Trends in Policy on the Prevention and Control of Non-Communicable Diseases in Japan

Abstract

Abstract—For the past decades Japan has remained number one in a range of population health metrics including the world's longest healthy life expectancy. While this was achieved through various socioeconomic factors besides public health interventions, health promotion policies to prevent and control non-communicable diseases (NCDs) played a major role. Japan introduced its first comprehensive national plan to prevent and control NCDs in 1978 and has revised the plan every decade since. These 10-year policy packages were instrumental in galvanizing stakeholders, while adapting to changing social, behavioral, and epidemiological trends. In this article, we provide an overview of trends in policy on the prevention and control of NCDs in Japan with a focus on successes and challenges especially due to a rapidly aging population. Through this review we aim to share the lessons learned in Japan for other countries tackling or expecting to be challenged by NCDs. These lessons include the role of multisectoral approaches, clear goals and targets with effective monitoring and evaluation mechanisms, addressing social aspects, adjustment to the local context, and foreseeing future demographic transition. Japan is committed to contributing to the world as a forerunner of the health challenges posed by unprecedented demographic change, by sharing its lessons in the global quest to create a world where all people can live longer and healthier lives.

Keywords:

• health policy
• NCDs
• Japan
• longevity
• health promotion

INTRODUCTION

For the past decades Japan has remained number one globally in a range of population health metrics, including life expectancy and healthy life expectancy at birth.¹ While longevity gains are a result of multiple policy efforts such as compulsory primary education, universal health insurance and public health interventions to control communicable diseases, a series of health promotion policies to prevent and control non-communicable diseases (NCDs) also played a major role in this achievement.²

Japan's health status has improved rapidly over the last half-century. In 1950, life expectancy at birth was 59.57 years for men and 62.97 years for women, and the leading cause of death was tuberculosis.^3,4 After rapid reductions in tuberculosis mortality the Japanese were challenged by a stroke epidemic, which peaked in 1965.⁵ Stroke was the leading cause of death from 1951 to 1980, replaced since then by malignant neoplasm. Thus, the Japanese faced an epidemiological transition from infectious diseases to NCDs followed by a gradual decrease in cerebrovascular diseases.

However, these transitions were successfully controlled over the past half-century and Japan attained the longest life expectancy globally of 83.3 years (2010–2015) as well as the longest healthy life expectancy, gaining more than 20 years of life expectancy at birth over the past six decades.^1,6 As life expectancy has lengthened and Japan's economy has developed, the burden of NCDs has also increased, accounting for approximately 60% of total causes of death in 2012.⁷ NCDs also grew to consume approximately 30% of total medical expenditure and long-term care.⁸ This new NCDs challenge requires focused policy and renewed political attention.

As the world's most rapidly aging country, Japan needs to implement wide-ranging and potentially radical policies to manage health and social care and the broader social implications of this rapid aging.⁶ As other countries are expected to follow Japan's demographic pathway, as an inevitable consequence of development, health improvement, and changing natal policy, it is essential that other countries develop policies for this new demographic context. In this article, we analyze Japan's past successes and future challenges, especially due to a rapidly aging population, and describe the Japanese government's future policy vision to manage the growing challenges of aging and NCDs.

METHODS

For this article, we reviewed the history of health promotion policies to prevent and control NCDs as well as basic health statistics in Japan. As comprehensive health promotion policies have been mainly implemented in line with national health promotion plans, we reviewed a series of national health promotion plans known as the First National Health Promotion Measures (1978–1988), Active Health 80 (1988–1999), and Health Japan 21(1999–current) alongside other government plans and policies. We analyzed these documents both via website and by hand using the search term of “NCDs,” “Adult disease,” “Life-style related disease,” or “Health Promotion.” We also reviewed disease-specific policies for cancer, cardiovascular disease and diabetes, and relevant national demographic and epidemiological statistics available from the Ministry of Health, Labour and Welfare (MHLW), the Health, Labour and Welfare Statistics Association, and other literature and data.

RESULTS

Historical Evolution of Japan's NCD Policies

Japan officially introduced its first NCD policy, known as the National Health Promotion Plan in 1978, and has revised the plan every 10 years. The third and fourth editions are known as Health Japan 21 (2000–2012) and Health Japan 21 (2013–2022), respectively. The overall historical evolution of NCD plans in Japan is shown in Figure 1.

Figure 1. Historical Evolution of National Health Care Measures under National Health Promotion and Disease Prevention Plans in Japan

NCD Measures before 2000

Before the introduction of the first NCD policy, Japan's efforts toward NCD prevention as far back as 1957 were managed by municipal governments, with a specific focus on health check-ups and prevention of NCDs.⁹ Following the trend of municipal governments to strengthen NCD prevention as part of broader public heath interventions at the community level, the national government in 1978 officially launched the first 10-year National Health Promotion Plan. Policy changes were implemented thereafter as shown in Table 1.¹⁰ Although overall population health was improving, Japan faced the need to create a new strategy, due to a rapidly aging society, with a focus on population aging, which led to the introduction of Health Japan 21.

TABLE 1. History of National Health Promotion Measures. Source: Adapted from Ref. 59

	1st National Health Promotion Measures	2nd National Health Promotion Measures (Active 80 Health Plan)	3rd National Health Promotion Measures (Health Japan 21)
Term	FY1978–1988	FY1988–1999	FY2000–2012
Basic Concept	Lifetime health promotionPromotion of primary prevention of geriatric diseases Promotion of health promotion measures through three major elements (diet, exercises, and rest) (special focus on diet)	Lifetime health promotion Promotion of health promotion measures with the focus on exercise habits as they are lagging behind the other two of the three elements (diet, exercise, and rest)	Lifetime health promotionFocusing on primary prevention, extended healthy life expectancy, and enhanced quality of life Setting specific targets to serve as an indicator for national health/medical standards and promotion of health promotion measures based on assessments Creation of social environments to support individuals' health promotion
Outline of measures	Lifetime health promotion Establishment of health checkups and a complete health guidance system from infants and small children through to older adults Establishment of health promotion bases Establishment of health promotion centers, municipal health centers, etc. Securing sufficient human resources, including public health nurses and dietitians Dissemination and enlightenment of health promotion Establishment of municipal health promotion councils Promoting the use of recommended dietary allowances Nutritional content labelling for processed food Conducting studies on health promotion, etc.	Lifetime health promotion Enhanced health checkup and guidance system from infants and small children through to older adults Establishment of health promotion bases Establishment of health science centers, municipal health centers, health promotion facilities, etc. Securing sufficient manpower such as health fitness instructors, registered dietitians, and public health nurses Dissemination and enlightenment of health promotion Promoting the use of and revising recommended dietary allowances Promoting recommended exercise allowance Promoting the system to approve health promotion facilities Action plan for tobacco control Promoting a system of nutrition information labelling for meals eaten outside home Promoting cities with health oriented cultures and health resorts Conducting studies on health promotion, etc.	National health promotion campaign Dissemination and enlightenment of effective programs and tools with regular revision Dissemination and enlightenment of the acquisition of good exercise habits and improved dietary habits with a focus on metabolic syndrome Implementation of effective medical examinations and health guidance Steady implementation of health checkups and health guidance with a focus on metabolic syndrome for insured persons/dependents aged 40 or older by Health Care Insurers (from FY2008) Cooperation with industry Further cooperation in voluntary measures of industries Human resource development (improving the quality of medical professionals) Improved training for human resource development in cooperation between the government, prefectures, relevant medical organizations, and medical insurance organizations Development of evidence-based measures Revision of data identification methods to enable outcome assessments
Guidelines	Dietary guidelines for health promotion (1985) Report on nutritional content labelling for processed food (1986) Announcement of a weight scale diagram and table (1986) Report on smoking and health (1987)	Dietary guidelines for health promotion (by individual characteristics: 1990) Guidelines for nutrition information labeling for meals eaten outside home (1990) Report on smoking and health (revised) (1993) Exercise and Physical Activity Guidelines for Health Promotion (1993) Promoting guidelines on rest for health promotion (1994) Committee report on action plan for tobacco control (1995) Committee report on designated smoking areas in public spaces (1996) Physical activity guidelines by age (1997)	Dietary guidelines (2000) Committee report on relevance to designated smoking areas (2002) Sleep guidelines for health promotion (2003) Guidelines on implementation of health checkups (2004) Japanese Dietary Reference Intake (2005 edition) (2004) Guidelines for well-balanced diet (2005) Manual for smoking cessation support (2006) Exercise and Physical Activity Reference for Health Promotion 2006 (exercise guide 2006) (2006) Exercise guidelines for health promotion 2006 (Exercise Guide 2006) (2006) Japanese Dietary Reference Intake (2010 edition) (2009) Physical Activity Reference for Health Promotion 2013 (2013)

 

Health Japan 21 (2000–2012, 2013–2022)

Health Japan 21 (2000–2012) was introduced in 2000 as the third edition of the National Health Promotion Plan with 79 targets in nine areas. This plan stressed primary prevention of NCDs, recommending achievement of targets in key risk factor areas to contribute to prevention of diabetes mellitus, cardiovascular disease, and cancer.

In 2011, an expert review committee issued a final assessment of Health Japan 21 (2000–2012). This evaluation concluded that targets were met or improved in 35 of 59 fields, 14 remained unchanged, 9 worsened, and one was difficult to assess (Figure 2).¹¹ The review committee also suggested three directions for the second term of Health Japan 21 (hereafter, Health Japan 21 (2013–2022)): importance of actions in response to socioeconomic changes, effective approaches based on progress in science and technology, and new challenges including improvement of sleeping habits and women's health.^12,13 In 2013, based on the evaluation of Health Japan 21 (2000–2012), Health Japan 21 (2013–2022) started and it remains the core strategy for tackling the NCD epidemic in Japan.

Figure 2. A Final Assessment of “Health Japan 21 (2000–2012)”. Source: Adapted from Ref. 11

Key Elements of NCD Policies

Twenty years after introduction of the first National Health Promotion Plan in 1978, changes in health promotion practice drove increasing demand for a new health promotion plan that incorporated modern principles in health promotion, such as transparent and accountable policy assessment; policy based on scientific evidence; comprehensive monitoring and evaluation frameworks; the need to address NCDs; and new understanding of the value of civil society participation. In response to these new trends, the third and fourth National Health Promotion Plans put increased importance on primary prevention, creating an environment where people are likely to make healthier choices, setting targets and evaluation mechanisms, and encouraging stakeholders to participate in the policy development and implementation process.¹⁴ Especially for setting and evaluating targets, the ministry decided that quantitative targets should be included in the plan and the plan's impact should be assessed 10 years after its implementation.^15,16 Health Japan 21 (2000–2012) was introduced with a strong focus on monitoring and evaluation mechanisms, and started with 79 targets in nine areas: nutrition and diet, physical activity and exercise, rest and promotion of mental health, tobacco smoking, alcohol intake, and dental health.¹⁵

Twelve years after the introduction of Health Japan 21 (2000–2012), the MHLW revised the plan and launched Health Japan 21 (2013–2025). The basic direction of this new plan is “to achieve a vibrant society with healthy and spiritually affluent lives according to each life stage so that all people have hope and meaning in life, while ensuring a sustainable social security system.”¹⁷ The plan consists of five pillars and 53 targets, set by the Minister of Health, Labour and Welfare based on recommendations from the expert panel considering the evaluation of Health Japan 21 (2000–2012). Table 2 shows examples of specific targets and indicators.¹⁷ The complete list of indicators and targets is available as an Annex (Supplemental Material) and ongoing trends can be found on the MHLW website.¹⁸ Table 3 shows the summary of the five pillars and the role of the national government.¹⁷

TABLE 2. Examples of Specific Targets and Indicators in Health Japan 21 (2013–2022). Source: Adapted from Ref. 17.

Item	Current	Target
Mean duration which people can live with no limitation for daily life	M: 70.42 yrs. F: 73.62 yrs.	More increase than that of life expectancy
Reduce the age-adjusted mortality of cancer under 75 (/100,000)	84.3	73.9
Mean systolic blood pressure	M: 138 mmHg F: 133 mmHg	M: 134 mmHg F: 129 mmHg
Number of newly introduced dialysis patient due to Diabetes	16,247 people	15,000 people
Proportion of obesity (BMI ≧ 25) among male aged 20 to 60 years	31.2%	28%
Total amount of salt intake (g/day)	10.6g	8g
Number of steps in daily life among aged 20 to 64 years	M: 7841 steps F: 6883 steps	M: 9000 steps F: 8500 steps
Reduction in percentage of individuals who consume alcohol over recommended limits (male > 40 g, female > 20 g per day)	M: 15.3% F: 7.5%	M: 13% F: 6.4%
Adult smoking rate	19.5%	12%
Increase in percentage of 80-year-old individuals with over 20 teeth remaining	25.0%	50%

¹ pure alcohol consumption per day: Male 40 g or more, Female 20 g or more

TABLE 3. Pillars of Health Japan 21 (2013–2022)

Pillar	Goal	Role of the National Government
1	Extend healthy life expectancy and reduce health disparities	Reduce the burden of NCDs and support all necessary domains such as public health systems and medical care systems
2	Prevent incidence and progression of NCDs, including cancer, cardiovascular disease, diabetes mellitus, and chronic obstructive pulmonary disease.	Promote behavioral change or arrangement of social environments that are beneficial to health, such as healthy diet, physical activity, and smoking cessation through massive health communication campaigns involving the private sector. Offer health check-ups and health guidance.
3	Maintain and improve necessary functions through their life courses, to ensure self-reliant lives by promoting “mental health”, “health for the next generation,” and “health for the aged population”. Healthy Parents and Children 21 and Health Japan 21 (2013–2022)	Advocate the key points outlined in the third pillar
4	Secure an environment that protects health based on mutual support, including people who are facing difficulty in having a balanced social and private life as well as mentally healthy lives. The national government	Share information on activities of the private sector and civil society for health promotion, and evaluates these activities.
5	Improve the social environment and lifestyles related to diet, physical activity, recreation, smoking, drinking, and oral health.	Promote the improvement of lifestyle and analyze the characteristics of each target population and health challenges.

Under the National Health Promotion Plan, Japan also created disease-specific policies, mainly for cancer control, cardiovascular disease and diabetes, as well as policies for three key risk factors: tobacco smoking, obesity, and hypertension.

Disease-Specific Policies

Cancer

Cancer has been the leading cause of death in Japan since 1981. The Japanese government has implemented the Comprehensive 10-year Strategy for Cancer Control since 1984, now in its third edition, in order to promote cancer research and disseminate high quality cancer-related medical services.^19,20 In 2006, the Cancer Control Basic Act was enacted. In parallel with 10-year Strategy for Cancer Control, the National Basic Plan to Promote Cancer Control Programs (Basic Plan) has also been implemented under the Cancer Control Basic Act since 2007.²¹ Because of these efforts, Japan has the fifth lowest total age-standardized cancer mortality rate among the 35 OECD plus countries.²² However, according to a 2015 mid-term review by the Cancer Control Promotion Council, the overall reduction of cancer deaths will only be 17%, failing to meet the goal of a 20% reduction.²³ Additionally, there are rising public expectations to further prevent and control cancer especially by using high-priced medicines, and growing pressure to contain overall costs.²⁴ New emerging challenges from the mid-term review in 2015 include work-related support for survivors, integrating health care, long-term care, living and housing care for cancer patients at the community level, and primary education on the basics of cancer. The MHLW, together with experts, is now preparing for the third version of the Basic Plan, which will start in 2018, and is expected to provide countermeasures for above mentioned challenges.

Cardio- and cerebrovascular diseases

In the first decade of the twenty-first century, age-standardized mortality rates from cerebrovascular disease and coronary heart disease were reduced through blood pressure control and reduction of salt intake, although the burden of disease from these causes remains large.²⁵ Previous research shows that cardiovascular diseases accounted for approximately 30% of Japanese deaths in 2013 as well as being the leading cause of long-term care needs.^4,26 There is no cardiovascular specific policy or legislation, and its policy is mainly under Health Japan 21, adjusted to fit with the local context. Although there is no specific act for cardiovascular disease control at this moment, officials from the MHLW report that a “novel policy” to control cardiovascular disease is currently under consideration.

Diabetes mellitus

Mortality rates from diabetes mellitus are not as high as those of cancer or cardiovascular diseases, but its disease burden is of national concern.²⁷ To tackle this disease, Health Japan 21 (2013-2022) establishes a goal to keep the number of diabetic persons under 10 million in 2022 by appropriate control of blood glucose levels, improvements in treatment adherence, and a reduction in complications.¹⁷

Risk-Factor–Specific Policies

Risk-factor policies have also evolved since the earlier era of the national NCD plans. The first and second editions of the National Health Promotion Plan (1978–1999) put a strong focus on stroke control, and therefore targeted and reduced salt intake and high blood pressure, leading to a massive decrease in stroke mortality and incidence. Health volunteers as well as public health nurses and registered dietitians have played an important role in education for reduction of salt intake in communities, and food manufacturers have also begun to become involved with health promotion campaigns such as marketing salt-reduced food products.

In 2008, MHLW introduced the nation-wide Specific Health Checkups and Specific Health Guidance screening program (SHCSHG).²⁸ All health insurers are mandated by law to conduct SHCSHG for enrollees aged 40–74 years with the aim of preventing life-style related risk factors.²⁹ It is estimated that SHCSHG participants have reduced prevalence of NCD risk factors and utilization of health care services compared with nonparticipants, which resulted in reducing outpatient services costs for participants. In addition, data from SHCSHG screening together with computerized health insurance claims data enable Japanese health insurers to conduct in-depth analyses of their enrollees' health status. The MHLW has asked health insurers to draw up Data Driven Health Plans, including interventions to promote enrollees' health that are expected to enhance insurers' health service for enrollees.^30,31

Key Relevant Policies

Health Japan 21 (2000–2012) is supported by several other relevant health plans. For example, Japan has a dedicated plan for the health of parents and children entitled Healthy Parents and Children 21, and Health Japan 21 (2013–2022) also includes targets for parents and children such as reducing the smoking rate among minors.³² Also, as 7 million people are expected to be affected by dementia in 2025, a comprehensive national strategy for promoting dementia policy replaced the existing plan in 2015 in line with Health Japan 21.³³

Driving Factors for NCD Policies

Although Japan's Health Ministry has been the central organization involved in creating and implementing NCD policies, these policies are also driven by factors outside of the ministry. There are three major trends that influenced the development of NCD policy in Japan: global momentum toward NCDs, the aging society, and renewed awareness of the social determinants of health (SDH).

NCDs are a global as well as a Japanese concern. They kill 38 million people each year globally and around three quarters of deaths occur in low- and middle-income countries.³⁴ As a consequence, many countries suffer from a double burden of disease and the World Health Organization (WHO) has started to focus on how to mitigate this disease burden. In 2008, the WHO published the first comprehensive NCD strategy titled Action Plan for the Global Strategy for the Prevention and Control of NCDs.³⁵ In April 2011 the first global ministerial conference on healthy lifestyle and NCD control was held in Moscow, and the United Nations (UN) High Level Meeting on Prevention and Control of NCDs was held in New York in September of that same year. Global leaders adopted the Moscow Declaration and the political declaration of the High-Level Meeting of the UN General Assembly on the Prevention and Control of NCDs.^36,37 These declarations urged each country to further strengthen their efforts surrounding NCDs. Japan's NCD policy was influenced by these global trends as indicated in pillar two of Health Japan 21 (2013–2022), “Prevent incidence and progression of NCDs, including cancer, cardiovascular disease, diabetes mellitus, and chronic obstructive pulmonary disease” (Table 3).

Japan's overall health and long-term care policies have also been influenced by its rapid aging.³⁸ In Health Japan 21, for example, key targets include containing the number of older adults requiring long-term care, early detection of dementia, and containing the number of undernourished older adults.

The growing global awareness of the social determinants of health has also affected Japan's NCD policies, for instance, through the 2008 WHO report, A Conceptual Framework for Action on the Social Determinants of Health.¹² In 2002 individual income in Japan was found to be strongly associated with self-rated health at the prefecture level.³⁹ Also in 2010, Oshio and Kobayashi found that individuals who live with large inequality were more likely to report themselves as unhealthy.⁴⁰ Based on these findings, together with the global momentum toward SDH, the MHLW has emphasized the importance of SDH in the second edition of Health Japan 21 (2013–2022).¹⁸

Major Actors

Various major actors participated in creating and implementing NCD policies in Japan, including the central government, ministries, local government, community health care professionals, insurers, and private industries. One unique point of Japan's health care system is the prominence of community health workers.⁴¹ Japan has 495 public health centers and 48,452 public health nurses nationwide who are responsible for public health measures such as health screening, health check-ups, health guidance, and health education under the Health and Medical Services Act for the Aged (Act No.80 of 1982).^42,43 At the beginning of the first 10-year National Health Promotion Plan in 1978, the health centers worked as community hubs with public health nurses and other health professionals. Public health nurses and volunteers visited individual homes and provided feedback about how individuals could manage their lifestyle-related risks. They also reported to public health centers about information and data through their home visits so as to create region tailored public health systems.

Another unique aspect of Health Japan 21 (2013–2022) is active engagement of the private sector. The plan includes the target, “Increase the number of corporations that deal with health promotion and educational activities.” From 420 corporations in 2012, there are now 3010 corporations that are expected to achieve the proposed target by 2022. As part of Health Japan 21, the Smart Life Project has been launched under the leadership of the MHLW, to encourage three concrete strategies: proper exercise, appropriate dietary habits, and smoking cessation. It appeals to corporations to take the necessary measures for tackling NCDs and commends corporation with outstanding outcomes.⁴⁴

DISCUSSION

As a result of a series of policy efforts, including several generations of NCD national plans and disease-specific, risk-factor–specific measures with periodic revision, overall health metrics such as average life expectancy and healthy life expectancy in Japan have been among the best in the world.¹ Based on our review of four decades of Japan's national health promotion efforts and challenges, five key lessons are proposed to help inform other countries tackling or preparing for NCDs including: the role of multi-sectoral approaches, clear goals and targets with effective monitoring and evaluation mechanisms, addressing social determinants of health, adjusting policies to fit the local context, and predicting and responding to future demographic transitions.

First, as indicated in the global action plan for the prevention and control of NCDs published by the WHO,⁴⁵ a multisectoral approach is crucial for controlling the NCD epidemic. For example, Japan promoted multisectoral approaches by establishing a government-wide working group to tackle the tobacco epidemic with 14 ministries and government organizations, which became the basis for fostering government-wide collaboration.⁴⁶ This government-wide working group was created in order to respond to the criteria for ratifying the WHO's Framework Convention on Tobacco Control.

WHO's global action plan also emphasizes the importance of monitoring and evaluation with clear goals and targets.^45,47–49 Japan introduced monitoring and evaluation mechanisms from its first National Health Promotion Plan, but due to the increasing demand for transparency and accountability, Japan put further emphasis on clear goals and targets, adopting quantitative goals since the third edition of the National Health Promotion Plan. Japan needs to enhance adequate program evaluation and revision, to move beyond simply setting targets to enacting policy that is capable of responding to benchmarks and modifiable to ensure the targets affect the relevant policy. It is important to ensure the full policy cycle—including planning, implementation, monitoring, and evaluation—contributes to achieving the overarching target of improving healthy life expectancy and other targets defined in Health Japan 21 (2013–2022).¹⁷ Although indicators and targets are set in a hierarchical manner as a concept and wherever possible linked by some causal and hierarchical relationship, some are unclear, making it difficult to identify the mechanism by which policy can affect targets, or be adjusted if failing. This remaining challenge suggests the importance of periodic revision of health policy based on available data.

Addressing the social determinants of health is critical to improving health, since several studies have shown strong linkage between social inequity and NCDs.^50,51 S. Mendis and A. Banerjee reported that in Finland, there was a strong relationship between social inequity and prevalence of cardiovascular diseases, and effective measures for diminishing these health disparities.⁵² In Japan as well, Health Japan 21 (2013–2022) includes targets and goals related to SDH, with a target of “putting in place a social environment to support and protect health” and indicators such as “strengthening of community ties.”⁵³

Adjusting policies to fit the local context is crucial, since each community has a different structure of society as well as different patterns of mortality and morbidity. Aulikki, Ximena, and Pekka conducted community-based NCD interventions in Finland and concluded the importance of these approaches in tackling NCDs.⁵⁴ Although the aging population and the associated burden of NCDs are major challenges to the entire nation, there are substantial regional differences which have important implications for local health care needs and health outcomes.⁵⁵ As mentioned, Japan has used health centers and community health workers to play a major role in health promotion activities and also to provide health care services tailored to local needs.

Lastly, the demographic transition and associated health challenges unique to the elderly should be taken into consideration when preparing a national plan for NCDs. Japan started to emphasize its aging society in the third edition of the National Health Promotion Plan with some targets and indicators related to the health of older adults. As the global community is aging, especially in high-income countries but also in low- and middle-income countries, governments should introduce key indicators and targets specific to health challenges for older adults.

Despite these successes for Japan's NCD policies, major policy challenges remain, such as inadequate quality of monitoring and mechanisms, and meeting public expectations in cancer control. One way to address these challenges would be to upgrade the current health promotion campaign in Japan, including the disease-specific and risk-factor–specific programs, from a ministerial to a government-wide level.³⁷ This would elicit government level leadership on NCDs, as recommended in the political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of NCDs. Such an upgrade would ensure that the entire government has clearer mandates, drawing all of government into the role of preventing and controlling NCDs. This in turn would pave the way to achieving defined targets including the extension of healthy life expectancy.

CONCLUSION

This review identified a number of lessons learned in Japan related to the policy challenges of addressing NCDs. We showed the importance of comprehensive multisectoral policies adjusted to fit with the local context. Simultaneously, it is important to balance public expectations and efficacy through periodic revision of policies, along with coordinated and high-level legislative arrangements.

Prolonging healthy lives through tackling NCDs is a major priority of Japan's current administration, as it is for the global community. As Prime Minister Abe firmly stated, “Japan is willing to contribute to resolving the challenges that countries have in common, drawing on its own experiences.”⁵⁶ Japan's efforts over decades to advance the prevention and control of NCDs provide a good example of these common challenges. As stated in the recently launched Japan Vision: Health Care 2035, Japan's health ministry is fully aligned with the administration's determination to contribute to the global community to tackle common challenges such as NCDs, sharing lessons learned and policy evidence along the way, in the quest for a healthier Japan and a world better prepared for the coming health and demographic challenges.^57,58

DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST

None declared.