The New Health Check up The New Health Check up System in Japan for System in Japan for Metabolic SyndromeMetabolic Syndrome

The 25The 25ThTh APAN in Hawaii APAN in Hawaii

Medical workshop : Health Care 1 sessionMedical workshop : Health Care 1 session

Mie University In Japan, Shinobu Sakurai Mie University In Japan, Shinobu Sakurai (Prof)(Prof)

abstract• The health checkup system of Japan changes greatly in April,

2008. To decrease incidence rate with the lifestyle disease, and to reduce the medical treatment expense, It makes it to the content to which power improves giving priority to the Metabolic Syndrome prevention. The health guidance with the main transmission of the medical examination result will change dramatically. The doctor and the public health nurse and the dietitian support "The lifestyle is changed" spending time in the person for whom the support is necessary. The object person of the medical examination provisionally calculates the Ministry of Health, Labor and Welfare and about 50 million people the object person of the health guidance is calculating to reach 14 million people provisionally. It introduces this epoch-making system and the mechanism in this session

Health care policy for health promotion Health care policy for health promotion in Japan in Japan

All the nations have the obligation of the basic medical All the nations have the obligation of the basic medical check upcheck up

This system main object is to find illness. This system main object is to find illness. People life style become westernizationPeople life style become westernization Medical cost (a senior citizen in particular) increases. Medical cost (a senior citizen in particular) increases. Starting healthy Japan 21 (2000) for the making of health Starting healthy Japan 21 (2000) for the making of health

and establish National Health Promotion (2003) law. and establish National Health Promotion (2003) law. The increase of diabetes patient and the obesity, the The increase of diabetes patient and the obesity, the

decrease of walking in the everyday life. decrease of walking in the everyday life. The present conditions that a lifestyle-related disease rather The present conditions that a lifestyle-related disease rather

turns worseturns worse

2004 national diet survey

Patient number→ 　約９ . ４ million

Spare group 　→　約１０ . ２ million

Total amount 　→　約１９ . ６ million

40 ～ 74(years old)

male 　　→　　

female 　　→　　

metabolic syndrome population

1/2 person

1/5 person

（％）

25.710

26

9.6

0

10

20

30

40

50

60

male femaleMiddle risk High risk

0

10

20

30

40

50

総数 20歳代 30歳代 40歳代 50歳代 60歳代 70歳以上

23

5.1

7.4

16.5

22.1

27.4

34.4

22.6

12.713.6

25.927.8

26.2

20.9

(%)

メタボリックシンドローム有病者調査（男性）

メタボリックシンドロームが強く疑われるメタボリックシンドローム予備群と考えられる

H16 国民健康栄養調査より

The metabolic characteristic in Japan

Many patient and spare group are almost in working age

Carry out “specific health check up”,Carry out “specific health check up”,“specific health guidance“specific health guidance””

What for: thoroughly prevent life style-What for: thoroughly prevent life style-related diseases.related diseases.

When: April 2008When: April 2008 Who: from 40 to 74 years oldWho: from 40 to 74 years old Which object: policy target is to decrease Which object: policy target is to decrease

a lifestyle-related disease patient / spare a lifestyle-related disease patient / spare group such as the diabetes 25% group such as the diabetes 25% comparing with 2008 in 2015comparing with 2008 in 2015

Penalty or reward: The addition / Penalty or reward: The addition / subtraction of 10% of the money of subtraction of 10% of the money of senior citizen insurance according with senior citizen insurance according with the performance in the latter period the the performance in the latter period the achievement situation of each health achievement situation of each health insurance fund or society from 2013insurance fund or society from 2013

Health check up contents( minimum)Health check up contents( minimum)

Blood pressureBlood pressure Blood test (total protein, albuminBlood test (total protein, albumin, , HDL-HDL-

cholesterolcholesterol, triglyceride, , triglyceride, fasting blood sugar, et fasting blood sugar, et al.)al.)

Waist size measure (new one)Waist size measure (new one) ECGECG Urine testUrine test Doctors interview so on……Doctors interview so on……

Fasting blood sugar 　１１０ mg ／ dL<

High risk : 2 among 4

Middle risk: 1 among 4

Visceral fat Obesity

Male

female

８５ｃｍ <

９０ｃｍ <

BP 　Systolic BP 　１３０mmHg<Diastolic BP 　８５ mmHg<

Triglyceride 　　　　１５０ mg ／dL<

HDL Cholesterol 　４０ mg ／ dL>

Diagnostic criteria of new check up for metabolic syndrome

Waist sizeOR

Specific health check up systemSpecific health check up system

the purpose of preventing the onset and the the purpose of preventing the onset and the aggravation of the lifestyle-related disease,aggravation of the lifestyle-related disease,

Focus on metabolic syndrome Focus on metabolic syndrome To screening a high risk person and a To screening a high risk person and a

person needing identification health person needing identification health guidance to decrease spare group preciselyguidance to decrease spare group precisely

Specific health guidanceSpecific health guidance

the purpose of preventing a lifestyle-related the purpose of preventing a lifestyle-related disease through that a person of object disease through that a person of object recognizes a problem in own habit recognizes a problem in own habit

to improve a habit and change their own to improve a habit and change their own health behavior and learn their self care and health behavior and learn their self care and maintain healthy life.maintain healthy life.

What is point on New health What is point on New health check up system ?check up system ?

Conduct the specific health guidance for Conduct the specific health guidance for patient or high risk person in metabolic patient or high risk person in metabolic syndrome by a specific health checkup. syndrome by a specific health checkup.

Conduct individual order made health guidance Conduct individual order made health guidance by doctor, PHN, as follow points:by doctor, PHN, as follow points:

1)1)degree of the internal organs fat accumulation degree of the internal organs fat accumulation and the number of the risk factorand the number of the risk factor

2)2)the age or the risk level the age or the risk level 3)3)Health guidance has 3 contents : “positive Health guidance has 3 contents : “positive

support ", "incentive support", “offering support ", "incentive support", “offering information " are performed.information " are performed.

Thank you Thank you

Shinobu SAKURAIShinobu SAKURAIProfessor, Dep of community nursing,Professor, Dep of community nursing,Faculty of Medicine, school of nursingFaculty of Medicine, school of nursing

Mie University, JapanMie University, JapanCenter for International education & research, Mie University Center for International education & research, Mie University

romane@nurse.medic.mie-u.c.jpromane@nurse.medic.mie-u.c.jp