地域経済の持続可能性の確保は重要な課題である。持続可能性の定量的な評価方法として有効なものに，将来世代の福祉を現在の資本ストックの価値に換算するキャピタル・アプローチがある。それに基づいた経済指標である，新国富指標（Inclusive Wealth Index，IWI）を用いれば，その増加から持続可能性を判別できる。日本において，IWIの成長を妨げる一つの要因が健康資本の減少である。ところが，健康資本には長命の価値のみが考慮されており，影響が大きいはずの疾病による損失が考慮されていない現状にあった。

そこで本研究は，健康資本を個人の平均寿命までの余命年数（以下長命資本）及び疾病の割引障害調整年数（以下疾病損失）の二つの側面の割引現在価値として捉えた。そして三大疾病を対象に，1999・2002・2005・2008・2011・2014年の６時点，都道府県別に健康資本を推計した。得られた主要な結果は以下の２点である。

1）年間で１人当たりの損失額が一番大きい疾病はがんであり（33,055円），次いで脳卒中（15,687円），虚血性心疾患（7,041円）の順であった。空間的分布に着目すると，三大都市圏に比べ地方が相対的に17％ほど疾病損失の影響が大きいことが分かった。

2）１人当たりのIWIの変動に対する疾病損失の寄与について，がんによるIWIの損失は増加傾向にあるが，脳卒中と虚血性心疾患の損失は改善される傾向にあった。そして，三大都市圏ではがんのIWIを損なう影響が大きく，逆に地方では脳卒中のIWIを改善する影響が大きかった。

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  This article explains how LDP had developed post-war medical policy. Having very strong political ties with Japan Medical Association, LDP had supported JMA's claims for higher payment of social health care insurance. Business leaders and mayors as well as workers were all against high payment, but JMA doctors were strongly united and available to simultaneously refuse social insurance contract. Since no health care system would be possible without contracted doctors, LDP was afraid enough for big compromises with them. JMA seemed a successful political giant as a pressure group for medical industry.
  On the other hand, new medical schools graduated 4000 more doctors every year since early 1970s. The expansion against JMA's favor was eagerly supported by local politicians and LDP pursued the programs for more rural doctors. Number of doctors increased rapidly and this was the beginning of the end of JMA era.
  Structural changes inside medical environment happened to make hospitals more focused. Being grown surgical needs and chronic invalids, majority of medical expense went to hospitals. More doctors, nurses, and other medical professionals worked in hospitals. Thus interests within medical industry became greatly diffuse and JMA was no longer an exclusive representative of the business.
  Politics of the medicals was the politics of medical economy for long time and JMA won games against cost bearers and Ministry of Welfare. The policy, however, also had another important element: public control over medical supply such as beds, professionals, and networks. MOW failed to establish authorities on such control so that this constraint limited following attempts for systematic medical service.

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