The National Framework for Promotion of Dementia Policies (2019)

Transitioning from the New Orange Plan to the National Framework for Promotion of Dementia Policies

The New Orange Plan was a major shift from the Orange Plan. Starting with the Ministry of Health, Labour and Welfare (MHLW), its joint signatories included the Cabinet Secretariat, the Cabinet Office, the National Police Agency, the Financial Services Agency, the Consumer Affairs Agency, the Ministry of Internal Affairs and Communications (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 and Transport (MLIT). By creating a system for joint action spanning multiple ministries and agencies , the New Orange Plan made it possible to expand measures for dementia in fields other than healthcare, long-term care, and welfare policy.

An example of one such measure was “Growth Strategy 2018 – Reforms for Achieving ‘Society 5.0’ and a ‘Data-Driven Society,’” which was approved by the Cabinet in 2018. In addition to conventional medical research, Growth Strategy 2018 also demonstrated the Government’s intent to engage in public-private cooperation with a focus on fostering industries for supporting the daily lives of people living with dementia, saying “Local governments, researchers, companies and others are to cooperate and establish a testing ground for the production of new products and services that are ‘friendly to people with dementia,’ including livelihood support from very early prevention to creating an environment for livelihood support and social acceptance after onset. During the current fiscal year, we will create plans to develop frameworks for dementia research through public-private partnerships.” One item that may have been a significant influence on this was a study conducted by HGPI in FY2016 called “Research Project on the Construction and Use of a Model for an International Public-Private Partnership (PPP) in Dementia Research,” as well as the policy recommendations offered as part of that project in 2017. Following these developments, since 2018, the Japan Agency for Medical Research and Development (AMED) has been advancing concrete efforts to examine PPPs under the “Project for Establishing a Verification Infrastructure for Public-Private Innovation in Dementia Countermeasures,” which is mainly being funded by METI. The creation of systems for promoting measures that cut across ministries and agencies such as these has added to momentum for public-private collaboration by surpassing the conventional frameworks of policies for healthcare, long-term care, and welfare.

The Cabinet Secretariat then reorganized the Liaison Conference of Relevant Ministries and Agencies for the Development of Dementia- and Aging-Friendly Communities that had been in place since 2013 to establish the Ministerial Council on the Promotion of Policies for Dementia Care in December 2018. The intent of the new Council was to reinforce the system for promoting policies that span multiple ministries and agencies through stronger political leadership by having the Chief Cabinet Secretary serve as chair and Ministers of State serve as vice-chairs and in other roles. At the Advisor Meeting on Health and Medical Care Strategy held in 2014, Dr. Kiyoshi Kurokawa (who was participating as an advisor) proposed reinforcing systems for promoting policies that span multiple ministries, and we can assume that the decision to establish the aforementioned Ministerial Council was based on that statement and similar discussions.

The first meeting of the Ministerial Council in December 2018 set a target date of May or June 2019 for compiling the National Framework for Promotion of Dementia Policies (the “National Framework”). Various efforts to meet that target then began at each ministry and agency in earnest and included discussions at the Advisory Committee for the Promotion of Dementia Policies and at the Expert Committee for Promotion of Dementia Policies established under the Ministerial Council, as well as at the Executive Committee of the Ministerial Council on the Promotion of Policies for Dementia Care.

Chart 1


Source: Japan Public-Private Council on Dementia website (https://ninchisho-kanmin.or.jp/about.html). Accessed October 2022.

Later, in April 2019, the Japan Public-Private Council on Dementia was established to provide opportunities for the public and private sectors to discuss and consider concrete measures for dementia. This was also a decision made when the Ministerial Council was first established. As of March 2023, approximately 100 organizations were participating in the Japan Public-Private Council on Dementia. In addition to ministries, agencies, and local governments, its members include economic organizations; business groups in finance, transportation, housing, retail, lifestyle, IT, telecommunications, healthcare, long-term care, and welfare; and dementia-related academic societies and patient advocacy organizations. The MHLW, METI, and an NPO called the Community-based Co-Operation Policy-Alliance of Local Governments serve as its secretariat. Two working groups have been established under the Council, which are the Working Group on a Barrier-free Environment for People with Dementia (which is under the jurisdiction of the MHLW) and the Dementia Innovation Alliance Public and Private Sector Working Group (which is under the jurisdiction of METI). Discussions and projects based on each of their respective themes are now advancing.

Chart 2
Source: Japan Public-Private Council on Dementia website (https://ninchisho-kanmin.or.jp/about.html). Accessed October 2022.

The National Framework for Promotion of Dementia Policies

The National Framework for Promotion of Dementia Policies was enacted by Cabinet Decision on June 18, 2019. As of April 2023, it is Japan’s most recent national strategy for dementia. The National Framework is set to be in effect until 2025, when members of the baby boomer generation will be 75 years of age or older. Its underlying philosophy is that “Dementia is a condition that can affect anyone and that has become familiar to many people, including the family members of people living with dementia and others that are close to them. While emphasizing the perspectives of people living with dementia and their families, based on the pillars of ‘inclusion’ and ‘prevention,’ we will promote measures aiming to delay the onset of dementia and create a society where people can live their daily lives with hope even if they develop dementia.” While the keywords “inclusion and prevention” had not been prominent in Japan’s previous national strategies for dementia, their inclusion here brought these concepts to the forefront. The National Framework is characterized by the way it assigns multiple nuances to each of these keywords. “Inclusion” is defined as “circumstances in which people can live alongside dementia with hope and dignity, and in which people can live together in the same society even if they have dementia.” “Prevention” is defined as “actions that delay the onset of dementia,” or “actions that slow dementia progression.” It is noteworthy that it does not define prevention as “preventing the onset of dementia.”

The National Framework aims to pursue this philosophy with five pillars:
(1) Promoting public awareness and supporting efforts to issue statements from people living with dementia
(2) Prevention
(3) Supporting healthcare, caregiving, and long-term care services and long-term care providers
(4) Promoting the creation of barrier-free spaces and services for people with dementia, supporting people with early-onset dementia, and promoting social participation
(5) Promoting R&D and industry and disseminating results internationally
The structure of the National Framework differs drastically from the Orange Plan and the New Orange Plan. It also includes new keywords like “dementia barrier-free” and new perspectives like “promoting industry and disseminating results internationally.”

1. Promoting public awareness and supporting efforts to issue statements from people living with dementia
The key items of this pillar are: (1) promoting understanding toward dementia; (2) informing the public of consultation services; and (3) providing support for communication from people living with dementia. Specific initiatives being undertaken in line with this pillar include ongoing efforts to train Dementia Supporters, which have been underway since the MHLW launched the “Ten-Year Vision for Dementia-Centered Community Development” program in 2005. To date, over 13 million Dementia Supporters have been trained. In addition to people working in retail, financial services, public transportation and other settings where they are in frequent contact with people living with dementia, the Dementia Supporter program aims to further expand its targeted audience to include children and students.

Another new addition introduced by the National Framework is supporting the ability of people with dementia to issue statements on their own. Regarding this topic, the National Framework states that “The sight of people with dementia energetically engaging in activities can transform society’s view of dementia and give hope to many people with dementia.” It goes further to say, “We will advance joint awareness-building efforts with community members living with dementia that will aim to sweep away stereotypical and negative preconceptions of dementia.”

2. Prevention
The main items included in this pillar are (1) promoting activities that can contribute to preventing dementia; (2) promoting efforts to accumulate evidence for prevention; and (3) considering systems for evaluating and certifying products and services from the private sector. The National Framework repeatedly states that it uses “prevention” to mean “actions that delay the onset of dementia” or “actions that slow dementia progression even in people who develop dementia.” Under these definitions, it encourages active involvement from older adults in programs centered around social activities, exercise, and other activities that are known to contribute to prevention.

Furthermore, based on the current lack of sufficient evidence for dementia prevention, efforts are underway to examine the best methods of gathering and analyzing data, as well as evaluating and verifying products and services from the private sector that are thought to contribute to dementia prevention.

3. Supporting healthcare, caregiving, and long-term care services and long-term care providers
The main items of this pillar are: (1) providing early detection, intervention, and support and improving the healthcare system; (2) promoting efforts to improve responses to dementia among health and other professionals; (3) developing an infrastructure for long-term care services, securing human resources to provide long-term care, and promoting the ability of long-term care professionals to respond to dementia; (4) developing and disseminating methods of providing medical and long-term care; and (5) promoting efforts to reduce burdens placed on caregivers for people living with dementia. While this pillar is mostly centered on items that were also in the New Orange Plan, it provides updates to various numerical targets.

Many of its targets were set with the objective of achieving equity in the support system by ensuring that a certain level of support is available throughout Japan. This intent can be seen in indicators like “Municipalities providing dementia-related consultation services: 100%;” “Municipalities that have established care pathways for dementia: 100%;” and “Disseminate Dementia Café events to all municipalities (by the end of FY2020).”

Targets set for Initial-Phase Intensive Support Teams for Dementia include: “Create a case study compilation of innovative initiatives;” “Visit 40,000 people per year nationwide;” and “Support beneficiaries guided to health and long-term care services: 65%.” The Initial-Phase Intensive Support Team for Dementia system was launched as a model project in FY2012 and measures for its full-scale implementation were included in the Orange Plan in 2013. Currently, almost all municipalities have established these teams, and expectations are high for future efforts to clarify their role in each region and to improve quality. “Initial phase” as it is used in this program does not only refer to the early stages of dementia, but also refers to when people have their initial contact with health and long-term care services. These Teams are expected to shoulder a broad range of responsibilities including responding to people who require support but are isolated.

4. Promoting the creation of barrier-free spaces and services for people with dementia, supporting people with early-onset dementia, and promoting social participation
The main items in this pillar are (1) promoting the concept of “dementia barrier-free;” (2) supporting people living with early-onset dementia, and (3) supporting social participation. “Dementia barrier-free” is a new keyword that can be thought of as one of the main features of the National Framework. While the New Orange Plan included a similar pillar that stated, “Promoting efforts for community development to be friendly to older adults, including people living with dementia,” “dementia barrier-free” encompasses a broader range of situations related to the daily lives of people living with dementia.

1: Encourage barrier-free community development2: Support efforts to secure transportation methods3: Promote traffic safety measures
4: Promote housing security5: Reinforce support systems in communities6: Establish certification and award systems for companies, etc. carrying out initiatives for dementia
7: Promote the development of products and services8: Promote the development of financial products9: Encourage use of the adult guardianship system
10: Promote consumer protection measures11: Promote abuse prevention measures12: Promote various forms of private insurance related to dementia
13: Provide welfare support for older persons who commit illegal acts

It specifically includes the thirteen items in the table above, which are meant to represent a broad range of options that are not limited to policies for healthcare, long-term care, and welfare. For people to be able to “continue living in familiar environments as long as possible, even if they develop dementia,” it will be necessary to promote dementia-friendly measures in situations other than healthcare and long-term care services. We can see that the above list was compiled with various situations in daily life in mind. In particular, “7: Promote the development of products and services” was mentioned in Growth Strategy 2018, mentioned above, and progress is currently being made in discussions and verification projects centered around the Japan Public-Private Council on Dementia’s Dementia Innovation Alliance Public and Private Sector Working Group (as of April 2023.)

5. Promoting R&D and industry and disseminating results internationally
The main items in this pillar are: (1) research in areas like prevention, diagnosis, treatment, and caregiving for dementia; (2) establishing a research infrastructure; and (3) promoting industry and international dissemination. As the National Framework states, the underlying mechanisms for the onset and progression of many of the diseases that cause dementia are not fully understood, so further R&D is necessary. Furthermore, Disease Modifying Therapies (DMTs) and prevention methods have also yet to be established, so expectations are high for sufficient investment in R&D to be made so society can benefit from the results of efforts in these areas.

The New Orange Plan also clearly stated the importance of R&D, so it continues to be treated as a priority policy. In comparison, the National Framework contains a new addition, which is “promote industry and international dissemination.” It appears that “promote industry and international dissemination” was identified as a priority measure after a statement from then-Prime Minister Abe at the first meeting of the Ministerial Council on the Promotion of Policies for Dementia Care held on December 30, 2018, who said, “It is also important to contribute to the development of the care-service industry and promotion of global health through proactively sharing the findings obtained through these efforts with Asia.” These targets are also linked to the Asia Health and Wellbeing Initiative from the Headquarters for Healthcare Policy, which marks a significant shift from past dementia policies.

 

(Author: Shunichiro Kurita)
(Last updated: April 2023)

 

The above article is an updated and revised portion of chapter one of Upholding the Rights of Older Adults, “Current Circumstances Surrounding Dementia and the Status of Related Policies” (Kurita S., 2023).