Transcript Dr. Kiyotaka Segami

How Has The National Policy To Prevent The
Metabolic Syndrome Been Developed In
The Japanese Ministry Of Health?
-To Facilitate The Healthier Longevity
SocietyAt ECOSAC Regional Ministerial Meeting
on Financing Strategies for Health Care
16-18 March 2009
Colombo, Sri Lanka
Kiyotaka SEGAMI, M.D., Ph.D.
Executive Board-Director
Welfare and Medical Service Agency
The former Minister’s counsel in health
[email protected]
[email protected]
Financial Concerns
-Containment of --
Social Concerns
-Better QOL
Medical Concerns
–Better Health
Business Concerns
-Finding Chances
Aging
Population
Issues
Sustainability in Policy
Feeling Not Unhappy, Not in Poverty among Citizen
28 Sept 06/ Segami, K
Depiction of Medical Expenditure Growth
Increase of medical Expenditure
A n al ys i s o f fac to rs
Increase of Medical Expenditure of the elderly is a Major Factor
Aging of the population
Per Capita Medical Expenditure of the Elderly
1.5 ratio of elderly to non-elderly
Large Variation of Per Capita Medical Expenditure for the elderly
（Average \750,000, Highest：\900,000, Lowest：\600,000）
Increase of Inpatient Medical
Expenditure per Patient
Increase of Outpatient Medical
Expenditure per Patient
Large number of Beds (Long Average LOS）
Prevalence of Lifestyle-related Disease in Outpatient
Low Home Care Rate
Increase of Patients with Life Style-Related Disease due
to Visceral Obesity / Adipose Tissue
Japanese Trial in Various Methods of Controlling Medical Expenditure
＜Chronic＞
＋
Promotion of
Home Care
Improvement of
Residence Other
than Home
Referral System
at Discharge
＜Acute＞
Functional Specialization and
Referral System According to
Acute Phase, Rehab Phase,
Nursing Care Phase and Home
Care Phase of illness
Decrease of Average
Length of Stay
Reduce Admission Rate by
Preventing the occurrence of Severe Diseases
Outpatient Medical
Expenditure
Prevention of Lifestyle-Related Diseases
（Medical Check-ups and Health Advice by Insurers etc.）
Reduce the incidence of diseases
Home Visit for Patients with patients with duplicate care
and Frequent Outpatient Visit
Containment of Medical Expenditure
Growth
Inpatient Medical
Expenditure
Conversion of Long-term
in-patients to
Nursing Care
Promotion of Terminal
Care at Home
Control of Medical Expenditures involving All Stakeholders
Patient
(Insured)
・ Effort to Improve Lifestyle
・ Appropriate Physician Visit
Effective Health Care
・ Achieving Early Discharge,
Reduction of he Number of Beds
Providers
・ Creating Incentives for Patients to Pass
Away at Home or Nursing Facilities by
Improving Home Care
Reduce Prevalence Rate of
Life-style Related Disease
・ Implementing Health Checkup and
Insurers
Health Education to Prevent Life-style
Related Disease
Shorten average Length
of Stay (LOS)
Containment of
Health Care
Expenditures
・ Review of the universal fee schedule
National
Government
to produce effective health care
・ Budgetary steps for Prefectures to
guide healthcare providers
・ Planning & implementing plan for Medical
Prefectures
Expenditures Control, and Health Promotion Planning,
Health Care Planning, Long-term Care
Insurance Planning
・ Guidance of Municipalities
Municipalities
・ Promotion & Education of prevention of
life-style related disease
・ Enhancing the provision of nursing care
as a foundation of home care
Steps for Promoting Effective Health Care
Development of Stages of Life-style Related Diseases and Medical Care
Expenditure in 2004
Physical Inactivity
Visceral Obesity
Metabolic Syndrome
50% / Male 40yrs+
20% / Female
Unhealthy Diet
Smoking accelerates all
stages of development and
more damages
Sleep Apnea
Hypertension
Diabetes
5,939,000 patients
receive medical care
Medical Exp:
8 Billion USD
2,284,000 p
Med Exp:12 B USD
(7,400,000 Suspected
+ 8,800,000 Possible)
Arteriosclerosis
Cerebrovascular D.
Ischemic H. D.
1,374,000 p
Annual Death: 130,000
Annual Occur: 234,000
Med Exp: 17 B USD
911,000 p
Annual Death: 72,000
Med Exp: 6.8 B USD
47.2 B USD
Amputation from
Diabetic Neuropathy
Ann. Registry: 3,000
Diabetic
Nephropathy
Vision Loss from
Diabetic Retinopathy
Ann. R.: 3,000
Hemodialysis from
Renal Failure
(For Reference)
Malignant Neoplasm
230,000 p
Annual Incr: 14,000
Med Exp: 3.4 B USD
1,280,000 p
Annual Death: 305,000
Med Exp: 21.4 B USD
Medical Concerns on Hypertension
Genetic Factor
Insulin Resistance
RAS Activity
SNS Activity
Salt Sensitivity
Drugs
(30-50% influence)
Salt Intake
Physical Inactivity
Mental Stress
Visceral Obesity
Hypertension
Cardiovascular/Renal
Complications
Status of the
paralyzed
after stroke
Status of the
sight-lost
after retinal
hemorrhage
Life Style
Modification
Kamide K, et al.
Jp Heat J 2004
Financial
Concerns
Numbers of
Patients and
Latent ones
Cost of
Medical Care
Medical
Expenditure
in Future
PREVENTION
Public Health
Approach
Number and
Status of Renal
Failure and the
Dialyzed
Social Concerns
Status Quo: Hypertension in Japan
• Receivers of medical services
– 5,939,000 are under the medical care due to
Hypertension. (2004)
– 9.2% of total “receivers”
• Medical Expenditure for Hypertension
– 946 BJY (=8,085 MUSD) in 2004
• 19.9% for Inpatient, 80.1% for Outpatient
– 7.8% of Total Medical Expenditure (12,106 BJY)
• Latent Patients estimated
– Patients are estimated 31,000,000
– persons at risk are also estimated 20,000,000
• Hypertension is not only the medical issue, but
also the national financial one
Health adjusted Life Expectancy
and Years Lost of Life Expectancy
due to Hypertension
Male
０ yrs
６５ yrs
７５ yrs
８５ yrs
Life Expectancy in
1995
77.7
17.6
10.7
5.8
Health Adjusted LE
Hypertension
68.3
16.2
9.4
4.7
9.4
1.3
1.3
1.1
Years Lost of
Life Expectancy
Female
Life Expectancy in
1995
Health Adjusted LE
Hypertension
Years Lost of
Life Expectancy
０ yrs
６５ yrs
７５ yrs
８５ yrs
84.6
22.5
14.2
7.7
77.1
18.7
12.1
7.6
7.5
3.8
2.1
0.1
Segami, K(2006)
Life Table Analysis of Hypertension in Female
Japanese
Years of Life Lost from
Hypertension is 569,237 personyears at 65yrs of female.
In other words, the differences
of life expectancies are 3.8 years
from 22.5 years at age 65.
(From Life Table and Vital Statistics in 2000)
Power of Mortality at the age of Diagnosis of Hｙpertension
Age
30's
50's
60's
70's
80's
Power 5.0 Times 2.2 Times 2.1 Times 2.4 Times 1.0 Times
From the JAPAN DATA by Okayama et al.
By Segami, K 2006
Output: Suppressing
increment of ME for
the Elderly
Health
Promotion
Suppressing
Onset of Dis.
Suppressing
Aggravation of
Dis.
Medical expenditure per Capita
Threshold of
onset
Risk Factors for Onset (Preventable)
Total measures of controlling Visceral Obesity and Diabetes and other Risk
Factors will cause suppressing the Medical Expenditure for the Elderly
Aging
（Preventive measures are effective for suppressing the Medical Expenditure of Diabetes, which
will cause the complication after 25 yrs to 70% of patients.)
Depiction of Medical Expenditure Growth
Necessity of Systematic Measures
Countermeasures to Suppress Life Style
Related Diseases
①Spread of Integrated and
Consistent Health Promotion by
Insurers and Regional Officials
(Significant is to increase their
motivation.)
②Complete and Efficient Medical
Check ups (Based on evidence
from mega cohort study.)
③Individual Health Advice for
High-Risk Groups (By well-trained
Health Personnel.)
1,325M USD to be allocated in 2007
Functional Specialization and Referral
System of Medical Facility
Acute Stage
Rehabilitation
Chronic Stage
Home Care
referral
Nursing Care System
Respect for Local Daily Activity of the
elderly
Systemic Approach to change Mechanism of
delivery of Health Services
Schematic Image of Medical Coordination
(in case of stroke)
[Acute Illness]
[Subacute/ Recovery Phase]
Community
Emergency Care
Services
Rehab Function
(Recovery Phase)
Use of Longterm Care
insurance
(if necessary)
(Transfer
Coordination)
(Discharge
Coordination)
(Discharge
Coordination)
(Referral
Coordination)
(Referral
(Care house,
Coordination) Nursing home
etc.)
(Discharge
Coordination)
Primary Care Function
(Clinic, Hospital etc.)
Discharge
Onset of
Disease
Living at
Nursing
Facility
Care Function
(Including
Rehab)
Discharge
Home Care
（Continuity care）
Management, Education
Living at Home
Discharge
Discharge
The theoretical understanding of the visceral obesity
as the starting point of most of those diseases
Countermeasures toward the more effective prevention of these diseases
Insulin
Resistance
Diabetes Care 19,
287, 1996
Diabetes, Hyperlipidemia
Left Ventricular
Dysfunction
Metabolism 36,
54, 1987
Am J Cardiol 64,
369, 1989
Bio-active
Mediators from
Adipose Tissue
Visceral
Obesity
Hypertension
Hypertension 16,
484, 1990
Hypertension 27,
125, 1996
Coronary Diseases
Atherosclerosis 107,
239, 1994
Int J Obesity 21,
580, 1997
Sleep Apnea
J Int Med 241,
11, 1997
All by Prof. Matsuzawa Y. et al
With complimentary regards
Prevention of Onset and Progression
of Lifestyle-Related Diseases
High Blood
Pressure
High
Blood sugar
High Blood
Lipid
○High blood glucose, High blood pressure, Hyperlipidemia do
not progress separately. These are like ”The tips of a single iceberg”.
Visceral fat
○Medication (ex. Hypoglycemic agent) merely reduces the
size of ”one tip of the iceberg”.
○It is necessary to reduce the size of “whole iceberg” by
improving life style, such as adherence to physical exercise
and improved diet.
Improvement of Life Style
Adherence to
physical exercise
Increase of energy
consumption, Cardiovascular
activity
Improved Diet
・Adherence to Exercise
・Improved Diet
・Quitting Smoking
Reducing caloric intake,
Balanced Nutrition
Activation of Metabolism / Reduction of visceral fat
（Good Hormone↑ , Bad Hormone↓ ）
Continuation
One medication merely
reduces the size of one tip of
iceberg. It does not cure the
whole disease.
1.Exercise
2. Diet
Appropriate blood sugar, pressure, lipid
Reduction in weight and waist circumference
Feeling of Well Being
Smaller Iceberg!
3.Non-Smoking
Drug is last resort
Comprehensive Implementation of Medical Expenditure Control
1. Ensuring a Balance between rising health care costs and the public financial burden
Rising Health Care Costs
Moderation in Health Care Cost in the mid-andlong term (Decrease the number of metabolic
syndrome patients, at-risk group, decrease the
Average Length of Stay etc.)
Review of the coverage policies of public health
insurance etc. (Short-term Policies）
Evaluate from both
perspective
Ensuring consistency with the New Health
Promotion Plan, new Health Care Planning
Incremental
Effects
Evaluate from an
economic perspective
Ensuring Secure and Reliable
Health System
Moderating Public Burden
Present a clear estimate of medical spending in the future
including mid-& long-term prospects for about 5 years
＝
Use as a way to examine the rising health care costs
after a certain period
of time
Examine the effectiveness of the control policies
by comparing the estimated and actual costs
Future review of policies
Comprehensive Implementation of Medical Expenditure Control
2. Promoting Plans for Medical Expenditures Control
The national government and prefectures must work together in;
• Promulgating systematic measures to control medical
expenditures, including of long-term hospitalization those
regarding lifestyle-related disease prevention and those for
rectifying the problem.
(2) Taking steps to support plan implementation. Formulating
such plans in a manner consistent with health promotion plans
and long-term care insurance will ensure coordination
between policy actions.
(3) Conducting examinations to verify that the plan is being
implemented.
* Excerpt from Outline of Health Care Reform Policy
For Longevity and
Healthier Life
• Death is inevitable, but a life of
protracted ill-health is not.
• A half but most, in future, of
cardiovascular diseases do/will not
result in sudden death.
• Rather, they are likely to cause people to
become progressively ill and debilitated,
especially if their illness is not managed
correctly.
• Prevention and control of
Cardiovascular disease helps people to
keep longer and healthier lives.
The speaker appreciates
your kind attention.
See you soon.
Something else
•
Lest of all, just for your sight….
Status Quo: Cardiovascular diseases in
Japan
Background of policy-making toward the
prevention of the metabolic syndrome
Population, Birth, and Death in Japan
140,000,000
2800000
120,000,000
2400000
100,000,000
2000000
80,000,000
1600000
60,000,000
1200000
40,000,000
800000
20,000,000
400000
19
50
19
52
19
54
19
56
19
58
19
60
19
62
19
64
19
66
19
68
19
70
19
72
19
74
19
76
19
78
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
0
0
In 2006
Population12
7,720 T
Over 65 yrs
26,400 T
(20.7%)
Death est.
1,600 T
Increment of Cardiovascular Deaths
CVD + Stroke: 303,000 and 28% of
total deaths in 2005
CVD
2005
171,000
15.9%
2004
132,000
12.3%
159,625
15.5%
2000
129,055
12.5%
146,741
15.3%
Stroke
Malignant Neoplasm
324,000
30.1%
132,529
13.8%
165,478
121,944
1980
161,764
123,505
320,358
419,564
40.8%
295,484
386,899
30.7%
40.2%
217,413
162,317
Others
450,000
41.8%
31.1%
1990
0
CVD + Stroke：Inpatient310T、Outpatient850T
Mal Neoplasm：Inpatient140T、Outpatient110T
315,470
275,215
500,000
1,000,000
3000
0
0
yr
s+
1000
８９
6000
９０
2000
～
9000
８４
3000
８５
12000
～
７９
4000
８０
Physician Visit
～
5000
７５
ye
１ ar
～
５ ４
～
１０ ９
～
１
１５ ４
～
１
２０ ９
～
２
２５ ４
～
２
３０ ９
～
３
３５ ４
～
３
４０ ９
～
４
４５ ４
～
４
５０ ９
～
５
５５ ４
～
５
６０ ９
～
６
６５ ４
～
６
７０ ９
～
７
７５ ４
～
７９
０
Anual
Prevalence
(estimated)
/ 100
000
100,000)
visits (per
first physician
rate of theRate
Incident
Annual
Annual Incident Rate of Cardiovascular Diseases
Prevalence Rate of Cardiovascular Diseases
15000
Admission
1 year after Cerebrovascular Events
Death 48,511（20.7％）
Annual Occurrence
234,352 (100%)
Alive 185,841（79.3％）
To be
decreased
in future
Institutionalized 13,195（5.6％）
Bed-bound at Home 17,469（7.4％）
Home help needed 30,850（13.2％）
Independent（Partially） 67,460（28.8％）
Recovery 57,053（24.3％）
To be
increased
Outline of Health Care Reform Policy
（Government and Ruling Parties Council on Health Care Reform (December 1st, 2005)
<Contents>
Ⅰ Guiding Principles for the Reform
1. Ensuring safe and reliable healthcare while emphasizing prevention
2. Comprehensive Implementation of Cost Containment
3. Creating a new health insurance system accounting for the aging of society
Ⅱ Ensuring safe and reliable healthcare while emphasizing prevention
1. Ensuring safe and reliable healthcare
2. Emphasizing prevention
Ⅲ Comprehensive Implementation of Cost Containment
Ⅳ Creating a new health insurance system accounting for the aging of
society
Ⅴ Reviewing the universal fee-schedule etc.
Ⅵ Reform timing
Ⅱ. Ensuring safe and reliable healthcare
while emphasizing prevention
Basic structure
Ⅱ - 1. Policy Outline
“Ensuring Safe and Reliable Healthcare”
→ (1) Establishing a new structure capable of providing safe,
secure and high-quality health care upon the
consumers’ perspective
Ⅱ - 2. of the Policy Outline
“Prevention as a centerpiece”
→ (2) Establishing a new structure focused on prevention of
lifestyle-related diseases
(1) Establishing a new structure capable of providing safe, secure and
high-quality health care upon the consumers’ perspective
- Enabling people to obtain sufficient healthcare information Assistance in healthcare decision-making by providing healthcare information
- Information collection and release by prefectures
--> Instituting a structure under which a medical institution can register its available healthcare service offerings with the prefecture,
which then disseminates such information in an easy-to-understand way.
- Clearly presenting to residents and patients at the regional level, in the form of a health care planning, the healthcare services which
are available, as well as the details of inter-institution coordination.
- Widening the range of information advertised.
- Enabling people to receive safe and high-quality healthcare Provision of unfragmented healthcare by promoting specialization and coordinating provision of healthcare services
- Establishing a system of regional healthcare coordination for respective fields of healthcare, such as stroke, cancer and pediatric
emergency care, by reconsidering the health care planning.
- Providing, within a system of regionally coordinated healthcare, unfragmented healthcare through the wider application of
networked critical pathways.
* Regional coordinated critical pathways
A treatment plan up until a patient goes home after being treated in an acute-care hospital and then a rehabilitation hospital.
Information-sharing between the patient and his or her medical institution leads to the provision of efficient and high-quality
healthcare as well as the patient's peace of mind
Ensuring appropriate healthcare provision even takes into account a patient’s care after discharge or transfer.
- Enabling people to recover quickly and return home
Improved quality of life (QOL) for patients through well-developed home healthcare services
Forecast of Medical Expenditure
(Estimate based on reform plan, January 2006)
FY2006
FY2010
FY2015
FY2025
27.5 (trillion)
31.2 (trillion)
37
48
% of National Income
7.3%
7.4% ～ 7.7%
8.0% ～ 8.5%
8.8% ～ 9.7%
% of GDP
5.4%
5.4% ～ 5.6%
5.8% ～ 6.1%
6.4% ～ 7.0%
28.5 (trillion)
33.2 (trillion)
% of National Income
7.6%
7.9% ～ 8.2%
8.7% ～ 9.2%
10.3% ～ 11.4%
% of GDP
5.5%
5.8% ～ 5.9%
6.3% ～ 6.6%
7.5% ～ 8.2%
(Budget)
Projection after reform
Without Reform (status quo)
40
(trillion)
56
(trillion)
(trillion)
(trillion)
National Income
375.6
(trillion)
403
～ 420
(trillion)
432 ～ 461
(trillion)
492 ～ 540
(trillion)
GDP
513.9
(trillion)
558
～ 576
(trillion)
601 ～ 634
(trillion)
684 ～ 742
(trillion)
(Assumption of the estimate)
1. “Without Reform” refers to the projected expenditures under the current health insurance law with an unrevised universal fee schedule.
The increase of Medical Expenditure per capita is extrapolated from past data (2.1% for people below 70 and 3.2% for people above 70)
2. “After Reform” refers to the Budget in 2006 and when the revision of health insurance law etc. and the revision of the universal fee schedule are implemented
3. Nominal Economic Growth used in the calculation of National Income and GDP is based on two cases, “Basic Case” and “Risk Case”.
Both cases are using the same assumption of “Reform and Prospect 2005 (Draft)” (until 2011) and “Recalculation for Pension Finance 2004” (from 2012)
Changes in Nominal Economic Growth
2006
2007
Basic Case
2.0%
2.5%
Risk Case
2.0%
1.9%
2008
2.9%
2.1%
2009
3.1%
2.2%
2010
3.1%
2.1%
2011
3.2%
2.2%
2012～
1.6%
1.3%
Status Quo: Diabetes in Japan
Background of policy-making toward the
prevention of the metabolic syndrome
Prevalence of Diabetes in Japan
40
Female
Diabetes Suspected
Diabetes Diagnosed
Diabetes Suspected
Diabetes Diagnosed
20〜29
30〜39
Male
35
Prevalence Rate
30
25
20
15
10
5
0
40〜49
Age
50〜59
60〜69
70〜
2002 Diabetes Survey by Ministry of Health
Correlation between Physician Visits for Diabetes and Mortality
from Renal Failure (Correlation Coefficient: 0.721)
P revalence of D iabetes V S M ortality from C hronic R enalFailure
correlation coefficiet:0.721
M ortal
ity C R F (per 100,000 capita)
Failure
Mortality Rate from Renal
R 2 = 0.5192
22
18
14
10
100
120
140
160
180
200
220
P revalence D ibabetes
240
260
280
Incident Rate of the first Physician Visits from Diabetes (per 100,000 capita)
300
Correlation between Physician Visits for Diabetes and Mortality
from Pneumonia
(Correlation Coefficient: 0.638)
P revalence of D iabetes V S M ortality from P neum onia
correlation coefficiet:0.638
M ortal
ity P neum oni
a
100,000 capita)
(per
Pneumonia
Mortality Rate from
110
R 2 = 0.4069
80
50
100
120
140
160
180
200
220
P revalence D ibabetes
240
260
Incident Rate of the first Physician Visits from Diabetes (per 100,000 capita)
280
300
Status Quo: Hypertension in Japan
Background of policy-making toward the
prevention of the metabolic syndrome
Status Quo: Hypertension in Japan
• Receivers of medical services
– 5,939,000 are under the medical care
due to Hypertension. (2004)
– 9.2% of total “Patients”.
• Medical Expenditure, burden of
cardiovascular diseases
– 946,000,000,000JY (=8,085 MUSD) in
2004 for Hypertension
» 187,9 BJP for Inpatient
» 758,1 BJP for Outpatient
– 7.8% of Total Medical Expenditure
(12,105,600 MJY)
Correlation between Physician Visits for Hypertension and
Mortality fromP reval
Renal
Failure (Correlation Coefficient: 0.753)
ence of H ypertension V S M ortality from C hronic R enalFailure
ortalityFailure
C RF
(per 100,000 capita)
Mortality Rate of from MRenal
correlation coefficiet:0.753
13
R 2 = 0.5678
9
5
300
350
400
450
500
550
600
P revalence H ypertension
650
700
Incident Rate of the first Physician Visits by Hypertension (per 100,000 capita)
750
800
Correlation between Physician Visits for Hypertension and
Mortality from Cerebral Infarct (Correlation Coefficient: 0.653)
M ortal
ity C erebral
Infarct(per 100,000 capita)
Infarct
Cerebral
Mortality Rate from
P revalence of H ypertension V S M ortality from C erebralInfarct
correlation coefficiet:0.653
R 2 = 0.4266
90
60
30
300
350
400
450
500
550
600
P revalence H ypertension
650
700
Incident Rate of the first Physician Visits by Hypertension (per 100,000 capita)
750
800
Decrease of Mortality in 5 years (1997-2002) from Cerebral Hemorrhage
Correlation between Physician Visits for Hypertension
And Decreases of Mortality in 5 years (1997-2002)
from
Cerebral
Hemorrhage
other
Cerebral
C orrel
ation betw een
Incidence of Hand
ospital
V isit byminor
H ypertensi
on A nd D.
D ifferences of M ortality after 5 years (1997-2002)
from Coefficient:
C erebrovascular-0.327
D iseases)Except B rain H em orrhage,Infarction
(Correlation
(C orrelation C oefficient:-0.327 )
0.5
0
300
350
400
450
500
550
600
650
700
750
-0.5
-1
-1.5
-2
R 2 = 0.1071
-2.5
-3
-3.5
-4
Incidence of the first Physician Visits for Hypertension
800
Correlation among these diseases
Background of policy-making toward the
prevention of the metabolic syndrome
The prevention from the starting point as the most
appropriate countermeasure
Countermeasures toward the more effective prevention of these diseases
• To prevent Visceral Obesity, Risk Factor Control by
individual behavior changes;
– Spread of Integrated and Consistent Health Promotion by
Insurers and Regional Officials (Significant is to increase their
motivation.)
– Complete and Efficient Medical Check ups (Based on evidence
from mega cohort study.)
– Individual Health Advice for High-Risk Groups (By well-trained
Health Personnel.)
• 1,325M USD to be allocated in 2007
What can we do
as the population approach?
From the desk plan to the social movement
The dawn of the national policy on Metabolic
syndrome Group
– Stepping in to the academic round-table
conference on making the Japanese version of
diagnostic standard of metabolic syndrome
– The achievement of agreement among the
high officials in the Ministry of Health on
what-to-do
– Involvement of the stakeholders
– Discussions on the Ministerial Council
– The appropriation to the budget compilation
of the National Government and exploitation
– To the deliberations on Congress
The dawn of the national policy on Metabolic syndrome Group
• The characteristics of the
Japanese version of metabolic
syndrome: Abdominal
perimeter
Male: 85cm, Female: 90cm
(From the employee based
cohort study with MRI, only
accomplished in Japan)