
BASKET CONTENTS CHECKOUT

Delivering the Science and the Art of Health Promotion

Robert F. Allen Symbol of HOPE Award

THE SCIENCE OF HEALTH PROMOTION
Michael P. O'Donnell		Special Issue Editors Notes
Yumiko Nishimura Yosuke Chikamoto	213	Health Promotion in Japan: Comparisons With U.S. Perspectives
		Conceptual Review
Kenneth R. Pelletier	216	International Collaboration in Health Promotion and Disease Management: Implications of U.S. Health Promotion Efforts on Japan's Health Care System An evidence-based review of the literature on the health and financial impact of U.S.-based workplace health promotion programs was conducted to determine the insights that might be drawn from these programs to inform the development of programs in Japan. These insights include the following: Randomized controlled research designs are the gold standard in research, but may not be realistic for workplace health promotion programs. Comprehensive multi-factorial programs are most likely to produce positive health outcomes. In measure the financial impact of programs, measures of medical cost provide an incomplete picture; measures of disability management, and productivity enhancement are important , especially in an aging society. To produce long-term change, programs should be maintained on a long-term basis. Measuring the impact of programs on retirees and dependents is important, but often neglected in U.S. studies. Creating health enhancing workplace environments is important to create lasting change, but is often neglected in U.S. research.
		Financial Analysis
Yosuke Chikamoto Isao Igarashi Rina Yamada	230	Relationships Between Behavioral Risk Factors and Dental Care Costs in a Japanese Worksite The relationship between dental-related behaviors and dental utilization were studied among 5915 employees in a Japanese worksite during the year 2000. Dental costs made up 24.3% of total medical costs, and averaged 11,816 yen (about U.S.$98) per person per year. Only 38% of employees used any dental care, and that group visited the dentist an average of 7 times during the year. Over 75% of employees reported brushing at least once per day and 60% said they used a relatively new tooth brush. All demographic and behavioral variables explained only 1.4% of the variance in having any dental costs. Tooth brushing and smoking were not statistically significant predictors. Age and gender explained 8.1% of the variance in having dental costs at the 90th percentile. Toothbrushing increased the variance explained to 9.5% and smoking behavior was not a statisitically significant predictor.
Wendy D. Lynch Yosuke Chikamoto Kumiko Imai Tsui-Fang Lin Donald S. Kenkel Ronald J. Ozminkowski Ron Z. Goetzel	238	The Association Between Health Risks and Medical Expenditures in a Japanese Corporation The relationship between health risks and medical care expenditures for fiscal year 2000 was examined among 6543 predominently male, white collar employees of a large Japanese electronics company. Average total expenditures were 48,017 yen (U.S.$445). The 90th percentile of the expenditure distribution was approximately 111,750 yen (U.S.$1037). The most commonly reported risk factors were lack of exercise (52.9%), current smoking (35%), stress (33%), and poor nutritional habits (23.6%). Least common were recently quitting smoking (2%), high blood pressure (4.1%), and high blood glucose (9.4%). The prevalence of overweight or obesity was 15.9%. High blood pressure and recent quitting were consistently related to high expenditures, after adjusting for the influence of other predictors. Adjusted expenditures were 76% higher for recent quitters and 22.6% higher for employees with high blood pressure. Current smoking, poor nutrition, and alcohol risk were also associated with lower expenditures. Those with multiple cardiovascular risk factors had adjusted medical expenditures that were 128% higher than those with no cardiovascular risks. Those who had multiple risk factors for stroke had expenditures that were 13% lower than those without stroke risk factors. This paper represents a first step in examining the association between health risks and medical expenditures in Japanese employees.
Yumiko Nishimura Yosuke Chikamoto Hideaki Arima	249	Association Between Lifestyle-disease Diagnosis or Risk Status and Medical Care Costs in a Japanese Corporation Medical care costs were compared among 3292 employees age 34 and older in a Japanese corporation who were categorized into one of four groups: 1) those diagnosed with diabetes, hypertension or hyperlipidemia, 2) those with none of those diagnoses, but extremely high levels of blood glucose, blood pressure or total cholesterol, 3) no diagnosis but high levels of the blood glucose, blood pressure or total cholesterol and 4) those with normal levels of glucose, blood pressure or total cholesterol. Among men and women, 14.9% had diagnoses, 24.6% were extremely high risk, 40.9% were high risk and 19.7% had none of these risks. Those with diagnoses had mean medical costs more than double the other groups, and were more than six times as likely to have high costs (90%), but there were no statistically significant differences in costs between the three groups with no diagnosis.
		Commentary
Jamie Hwang	255	The Evolution of Tobacco Use and Control in the United States: An Interview With Dr. John Farquhar Yumiko Nishamura, Associate Director of the Asia/Pacific Research Center's Comparative Health Care Research Project at Stanford University interviewed John Farquhar, Professor Emeritus of Medicine and of Health Policy and Research at Stanford University about tobacco control in the United States and lessons that might be extracted to address tobacco control in Japan.
Yumiko Asukai Yoichi Torii Yosuke Chikamoto	260	Tobacco Control: Recent Movements in Japan The authors contend that tobacco control in Japan has not kept pace with the rest of the global community in the last several decades, and 48.3% of men identify themselves as current smokers. Government programs to reduce smoking are based on courtesy and avoiding moral curruption of youth, not protecting health. National health goals include encouraging exercise, nutritious diet and appropriate rest, but do not mention tobacco control. Japan has more than four times as many cigarette vending machines as the United States, and national excise taxes are among the lowest in the world. These policies may be influenced by the fact that the national Ministry of Finance owns 66.73% of the stock of the Japan Tobacco, one of the largest tobacco companies in the world.

THE FUTURE OF HEALTH PROMOTION IN JAPAN: VISION, STRATEGY AND INFLUENCE

It has been a pleasure to work with Yumiko Nishimura and Yosuke Chikamoto in their roles as editors of this special issue on “Health Promotion in Japan: Comparisons With U.S. Perspectives.”

As I reflect on the contents to this issue and the aspirations of the editors to stimulate health promotion in Japan, some thoughts come to mind about the most effect strategies to make these aspirations reality. The first thought is to have a clear vision of your long term goal and work toward that vision. Is the vision to stimulate employers to develop workplace health promotion programs? Is the vision to build health promotion coverage into national health insurance? Is the vision to provide young people all the opportunities they need to develop good health habits and carry those habits into adulthood? Is the vision to create cultural norms that stimulates good health? Is the vision to integrate health promotion concepts into all aspects of society?

Once this vision is clearly articulated, it is important to develop a strategy designed specifically to make that vision a reality. To develop the strategy, it is important to understand the major forces and major players that will influence the future. The major forces will probably include federal government policy, medical costs, an aging society, employment patterns, national and global economic conditions, scientific knowledge and technical ability, and the demands of the general population. Scientists and medical practitioners tend to overestimate the importance of scientific knowledge and technical skill in charting the course of events. Such knowledge and skill are necessary, but they are insufficient to cause change. This certainly was true in charting the course of health promotion in the United States. Health policy experts have known for 25 years that lifestyle causes roughly half of all premature deaths.¹ The quality of data supporting that conclusion has improved,² but the conclusion has not changed. Physicians have asserted that better evidence is required before health promotion concepts are integrated into health care, when in fact there is already better evidence supporting most health promotion procedures than most medical procedures³. An excellent research base provides ammunition necessary to counter such claims. As such, Japanese researchers should work to develop a health promotion research agenda. Some of the areas of study will include culturally specific evidence on the link between lifestyle, health and costs, the most effective strategies to improve lifestyle, and the impact of the most effective strategies on health and financial outcomes. Major players will probably include scientists, the medical community, employers, government officials, and the general population. We probably cannot control the major forces or players, but we can determine how best to react based on the trends in each of the forces and determine how we can maximize the gain of each of the major players.

Health promotion has grown slowly in the United States for three decades, but is poised to grow rapidly because of growing support from the scientific community, growing investments by employers and shifts in national health policy. The scientific community is becoming involved because a sufficient amount of high quality evidence supports the links between lifestyle and health and the ability of health promotion programs to improve health. Many scientists are now willing to accept health promotion as a credible field. More importantly, they see federal research funds flowing into this area, and they want to be in a good position to capture these new funds.This may not be as much an issue or motivation in Japan. Employers are investing money in health promotion because medical costs are growing so fast that they exceed profits for most companies. Health promotion is one of the few proven ways to control these costs; however, the federal government has historically not been very interested in health promotion. That attitude is changing quickly now that Medicare costs are increasing at a rate that insolvency is likely during the lifetime of a typical middle aged American (in fact as early as 2019),⁴ and voters are telling members of Congress that employers are reducing their medical insurance coverage⁵ . In some ways, stimulating health promotion in Japan may be easier than in the United States. The older society in Japan will make the health and medical cost crisis more urgent. The smaller and more homogeneous population will make program delivery more feasible. The greater commitment of society to serving the needs of the people will make the paradigm shift less radical for the federal government. The workplace is one of the best places to reach the Japanese population because a large portion of the population spends a large portion of their waking hours at work. Finally, Japanese scientists and policy makers will be able to learn from all the mistakes and progress we have made in the United States over the past three decades.

The opportunities for trans-global learning are of course a two-way opportunity. Where, indeed, did health promotion start? Some of the first stories I heard about workplace health promotion back in the 1970’s were of plant-wide, early morning, stretch and warm-up breaks in Japanese factories. At a more sophisticated level, the success of Japanese manufacturers to implement quality control concepts introduced by an American named W. Edwards Deming in the 1950⁶ is now emulated by American manufacturers who are still struggling to catch up. I have no doubt the health promotion world has much to learn from Japan already, and will have much more to learn in a decade.

References

United States Department of Health, Education and Welfare. Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention. Rockville, Md; US Government Printing Office; 1979. Publication 79-55071
Mokdad A, Marks S, Stroup J, Gerberding J. Actual causes of death in the United States. JAMA. 2004;291:1238-1245.
Postponement of Illness and the Future of Medicare Costs (2004) (testimony of James F.Fries, M.D., before the Joint Economic Committee of Congress. Dirksen Senate Office Building, 628).
2004 Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust and Federal Supplementary Medical Insurance Trust Funds. Baltimore, MD: Centers for Medicare and Medicaid Research; 2004.
Kaiser HRET, Employer Health Benefits 2004 Annual Survey. Available at http://www.kff.org/insurance/7148/sections/ehbs04-sec3-1.cfm .. Accessed September 22, 2004
Demming WE. Out of the Crisis. Cambridge, Mass; MIT/CAES, 1986.

Michael P. O'Donnell, PhD, MBA, MPH
Editor in Chief and President
American Journal of Health Promotion

American Journal of Health Promotion | 248-682-0707

Privacy Policy