Implementing the Health Promotion Law

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The Law passed the Diet in July 26, 2002, and was implemented in May 1,2003. The Law aims to provide a basic framework for overall promotion of public health improvement, because the importance of improving public health increases remarkably in the progress of population aging and the changing of disease structure. The Law also attempts to improve public health through better nourishment of people and other public health measures.

Purpose of health policy or idea

The Public Health Law passed the Diet, the Japanese parliament, on July 26, 2002, and became effective May 1, 2003. Part of a major framework on Health Care Reform, it aims to provide a basic framework for recognizing overall promotion of public health improvement, enhancing the importance of public health in the light of demographic change and a changing pattern of disease. The Law also attempts to improve public health promoting healthy eating habits and other public health measures.

Guideline for health examinations
At present, entities to manage health promotion activities conduct health examinations by contracting-out with health examination institutions and hospitals. Methods of examinations differ a lot from entity to entity and the data collected in the examinations are not in the form that can be utilized in other entities. Therefore, it has been pointed out that the collected data cannot be utilized once insurers or examination bodies change after transfer of jobs, etc.. In order to build a consistent system for health examinations, the Law stipulates a common guideline on items such as a method of examinations, notification of results, and a format of a health handbook. 


Survey and guidance: "only on nutrition" to "on lifestyle as a whole"In the past, the National Nutrition Survey had been conducted based on the Nutrition Improvement Law. This reform package includes expansion of this survey from nutrition to lifestyle as a whole (National Health and Nutrition Survey), utilizing the result of the survey to promote related measures based on scientific grounds and to evaluate those measures. The previous nutrition guidance activities were also expanded to lifestyle as a whole, and the former legislation (abolition of the Nutrition Improvement Law) abolished. In terms of specific cooking facilities, regulations of the nutrition management in mass-feeding facilities by the present Nutrition Improvement Law were succeeded, and necessary regulations were added to the existing scheme.

Prevention of passive smoking
 "Passive smoking" describes a situation where a person (who usually does not smoke) is forced to breathe in the smoke of others' cigarettes in a closed environment. Article 25 of the Law stipulates that "those who are in charge of managing the facilities where many unspecified people gather shall make efforts in taking necessary measures to prevent passive smoking." Facilities specified in Article 25 include schools, hospitals, government and municipal offices, restaurants, department stores, shops, hotels, trains, buses, etc. However, at the point of implementation of the Law, Article 25 is only for promoting related efforts. Violation on this duty does not accompany any penalties.

The Public Health Law also specifies what is expected from the general public, on one side, and the various levels of public adminsitration, on the other. They are to foster greater interests and understandings on the significance of healthy lifestyles to be aware of their own health condition and to make efforts promote their own health throughout their life. 

Central and local government entities are expected

• to disseminate correct knowledge concerning improvement of health through educational activity and public relations
• to promote collection, management, analysis, provision, and research of information concerning advance in health
• to train human resources in charge of health promotion
• to provide technical support when necessary to those who are in charge of health promotion activities such as health promotion institutions

 

Health promotion institutions i.e., those who conduct health promotion activities, such as insurers of health insurance, are to promote necessary activities for the nation's health promotion, such as health education, health counseling, etc.

Main points

Main objectives

• To further advance health promotion activities, serving as a legal basis for "Healthy Japan 21" campaign, which was started three years ago in order to lengthen "healthy life expectancy" of the nation and to improve the standard of living.
• To reduce/cap health care cost: Lengthening "healthy life expectancy," which signifies years in which people can live a life without being bed-ridden or having lifestyle-related diseases, will contain costs for health and long term care even after further advancement of aging society.

Type of incentives

non-financial - disease prevention, health promotion

financial - reduction of health care cost in the future

Groups affected

The general public, Governments (central/local), Health promotion institutions (those who conduct health promotion activities, such as insurers of health insurance)

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Health promotion plans in municipalities will be boosted by this legislation. This reform will be successful if, in the process of drawing up municipal plans, local characteristics are discussed and awareness of the public is raised toward health promotion.

In terms of health examination, standardization of the procedure based on common guidelines will be conducted among examinations for maternity health, school health, industry health, elderly health, etc. in order to compare those various fields of health examinations. It is desirable to make changes to the existing scheme and to standardize examinations with reference to scientific study.

In terms of "health handbooks," it is hoped that they will be beneficial to primary prevention as a part of health activities. In addition, if information in the handbook can be used when the holder of the handbook consult doctors for some complications, the result of health examination will not only be beneficial to reducing health care cost but also be precious source of information in medical treatment. 

Anti-tobacco measures in the Law are highly evaluated because they signify an epoch-making progress. However, additional effort will be necessary in order to raise awareness of the public about smoke hazard and to foster a favorable environment for having sympathy and consideration to others. In addition, it is not clear how to ensure compliance with the rules (for example, relevant provisions in the Law do not accompany punishment in case of incompliance), which makes some doubt about their effectiveness.

Political and economic background

• Change of disease structure in Japan has urged to take health and medical measures based on new perspectives. 
• In other countries, comprehensive health and medical measures accompanied by specified targets have already been introduced and proved effective. 
• Requests from local governments have urged to provide a legal basis for promoting measured related to health promotion activities. 
• Costs for health and long-term care have increased.
• There is a necessity for decreasing burdens on health and long-term care in the future.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

• "Healthy Japan 21", the national health promotion movement of the 21st century has been promoted for the society as a whole. The campaign aims to support health activities of individuals. It provides a basic framework for health promotion activities for the next 10 years.
• This plan was drawn up with reference to the methodologies utilized in "Healthy People 2000" campaign in the United States. The plan had been put to practice in cooperation with local governments. In March 2000, the Ministry of Health and Welfare (then) addressed local governments, in the name of the Vice-Minister for Health and Welfare, about the key ideas of  Healthy Japan 21 as well as strategies in extending related measures in the future. 
• The Healthy Japan 21 campaign has a philosophy of realizing health through actions of individuals based on their own thought with support of various health-related groups in the society. Based on this philosophy, specific targets were set in relation with mortality rates of specific diseases, risk factors in some lifestyles, etc. In addition, it was decided to provide enough information and take necessary action to prepare an environment that enables healthy lifestyles based on one's own choice and health promotion activities, in order for each individual to live a fruitful and satisfactory life as well as to realize a sustainable society.

Approach of idea

The approach of the idea is described as:
amended: Combination of health promotion activities

Innovation or pilot project

Pilot project - There was a case that each enterprise was conducting the project.

Stakeholder positions

• "Measures against Lifestyle-related Disease in the Future" (interim report) was submitted by the Expert Meeting on Lifestyle-related Diseases, Joint Committee on Health Improvement, Nutrition and Lifestyle/Intractable Diseases, Council on Public Health to the Minister of Health and Welfare in July, 1997. 
• Opposition: JT (Japan Tobacco Inc.) and smokers, who argue that health is not what legislation can put obligations about, oppose to legislation at the point when discussions are only extended about health care cost and health insurance and those for health promotion is in its premature stage.

Influences in policy making and legislation

• In November 29, 2001, the Joint Committee on Social Security Reform (the government and ruling parties) drew up "Rationales for Health Care Reform," which pointed out that "health promotion and disease prevention shall be strongly promoted with smooth preparation of a legal basis for the reofrm as well as others."
• The government received the reform proposal, and proposed the Health Promotion Bill to the Diet (the 154th normal session) in March 1, 2002, in order to further promote people's activities for health promotion and disease prevention in line with the "Healthy Japan 21." The Bill passed the House of Representatives in June 21, and the House of Councillors in July 26. It became the Law and was promulgated in August 2 and implemented in May 1, 2003.

Legislative outcome

success

Monitoring and evaluation

There are no agencies or institutions with a special mandate to evaluate the result of the reform, but municipalities and many researchers/scholars will try to evaluate the result because the public had shown much interest in this matter. 

Expected outcome

• By setting a target of health promotion, all the people will be able to clearly understand what the whole scheme is aiming at. Moreover, by analyzing and judging one's own ability as well as the outside environment, which is indispensable in setting the target, drawing up the strategy to achieve the maximum result will be possible. Also, it is possible to lead evaluation activities to the improvement of the following result through comparing result of the evaluation and the target that is set beforehand. Various entities including public administration can engage in a series of those processes, and a great result as a whole can be expected. Besides this, improvement of effectiveness can be expected by applying the technique used in business management such as an effective dissemination method, etc. (*The Law is not intended to obligate individuals to change their lifestyle.)
• Entities that compose the environment include not only public administration but also mass media, independent activity group, corporations, communities, working places, schools, etc.  Every entity understands its roles and characteristics in promoting people's health, conduct activities in consideration for health promotion, and contribute greatly to realizing health of individuals.
• Ashtrays will be removed from public places such as railway stations in the Metropolitan area, which will promote a trend toward ban on smoking or separation of smoking areas.
• The government decided, in the Cabinet Decision in March 9, 2004, to sign the WHO Framework Convention on Tobacco Control and seek for ratification in the Diet.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

The Health Promotion Law lays the legal ground for the "Healthy Japan 21" campaign and for the development of regional plans in municipalities. The fact that the Law was proposed to the Diet in a health reform package (also including proposed amendments to the Health Insurance Law, etc.) indicates that implementation of the Health Promotion Law might have a future impact as a tool for reducing health care cost through disease prevention and health promotion. However, it is too early to judge how the overall impact of the Law is at present.

References

Sources of Information

• Journals (e.g. Shakai-hoken-junpo(in Japanese))
• Internet Homepages
• Newspapers

Author/s and/or contributors to this survey

Tetsuya Aman, Masayo Sato

Empfohlene Zitierweise für diesen Online-Artikel:

Tetsuya Aman, Masayo Sato. "Implementing the Health Promotion Law". Health Policy Monitor, June 2004. Available at http://www.hpm.org/survey/jp/c2/3