodontal disease compared to other conditions. As in the broader medical field and in line with international trends, such as the WHO resolution on oral health, Japan’s dental sector must recognize the limitations of target indicators and also consider other indicators, when necessary.

Translated Abstract

Japan’s national health policy, “Health Japan 21” is a program that sets target indicators and strives for their achievement. Starting from fiscal year 2024, “Health Japan 21 (Phase 3)” and its counterparts in the dental field, the revised “Basic Matters on the Promotion of Dental and Oral Health” and “Oral Health Promotion Plan” have commenced. These policies incorporate the concept of social determinants of health, setting the extension of healthy life expectancy and the reduction of health inequalities as their highest-level objectives, while taking into account the social environment. Logic models have been developed which hierarchically present the relative positions of individual measures and health goals. Furthermore, an action plan has been introduced, which categorizes the measures based on their nature and effectiveness. This action plan emphasizes not only traditional health education, but also more practical measures that consider the impact of the social environment, such as policies aimed at improving the environment and changing incentives or defaults. It is crucial, however, to carefully consider which measures may reduce or exacerbate health inequalities. For example, in health education and check-up programs, individuals with higher health awareness tend to participate more, while those at higher risk do not, presenting the challenge of the so-called “inverse care (prevention) law.” Thus, a “proportionate universalism” approach, which is a population strategy aimed at reducing health inequities, is required. In the dental field, school-based fluoride mouth rinsing programs have been identified as an effective proportionate universalism approach. The implementation of individual measures necessitates the use of the PDCA cycle (Plan-Do-Check-Act) cycle. In utilizing the PDCA cycle, rather than setting target indicators that are difficult to improve in the short term, such as the percentage of individuals retaining 20 or more teeth at age 80, the recent trend is to focus on utilizing outputs and intermediate outcomes that provide more visible evidence of progress regarding execution and improvement. Lastly, an excessive focus on target indicators alone may overlook certain trends, such as an increase in individuals with fewer teeth due to aging, and the high dental treatment needs for dental caries and periodontal disease compared to other conditions. As in the broader medical field and in line with international trends, such as the WHO resolution on oral health, Japan’s dental sector must recognize the limitations of target indicators and also consider other indicators, when necessary.

References
 
© 2024 National Institute of Public Health, Japan
feedback
 Top