Health Equity Assessment and Response Tool （HEART）

developed by JAGES

Katsunori Kondo, PhD, MDCenter for Preventive Medical Sciences, Chiba University

Department of Gerontological Evaluation, National Center for Geriatrics and Gerontology

1

Contents

• Necessity of HEART• Developing process• Overview of JAGES HEART

–Use case and usefulness –Remaining challenges

Health Equity Assessment and Response Tool

Recommendations of CSDHCommittee on Social Determinants of Health

(WHO 2008)

Background & Purpose• Scientific evidence accumulated

– Health Inequality by Social Determinants of Health – We need measurement and assessment systems

which induce responses

• We developed a prototype of measurement (benchmark) system for Age Friendly Cities /Communities (AFC) policy collaborated with WHO Kobe Center (WKC).

JApan Gerontological Evaluation Study (JAGES)

• One of the few population-based gerontological surveys in Japan

• Focused on social determinants of health (SDH) and social environment

• Collaborated with municipalities as insurers of public long term care

• In 2010- 112,000 older people across 31 municipalities responded (response rate: 66.3%)

• In 2013- 138,000 older people responded. (RR: 70.3%)

• In 2016- about 200,000 in 39 municipalities responded. (RR: 70%)

Collaboration between WKC + JAGES

http://www.doctoral.sakura.ne.jp/WebAtlas/

JAGES: Japan Gerontological Evaluation Study

http://www.doctoral.sakura.ne.jp/WebAtlas/JAGES_HEART/23000_Chita/Double/atlas.html

http://www.who.int/kobe_centre/ageing/j_ages_heart/en/

Management Cycle

• Neighbourhood walkability• Accessibility of public spaces and buildings• Accessibility of public transportation vehicles• Accessibility of public transportation stops• Affordability of housing

• Positive social attitude toward older people• Engagement in volunteer activity• Engagement in paid employment• Engagement in socio-cultural activity• Participation in local decision-making• Availability of information• Availability of health & social services• Economic Security

• Quality of life

• Difference between two reference groups• Difference between population average and

highest attainable level of outcome

Accessible Physical Environment

Inclusive Social Environment

Impact on Well-being

Equity Measures

WHO Monitoring Framework & Core Indicators for AFC

JAGES‐HEART 2014

One block represents rank of one municipality

%  of depression (GDS>=5)Limited to 65‐74 y.o.

% of depression: 14.9～34.5％

Participant rate of volunteer

Resources should be allocated or developed in this area  Risks & Resources 

are visible 

4～15％

School districts with higher sports-group participation rates = lower rates of fall among aged 65–74

Sports group participation rate

Rate of elderly who fell at least once in the previous year

Fall

Sports group participation

R = -0.55

Can we facilitate social participation and it reduces the incidence of functional decline?

We need intervention trials

How to use the benchmark system

Lunch club for older people living alone

Setting the agenda

Sharing the results Community meeting

Developing programFostering volunteers

Visualizing status

Poor health and difficulty of shopping are detected in area A 

Implementing the program

Needs of shopping are simultaneously filled by mobile shop invited

M. Yamaya, et. al. 2015

Enjoyable Social Programs←Ping-Pong

Game→

Just chatting is very popular!

Taketoyo town project since 2007

Various programsMaking a Short Poem→led by volunteers

Physical Exerciseinstructed by volunteers

（人） （％）

年度 2007   2008  2009           2010          2011           2012          2013           2014          2015          2016ｻﾛﾝ数 3             5  7   8  8  10              10                11              11               13

401583 637

727794

894 875965 932

1063

90133 151 177 195

226256 247

282328

5.4

7.47.7

8.79.1

9.89.4 9.7

9.110.2

6.1

8.4 8.7

9.910.3

11.1 10.8 11.1 10.511.7

0

5

10

0

200

400

600

800

1000

実参加者数 ボランティア数 65歳以上参加率 65歳以上（要介護者除く）参加率

persons%

Trend of Number & rate of Participants

No. of site3 5 7 8 8 10 10 11 11 13

Source: Taketoyo town

for 65 y.o.and +Rate of Participation

volunteerparticipants

volunteer

participants

for independent and 65 y.o.and +

Participants Rate by Education

010203040506070

<6years

6-9 10-12 13+0

5

10

15

20

25

<6years

6-9 10-12 13+

Health Check Up The New Program

Educational Attainment

%

The program reduced inequalities in social participation

%

Participants keep functions

02468

10121416

Participants Not Participants

% of persons function declineｄ%

Comparison between Participants and Non-Participants in Taketoyo Project

6.3% point reduction during 5 years followed up

Taketoyo project, 2014

N = 2178 312

Hikichi, H., Kondo, N., Kondo, K.,et. All: Effect of community intervention program promoting social interactions on functional disability prevention for older adults: propensity score matching and instrumental variable analyses, JAGES Taketoyo study.Journal of Epidemiology and Community Healthdoi: 10.1136/jech-2014-205345

Incidence of dementia reduced

0

0.2

0.4

0.6

0.8

1

1.2

Participants Not Participants

OR of Incidence of dementiaOdds ratio

7 years follow upDementia rank ≧1

Taketoyo project

N = 152 1885

Hikichi, H., Kondo, K., Takeda, T., and Kawachi, I.: Social interaction and cognitive decline: Results of 7-years community intervention. Alzheimer's & Dementia: Translational Research & Clinical Interventions 3 (1): 23-32, 2017.

0.73

JAGES HEART Using comparative statistics, it supports; 1. to make the health inequalities more 

easily visible2. to support setting priorities and targets 

for local policies3. to analyze possible factors relating to 

policy targets such as participation in sports clubs for fall prevention

4. to monitor changes in time and effects of intervention.

Conclusions• JAGES HEART is useful to find the determinant of healthy aging communities. – social participation seems to be a good for prevention of fall, depression, and functional decline, etc.

– It provides response tools tackling health inequalities. 

• Remaining challenges are– To validate indicators– To collect more go od practices– To increase number of municipalities/countries which use these kind of HEART systems