The third term of Health Japan 21 focuses on developing “health promotion that leaves no one behind” (Inclusion) and promoting of “more effective measures” (Implementation) in response to the diversity in health issues that accompanies the diversity of society. The vision behind the third term is “achieving a sustainable society in which all citizens can lead healthy and fulfilling lives,” and is scheduled for a 12-year period from FY2024 to FY2035. The basic direction of the vision is to promote health a based on the life course approach, improve the quality of the social environment over and above improving individual behavior and health status, ultimately achieving an increase in a healthy life expectancy and reduction in health disparities, and conduct a health promotion campaign to realize the vision and health promotion that leaves no one behind. In developing health promotion that leaves no one behind, Health Japan 21 (the third term) incorporates new perspectives such as women's health, the creation of a naturally healthy environment, setting goals that involve coordination with other plans and measures, presenting action plans, and specifying descriptions of the visualization and utilization of personal health information. A total of 51 goals were set for the third term. In principle, the targets should be based on scientific evidence on health and sustainability. A post-event grasp of an actual situation should be considered, and official statistics should be used as the data source. Higher targets should be set for issues for which the earlier targets have been achieved. New targets include increasing the number of people who get enough sleep, decreasing the mortality rate from chronic obstructive pulmonary disease, promoting “strategic initiatives for a healthy and sustainable food environment,” promoting health management, and increasing the rate of osteoporosis examinations. The evaluation method and timing should be decided during plan formulation. This has been done, and a baseline is presented using the results of the 2024 National Health and Nutrition Survey as the latest values. An interim evaluation will be conducted for all goals by 2029, six years after the start of the plan, and a final evaluation, by 2033, ten years after the start of the plan so that the results of various activities to achieve the goals can be appropriately evaluated and reflected in subsequent health promotion efforts. In response to this evaluation and analysis, the basic policy will be updated as necessary to promote health more effectively through the Plan-Do-Check-Act (PDCA) cycle.

Basic Matters (First Phase) were published in 2012 based on the Dental and Oral Health Promotion Act. Nineteen indicators were established to assess the progress of the basic matters (first phase), which were evaluated in 2023. Based on the final evaluation, the Basic Matters (Secondary) of the Dental and Oral Health Promotion Plan were launched in 2024.

This study highlights the dental and oral health challenges in Japan and reviews the achievements of the 19 indicators presented in the final evaluation report of the basic matters (first phase). It also provides an overview of the basic matters (secondary), including 17 newly established evaluation indicators.

A data health plan is an implementation plan for the health services provided by medical insurers. To contribute to maintaining and promoting the health of the insured, medical insurers and others must provide health services effectively and efficiently, using health and medical information such as the results of specified health examinations, specified health guidance, and receipt data, among others, in the Plan-Do-Check-Action (PDCA) cycle. The data health plan was initiated by the Revitalization Strategy of Japan (approved by the Cabinet in 2013). The 1st-term plan for FY2015–FY2017 (3 years), 2nd-term plan for FY2015–FY2023 (6 years) have been completed, and 3rd-term plan for FY2024–FY2029 (6 years) are in progress. The latest guidance for formulating data health plans is contained in the Guidance for Formulating National Health Insurance Health Service Implementation Plan, Guidance for Formulating Health Service Implementation Plan for Older people, and Guidance for Formulating Data Health Plan 3rd Revised Edition, respectively. This study focuses on those for the national health insurance and provides explanations with reference to the abovementioned guidance and other documents.

The 3rd-term data health plan is characterized by standardization. The advantages of standardization include monitoring over time using the same indicators, comparisons with other insurers, and a reduced workload. Standardization includes the standardization of (1) forms, (2) indicators, and (3) the flow of formulation. The flow of formulation involves analyzing the current situation, identifying health issues, and considering and describing objectives, goals, strategies to achieve the goals, and respective health projects. To standardize a form, the sheet of the overall plan is designed to describe the insured’s health issues (priority health issues), objectives in the overall data health plan (including evaluation indicators and target values of the overall plan), strategies to achieve the objectives, and the respective health projects. Common evaluation indicators are provided for national health insurance, wide-area federations for older adults, and health insurance associations.

In addition, the formulation guidance describes points of analysis, an identification of health issues, objectives, targets, and strategies, a cooperation with healthcare professionals, an integrated implementation of health services and care prevention, and a comprehensive community care.

Health insurance associations are promoting initiatives such as data health portal sites, collaborative health, and health scoring reports.

The PDCA cycle is expected to be implemented through actions such as respective health projects to maintain and promote people's health effectively and efficiently.

The Specific Health Examination and Specific Health Guidance Program began in FY2008 to promote prevention of lifestyle-related diseases with a focus on metabolic syndrome. In the fourth phase (FY2024–FY2029), questions on smoking and alcohol consumption were revised, and more detailed options were added to identify risk more accurately. In addition, the question regarding checking the history of receiving specific health guidance was revised. The main achievement goals of the specific health guidance were set at a two cm abdominal circumference and two kg reduction in body weight. Emphasis was placed on behavioral changes (improvement in lifestyle habits such as eating, exercise, smoking, and rest habits) that lead to the prevention of lifestyle-related diseases. This study reviews the history of prevention of lifestyle-related diseases in Japan and provides an overview of the above system and points emphasized in the fourth phase.

The purpose of medical care plans is to ensure a medical care provision system in a prefecture according to the actual conditions of the region and the basic policy established by the national government. The plan period is six years, with necessary interim reviews. The main items in a medical care plan are the establishment of medical districts, calculation of the standard number of beds, matters related to five diseases, six services, and home medical care, those related to securing doctors, matters pertaining to securing an outpatient care provision system, and a community health care vision. The eighth medical care plan will begin in FY2024.

The plan should address community health care issues highlighted by the spread of the COVID-19 infection. In addition, medical care during emerging infectious disease outbreaks and epidemics was added. It is also important to review based on guidelines added during the seventh medical care plan period regarding the plan for securing doctors, outpatient care plan, and the set of specific medical areas, among others.

As entities that formulate medical plans, prefectures are required to establish effective and efficient medical care provision system. It is necessary to make medical care plans more functional and promote the community health care vision.

The Ninth Insured Long-Term Care Service Plan will also commence in FY2024. As the number of elderly with combined medical and long-term care needs is expected to increase, cooperation between medical and long-term care services will become increasingly important. Therefore, to achieve a functional differentiation and coordination, prefectures are also required to work closely with municipalities to ensure consistency between medical care plans and insured long-term care service plans.

Because the demand for medical and long-term care differs across communities, it is possible to discuss community health care vision and community-based integrated care using objective data based on demographics and age structure and visualize community medical and long-term care provision system. Therefore, establishing indicators for this management and the concept of prioritization for an effective use of the limited medical resources will become even more important in the future.

With regard to Basic Guidelines, municipalities and prefectures are required to provide the Municipal Insured Long-Term Care Service Plan and Prefectural Insured Long-Term Care Service Plan by specifying three years as one term under the Long-Term Care Insurance Act.

These are offered for an efficient implementation of insurance benefits. The Municipal Insured Long-Term Care Service Plan sets out the prospective quantities of service by type covered by long-term care benefits as well as the details of and targets for the initiatives to prevent long-term frailty. The municipality sets the long-term care insurance premium. Prefectures are required to support municipalities as insurers. The content of and goals for support for municipalities must be set forth in a Prefectural Insured Long-Term Care Service Plan.

The long-term care insurance system began in FY2000, and the three-year period starting FY2024 constitutes the ninth period. The plan period includes the year 2025, when all baby boomers will be 75 years of age or older. We have been working on establishing a community-based integrated care system and other initiatives toward 2025. Looking ahead to 2040, when the elderly population is expected to peak, it is necessary to consider measures to address a further decline in the birth rate and population aging, as well as measures that are more tailored to local conditions, such as those to address the substantial regional differences in the aging process.

In light of this, Insured Long-Term Care Service Plans for the ninth period require the following three major responses. 1. Systematic development of a long-term care service infrastructure, 2. Efforts to deepen and promote community-based integrated care system, and 3. Maintain sufficient manpower to support the community-based integrated care system and improving productivity in long-term care. Over the next three years, efforts will be required to build long-term care service infrastructures and the human resources to support them in accordance with local conditions, strengthen the management of long-term care insurance, and realize a community-based inclusive society.

In addition, the number of older adults with complex medical and nursing care needs is expected to increase; hence, cooperation between medical and long-term care services is more important. This is the year in which medical plans are also be formulated, and prefectures are required to ensure the volume of long-term care services through the Insured Long-Term Care Service Plans, including establishing community-based integrated care system and developing home medical care under medical plans, including regional medical plans. Therefore, a close cooperation between prefectures and municipalities must be promoted.

While the number of older adults requiring nursing care is expected to increase, the working-age population is expected to rapidly decline. Therefore, to sustain the system, planning and implementing measures from a medium- to long-term perspective are necessary.

This study outlines the requirements from prefectures and municipalities in developing the infrastructure for welfare services for persons with disabilities based on the basic guidelines of the Seventh Welfare Plan for Persons with Disabilities. The basic guidelines have been rapidly expanding in recent years, as a coordination of services across domains and an integration of service delivery systems are required to realize a community-based inclusive society, and it has become clear that a policy harmonization among health and other welfare fields is essential. Meanwhile, data-based health management initiatives are underway in Japan to improve data collection in the health, medical, and long-term care fields and use these data in service provision. In the welfare of persons with disabilities, the environment is being improved to use the National Database of Welfare Services for Persons with Disabilities of Japan that includes data indicating disability support categories and the claims for welfare services for persons with disabilities. Moreover, with a growing demand for Evidence-based Policy Making (EBPM), the basic guidelines also indicate that in addition to the expected volume of various services, output indicators should be set for goals and activities to confirm the status of measures. Prefectures and municipalities are required to implement the PDCA cycle by evaluating performance during the planning year, which is once every three years and taking countermeasures when necessary. Under these circumstances, it is predicted that there will be disparities in the efforts of prefectures and municipalities, which vary in size and local resources. Therefore, it is expected to enhance wide-area coordination and support for municipalities at the level of prefectures and disability health and welfare regions and to reflect the diverse needs of those who need services more precisely in developing infrastructure for disability welfare services according to the actual regional conditions.

Due to the rapid increase in the number of suicides in Japan in 1998, the problem of suicide has gained considerable attention. The Japanese government has promoted suicide prevention measures through revisions to the Basic Act on Suicide Prevention (2006) and the General Principles of Suicide Prevention Policy (2007). However, suicide trends in Japan have changed since the start of the COVID-19 pandemic. Herein, we overview the suicide prevention measures in Japan by reviewing the establishment and revisions to the General Principles of Suicide Prevention Policy and subsequently refer to the suicide trends during the COVID-19 pandemic in Japan. Notably, the number of suicides among women and children has increased compared to that before the pandemic, and researchers have suggested that this is attributable to irregular employment among women and less communication among children. The General Principles of Suicide Prevention Policy, revised in 2022 during the pandemic, includes measures that address the impact of the pandemic. The primary themes related to the General Principles of Suicide Prevention Policy and the implementation of suicide prevention measures include prompt responses in emergencies, discussions regarding the effectiveness of each measure, measures of slander on SNS, and development of a platform for suicide prevention.

Objectives: The COVID-19 pandemic made it difficult to implement clinical practice in basic nursing education. Clinical practice was canceled or postponed, and on-campus alternatives were implemented. In this study, we examined whether the reduction in total days of clinical practice due to the COVID-19 restrictions had an effect on nursing students' acquisition of nursing skills.

Methods: The total days of clinical practice and self-reported achievement level of nursing skills among students at University A were extracted from existing data for secondary analysis. To clarify students' nursing skills acquisition status, based on the graduation attainment level determined by the Ministry of Health, Labor and Welfare, we calculated the proportion of those who achieved the level and those who did not, for each of the 144 nursing skills. Next, to examine the impact of shortening the total days of clinical practice on students' nursing skill acquisition, the association between the total days of clinical practice and the nursing skill achievement rate against the graduation attainment level was evaluated using Spearman's correlation coefficient. Furthermore, descriptive statistics and t-test were used to evaluate the difference in the total days of clinical practice between the group that achieved the graduation attainment level and the group that did not. All analyses were performed using EZR on R commander 1.61.

Results: Of the 144 skills evaluated, in 22 skills, 80% or more students achieved the graduation attainment level, while in 18, 80% or more did not. The skill acquisition and non-acquisition patterns were consistent with findings from studies conducted before the COVID-19 pandemic. The correlation between the total days of clinical practice and the nursing skill achievement rate was not significant, as indicated by the correlation coefficient of -0.113 (p = 0.395). In 9 of the 144 skills, the non-achievers group had significantly more days of clinical practice than the achievers group.

Conclusion: The reduction in the total days of clinical practice had no significant effect on students' acquisition of nursing skills, suggesting that the on-campus alternative practice conducted during the COVID-19 pandemic contributed to students' acquisition of nursing skills. However, since clinical practice involves learning aspects other than technical skills, further research is necessary to assess the overall impact of reduction in the total days of clinical practice.

Objectives: This study focused on food after weaning and examined the children's diet and home environmental factors that influence parents' concerns for his/her infants aged 1.6 and 3 years.

Methods: In the analysis, 646 participants, excluding invalid responses, who cooperated with the survey during health checkup for 1.6- and 3-year-old in the Tohoku, Chubu, and Chugoku regions from March 2019 to January 2020, were included. The survey included 56 items of dietary, lifestyle, and health concerns (yes/no answers), child attributes, and frequency of food intake (six options, 18 types). Concern factors were extracted by factor analysis. The association between the worry scores and each the diet and home environmental factor was analyzed.

Results: In the 1.6- and 3-year-olds, high scores for health awareness and lifestyle were associated with low fruit intake, high salty snacks intake, and low subjective economic status; high scores for diet content and atmosphere were associated with low intakes of carotene-rich vegetables, other vegetables, seaweed, and fruits; high scores for interest and motivation in food were associated with low carotene-rich vegetables intake; high scores for food experience and behavior were associated with high cereals (bread) intake and low subjective economic status. The 3-year-olds were associated with high scores and being boys.

Conclusion: We extracted four concern factors that parents have with his/her children after the weaning period and clarified the children's diet and home environmental factors related to the concern factors.

The formation potentials of haloacetic acids (HAAs) in raw water and the behavior of HAAs in process waters and finished water were investigated during the high turbidity of raw water associated with typhoons and heavy rains and normal turbidity conditions. During the high turbidity conditions, the HAA formation potentials increased with an increase in total organic carbon. In case of high turbidity levels of raw water, the concentrations of HAAs, particularly dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA), in process water and finished water were higher due to prechlorination. The decrease of removal rate of the DCAA formation potentials in the coagulation and sedimentation processes by prechlorination was greater than those of TCAA. For both substances, the removal rates of their formation potentials were lower for the longer prechlorination time, and the percentage of reduction was about the same level. In the high turbidity levels of raw water, the removal rate of the HAA formation potentials by the coagulation and sedimentation processes was high, but the formation potentials after prechlorination significantly increased from normal turbidity levels.