OECD reviews of public health : Japan : a healthier tomorrow.

Foreword
Acknowledgements
Acronyms and abbreviations
Executive summary
Assessment and recommendations
	Japan’s public health system
		Japan has a highly decentralised public health system
		In Japan’s decentralised system there is more scope for sharing best practice examples
		Cross-governmental collaboration could be strengthened
		Companies and employers are expected to play an important public health role
		Japan’s health workforce presents challenges and opportunities for delivering public health interventions
	Primary prevention and the Health Japan 21 strategy
		The Health Japan 21 strategy takes an ambitious approach to public health risks
		A wide range of actors are involved in delivering Health Japan 21 and other primary prevention interventions
		Health Japan 21 could be improved by clearer prioritisation and systems to ensure quality of public health actions
		Japan has a small number of population-level policies to reduce health risks
		Additional population-level policies could help Japan achieve its HJ21 targets
	Health check-ups in Japan
		A wide range of health check-ups are offered to the Japanese population
		Japan should undertake an assessment of whether all health check-ups are necessary
		There may be more cost-effective ways to deliver secondary prevention in Japan
		The health information system needs to be developed further for better monitoring and evaluation
		Cancer screening could be strengthened with a standardised, national approach
	Public Health Emergency Preparedness in Japan
		Japan is a disaster-prone country with growing vulnerabilities
		Japan prioritises preparedness for public health emergencies, as reflected in its legal and institutional framework and its international cooperation activities
		A good knowledge of the critical risks and their public health consequences is essential to prepare for public health emergencies
		Capabilities for public health preparedness and response in Japan are fairly robust
		Improvement to inter-agency co-ordination across sectors and more regular multi-stakeholders exercises with the health sector are necessary
Chapter 1.  The Public Health System in Japan
	1.1. Introduction
	1.2. The public health picture in Japan
		1.2.1. The health status of the Japanese population
		1.2.2. Burden of disease
		1.2.3. Risk factors
		1.2.4. Mental wellbeing and suicide in Japan
	1.3. Organisational Structure
		1.3.1. The Japanese Health System
			Primary care system
		1.3.2. Delivery of essential public health operations in Japan
			Vaccination programmes in Japan
			Food Safety Commission for food safety assurance
			Tackling Antimicrobial resistance (AMR) in Japan
		1.3.3. Primary, secondary and tertiary prevention in Japan
			Primary prevention programme with Health Japan 21
			Secondary prevention
			Tertiary prevention
	1.4. Leadership and governance
		1.4.1. Key actors in the public health system
		1.4.2. Engagement across government
		1.4.3.  Regional and local public health leadership
		1.4.4. Leadership from Japanese civil society
	1.5. Partnerships and collaborations
		1.5.1. Engagement with patient groups
		1.5.2. Partnerships with the private sector
	1.6. Financial resources
		1.6.1. Spending on health and public health
		1.6.2. Some payment mechanisms exist to incentivise public health functions amongst key providers
	1.7. Knowledge development
		1.7.1. Key data sources for understanding public health
		1.7.2. Promoting health literacy around public health
	1.8. Workforce
		1.8.1. Human resource in public health care
		1.8.2. Opportunities and challenges given Japan’s a-typical public health workforce
	1.9. Conclusion
	References
Chapter 2.  Primary prevention and the Health Japan 21 strategy
	2.1. Introduction
	2.2. Japan faces a range of public health challenges, including smoking, overweight and alcohol consumption
		2.2.1. Changing lifestyles are having an impact on population health in Japan
		2.2.2. There exist disparities in risk factors between prefectures
	2.3. The Health Japan 21 strategy provides a framework for national, local, workplace-based and school-based health promotion interventions
		2.3.1. The Health Japan 21 strategy functions as a framework for primary prevention in Japan
		2.3.2. The primary role of the central government in HJ21 is setting and monitoring targets, and incentivising action
		2.3.3. Local communities are developing multisectoral health promotion plans
		2.3.4. Companies play an important part in prevention through workplace-based interventions, though their impact is difficult to measure
		2.3.5. Nutritional education and healthy meals are a central part of the curriculum in Japanese schools
	2.4. Several population-level policies are in place to support the prevention strategy
		2.4.1. To reduce smoking rates, Japan is trying to implement a ban on smoking in public places – but tobacco marketing is not yet being addresses
		2.4.2. New food labelling regulation has been introduced to improve nutritional information
		2.4.3. Japan is reforming its tax rate on alcohol products and has already implemented strict drink-driving regulation
	2.5. There are a number of steps Japan can take to advance its primary prevention strategy
		2.5.1. The HJ21 strategy is ambitious, but would benefit from clearer priorities
		2.5.2. Systems need to be put in place to ensure quality prevention programmes across the entire population
		2.5.3. Additional population-level policies, following recommended best practice, can help create a health-promoting environment that supports the HJ21 achievements
		2.5.4. To achieve the HJ21 targets on tobacco, Japan could consider implementing population-level policies in line with international conventions.
		2.5.5. Recent reform on food labelling could be expanded to promote healthier food choices in combination with other population-level policies
		2.5.6. To reduce alcohol consumption, Japan could consider implementing cost-effective interventions such as marketing regulation
	2.6. Conclusion
	Notes
	References
		Annex 2.A. Health Japan 21 Targets
Chapter 3.  Health check-ups in Japan
	3.1. Introduction
	3.2. Several health check-ups are legally required in Japan
		3.2.1. Health check-ups for infants and preschool children have a long history in Japan
		3.2.2. School children usually undergo an annual health check-up in Japan
		3.2.3. Employers are required to provide a core health check-up annually to full-time employees
		3.2.4. Employment-based insurers needs to provide an annual stress test to employees
		3.2.5. The specific health check-up to tackle lifestyle-related diseases is provided annually to people aged 40-74
	3.3. Provision of other health check-ups including cancer screening is also encouraged
		3.3.1. Additional health check-ups delivered by municipality vary across regions
		3.3.2. Japan does not have nationally organised cancer screening programmes and cancer screening coverage is low
		3.3.3. The coverage of additional health check-up items varies across employment-based insurers
		3.3.4. Many other health check-ups are available privately
	3.4. Japan needs to review its secondary prevention strategies and focus on implementing effective and economically sound secondary prevention policies
		3.4.1. Japan ought to review all health check-ups together and develop secondary prevention policies based on national and international evidence
		3.4.2. Cancer screening could be strengthened with a standardised, national approach
		3.4.3. Economic evaluation of health check-ups needs be undertaken to develop economically sound secondary prevention policies
		3.4.4. The public could play a role in developing secondary prevention policies and designing their strategies
		3.4.5. The health information system needs to be developed further for better monitoring and evaluation
		3.4.6. In order to improve access, Japan could seek more innovative and efficient methods of providing health check-ups and cancer screening
	3.5. Conclusion
	References
Chapter 4.  Japan’s preparedness for public health emergencies
	4.1. Introduction
	4.2. Japan’s risk profile and potential public health consequences
		4.2.1. Japan is a natural hazard-prone country with growing vulnerabilities
		4.2.2. Public health consequences of disasters can be both direct and indirect
		4.2.3. Japan has other specific vulnerabilities to disaster risks, some of which are growing
		4.2.4. Japan is at risk of infectious disease outbreaks
		4.2.5. Japan’s high population density and international exchanges contribute to increasing the risk of infectious disease outbreaks but vaccination and hygienic measures lower the risks
		4.2.6. Other risks of public health emergencies in Japan should be part of an all-hazard preparedness approach
	4.3. Japan makes of preparedness for public health emergencies a priority, as reflected in its public policies
		4.3.1. Japan has a sophisticated legal framework for public health emergencies
		4.3.2. Japan’s institutional setting for public health emergency preparedness and response involves the whole-of-government
		4.3.3. Horizontal coordination is better established for disaster risks compared to other public health emergencies
		4.3.4. Beyond government, the private sector and civil society also play a role
		4.3.5. Internationally, Japan is a key supporter of the Global Health Security Agenda
	4.4. Identifying and assessing public health emergencies risk in Japan
		4.4.1. Japan conducts a comprehensive risk assessment for infectious diseases
		4.4.2. Japan significantly improved its disaster risk assessment following the Great East Japan Earthquake
		4.4.3. Assessing other public health risks caused by rare events such as terrorism and nuclear disasters should be continuously improved
		4.4.4. Risk communication and awareness programs is a major priority in the country
	4.5. Capabilities for public health preparedness and response in Japan
		4.5.1. Surveillance, monitoring and information systems make good use of innovation, but more could be done to foster early detection and inter-agency cooperation
		4.5.2. Japan has made large investments in health infrastructures dedicated to emergencies
		4.5.3. Japan stocks large amounts of medical countermeasures and emergency supplies for emergency response
		4.5.4. Emergency health care providers can be mobilised rapidly when disasters hit, but skills shortage in infectious disease control and treatment is a concern
	4.6. Emergency countermeasures and their implementation during crisis
		4.6.1. Public health emergency plans are developed at all levels but there is a lack of oversight and control of these plans
		4.6.2. Inter-agency coordination mechanisms for emergency response are too complex and MHLW lacks resources to contribute effectively
		4.6.3. Improving crisis communication requires better training of public officials and an increased use of social media
		4.6.4. Multi-stakeholders emergency simulation exercises based on complex scenarios could be done regularly
	4.7. Conclusion
	References