The Sustainable Development Goals (SDGs) are international goals adopted in 2015 that aim to create a better world by 2030. The SDGs consist of 17 goals, 169 targets, and 232 indicators that were selected to monitor the achievement of the SDGs, to “leave no one behind” and achieve a sustainable, diverse, and inclusive society. Among the 17 goals, SDG3, the health-related goal, consists of 13 targets and 28 indicators. Universal efforts have been made to transcend the boundaries between developed and developing countries, as well as those between governments and the private sectors, to meet the SDGs.

In 2019, the United Nations General Assembly proclaimed the Decade of Action to accelerate efforts to achieve the SDGs. The risk of the COVID-19 pandemic and the disruption of essential health services was discussed at the 74th World Health Assembly in 2021. In response, the WHO plans to assess the impact of COVID-19 on the progress toward achieving the SDGs.

After adopting them in 2015, the Japanese government established Promotion Headquarters as well as three initiatives to develop the domestic foundation for achieving SDGs through domestic implementation and international cooperation. The SDGs Implementation Guiding Principles was formulated in 2015 and revised in 2019. The revised Guidelines for the Implementation of the SDGs list eight priorities for Japan's efforts, with SDG3 falling under Priority 2, the “Promotion of Health and Longevity,” and Priority 6, the “Conservation of Environment, including Biodiversity, Forests and Oceans.”

Second, specific measures have been added to the “SDG Action Plan” by the Promotion Headquarters since 2018. The “SDGs Action Plan 2021” states that Japan will accelerate its efforts to achieve the SDGs despite delays due to the COVID-19 pandemic. Additionally, it stipulated the importance of building a strong and inclusive health system to prepare for the next health crisis and to promote universal health coverage, as outlined in SDG 3.

Lastly, efforts to promote and achieve the SDGs are published in the Voluntary National Review, which was prepared in 2021 for the second time since 2017. Regarding Priority 2, the “Promotion of Health and Longevity” related to SDG3, the extension of healthy life expectancy was identified as an important domestic issue and the strengthening of health and medical systems in developing countries was identified as an important element of international cooperation. The government has thus made efforts to strengthen the SDG promotion and progress evaluation system.

The Sustainable Development Goals (SDGs), adopted in September 2015 as successors to the Millennium Development Goals, establish health goals for both developing and developed countries, further strengthening international efforts to “leave no one behind.” SDG 3 aims to "Ensure healthy lives and promote well-being for all at all ages" by implementing Universal Health Coverage (UHC), which is defined by fourteen tracing indicators in four areas of coverage of essential health services as Target 3.8.1, including reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases, and service capacity and access. This study examines the utility of national statistics and administrative reports according to UN metadata for these indicators in Japan and reviews the monitoring status and international partnership of OECD countries for supporting developing countries.

This review reveals changes in ageing measures related to the SDGs and examines ageing indicators based on the SDG framework. In addition to a review of secondary data published by the United Nations and other organizations, a literature search was conducted using Pub Med and Scopus to summarize the evaluation indicators for the elderly at the national level. We also examined whether the extracted indicators could be calculated when applied to Japan.

The WHO has suggested that the concept of “Healthy Ageing” is essential to meeting the SDGs. The Active Ageing Index (AAI) has the best track record as a national indicator for “Healthy Ageing.” The AAI can be adapted to Japan to some extent by utilizing existing statistical data. However, there are some indicators for which there are few approximate data, such as those for which the age category is 55 or older as well as indicators concerning “political participation.” Thus, additional surveys must be conducted to calculate the AAI in Japan. The AAI was also significantly related to the service access subscale score of the UHC Service Coverage Index (SCI).

The results of this study suggest that the AAI is a suitable indicator for assessing ageing. However, the existing statistical data are insufficient for applying the AAI to Japan. Therefore, it is necessary to consider utilizing alternative values identified through additional surveys and estimates

In 2015, the United Nations General Assembly ratified the Sustainable Development Goals (SDGs), which set 2030 as the target year for their achievement. Maternal and Child Health (MCH) was identified as a remaining challenge from the Millennium Development Goals. The SDGs address maternal and child health concerning maternal mortality, under-five and neonatal mortality, young childbirth, and essential health service coverage under Universal Health Coverage, in which everyone has access to quality health services without financial risks, such as access to family planning, prenatal care, child immunization, and child pneumonia treatment. Many of these goals have already been achieved in Japan. Particularly, maternal and child mortality has been improved since 1900 by measures such as the implementation of rural health surveys to assess the health status of mothers and children; the establishment of Aiiku-Kai, community-based maternal and child support activities carried out by local residents; and the promotion of institutional deliveries and health education by municipal maternal and child health centers.

Japan lacks primary data regarding access to prenatal care and the treatment of pneumonia in children and there are limitations in the collection of data for SDG indicators related to maternal and child health. Additionally, these goals and indicators are not appropriate for improving the current state of maternal and child health in Japan. Japan cannot monitor achievement of the SDGs' principle of “leaving no one behind” under the current situation. The challenges of maternal and child health as expressed in the SDGs should not be considered issues of the past for Japan. Rather, it is necessary to consider current maternal and child health challenges in Japan from the perspective of initiatives in the SDGs' philosophy of “leaving no one behind.”

To achieve sustainable development goal 3, accurate monitoring of epidemics and assessment of prevention program are important for the control of infectious diseases. WHO/UNAIDS announced “90-90-90（95-95-95）targets for ending the HIV-1 epidemic” in 2014. WHO/UNAIDS announced “90-90-90（95-95-95）targets” in 2014 based on the concept that early diagnosis and treatment after HIV infection leads to a decrease of HIV-1 incidence. In many countries, it is challenging to estimate HIV-1 incidence, prevalence, and assess ART rates. In this article, I present a summary of the current status of the HIV-1 epidemic using published data and discuss the applications of SDG3 monitoring indexes.

Objectives: This study aimed to develop proposed indicators for Sustainable Development Goals section 3.5 (SDGs 3.5) based on existing databases published in Japan.

Methods: The following data sources were selected to identify potential indicators because they contained information consistent with the research objectives, the surveys were conducted sustainably, and the information was available on the Internet: Nationwide General Population Survey on Drug Use in Japan (2007–2019), reports on the status of the implementation of a substance abuse preventive class (SAPC) (2015–2018), Nationwide Mental Hospital Survey on Drug-related Psychiatric Disorders (2012–2020), and mental health and welfare-related reports from the National Database (2014–2017).

Results: The lifetime prevalence of illicit drug use among the general population in 2019 was as follows: marijuana, 1.81%; methamphetamine, 0.39%; inhalants, 1.09%; MDMA, 0.30%; cocaine, 0.34%; heroin, 0.13%; new psychoactive substances (NPSs), 0.31%; and LSD, 0.30%. Regarding changes in the lifetime prevalence of substance use from 2007 to 2019, marijuana showed a significant increase, while inhalants showed a significant decrease. The SAPC implementation rate was 78.6%, 90.6%, and 85.8% in elementary, junior high, and high schools respectively. The proportion of principal drugs among patients with substance use disorders (SUDs) visiting psychiatric facilities was as follows: methamphetamine, 36.0%; hypnotics/anxiolytics, 29.5%; over-the-counter drugs (OTCs), 15.7%; polysubstance, 7.3%; marijuana, 5.3%; inhalants, 2.7%; non-steroidal anti-inflammatory drugs, 0.7%; opioids, 0.5%; and NPSs, 0.3%. While the proportion of methamphetamine cases has remained the highest, the proportions of hypnotic/anxiolytic and OTC cases are increasing. The number of inpatients with SUDs in psychiatric wards was 1,689 in 2014, 1,437 in 2015, 1,431 in 2016, and 2,416 in 2017. The number of outpatients who received treatment for substance use at least once was 6,636 in 2014, 6,321 in 2015, 6,458 in 2016, and 10,746 in 2017.

Conclusions: Considering the accumulation and sustainability of databases in the area of substance abuse and dependence, we concluded that it is appropriate to use the following as SDGs 3.5 indicators for Japan: 1) the lifetime prevalence of illicit drug use in the general population; 2) the SAPC implementation rate in schools; 3) the composition ratios of the principal drugs among patients with SUDs in psychiatric facilities, and 4) the number of patients with SUDs and the medical facilities available to them.

Environmental health-related indicators must be examined when considering the Sustainable Development Goal (SDG) targets. A review of literature regarding chemical and physical issues that carry environmental risks in reports from WHO and other academic papers in Japan and overseas showed a relationship between indoor temperature difference and mortality. Further, indoor concentrations of semi-volatile organic compounds (SVOC) and humid environments were found to be related to allergic diseases, and atmospheric microparticulate matter was found to be related to respiratory and circulatory system diseases. Furthermore, the index related to 3.9.2 “Unsafe water, unsafe public health, and death due to unsafe hygiene knowledge” is defined using the sum of specific diseases, and the index is classified as Tier I, but the occurrence of water-borne diseases based on information from domestic water quality accident cases over the past 30 years was significantly lower than that reported by UN-designated coding using ICD10. This may be because the WHO WASH disease code was defined based on conditions in developing countries.

This study reviews the measures taken to ensure the radiation safety of food during the ten years since the accident at TEPCO's Fukushima Daiichi Nuclear Power Plant. The criteria used to ensure the radiation safety of food after the accident had been prepared in advance. In the situation of exposure during the period of recovery from the accident, indicator values for control were introduced based on international standards, and measures were taken following internationally harmonized regulations. Among the measures taken, the monitoring of the concentration of radioactive materials in foodstuffs was handled in accordance with the local situation using the PDCA cycle. Consensus-building among stakeholders will continue to be necessary as part of the post-accident response process.

When the Great East Japan Earthquake triggered the Fukushima Daiichi Nuclear Power Plant accident (the “Fukushima nuclear accident”), many residents evacuated to avoid radiation exposure. Two types of evacuation occurred: “forced evacuation,” in which residents living in the area of high-level radiation exposure were forcibly evacuated under the orders of the national or local government, and “voluntary evacuation,” in which residents living outside of the forced evacuation area voluntarily evacuated. Although these residents evacuated due to the same disaster, the support provided to the voluntary evacuees was inadequate, and little is known about the hardships they experienced. Thus, the purpose of this study was to explore the confusion regarding the evacuation of residents after the Fukushima nuclear accident and the problems voluntary evacuees experienced in their health and daily life to present suggestions for future disasters.

In the aftermath of the Fukushima nuclear accident, the national government gradually expanded the evacuation area. However, the residents did not understand this expansion and were confused. Hot spots were identified in which the annual accumulated radiation dose was estimated to exceed 20 mSv. The national government designated specific recommendations for evacuation areas without certifying any external areas. This led to more voluntary evacuations and increasing distrust in the government.

Most studies examining this issue have focused on mothers who voluntarily evacuated with their children and reported a lack of understanding about voluntary evacuation among their relatives due to the government’s assurances of safety, maternal physical and mental issues, the loneliness of children who were unable to see their fathers, and marital discord. The economic burden of living a double life was also found to be significant. Some of these evacuees returned to Fukushima when their children were admitted to school or when the residential support policy ended.

Several other studies focused on fathers who continued working in Fukushima after their wives and children voluntarily evacuated. The accumulation of fatigue from traveling back and forth between the evacuation area and Fukushima, the isolation caused by keeping their families’ voluntary evacuation secret, and the worsening of their physical and mental health were reported. These men might have felt anxiety and a fear of discrimination for their voluntary evacuation. Additionally, while tea ceremonies and meetings were held to prevent the isolation of mothers at the evacuation site, there were no support measures in place for men.

Another nuclear accident will likely occur in the future due to prior disasters, and voluntary evacuations will again take place. Therefore, local governments and those that are responsible for nuclear power plants should discuss and prepare support measures for voluntary evacuees under normal conditions.

Objectives: We analyzed hospitalization trends of medical services by secondary medical area in Shizuoka Prefecture to clarify the role and issues of the medical care system and the cooperation status of medical supply and demand in each area.

Methods: Population, geography, and inpatient background in Shizuoka Prefecture as a whole and in each secondary medical area were examined using the Shizuoka Prefecture Statistical Yearbook and Patient Survey by the Ministry of Health, Labour and Welfare. We calculated four indicators (within-area completion rate, within-area patient rate, dependence entropy, and medical treatment area entropy) and analyzed hospitalization trends. Secondary medical areas were classified according to the characteristics of inpatient medical services by using principal component analysis and inputting data on the four indicators. We examined trends in inpatient inflows and outflows according to classification of injuries and illnesses based on the 10th revision of the International Classification of Diseases (ICD-10).

Results: Of the secondary medical areas, Suntoutagata, Shizuoka, and Seibu served as central medical areas in Shizuoka Prefecture. Suntoutagata had a wide medical service area for neoplasms and the eastern part of the prefecture played a major role in emergency medical care. In Seibu, disparity within the area in terms of medical services for cerebrovascular diseases was found to be an issue. In Kamo, the only depopulated medical area in the prefecture, strengthening of the medical system was recognized, but its limited dependence on Suntotagata's emergency care was clarified. In Atamiito, inflows and outflows of inpatients were large, revealing a characteristic of its medical cooperation with multiple areas. In Shidahaibara, there were outflows of inpatients to multiple areas and medical dependence was decentralized.

Conclusion: We clarified the role and issues of inpatient medical services and the cooperation status of medical supply and demand by secondary medical area in Shizuoka Prefecture. Further analysis of these findings will contribute to realizing a high-quality medical system in each area.

Objective: Significant changes were introduced to the International Classification of Diseases in the 11th revision (ICD-11). Moreover, extension codes (supplementary information such as the severity of conditions and anatomical sites) have been introduced, which may change the content of coding and affect its quality. This study by using the coding data from a field trial conducted in Japan in 2017, we aimed to analyze the consistency in the results of the coding of diagnostic terms for which the gold standard (GS) codes were provided by the WHO. Specifically, we calculated the percentage of correct answers by comparing the raters' coding results based on ICD-10 with the WHO GS for ICD-10 codes. Similarly, we calculated the percentage of correct answers by comparing the raters' coding results based on ICD-11 with the WHO gold standard for ICD-11 codes. Subsequently, we analyzed the consistency between “correct/incorrect answers based on ICD-10” and “correct/incorrect answers based on ICD-11” to determine the necessary measures for the implementation of accurate coding.

Methods: A field trial involving 298 health information managers was conducted in Japan from August 1 to September 10, 2017. We calculated the percentage of correct answers in the coding of diagnostic terms based on ICD-10 and ICD-11. Moreover, the percentage of correct answers in the coding of the main conditions based on the ICD-11 was also calculated. We examined the relationship between these results and the characteristics of the codes. The characteristics of the codes included the number of GS codes, the number of digits in the codes for main conditions, the presence/absence of other specified codes (Y codes)/ unspecified codes (Z codes), and the presence/absence of extension codes. In addition, Gwet's AC1 was used to evaluate the consistency between coding based on ICD-10 and that based on ICD-11 in the evaluation results of valid response raters.

Results: The percentage of correct answers for cytomegalovirus colitis improved from 36.55% (coded using ICD-10) to 89.85% (coded using ICD-11), the highest among the 19 diagnostic terms. This was due to the assignment of a code for each disease in ICD-11, which enabled detailed classification. There were many diagnostic terms with a high percentage of correct answers based on ICD-11, that had few GS codes, few digits in the code for the main condition, and did not require extension codes, other specified codes (Y codes), or unspecified codes (Z codes). Low percentages (<5%) of correct answers in the diagnosis coding based on ICD-11 were noted for diagnostic terms that required multiple codes or extension codes. Diagnostic terms with a low Gwet's AC1 value of less than 0 also required extension codes.

Conclusion: The percentage of correct answers was high for diagnostic terms for which a detailed classification was introduced. The 11th revision of the ICD led to improved coding results. In contrast, the percentage of correct answers was low for diagnostic terms that required multiple codes or extension codes. The results of this study indicate that it is necessary to prepare sufficient educational content on the use of multiple codes and extensions. Since this field trial was conducted in an English environment (with the exception of some materials), sufficient training and a field trial conducted in a complete Japanese environment are required before the application of ICD-11 in Japan.

Object: First coronavirus disease 2019 (COVID-19) endemic wave in Japan was almost stabilized in late May in 2020, without strong physical distancing interventions. Our objective was to analyze temporal trends in the incidence of symptomatic COVID-19 during this phase in Osaka Prefecture (population of 8.8 million).

Methods: We calculated 7-day moving averages of the date-of-onset-based number of symptomatic COVID-19 cases using anonymous data posted on the official website of the Osaka Prefectural Government between February 27 and May 23 in subjects whose route of transmission was known (linked case) or unknown (unlinked case). Joinpoint regression analysis was performed. Daily percent change (DPC) in the incidence and dates of significant change (“joinpoint”) were identified in the Joinpoint regression analysis.

Results: The maximum daily number of symptomatic COVID-19 cases was 72 on April 3. From March 12 to April 2, the incidence of unlinked cases significantly increased (DPC: +14.8%). Then, the incidence rapidly decreased until late May with accelerating downward trend between April 12 and 17 (DPC%: -15.8%). The temporal change in linked cases was almost synchronized to that of unlinked cases with 6-7 days’ delay.

Conclusions: The peak incidence of unlinked COVID-19 cases in the first endemic wave in Osaka was observed at April 2, 2020. The temporal trend was synchronically followed by that of linked cases with 6-7 days’ delay.