The New Health Check up System in Japan for Metabolic Syndrome The 25Th APAN in Hawaii Medical workshop : Health Care 1 session Mie University In Japan, Shinobu Sakurai (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 in Japan All the nations have the obligation of the basic medical check up This system main object is to find illness. People life style become westernization Medical cost (a senior citizen in particular) increases. Starting healthy Japan 21 (2000) for the making of health and establish National Health Promotion (2003) law. The increase of diabetes patient and the obesity, the decrease of walking in the everyday life. The present conditions that a lifestyle-related disease rather turns worse 国民全員に基本的な健康診断の義務付け 疾病を見つけるためのもの 増大する医療費（特に高齢者） 健康づくりのため健康日本２１（2000年）を開始し健康増進法（2003年）を制定 しかし、糖尿病有病者・予備群の増加、肥満者の増加、日常生活における歩数の減少 生活習慣病がむしろ悪化している現状

metabolic syndrome population Patient number→　約９.４ million Spare group　→　約１０.２ million Total amount　→　約１９.６ million 40 ～74(years old) male　　→　　 female　　→　　 1/2 person 1/5 person （％） 25.7 10 26 9.6 20 30 40 50 60 male female Middle risk High risk 2004 national diet survey

The metabolic characteristic in Japan Many patient and spare group are almost in working age

Carry out “specific health check up”, “specific health guidance” What for: thoroughly prevent life style-related diseases. When: April 2008 Who: from 40 to 74 years old Which object: policy target is to decrease a lifestyle-related disease patient / spare group such as the diabetes 25% comparing with 2008 in 2015 Penalty or reward: The addition / subtraction of 10% of the money of senior citizen insurance according with the performance in the latter period the achievement situation of each health insurance fund or society from 2013 平成20年4月から、"高齢者の医療の確保に関する法律"より、医療保険者は、メタボリックシンドローム（内臓脂肪型肥満）の早期発見を目的とした健康診査（特定健康診査）を行い、健康診査でメタボリックシンドローム、あるいはその予備軍とされた人に対して、保健指導（特定保健指導）の実施を義務付けられました。

Health check up contents( minimum) Blood pressure Blood test (total protein, albumin, HDL-cholesterol, triglyceride, fasting blood sugar, et al.) Waist size measure (new one) ECG Urine test Doctors interview so on……

Diagnostic criteria of new check up for metabolic syndrome Visceral fat Obesity Male female ８５ｃｍ< ９０ｃｍ< Fasting blood sugar　１１０mg／dL< Waist size BP　 Systolic BP　１３０mmHg< Diastolic BP　８５mmHg< OR Triglyceride　　　　１５０mg／dL< HDL Cholesterol　４０mg／dL> High risk : 2 among 4 Middle risk: 1 among 4

Specific health check up system the purpose of preventing the onset and the aggravation of the lifestyle-related disease, Focus on metabolic syndrome To screening a high risk person and a person needing identification health guidance to decrease spare group precisely 生活習慣病の発症や重症化を予防することを目的として、メタボリックシンドロームに着目し、この該当者及び予備群を減少させるための特定保健指導を必要とする者を、的確に抽出するために行うもの。

Specific health guidance the purpose of preventing a lifestyle-related disease through that a person of object recognizes a problem in own habit to improve a habit and change their own health behavior and learn their self care and maintain healthy life. 生活習慣を改善するための保健指導を行うことで、対象者が自らの生活習慣における課題を認識して行動変容と自己管理を行うとともに健康的な生活を維持することができるようになることを通じて、生活習慣病を予防することを目的とするもの。

What is point on New health check up system ? Conduct the specific health guidance for patient or high risk person in metabolic syndrome by a specific health checkup. Conduct individual order made health guidance by doctor, PHN, as follow points: degree of the internal organs fat accumulation and the number of the risk factor the age or the risk level Health guidance has 3 contents : “positive support ", "incentive support", “offering information " are performed. 特定保健指導は、特定健康診査でメタボリックシンドロームと判定された人、あるいは一定のリスクをもつ方に対して実施。 特定健診の結果から、内臓脂肪蓄積の程度とリスク要因の数に着目し、リスクの高さや年齢に応じ、保健指導のレベル分けがされ（階層化）、各レベルに応じて『積極的支援』、『動機づけ支援』、『情報提供』が行われる。

Thank you Shinobu SAKURAI Professor, Dep of community nursing, Faculty of Medicine, school of nursing Mie University, Japan Center for International education & research, Mie University romane@nurse.medic.mie-u.c.jp