NCDs

Background and Challenges

Domestic Situation

The average life expectancy in Japan is 87.32 years for women and 81.25 years for men, which is one of the highest in the world. At the same time, cause of death data from Japan shows that there has been a major shift from communicable diseases, during and after World War II, to non-communicable diseases (NCDs) such as cancer and cardiac and cerebrovascular diseases. NCDs are defined by the World Health Organization (WHO) as a group of chronic diseases including cancer, diabetes, cardiovascular disease, respiratory disease, and mental health that are caused by unhealthy diet, lack of exercise, smoking, excessive drinking, and air pollution. In Japan, about 82% of the total number of deaths are due to NCDs, a figure that highlights the urgency of this issue. Focusing on disability-adjusted life years (DALYs), which is a measure of health loss (disease burden) due to a specific disease or injury, the disease burden is particularly high for cardiovascular disease, cancer, musculoskeletal disorders, mental illness, diabetes, chronic respiratory disease, neurological disorders, and gastrointestinal disease.

International Situation

According to WHO statistics, 41 million deaths were attributed to NCDs worldwide in 2016, accounting for about 71% of all deaths. Of these, about 15 million died before the age of 60. Moreover, low- and middle-income countries (LMICs) suffered the greatest losses, with NCDs accounting for 86% of all deaths. This is thought to be due to the fact that people in LMICs are particularly vulnerable to risk factors such as unhealthy diet, tobacco and alcohol, and lack access to appropriate health services after the onset of the disease. The impact of NCD treatment on households is also significant, especially in LMICs, where NCDs are a major cause of poverty. In economic terms, it is said that the damage caused by NCDs to the world economy over the next 20 years will amount to USD 47 trillion. Measures to combat NCDs are required at the global level.

Policy Trends

International Policy Trends

  • September 2011: A political declaration on NCDs was adopted at the UN High-level Meeting, confirming the health and socio-economic burden of NCDs and the need to address them.
  • May 2013: WHO published the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020, which set nine global targets.
    1. A 25% relative reduction in risk of premature mortality from NCDs
    2. At least 10% relative reduction in the harmful use of alcohol
    3. A 10% relative reduction in prevalence of insufficient physical activity
    4. A 25% relative reduction in the prevalence of raised blood pressure
    5. A 30% relative reduction in mean population intake of salt/sodium
    6. A 30% relative reduction in prevalence of current tobacco use
    7. At least 50% of eligible people receive drug therapy and counseling to prevent heart attacks and strokes.
    8. An 80% availability of the affordable basic technologies and essential medicines required to treat major noncommunicable diseases
  • September 2015: Goal 3 of the Sustainable Development Goals (SDGs) includes a target on NCDs.
    • Target 3.4 “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.”
    • Target 3.5 “Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.”
    • 3.A “Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate.”
    • 3.B “Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing countries”
  • May 2016: At the G7 Ise-Shima Summit and G7 Kobe Health Ministers’ Meeting, Japan became the first G7 country to set the promotion of Universal Health Coverage (UHC) as a major theme at a summit-level meeting.

National Policy Trends

Addressing the issue of NCDs requires prevention and health promotion efforts to reduce risk factors such as smoking, alcohol, unhealthy diet, lack of exercise, and harmful use of alcohol, as well as ensuring access to essential medicines and treatment. In Japan, the National Health Promotion Measures were introduced as an initiative for prevention and health promotion, and a universal health insurance system was developed to ensure access to treatment. In recent years, the Cancer Control Act and the Basic Act on Stroke, Heart Disease, and Other Cardiovascular Disease Measures for Extending Healthy Longevity have been enacted, and comprehensive measures are being promoted for individual diseases such as cancer and cardiovascular diseases. A summary is given below.

National Health Promotion Measures

Preventive measures for NCDs include primary prevention, which promotes health and prevents the onset of disease; secondary prevention, which detects disease at an early stage and treats it; and tertiary prevention, which treats, restores, and maintains function as a response to disease after it has presented.

Based on this concept, Japan updates its National Health Promotion Measures every 10 years.

  • 1978: The First National Health Promotion Measures
    • The 10-year plan was formulated with three basic measures: 1) advancement of lifelong health promotion, 2) development of infrastructure for health promotion, and 3) public awareness of health promotion.
  • 1988: The Second National Health Promotion Measures
    • In the field of health and medical care, which had previously focused only on “treatment,” emphasis was placed on primary and secondary prevention, and improvements were made, including early detection and treatment of diseases through the implementation of health examinations and the development of infrastructure such as municipal health centers.
    • Due to the decline in infant and neonatal mortality rates, improved nutritional status, and other factors, life expectancy in Japan continued to increase, and in the 1980s, the average life expectancy for women exceeded 80 years. Against this backdrop, the Second National Health Promotion Measures is called the Active 80 Health Plan, with the aim of enabling people to take care of themselves and participate in society even at the age of 80.
  • 1996: From adult diseases to lifestyle-related diseases
    • The Ministry of Health and Welfare at the time proposed that “adult diseases,” which had been used as an administrative term until then, be called “lifestyle-related diseases.” Since then, diseases such as cancer and diabetes included in NCDs have been described as lifestyle-related diseases.
  • 2000: The Third National Health Promotion Measures (Health Japan 21)
    • Emphasis was placed on primary prevention, and measures were taken by setting numerical targets in nine areas (1) nutrition and diet, (2) physical activity and exercise, (3) rest and mental health promotion, (4) tobacco, (5) alcohol, (6) oral health, (7) diabetes, (8) cardiovascular disease, and (9) cancer.
  • 2003: Enforcement of the Health Promotion Law
    • With the enactment of the Health Promotion Law, the legal basis for promoting the health of the people has been established. In addition, the Basic Guidelines for the Comprehensive Promotion of the Health of the People was presented based on the Health Promotion Law
  • 2008: Introduction of specific health checkups and health guidance
    • Based on the Act on Assurance of Medical Care for the Elderly, specified health checkups and health guidance focusing on metabolic syndrome (visceral fat syndrome) were introduced.
  • 2012: The Basic Policy for the Comprehensive Promotion of Health Promotion of Citizens were Completely Revised.
    • It was decided that Health Japan 21, the fourth National Health Promotion Measures, will be promoted from FY2013 to FY2022.
    • In addition to extending healthy life expectancy, the guideline aims to reduce health inequalities and, for the first time, specifies the prevention of NCDs.
  • 2018: partial amendments to the Health Promotion Act
    • In order to prevent unwanted second-hand smoke exposure, smoking in facilities used by a large number of people was prohibited.

Cancer Control

In Japan, cancer has been the leading cause of death since 1981, with approximately 370,000 deaths per year in 2015, making it an important issue for the health of the population. In view of this situation, the Cancer Control Act was enacted in June 2006 with the aim of further improving cancer control measures, and came into effect in April 2007. In June of the same year, the first Basic Programme Relating to Cancer Control was formulated to promote cancer control in a comprehensive and systematic manner.

Despite these various efforts to combat cancer, Japan was unable to achieve its 10-year goal from FY2007 of a 20% reduction in the age-adjusted cancer mortality rate (under 75). In the future, it will be necessary to further improve prevention measures in light of these circumstances. When it comes to cancer, it is also important to improve the rate of medical checkups so that early detection and treatment can be achieved.

The 3rd Basic Programme Relating to Cancer Control (FY2017-2022) sets the overall goal as “citizens, including cancer patients, learn about cancer and aim to overcome cancer,” and the measures by field are as follows.

1. Cancer Prevention

(1) Primary prevention of cancer; (2) Cancer screenings and early detection (secondary prevention)

2. Improvement of Cancer Treatments

(1) Genomic medicine; (2) Surgical therapy, radiation therapy, chemotherapy, and immunotherapy; (3) Team care; (4) Rehabilitation; (5) Psychological and emotional support; (6) Rare and treatment-resistant cancer (measures according to the characteristics of each cancer); (7) Childhood cancer, AYA (Adolescent and Young Adult) cancer, and cancer in the elderly; (8) Pathological diagnosis; (9) Cancer registration; (10) Efforts aimed at early development and approval of pharmaceuticals and medical devices

3. Living with Cancer

(1) Palliative care from the time of diagnosis; (2) Counseling and support, communication of information; (3) Countermeasures/support based on community cooperation; (4) Social issues including the employment of cancer patients; (5) Countermeasure that correspond to developmental life stages. Cancer research, human resource development, cancer education, and raising public awareness make up the foundation that supports these three pillars.

The following points are also listed as necessary for the comprehensive and systematic promotion of cancer countermeasures: further strengthening of collaboration and cooperation among stakeholders; formulation of plans by prefectural governments; efforts by the public, including cancer patients; cooperation with patient organizations; implementation of necessary fiscal measures and budget optimization/prioritization; progress assessments and reviews of the Basic Plan.

(Quoted from 4.4 Regional Medical Care Delivery System Maintenance)

Cardiovascular Disease Control

Stroke, heart disease and other cardiovascular diseases (hereafter referred to as cardiovascular diseases) are the major diseases of NCDs, and include ischemic stroke (cerebral infarction), hemorrhagic stroke (intracerebral hemorrhage, subarachnoid hemorrhage, etc.), transient ischemic attack, ischemic heart disease (angina pectoris, myocardial infarction, etc.), heart failure, arrhythmia, valvular disease (aortic stenosis, mitral regurgitation, etc.), aortic diseases (aortic dissection, aortic aneurysm, etc.), peripheral vascular diseases, pulmonary thromboembolism, pulmonary hypertension, cardiomyopathy, congenital heart and cerebrovascular diseases, genetic diseases, and many other diseases. Deaths from heart disease were the second most common cause of death in 2018, after cancer, and cerebrovascular disease was the fourth leading cause of death, with the two together accounting for more than 310,000 deaths annually.

In light of this situation, the Basic Act on Measures for Stroke, Heart Disease and Other Cardiovascular Diseases to Extend Healthy Life Expectancy was enacted in 2018 and came into effect in 2019. The following year, in October 2020, the “Basic Plan for the Promotion of Measures against Cardiovascular Diseases (FY2020-2022)” was formulated based on the Basic Law. Many cardiovascular diseases develop and progress due to lifestyle, obesity, and other factors, but there are also a variety of other conditions, including congenital and genetic diseases. In addition, the disease is often life-threatening within minutes to hours of onset, and appropriate treatment must be given as soon as possible after onset. The recovery period and the chronic period are characterized by the possibility that disabilities that occurred in the acute period may remain as sequelae, and by the risk of relapses and exacerbations, as there is always a risk that symptoms may become severe or deteriorate rapidly multiple times. Based on these characteristics, a wide range of measures are required to combat cardiovascular disease, from prevention to services related to medical care and welfare.

The Basic Plan for the Promotion of Measures against Cardiovascular Diseases sets the overall goal as “extending healthy life expectancy by three years or more and reducing the age-adjusted death rate from cardiovascular diseases by 2040.” The policies included are outlined below:

1. Prevention of cardiovascular disease and promotion of correct knowledge

Prevention of the onset and severity of cardiovascular diseases, and enhanced public awareness about cardiovascular diseases (prevention, early response, etc.) from childhood

2. Health, Medical Care and Welfare System Strengthening

(1) Promotion of health checkups and initiatives to prevent cardiovascular diseases, (2) improvement of emergency transport system, (3) establishment of medical care provision system for cardiovascular diseases including securing emergency medical care, (4) countermeasures against cardiovascular diseases and support for patients with cardiovascular diseases based on social cooperation, (5) initiatives for rehabilitation, (6) provision of appropriate information and consultation support for cardiovascular diseases (7) palliative care for cardiovascular diseases, (8) support for people with sequelae of cardiovascular diseases, (9) support for balancing treatment and work and support for employment, (10) measures for cardiovascular diseases that require consideration from childhood and young adulthood

3. Promotion of Research on Cardiovascular Diseases
4. Research and development contributing to the elucidation of the pathogenesis of cardiovascular diseases and methods related to prevention, diagnosis, treatment, rehabilitation, etc.

The development of a system to collect and provide medical information on cardiovascular diseases is set as the foundation to support the above 1 to 3.

In addition, as necessary items for the comprehensive and systematic promotion of measures against cardiovascular diseases, the following items are listed: further strengthening of coordination and cooperation among related parties, formulation of plans by prefectures, implementation of necessary financial measures and streamlining and focusing of budgets, measures based on new coronavirus infections, and review of the basic plan.

HGPI'S INITIATIVES

The Health and Global Policy Institute (HGPI) raised the importance of NCD countermeasures from early on, and held the NCD Japan Forum in November 2011, where experts from Japan and abroad held discussions. In 2013, we also established a Japanese branch of the NCD Alliance, a collaborative platform of about 2000 civil society and academic groups in 170 countries. Recently, in 2018, a global forum was held to identify patient- and party-centered policy issues in the fields of diabetes, cancer, dementia, and cardiovascular diseases including stroke, and to propose policies. The forum has been held several times. In addition, we held workshops and meetings for patients before and after each Global Forum to identify patients who can actively participate in advocacy activities and evaluate the value of innovation. Through these activities, we accumulated policy issues common to NCDs and best practices that can be developed across diseases, and provided a forum for patient- and party-centered policy proposals.

On January 17, 2019, the company officially joined the NCD Alliance as a full member, and held a global forum in October 2019 to further promote comprehensive and cross-disease NCDs control in Japan and abroad. Since then, it has continued to build on three areas: policy proposals, patient and party support, and surveys and research.

In policy advocacy activities, “Proposal on Achieving Better Communication Between Healthcare Providers and Beneficiaries” was published in July 2020, and made recommendations for the realization of a flat healthcare system in which the power of both patients/parties and medical care providers is equally demonstrated. In the area of patient support activities, from FY2019, we developed a Japanese version of the Our Views, Our Voices workshop for strengthening the advocacy capacity of parties organized by the NCD Alliance, and implemented it in Japan, thereby contributing to improving the advocacy capacity of patients and parties in Japan. In addition, interviews are conducted with PLWNCDs and their caretakers who are engaged in policy advocacy and disease awareness and peer support. The interviews are regularly published on the NCD Alliance Japan website. As part of our research activities, we collaborated with the World Stroke Organization (WSO), an international non-profit organization, and published the Japanese translation of the “World Stroke Guidelines and Action Plan: Roadmap for Quality Stroke Care—Implementation Guidelines for the Roadmap” under the supervision of experts from the Japanese Stroke Association and the Japan Stroke Association. In addition, in January 2021, “Survey on Optimizing the Roles and Work Styles of Japan’s Healthcare Workforce in the Field of Non-Communicable Diseases-Strengthening of Health Workforce on Non-communicable Diseases and Universal Health Coverage” was commissioned by the NCD Alliance, and the results were published.

PLAN FOR HGPI'S FUTURE ACTIVITIES

The NCD Alliance Japan will continue to focus on gathering the voices of PLWNCDs and making policy proposals based on these voices in order to realize the mission of the Health and Global Policy Institute, which is to promote citizen-centered healthcare policy. In addition, as a platform for PLWNCDs, we hope to provide a place where patients and their caretakers can, regardless of their disease, and learn about medical policy. Our goal is make policy proposals to solve immediate problems related to treatment and daily life by listening closely to the voices of parties concerned. We will also continue to promote the NCDs policy agenda, stimulate debate, and implement evidence building for NCDs in general, as well as for specific diseases.

References

[1] 内閣府「令和2年版高齢社会白書（全体版）」https://www8.cao.go.jp/kourei/whitepaper/w-2020/html/zenbun/s1_1_1.html (Accessed on 15 December 2020)
[2] World Health Organization “Noncommunicable diseases country profiles 2018” https://apps.who.int/iris/rest/bitstreams/1151362/retrieve (Accessed on 15 December 2020)
[3] 厚生労働省「健康日本21（総論） 総論参考資料」https://www.mhlw.go.jp/www1/topics/kenko21_11/s1.html (Accessed on 16 December 2020)
[4] Institute for Health Metrics and Evaluation “GBD Compare (2019)” https://vizhub.healthdata.org/gbd-compare/ (Accessed on 15 December 2020)
[5] 厚生労働省「循環器病対策推進基本計画 令和2年10月」https://www.mhlw.go.jp/content/000688359.pdf (Accessed on 30 March 2021)

Last Modified: June 2021