Past Changes in Japan’s Dementia Policy

The Ministry of Health, Labour and Welfare (MHLW) formed the Committee for Examining Affairs Concerning the Term “Chiho” in 2004. The Committee identified three problems with the term “chiho”: that it is a derogative that causes feelings of contempt, that it does not accurately portray the state of the person being described, and that it obstructs early detection and early diagnosis[1]. The Committee then conducted a wide-ranging public opinion survey and other research and revised the term for dementia to “ninchi-sho,” meaning “cognitive disorder.” When revising the term, they also took the opportunity to create plans for promoting the correct understanding of dementia and for upholding the rights of people with dementia.

The Emergency Project for Improvement of Medical Care and Quality of Life for Persons with Dementia began in 2008 to promote future measures for dementia more effectively. It released a report that identified early diagnosis as a key starting point for promoting appropriate measures for dementia and named it a basic principle for dementia policy. It identified five specific action items: (1) Accurately understand the condition of the person with dementia, (2) Accelerate research and development, (3) Promote early diagnosis and the provision of appropriate healthcare, (4) Normalize appropriate care and support for people with dementia and their families, and (5) Implement measures for early-onset dementia.

Based on the aforementioned Emergency Project report, a proposal entitled the “Future Direction of Policies on Dementia” was prepared to re-examine past dementia policy and propose the foundation of policy to come. It was presented by the Dementia Measures Investigation Project team which was established by the Team for Investigating the Creation of a New Regional Mental Healthcare System in 2010 to deepen discussion on dementia measures and recreate the path for dementia treatment. In the past, admission to a nursing home or hospital was considered an inevitable step in dementia treatment. Hospitalization was the final step in a care path in which people were moved from their home to a group home and then into a nursing home, general hospital, or psychiatric hospital. This team set out to recreate that pathway by rebuilding society so that the rights of people with dementia are respected and so that those people can continue living in familiar spaces and communities. The new care pathway would provide appropriate care according to the condition of the person receiving it. The plan also specified a goal to encourage efforts to research the promotion of such a policy[1].

Based on 2012’s Future Direction of Policies on Dementia, the Five-Year Plan for the Promotion of Dementia Measures (the Orange Plan) was developed that same year. The Orange Plan consisted of seven pillars: (1) Create a standardized dementia care pathway and make it widespread, (2) Promote early diagnosis and intervention, (3) Improve community-based healthcare services to provide daily support, (4) Develop long-term care services that support daily living, (5) Strengthen support for daily living and family support in communities, (6) Reinforce measures for early-onset dementia, and (7) Accelerate the development of human resources for providing healthcare and long-term care.

The first G8 Dementia Summit was held in the United Kingdom in December 2013. In addition to representatives from every G8 nation, the European Commission, the World Health Organization (WHO), and Organization for Economic Co-operation and Development (OECD), the Senior Vice Minister of Health, Labour and Welfare from Japan also participated. He explained population aging in Japan, the then-current situation surrounding dementia, and the Orange Plan. The Summit agreed on the necessity of a new, international approach in which issues related to aging such as dementia research and accelerating research are pursued as a common goal for every nation instead of letting these efforts be shouldered by a single nation.

In response to the G8 Dementia Summit, the Global Dementia Legacy Event Japan was held in Tokyo in November 2014 with the theme of planning a new care and prevention model. HGPI supported this event and HGPI Chairman Kiyoshi Kurokawa participated by giving a speech. A new strategy consisting of three pillars was announced after the event. Those pillars were: (1) Construct a circular medical system that offers seamless service dependent on the condition of the person receiving healthcare, in which healthcare and long-term care services coordinate organically and in which early diagnosis and prevention are promoted, (2) Create a holistic, cross-ministerial strategy for building dementia-friendly communities, and (3) Promote policies that emphasize the perspectives of people with dementia and their families.

Together with this event, HGPI and the OECD held the Taking Action on Dementia: Opportunities for Social Investment – A G7 Global Dementia Legacy Event Private Sector Side Meeting. This meeting provided an opportunity for the private and public sector to discuss private sector-led strategies and approaches for addressing various issues related to dementia using social investment.

In January 2015, a new plan based on the strategy announced after the Global Dementia Legacy Event Japan called the New Orange Plan was unveiled. The New Orange Plan was created after a wide-ranging survey was conducted to collect stories and opinions from people with dementia, their families, and other related parties. It emphasizes the perspectives of people with dementia and their families. Although the New Orange Plan is effective until 2025, its numerical targets and other targets will be reviewed every three years. A unique feature of the New Orange Plan is that it is not driven by efforts from the MHLW alone, but that it involves multiple government agencies, including the Cabinet Secretariat; the Cabinet Office; the National Police Agency; the Financial Service Agency; the Consumer Affairs Agency; the Ministry of Internal Affairs and Communication (MIC); the Ministry of Justice (MOJ); the Ministry of Education, Culture, Sports, Science and Technology (MEXT); the Ministry of Agriculture, Forestry and Fisheries (MAFF); the Ministry of Economy, Trade and Industry (METI); and the Ministry of Land, Infrastructure, Transport and Tourism (MLIT).