The final evaluation of "Health Japan 21 (the second term)," which started in April 2013, ended in October 2022. According to the report, out of 53 target items, 8 items (15.1%) achieved the target value, 20 items (37.7%) improved, and 14 items (26.4%) did not change, while 4 items (7.5%) became worse, and 7 items (13.2%) were difficult to evaluate.

From 2010 to 2019, healthy life expectancy increased by 2.26 years for men and 1.76 years for women. As this is greater than the increase in life expectancy (1.86 years for men and 1.15 years for women), the most important goal of "Health Japan 21 (the second term)," of "increasing healthy life expectancy to exceed the increase in life expectancy" has been achieved.

On the other hand, the prefectural disparity in healthy life expectancy shrank for men, but increased for women. By showing the changes in prefectural disparities in various lifestyle habits, the author emphasized that in order to reduce health disparities, it is important to identify sub-populations with major health problems, and to strengthen efforts to raise their health levels.

The age-adjusted death rate (outcome index) for cancer, cerebrovascular disease, and ischemic heart disease decreased significantly beyond the target. On the other hand, regarding the lifestyle habits that are related to the above diseases (e.g., numbers of persons with metabolic syndrome and those at risk, percentage of obese persons, adult smoking rate, etc.) and the related clinical conditions (e.g., average systolic blood pressure, prevalence of hyperlipidemia, etc.), there was a contradictory phenomenon in which indicators remained unchanged or worsened.

Lastly, the author explained that the next National Health Promotion Plan is being formulated in view of future changes in the demographic, economic, and industrial structures in Japan. The author mentioned the points that should be kept in mind for all policy makers, at all levels of local governments.

As part of the final evaluation of Health Japan 21 (the second term), a survey was conducted to evaluate the health promotion measures in prefectures and municipalities during the campaign.

The results of the survey showed that there was significant progress in development of the system for health promotion, such as the system for evaluating health promotion plans and the cross-departmental organizational framework, in comparison to the time when the Health Japan 21 final evaluation was conducted. Although many local governments have been collaborating with departments other than health promotion departments, such as education departments and nursing care departments, only a small percentage of prefectures and municipalities have been collaborating with town/city development departments, which is considered to be one of the challenges.

While all prefectures and roughly half of municipalities understood the situation regarding health disparities, only about 10% of prefectures and municipalities were able to identify disparities due to socio-economic factors such as income, education, and occupation.

The results of the survey also showed that many local governments have promoted initiatives in the areas of cancer, cardiovascular disease, diabetes, nutrition and dietary habits, and physical activity and exercise, and that they would like to continue promoting measures intensively in these areas. However, fewer prefectures and municipalities promoted efforts in the areas of rest and alcohol consumption, and it is considered to be necessary to present specific measures to achieve the goals in these areas.

The Ministry of Health, Labour and Welfare is currently preparing the next plan based on the results of this final evaluation, and plans to publish it in the spring of next year. Prefectures and municipalities are encouraged to work on the next health promotion plan, which is to be launched in 2024, based on the results of the final evaluation and the next plan that will be drawn up by the national government.

The final evaluation of “Health Japan 21 (the second term)” was carried out in 3 stages: 1) evaluation of the target items against the target values; 2) evaluation of the results of various activities; and, 3) evaluation of the health promotion movement as a whole in the 21st century, and clarification of the issues that exist for formulating the next National Health Promotion Plan. This paper primarily explains the methods for stage 1), so that it can be used as a reference when evaluating the health promotion plans of local governments.

“Health Japan 21 (the second term)” has 53 specific “target items,” based on five basic directions. One or more specific “indicator(s)” are set for each target item, and the actual values ​​of the indicators against the target values, as well as related efforts are evaluated. To better understand the trends of the indicators by segment, the data were presented in a visual and attractive manner using charts and figures. In addition, confidence intervals were calculated for the values of indicators, a statistical test was performed, and adjustments for age were made if necessary and possible. By comparing the actual value of each indicator against the target value, an evaluation was made by classification into the following categories: A) achieved the target value, B) improved, C) unchanged, D) became worse, or E) difficult to evaluate. In addition to the individual indicators, the overall evaluation of each target item was similarly classified into A to E. The results of the evaluation and analysis for each target item were summarized in the “Evaluation Sheet - Form 1,” which included annual trends in the indicators against target values, data sources and calculation methods, analysis results (including issues regarding the survey), and the evaluations of the individual indicator(s) and target items. In the “Evaluation Sheet - Form 2,” the results of the evaluations were reported in more detail, consisting of a summary of the evaluation status of the target items, the organization of related efforts, analysis related to the evaluation of each target item, future issues, and the impact of the spread of the COVID-19 infection. Furthermore, in stage 2), the efforts of the national government, local governments, companies, and organizations were organized and evaluated. In stage 3), in addition to the evaluation of Health Japan 21 (the second term), the major flow of movement of Japan’s health promotion, continuing from Health Japan 21 was comprehensively evaluated, and the issues for the next National Health Promotion Plan were sorted out.

For convenience in evaluating the health promotion plans in local governments, PC tools that enable the same data analysis, such as age-adjustment, statistical tests, figures, and charts, that are used for the evaluation of “Health Japan 21 (the second term)” are provided on the website of National Institute of Public Health, and are also used in the training programs. When evaluating the local health promotion plans in prefectures and municipalities, it is advisable to refer to them, as necessary.

The indicators of healthy life expectancy that are used in the national health promotion program Health Japan 21 (the second term) are the “average period of time spent without limitation in daily activities,” “average period of time individuals consider themselves as healthy,” and “average period of time spent without requiring assistance for activities of daily living.” It has been confirmed that there are large differences in definitions and calculation methods among these three indicators. From 2010 to 2019 (the evaluation period for achieving the target of healthy life expectancy), the expected number of healthy years for each indicator increased nationwide. The expected number of unhealthy years for the “average period of time spent without requiring assistance for activities of daily living” increased slightly; however, those for the other two indicators decreased. The definitions and calculation methods of the indicators, and their nationwide trends from 2010 to 2019 are important for interpreting healthy life expectancy at the prefecture and municipality levels.

The purpose and methods of this paper are as follows: 1) First, the training courses at the National Institute of Public Health (NIPH) related to Health Japan 21 (the second term), which ran from 2013 to 2022, were reviewed. The review focused on (1) changes in the themes and issues of the training programs, (2) progress in the training methods and contents, and (3) project-related collaborations with other organizations as well as dissemination; 2) Next, the outcomes for the local governments that participated in the NIPH training were identified. This focused on comparisons of (1) progress in health promotion plans, between the group of local governments with a large number of participants, and the group with a small number of participants, and (2) certain indicators for Health Japan 21 (the second term), between the group of local governments with a large number of participants, and the group with a small number of participants, using published data from the National Health and Nutrition Survey; and, 3) Finally, future training at the NIPH was discussed.

The results were as follows:

1) The main theme for the Health Japan 21 Training course was “the planning of countermeasures and the creation of a system for resolving nutrition and dietary habits related to high-priority health issues;”

2) The training methods were conducted as follows: (1) The elements for nutritional measures to produce achievements in administrative dietician guidelines were shown, and (2) materials were presented for putting the guidelines into practice; (3) For the monitoring, evaluation, and review of health promotion plans, materials for understanding various survey results and tools for statistical analysis were created, and health issues were confirmed using them; (4) To proceed with the above analysis in local governments, long-term training at the NIPH was provided; (5) Measures were planned and coordinated using worksheets to improve nutrition and eating habits related to health issues; and, (6) In cooperation with other organizations (such as the Japan Public Health Association and the Japan Dietetic Association), programs were carried out to deepen and disseminate the training content of the NIPH.

3) The training courses had the following effects on the health promotion plans of local governments: (1) the group of local governments with a large number of participants identified disparities between areas and conducted a health promotion plan for working persons; and, (2) With reference to the effects of the indicators of Health Japan 21 (the second term), no difference was seen in the average BMI between the two groups in 2012. However, it was significantly lower in the group of local government with a larger number of participants in 2016. In addition, while no difference was seen in the average number of steps between the two groups in 2012, it was significantly higher in the group of local governments with a larger number of participants in 2016.

Although there are some limitations, it is thought that it is possible to evaluate the long-term effects of training at the NIPH using published data from existing surveys. For this purpose, it will be necessary to investigate the status of various indicators of health promotion plans of prefectures and municipalities at the time of formulation and interim and final evaluation, and to publish appropriate data continuously.

In addition, in this investigation, we attempted a long-term evaluation of two short-term training courses. However, it may be necessary to consider a standard long-term evaluation method for the entire range of training courses at the NIPH.

Objectives: Mothers' depressive symptoms are known to be associated with sleep problems in mothers and preschool children. More recently, it has been shown that mothers' depressive symptoms are associated with not only children's nighttime sleep problems but also daytime problems associated with sleep. However, until now, mothers' depressive symptoms and mothers' sleep problems, as well as children's nighttime sleep problems or daytime problems associated with sleep, have been examined separately. This study investigated the associations with mothers' depressive symptoms and mothers' and preschool children's sleep using a questionnaire that can simultaneously evaluate nighttime sleep problems and daytime problems associated with sleep.

Methods: A questionnaire survey was administered to 205 caregivers who have children attending nursery schools and kindergartens. From the 159 responses obtained (response rate of 77.6), 132 pairs of mothers and children (valid response rate of 83.0) were selected for analysis. The Japanese Sleep Questionnaire for Preschoolers (JSQ-P) was used to evaluate sleep problems of the children. The questionnaire was designed 10 factors, in this study, 6 factors of parasomnia, insomnia/rhythm disorders, morning symptoms, excessive daytime sleepiness, daytime behavior, and sleep deprivation, which were consistent with the purpose of this study were used. Athens Insomnia Scale (AIS) was used to evaluate mothers' sleep problems, and the Overall Depression Severity and Impairment Scale (ODSIS) was used to evaluate mothers' depressive symptoms. The analysis was based on the scores obtained by each questionnaire, and correlation analysis and multiple regression analysis were conducted.

Results: The results of the correlation analysis showed that the ODSIS positively correlated with “insomnia/rhythm disorder,” a nighttime sleep problem, and “daytime behavior,” daytime problems associated with sleep among the 6 factors of JSQ-P, and the 2 factors of the AIS. However, only the children's scores of “daytime behavior,” daytime problems associated with sleep, and maternal nighttime sleep problems were associated with the scores of ODSIS on multiple regression analysis (daytime behavior: β=0.20, p=0.03, maternal nighttime sleep problems: β=0.32, p=0.001).

Conclusion: Preschool children's daytime problems associated with sleep (daytime behavior) and the mothers' nighttime sleep problems were considered to be related to the mothers' depressive symptoms. The results suggest the necessity of assessing not only the mothers' sleep problems but also the children's nighttime and daytime sleep problems when considering the mothers' mental health problems in the future.

The “Basic Policy on Economic and Fiscal Management and Reform” approved by the Cabinet on June 7, 2022 includes the statement, “We will review cannabis-related programs and establish the environment needed for the use of cannabis-derived drugs,” and it is expected that regulatory development for the use of cannabis-derived ingredients in medicines will certainly progress in Japan in the future. Medical cannabis in the broad sense can be divided into three main categories: cannabinoid medicines, hemp-derived cannabidiol (CBD) products, and cannabis-derived products (medical cannabis in the narrow sense). What is currently under consideration in Japan is the lifting of the ban on the import, manufacture and use of cannabinoid medicines based on medical needs. Medical cannabis in the narrow sense is used in other countries as a substitute for cannabinoid medicines, but it contains Δ9-tetrahydrocannabinol (THC), which causes psychiatric dependence and has significant health effects. Therefore, it should be discussed separately from CBD, which has a low risk of dependence and abuse.

It has been pointed out that the background of recent cannabis abuse in Japan is that many young people disregard the harmfulness and danger of cannabis, and in promoting cannabinoid medicines and CBD products, care should be taken to avoid the spread of a false perception that cannabis is safe, which could lead to cannabis abuse. Health professionals should also strive to avoid affirming or spreading discourses that emphasize only the usefulness of cannabis. However, the situation regarding cannabis-derived ingredients has changed significantly since around 2018, and many health professionals have not had the opportunity to receive appropriate input in curricula. Therefore, it is necessary to provide opportunities for healthcare professionals to update their awareness of the situation and to enhance educational and awareness-raising content.