Japan's national health policy, “Health Japan 21” is a program that sets target indicators and strives for their achievement. Starting from fiscal year 2024, “Health Japan 21 (Phase 3)” and its counterparts in the dental field, the revised “Basic Matters on the Promotion of Dental and Oral Health” and “Oral Health Promotion Plan” have commenced. These policies incorporate the concept of social determinants of health, setting the extension of healthy life expectancy and the reduction of health inequalities as their highest-level objectives, while taking into account the social environment. Logic models have been developed which hierarchically present the relative positions of individual measures and health goals. Furthermore, an action plan has been introduced, which categorizes the measures based on their nature and effectiveness. This action plan emphasizes not only traditional health education, but also more practical measures that consider the impact of the social environment, such as policies aimed at improving the environment and changing incentives or defaults. It is crucial, however, to carefully consider which measures may reduce or exacerbate health inequalities. For example, in health education and check-up programs, individuals with higher health awareness tend to participate more, while those at higher risk do not, presenting the challenge of the so-called “inverse care (prevention) law.” Thus, a “proportionate universalism” approach, which is a population strategy aimed at reducing health inequities, is required. In the dental field, school-based fluoride mouth rinsing programs have been identified as an effective proportionate universalism approach. The implementation of individual measures necessitates the use of the PDCA cycle (Plan-Do-Check-Act) cycle. In utilizing the PDCA cycle, rather than setting target indicators that are difficult to improve in the short term, such as the percentage of individuals retaining 20 or more teeth at age 80, the recent trend is to focus on utilizing outputs and intermediate outcomes that provide more visible evidence of progress regarding execution and improvement. Lastly, an excessive focus on target indicators alone may overlook certain trends, such as an increase in individuals with fewer teeth due to aging, and the high dental treatment needs for dental caries and periodontal disease compared to other conditions. As in the broader medical field and in line with international trends, such as the WHO resolution on oral health, Japan's dental sector must recognize the limitations of target indicators and also consider other indicators, when necessary.
View full abstract