Now Japan is facing new social problems such as an increase in anxiety about child care and child abuse, psychological problems of parents and children, and child-rearing stress after dramatically improvement of the health of mothers and children.

To approach such new issues, Healthy Parents and Children 21 revealed maternal and child health initiatives, directions, goals, and indicators for the 21st century in 2001. Since then, many issues related to adolescent health, safe pregnancy and delivery, and child health care have been further improved. Now, the second term of Healthy Parents and Children 21 from 2015–2024 aims at improving the lives of parents and children by ensuring constant, high-quality maternal and child health services all over Japan, and developing diverse maternal and child health services that cover various problems of child-rearing.

This paper provides a summary of past maternal and child health policies and an overview of the maternal and child health policy since 2001, especially focusing on the first and second terms of Healthy Parents and Children 21—Japan’s maternal and child health policy.

In Japan, with rapid aging, the measures surrounding oral health care in the elderly have significantly improved. Previously, prioritized goals concerning the prevention of dental diseases and an increase in the number of remaining teeth were adopted. However, maintaining and improving oral function are the new goals to be adopted, in addition to those goals. For prolonging healthy life expectancy, countermeasures against the frailty of oral function are necessary because oral function is frequently found to be deteriorating in the elderly. It is said that lowering oral function is a significant risk factor for malnutrition and sarcopenia. The concept of “oral frailty” was initially advocated in Japan. Oral frailty among the community-dwelling elderly has a close association with their nutritional condition. A healthy diet with well-balanced masticatory and swallowing function greatly contributes to improving the entire body function. Recent Japanese oral health policy and novel approaches to oral health care in the elderly will be beneficial to the other middle-income Asian countries as well. Thus, this article reviews the current situation of geriatric oral health care and countermeasures against oral frailty as a new concern in geriatric oral health in Japan.

For the Tokyo Olympic Games and Paralympic Games in 2020, the Ministry of Health, Labour and Welfare of Japan is working on various public health issues. Among them, this paper picks up three topics: secondhand smoke measures, securing food safety and supervising the private lodging business, and reviewing the present conditions, challenges and countermeasures. We also present some of our research works related to those subjects.

For the Tokyo 2020 Games, the Health Promotion Act was revised and the Tokyo Metropolitan Government passed the Smoking Prevention Ordinance in 2018. The laws have strong restrictions to prevent unhealthy effects by secondhand smoke. However, Japan has a large sales volume of heated tobacco products that are difficult to handle with the law.

Regarding food services, the “Basic Strategy for Food and Beverage Services at the Tokyo 2020 Games” was formulated. As countermeasures against the hazards of food security, the following matters are shown: compliance, voluntary hygiene control, cooperation with administrative organs, food defense, and cooperation with targets of food and beverage services.

Private lodging (minpaku in Japanese) has spread rapidly in the past several years. It has been promoted by the government as promoting tourism, regional activation, and effective utilization of vacant houses. The Private Lodging Business Act came into force in June 2018 for disseminating proper minpaku under certain rules. There are three types of minpaku: with permission under the Inns and Hotels Act, with authorization of the National Strategic Special Zones Act, and registered under the Private Lodging Business Act. At the moment, the Private Lodging Business Act does not contain sufficient rules regarding securing public health.

It is necessary to conduct research to accumulate evidence gradually for health impact assessment and to contribute to public health policy for the success of the Tokyo 2020 Games.

In Japan, annual medical expenditure reached 40 trillion yen in 2013 and it continues to increase under public health insurance scheme. One of the reason of increasing medical expenditure is population aging. However, another big reason is increasing technologies in health care, such as advanced medical devices and new pharmaceuticals. Insurance coverage and reimbursement prices are discussed and determined by the Ministry of Health, Labour, and Welfare. The Ministry has to consult with Central Social Insurance Medical Council (Chuikyo). Chuikyo has own rules for pricing pharmaceuticals and medical devices.

From fiscal year 2012, discussions on economic evaluation began within a subcommittee of the Chuikyo, Several issues were discussed in the subcommittee, such as target products to be evaluated, methods for evaluation, use of evaluation results. Based on the discussion in the subcommittee, in 2016, a pilot program of cost-effectiveness evaluation started for 7 pharmaceuticals and 6 medical devices. In the evaluation process, manufacturers of selected products were asked to submit cost effectiveness analysis, according to the guideline for cost effectiveness analysis. Then, submitted data were reviewed and re-analysed, if necessary, by expert groups. The results were discussed in the expert committee of cost effectiveness to make final decision. Based on the results, prices of some products were adjusted.

From 2019, economic evaluation of pharmaceuticals and medical devices will be fully implemented in order to provide efficient health care. To make the new evaluation system meaningful , “Center for Outcomes Research and Economic Evaluation for Health (CORE2-Health)” was established in the National Institute of Public Health to provide good evidence on cost effectiveness.

In Japan, the number of users of the long-term care system has been rapidly increasing, leading to increasing expenditure on benefits; this situation has become an issue from the perspective of the sustainability of the system. In addition, regional disparities in the long-term care cost per person and support for family caregivers are also a challenge. In responding to these issues, it is necessary to promote policies based on evidence, improve the quality and productivity of long-term care services, and expand various services in the community through public participation.

This study aimed to summarize the current status and issues concerning long-term care policies, and introduce the Comprehensive Service for Preventive Care and Daily Life Support for developing diverse care services provided by local citizens and promoting mutual aid in local communities, with the key concepts of “public participation” and “local resources.” Meanwhile, as a trend toward the promotion of evidence-based policy, we discussed an outcome evaluation of long-term care services and an evaluation of the efforts of local governments to support self-reliance and prevent the deterioration of health of the older adults. We reviewed empirical analyses with data and scientific evaluation on long-term care services or their delivering system from various viewpoints, that is, health services research in long-term care. In short, this work clarified the current issues in long-term care policy and research.

As regional disparities become more apparent in Japanese society, the prospect of maintaining a nationwide uniform service system needs to be examined, and the concept of “equity,” revisited. In addition, long-term care service contents will vary dramatically. It will be necessary to break one-way and fixed relationship between the carer and the cared. Multi-disciplinary coordination that includes residents will become more important. To respond appropriately to these issues, scientific evidence-based practice is indispensable where the views and quality of life of patients and the public must be fully considered.

This paper outlines the history of research and development (R&D) for intractable & rare diseases in Japan, and describes how the National Institute of Public Health (NIPH) has been involved in and contributed to R&D and how the NIPH will address it.

Since 1972, R&D for intractable & rare diseases had been implemented in accordance with the “Outline of Intractable Disease Measures”, which was a policy guideline for implementing national measures for addressing intractable & rare diseases. Because the outline listed “promotion of survey/research” as high priority measure, a wide range of research, including basic, clinical, and epidemiological research, was promoted for years. However, the goal of the research was not so clear, and on the other hand, it was not focused on development of orphan drugs, unlike in other countries. The R&D projects on intractable diseases were mainly implemented in the Research Program for Overcoming Intractable Diseases, funded by the Ministry of Health, Labour and Welfare. After the budget for the program was increased substantially, to 10 billion yen in 2009, the R&D was divided in two directions: “Expansion of target diseases for survey/research”, and “Development and clinical application of innovative medical technology such as pharmaceuticals”. Then, the NIPH became the Funding Agency for the program in 2010, and addressed clarification of the goal of research projects and development of the management system of the research program. As a result, disease concepts and diagnostic criteria were established for many diseases for which surveys and research had scarcely been conducted. Moreover, clinical trials and regulatory approvals were completed for several drugs and medical devices.

Since the enactment of the Act on Medical Care and Social Supports for Patients with Intractable/Rare Diseases in 2014, and the foundation of the Japan Agency for Medical Research and Development in 2015, the framework of R&D for intractable & rare diseases has changed significantly. Research programs had been divided into two programs: the Research Program on Policy of Measures for Intractable/Rare Diseases, and the Research Program on Practical Application of Measures for Intractable/Rare Diseases. The NIPH had the role of the funding agency for the former research program, and had the responsibility for providing a scientific basis for supporting the medical cost subsidy system and the medical services delivery system under the act, which meant establishing diagnostic criteria, disease severity classifications, and clinical practice guidelines.

Since 2014, the NIPH has established a new research program management system as follows: (a) The goal of the research program was set as maximizing the number of diseases for which diagnostic criteria, disease severity classifications, and clinical practice guidelines were developed or revised by the research projects, and were approved by the relevant academic societies; (b) It was required for each research project to set the goals for each disease to be studied, such as development of diagnostic criteria and disease severity classifications, revision of clinical practice guidelines, approval for the clinical practice guidelines by academic societies, etc.; (c) Annual submission of the research outcome report was made mandatory for each project in order to implement progress management and evaluate the research outcome. As a result, diagnostic criteria and disease severity classifications were developed or revised for many intractable & rare diseases at the end of 2017 (85% and 78% of 582 target diseases, respectively). On the other hand, the number of cases of development or revision of clinical practice guidelines remained at one half, and therefore, it is necessary to have projects set an appropriate goal in accordance with the program policy...

Japan Ministry of Health, Labour and Welfare (MOHLW) hosted the Third Patient Safety Ministerial Global Summit in April, 2018, in Tokyo, Japan. Healthcare quality including patient safety is one of critical aspects to achieve Universal Health Coverage (UHC) under Sustainable Development Goals (SDGs). Japan has been striving for patient safety improvement around the last 20 years. This article describes some of the recent activities including the new reporting system of death cases due to medical accidents, the reform of patient safety management at advanced treatment hospitals. These our experiences in Japan would be useful for other countries.