The Ministry of Health, Labour and Welfare (MHLW) launched the Strategic Initiative for a Healthy and Sustainable Food Environment in March 2022 as a platform to promote the creation of healthier food environments through collaboration among industry, academia, government, professional associations, and civil society. At the Tokyo Nutrition for Growth Summit 2021, the Japanese government committed to further advancing national nutrition policies under the principle of “leaving no one behind,” through multisectoral cooperation involving government, business, academia, professional associations, and civil society. Recognizing that the promotion of a healthy and sustainable food environment requires a multisectoral approach with nutrition at its core, the MHLW is implementing this Initiative in coordination with relevant ministries and agencies. The goal is to transform unhealthy dietary patterns—one of the major risk factors for non-communicable diseases (NCDs)—by improving the food environment through cross-sectoral collaboration. In Japan, excessive sodium intake across all age groups continues to be a significant public health concern, making salt reduction a top national priority. Other pressing nutrition-related challenges include underweight among young women, nutritional disparities linked to economic conditions, and broader environmental issues. The Initiative promotes the development of a food environment where everyone can naturally make healthier choices—regardless of individual health awareness—through collaboration among key sectors. By advancing these efforts, the Initiative aims to extend healthy life expectancy and help realize a vibrant, inclusive, and sustainable society, both in Japan and globally. In Health Japan 21 (Third phase), one of the key target indicators is full prefectural participation in this Initiative. To support the development of supportive food environments at the regional and local levels, a regional alliance has been established. Moving forward, it is expected that region-specific efforts will continue to be expanded and strengthened.

Since fiscal year 2023, the National Institutes of Biomedical Innovation, Health and Nutrition (NIBN) has been implementing the “Collaborative Project among Industry, Academia, and Government for Promoting Healthy Food Environments.” Currently, the project is being carried out in cooperation with eight companies. The objective of this project is to promote the development of an effective and sustainable food environment through research and surveys related to nutrition and dietary habits in collaboration with industry, academia, and government. This initiative aims to improve and enhance public health and thereby contribute to the advancement of national health. To date, efforts have included the development of a database compiling nutritional information on processed foods and recipes, the modification of a Nutrient Profile Model for dishes in Japan, the proposal of a model for a naturally health-promoting food environment, and the estimation of future public health and economic impacts through the promotion of healthy eating—backed by scientific evidence. Currently, following publication of the Nutrient Profile Model in Japan in September 2024, studies are underway to validate and implement it in society. Research to further improve the model itself is also ongoing. By integrating these efforts with the outcomes of this project, we aim to promote improvements in food and dish offerings by food businesses and enhance consumer access to healthier food options. In this manner, we are striving to contribute to the development of a naturally health-promoting food environment, fulfilling our role as a national center for research in health and nutrition policy.

This study aimed to establish a method for evaluating the effects of nutrition policies on reducing social security costs, by improving the health and nutritional status of the population and preventing illness and long-term care. Recent trends in salt reduction activities using a population approach have seen local governments taking the lead in collaboration with related organizations and local companies. A literature review on the effectiveness of personal nutritional guidance indicated that nutritional guidances was provided in a variety of ways to individuals with various health conditions in the community, workplaces, and medical institutions. With regard to nutritional policies overseas, from the perspective of the double burden of malnutrition, it was thought that double-duty actions for nutrition should also be considered from the perspective of nutritional policies and interventions targeting a wider range of generations, as has traditionally been done in Japan. The contribution of high sodium intake to disability- adjusted life years (DALYs) due to cardiovascular disease declined significantly between 1990 and 2017, but has been trending flat since the 2010s, and Japan has the highest contribution rate of high sodium intake among OECD member states. Regarding economic evaluation research on the reduction of social security costs by preventing cardio-metabolic diseases through nutrition policies, scientific evidence obtained from health economic evaluations based on simulation models on the costs and effects of national salt reduction policies for preventing cardiovascular diseases has been published overseas. A simulation study on the impact of long-term care prevention on medical and long-term care costs in the elderly showed that the total amount of medical and long-term care costs increases when the mortality rate decreases, but that this increase can be reduced if the proportion of dependent persons decreases through long-term care prevention. A study of long-term trends in mortality rates using simulations based on counterfactual scenarios estimated that approximately 298,000 deaths in men and approximately 118,000 deaths in women were prevented through salt reduction throughout the full period from 1950 to 2017. Regarding the effects of reducing medical costs related to cardiovascular diseases when the salt reduction target is achieved, it was suggested that moderate health economic effects can be expected if the reduction target for salt intake in adults is achieved. In order to evaluate the effects of Japan’s nutrition policies on reducing social security costs, it is necessary to further develop public health and health economic simulation research by referring to previous research overseas.

This paper explores the significance of addressing nutrition-related challenges through the lens of ESG (Environmental, Social, and Governance) finance, highlighting the growing role of institutional investors and capital markets in transforming food environments. Traditionally, nutrition policy has been the domain of public health authorities and international organizations. However, recent developments—such as the Access to Nutrition Initiative (ATNI) and the adoption of the Principles of Responsible Investment—have brought nutrition to the forefront of ESG finance strategies, particularly in the food and beverage industry. Institutional investors, especially “universal owners” such as pension funds and life insurers managing large and diversified portfolios, are increasingly recognizing that long-term financial returns depend on the sustainability of the overall economy. Unhealthy nutrition outcomes—such as obesity, undernutrition, and micronutrient deficiencies—impose significant macroeconomic costs, including reduced productivity, increased healthcare spending, and slower GDP growth. These risks are now considered to be material to long-term financial performance. Global forums, such as the 2025 Paris Nutrition for Growth (N4G) Summit, have emphasized the need for private sector engagement and transparency. ATNI’s investor frameworks encourage companies to disclose sales-weighted nutrition scores, adopt credible Nutrient Profiling Models (NPMs), and integrate nutrition into corporate governance and strategies. In response, global food companies are increasingly being assessed with regard to the nutritional quality of their product portfolios, marketing practices, and affordability strategies. In Japan, ESG investment has grown rapidly, but remains heavily focused on environmental issues, with limited awareness of nutrition as a financial and societal issue. The market structure, which is dominated by small and mid-sized food companies outside of institutional investor reach, places further limits on impact. In this context, regional financial institutions—particularly banks—are seen as key actors in promoting nutrition-sensitive business practices through ESG banking. This paper also highlights Japan’s progress in developing a localized NPM that reflects national dietary patterns and public health priorities. As the global financial community seeks standardization, reconciling local relevance with global comparability remains a central challenge. Overall, the paper argues that improving food environments through ESG finance is not only a public health imperative but also a strategic economic agenda. By integrating nutrition into financial evaluation and corporate dialogue, both financial institutions and policymakers can drive systemic change toward healthier and more sustainable societies.

In August 2024, Hyogo Prefecture launched the “Hyogo Healthy Eating Environment Creation Project (nicknamed BE WELL),” in cooperation with industry, academia, government, and other related parties, and this organization has taken the lead in creating a healthy eating environment. The goal of the project is “to create a society in which everyone, regardless of age, gender, economic status, or level of health concern, can naturally access healthy foods, and in which health is accessible, thereby extending healthy life expectancy (average period of self-reliance).” In this manner food manufacturing, distribution, and meal delivery companies are working in line with the action goals while interrelating people’s access to food and information, and are developing activities through multidisciplinary horizontal collaboration that takes advantage of the strengths of the individual companies.

Health Japan 21 (the third term) emphasizes the importance of improving social environments to extend healthy life expectancy and reduce health disparities. In recent years, promoting employee health has become increasingly important among Japanese companies participating in the Ministry of Economy, Trade and Industry's “KENKO Investment for Health (KIH)” program, which recognizes corporate efforts to improve health management, and identifies promoting a healthy food environment as a key initiative. For example, a KIH survey required to apply for certification as a KIH Outstanding Organization includes many items related to improving the food environment (food availability and information availability, integrating both) as part of overall efforts to improve eating habits. Studies show that improving food availability is more effective than education alone, and combining both yields better outcomes. Additional effects are expected when implemented under the KIH initiative. For workplaces with food service facilities, it is particularly important for public health centers to provide specific guidance under the Health Promotion Act. Studies have reported that improving the food environment through workplace cafeterias contributes to increased vegetable intake, reduced salt intake, better weight management, and improved metabolic syndrome. However, it remains uncertain as to whether they were conducted under the supervision or guidance of public health centers, which are responsible for designated food service facilities. Therefore, we collaborated with a public health center to implement Smart Meal® at employee cafeterias and reduce salt across all menu items through guidance targeting businesses in its jurisdiction. During the one- to two-year intervention period, employees' salt intake was reduced, and blood pressure levels were lowered. It has been suggested that health centers and other local government facilities played an important role in promoting healthy workplace food environments. Health Japan 21 (the third term) aims to increase the number of specific food service facilities that provide meals tailored to users' needs, and to raise the number of facilities employing registered dietitians or nutritionists in the workplace and other food service settings. It is important to improve food availability in the workplace and demonstrate the effectiveness of these measures. Specific guidance for designated food service facilities is the responsibility of public health centers under the Health Promotion Act. Promoting employee health is also important for preventing lifestyle-related diseases among local residents. Therefore, strengthening such guidance by local governments is urgently required.

In order to implement a nutrition policy that leaves no one behind, it is necessary to promote health promotion not only among those who are interested but also among those who are indifferent. In Healthy Japan 21 (Third Phase), amid the diversification of health issues accompanying the diversification of society, emphasis is placed on the implementation of “health promotion that leaves no one behind” (inclusion) and the promotion of “more effective initiatives” (implementation). In addition, in Healthy Japan 21 (Third Phase), improving the quality of social environments, including food environments, is emphasized, and all prefectures are encouraged to collaborate on the “Strategic Initiative for Creating Healthy and Sustainable Food Environments” promoted by the national government. Since creating a food environment involves many stakeholders from the public, private, and academic sectors and requires cross-departmental and cross-disciplinary efforts, it is necessary to steadily promote the creation of such food environments and produce results through coordination with various stakeholders, including administrative nutritionists and other local government officials. This explanation introduces nutrition training at the National Institute of Public Health along with recent research conducted at the institute. Training programs include training on the planning and coordination of nutrition and dietary life policies for the promotion of Healthy Japan 21 (Third Phase), training on monitoring and analysis techniques for health promotion plans using various data such as health and nutrition surveys, training on the planning, operation, and evaluation of health checkups and health guidance for lifestyle-related diseases, and training for personnel involved in allergy disease countermeasures. Regarding research, we are involved in projects funded by the Ministry of Health, Labour and Welfare's Scientific Research Grant and the Child and Family Administration Promotion Survey Project Grant, and we will introduce these projects.

Objectives: From FY2024, Japan’s Specific Health Guidance system introduced a new outcome-based assessment, allowing participants to complete the program upon achieving a reduction of at least 2 cm in abdominal circumference and at least 2 kg in body weight, regardless of the intervention volume. This study examined whether there were differences in the incidence of short-term and medium/long-term health outcomes among individuals who achieved these targets, those who did not, and those who dropped out of Specific Health Guidance. Methods: This study utilized medical claims data and specific health check-up and guidance data from FY2012 to FY2022 across 15 municipalities participating in the LIFE Study. Participants were classified into achievement, non-achievement, and dropout groups based on whether they achieved ≥2 cm abdominal circumference and ≥2 kg weight reduction after Specific Health Guidance. Short-term outcomes were defined as the incidence of hypertension, diabetes, and dyslipidemia, while medium/long-term outcomes were defined as ischemic heart disease and cerebrovascular disease. Kaplan-Meier survival curves were generated, and log-rank tests were used to assess inter-group differences. Multivariable Cox proportional hazards models were applied to estimate hazard ratios (HRs), adjusting potential confounders. Additionally, sensitivity analyses were conducted, accounting for municipal clustering and adjusting standard errors. Results: The incidence of short-term outcomes was 88 (22.8%) in the achievement group, 423 (36.3%) in the non-achievement group, and 647 (30.3%) in the dropout group. The incidence of medium/long-term outcomes was 23 (6.0%), 84 (7.2%), and 116 (5.4%), respectively. Kaplan-Meier analysis showed significant differences in short-term outcomes. Using the achievement group as the reference, the HRs for short-term outcomes were 1.50 (95% confidence interval [CI]: 1.19–1.89) in the non-achievement group and 1.23 (95% CI: 0.98–1.54) in the dropout group. For medium/long-term outcomes, the HRs were 0.98 (95% CI: 0.62–1.57) in the non-achievement group and 0.77 (95% CI:0.49–1.21) in the dropout group. Sensitivity analysis, accounting for municipal clustering, showed a significant difference in the short-term outcome for the non-achievement group (HR: 1.50, 95% CI: 1.29–1.75, p < 0.001), but no significant difference in medium/long-term outcomes. Conclusion: For short-term outcomes, only the non-achievement group had a significantly higher risk than the achievement group, even after accounting for municipal clustering in the sensitivity analysis. In contrast, no significant differences were observed for medium/long-term outcomes. Given the prolonged progression of atherosclerotic diseases, it is important to continue undergoing Specific Health Check-ups and maintaining weight reduction through ongoing Specific Health Guidance.

Objectives: The International Network of Health Promoting Hospitals and Health Services (HPH), launched by the World Health Organization in 1989, has experienced difficulties implementing and upscaling HPH activities, even in its birthplace, Canada. In this study, we investigated the current HPH activities in Japan and examined how they could be expanded in the future. Methods: Surveys were conducted to the representative staff of member institutions of Japan HPH Network in 2022. We examined the visions and activities (e.g., social prescribing, community-based integrated care systems) of the institutions under the era of super-aging society. Additionally, a content analysis of free-text responses was performed to clarify which activities were being achieved and the challenges faced, using the 2020 HPH Standards. Possible strategies for improving the implementation of HPH activities were discussed. Results: In total,164 responses from four types of institutions (35 hospitals, 47 clinics, 17 pharmacies, and 65 long-term care providers) were included in the analysis. Regarding activities to “ensure access to the services” (Standard 2) from the point of view of improving the health equity for patients, screening tools for social and economic vulnerability (hospitals and clinics), and supporting activities for socially vulnerable groups were adopted in more than 50% of each institution type. Regarding “promoting health in the wider society”(Standard 5), more than 60% of hospitals provided various activities, and multidisciplinary meetings were frequently held in the other three types of institutions. Hospitals and pharmacies highly focused on changing patients' unhealthy behaviors such as smoking, excessive alcohol consumption and physical inactivity/excessive eating. Based on content analysis, the number of comments on HPH activities was ordered as follows (high to low) : “Promoting health in the wider society”(Standard 5), “Enhancing people-centered health care and user involvement” (Standard 3), and “ Ensuring access to the service” (Standard 2). The main barriers to disseminating HPH activities were a lack of health promotion awareness and limited financial and human resources. Conclusion: Various health-promoting activities were observed in hospitals, clinics, pharmacies and long-term care providers in Japan, such as support for socially vulnerable groups and activities for local residents. Improvements are required in HPH Standard 1, “Demonstrating organizational commitment for HPH ”, and Standard 4, “Creating a healthy workplace and healthy setting”. Systems thinking, clarifying organizational policies, and building organizational capacity are important for reducing health inequalities and creating sustainable community health.

Due to the deterioration of mental health among parents and children during the coronavirus disease 2019 (COVID-19) pandemic, the remote delivery of a parent support program became essential for infection prevention. This pilot study was aimed to assess the acceptance of implementing the Triple P group program through videoconference technology among Japanese participants and to evaluate the feasibility of a well-designed comparative study for such implementation. In 2020, thirty-six program participants were recruited from the Japanese population and compared with 36 controls from a research company panel. The acceptance of the program was comparable to previous studies that utilized in-person implementation within the Japanese population. Although the effectiveness mirrored that of earlier Japanese studies, the improvement in scores and the significance of effectiveness were less pronounced. Despite the limitations related to sample size and study design, the present study suggests the feasibility of conducting a well-designed comparative study.

Misuse of statistics in medical and sports science research is common and may lead to detrimental consequences to healthcare. Many authors, editors and peer reviewers of medical papers will not have expert knowledge of statistics or may be unconvinced about the importance of applying correct statistics in medical research. Although there are guidelines on reporting statistics in medical papers, a checklist on the more general and commonly seen aspects of statistics to assess when peer-reviewing an article is needed. In this article, we propose a CHecklist for statistical Assessment of Medical Papers (CHAMP) comprising 30 items related to the design and conduct, data analysis, reporting and presentation, and interpretation of a research paper. While CHAMP is primarily aimed at editors and peer reviewers during the statistical assessment of a medical paper, we believe it will serve as a useful reference to improve authors' and readers' practice in their use of statistics in medical research. We strongly encourage editors and peer reviewers to consult CHAMP when assessing manuscripts for potential publication. Authors also may apply CHAMP to ensure the validity of their statistical approach and reporting of medical research, and readers may consider using CHAMP to enhance their statistical assessment of a paper.