Primary Health Care, proclaimed by WHO in 1978, is a health strategy that aims to achieve the ultimate objective “Health For All”, with underlying political concerns for ideals such as social justice, equity and human rights. Meanwhile, “globalization”, urged by the U.S.A., other developed countries and multinational corporations, has since promoted liberalization of trade, capital and finance, which has in the past few decades been sweeping all over the world. With this “new economic liberalism”, values that put much emphasis on economic efficiency are now at the forefront. The World Bank, which supports the tendency along with the International Monetary Fund and the World Trade Organization, has become an influential actor in helping developing countries to prosper economically.
 The World Bank, whose basic idea is that investment in health is basic for economic growth, has in the 1990s also exerted considerable influence on the international health sector with its overwhelming provision of financial assistance. Instead of political concerns like equity and human rights, ’economic concerns’ such as fairer budget allocation, cost-effectiveness, cost reduction and efficiency have now become main points for discussion in the international health field. This shift in emphasis poses fundamental questions for the core goal of the World Health Organization; “Health For All”.

View full abstract

Objective To clarify relationships between BMI (body mass index) and the incidence of hypertension, diabetes and hypercholesterolemia among a community-based sample.
Method A 4.3-year follow-up study was conducted of 1,427 men and women aged 40-69 to examine the relationships between BMI (kg/m²) and the incidence of hypertension, diabetes and hypercholesterolemia.
Results During the follow-up, there were 118 cases of incident hypertension diagnosed, 56 of diabetes and 136 of hypercholesterolemia. After adjusting for sex, age, cognitive physical activity, food intake, alcohol intake, smoking, and blood pressure level, blood glucose level and serum total cholesterol level at the baseline, excess risks with the BMI category of ≥27.0 versus 21.0-22.9 were found for hypertension [relative risk (95%CI)=1.9(1.0-3.6)] and diabetes [2.9(1.2-7.4)]. However, no excess risk was evident for the 23.0-24.9 or 25.0-26.9 categories. Multivariate relative risks (95%CI) of hypercholesterolemia compared with the BMI category of 21.0-22.9 were 1.5 (0.9-2.6) for 23.0-24.9, 1.7(0.9-3.2) for 25.0-26.9 and 1.6(0.8-3.1) for ≥27.0, none of which reached statistical significance. When we combined all three diseases, the relative risks (95%CI) compared with the BMI category of 21.0-22.9 were 0.9(0.6-1.5) for 23.0-24.9, 1.2(0.7-2.1) for 25.0-26.9 and 1.8(1.0-3.3) for ≥27.0.
Conclusions Increased risks of hypertension, diabetes and lifestyle-related disease were only evident with the BMI category≥27.0. Education for weight reduction should be less emphasized for persons with a BMI of 25.0-26.9 than for these with a value of ≥27.0.

View full abstract

[in Japanese]

View full abstract

 The history of cystic hydatidosis (CH) in Japan is reviewed on the basis of case reports and other references during the period from 1881 to 2003. A total of 76 cases were identified as CH patients in Japan of which 47 were reported prior to 1945 and 29 thereafter. The occurrence was divided into 2 stages before and after the Slaughterhouse Act that was brought into force in 1906. The presence of endemic foci of CH was suggested before the Act was introduced in Japan, especially in southwestern prefectures, and the development of cattle breeding and unsanitary small slaughterhouses in the areas were thought to be cause. Japan emphasized cattle as a dietary protein source and also for various military accoutrements such as shoes and rucksacks for soldiers. China was a transit port to Japan from Europe and also a big endemic area of CH. Japan had sent a huge number of soldiers and citizens to China in the Japanese-Sino and Japanese-Russian War and a number of cattle, pet dogs and people have also came to Japan from China. After enforcement of the Slaughterhouse Act in 1906, the number of CH cases decreased dramatically, and only 2 cases were reported for the 30 years between 1920 and 1950 in Japan. The situation regarding CH in Japan thus suggested the existence of endemic foci in southwestern prefectures, although direct evidence was lacking because no one had found E. granulosus in dogs of the area. Almost all of the patients recently presenting with CH appear to have been infected in overseas endemic countries. The available information strongly suggest that sanitary control of slaughterhouses is essential for preventing CH in endemic areas. Diagnostic laboratory examinations and appropriate medical intervention are clearly important. An animal quarantine system against echinococcal infestation of pet dogs should also be established urgently in Japan, because hundreds of pet dogs are being imported annually from endemic countries in Europe and Asia.

View full abstract

Background “Ethical Guidelines for Epidemiological Research” took effect in July 2002, with a moral duty of all researchers to comply when conducting epidemiological studies although it is not legally binding. Public health research entails various forms of studies including not only epidemiological studies but also attenion to psychological, societal and economic aspects, which are outside of the jurisdiction of the guidelines. Hence, confusion may arise among members of Japanese Society of Public Health as to whether the study they conduct falls within the definition of epidemiological research.
 The author discusses legal interpretations of the guidelines arising in the course of translation work as part of government-funded project, “Dissemination of the ’Ethical Guidelines for Epidemiological Research’ via Internet (principal investigator: Toru Doi)” and argues that a case-method approach would be best suited to enhance understanding by researchers with diverse, non-legal backgrounds.
Methods The author proposes an algorithm for classification of studies as to whether the guideline applies, and applies it to all original articles published in the Japanese Journal of Public Health (JJPH) in one year (March 2002 thru February 2003) The rationale for classification is discussed from the strict legal viewpoint in each case.
Results Sixteen out of 46 original articles published in JJPH for one year were classified as epidemiological studies to which the guidelines apply. Those classified otherwise were psychological studies (10), epidemiological studies not targeting specific diseases and are exempt form the guidelines (3), purely methodological studies (4), economics studies (3), fact-finding or opinion surveys with no hypothesis testing (2), as well as studies authorized by law (4) or using unlinkable anonymous data only (4), all of which are exempt from the guidelines.
 Reference to ethical considerations in the methodology section as required by the instructions for authors was generally well performed in epidemiological studies although some shortcomings were noted.
Discussions The guidelines affect approximately a third of original articles published in the JJPH. The ratio of applicable to non-applicable articles was roughly 1 to 2. This gives both authors and reviewers confusion as to whether articles are subject to the guidelines and would require ethical approval. This case-method approach using actual articles readily available to members should help unnecessary confusion and enhance appropriate application of the guidelines. (366 words)

View full abstract