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If you are like many executives in Japan, you work hard, network with your colleagues several times a week and squeeze in a little family time on the weekends. Your busy schedule leaves little time for exercise, proper rest or taking part in hobbies away from work. You also likely do not eat well, skipping breakfast, grabbing a quick lunch and/or dinner when you can, followed by several nights of drinking at the pub. You might think that you’re doing your best for your company, devoting every ounce of energy to business interests. However, you are wrong. Your behavior might actually be hurting your company in the long run by making you unhealthy.
According to a major study released by the ACCJ, the costs associated with disease and unhealthy lifestyles cost the Japanese economy at least ¥3.3 trillion per year in lost productivity, a major drag on economic competitiveness and growth. For a country that is already ailing, this loss amounts to a prescription for economic ruin.
GROUND-BREAKING STUDY
The ACCJ study, spearheaded by the Chamber’s Healthcare Committee, was released in conjunction with a comprehensive White Paper on healthcare, containing policy proposals to reduce the economic burden of disease. Suggestions include better promotion of screening, prevention and early detection by the government, health insurance providers and employers. Healthcare systems and health policies in Japan have traditionally focused on treatment of medical conditions after they occur, rather than on prevention and early detection. However, since medical experts believe that many forms of infectious and chronic disease can be prevented or detected early in a cost effective manner, the ACCJ believes its proposals could boost productivity and prevent excessive increases in healthcare costs.
The ground-breaking “ACCJ Survey on Prevention, Early Detection and the Economic Burden of Disease in Japan” was an 80-question national survey. It was sent out in November to 5,000 members of the Japanese public; a cross-section of men and women across all regions and age cohorts.
Based on responses, the ¥3.3 trillion nationwide productivity loss was calculated from Absenteeism (the economic value of sick time off), Presenteeism (the economic value of health-related productivity impairment at work) and Disability Loss (the economic value of salary income lost due to changing or quitting jobs). However, this total is considered a conservative loss estimate, because the data did not include the costs of medical treatment, which were outside the scope of the survey.
ECONOMIC BURDEN OF DISEASE IN JAPAN ESTIMATED AT ¥3.3 TRILLION
“The ACCJ Survey is the first comprehensive estimate of the economic costs of disease ever conducted in Japan, and shows that chronic pain and mental health are greater burdens on economic productivity than expected,” according to Bruce Ellsworth, Vice Chair of the ACCJ Healthcare Committee.
“The large economic impact of these chronic diseases does not show up in statistics about mortality rates, but the survey shows that they deserve special attention.”
Health issues were categorized under five headings: pain, mental illness, physical injury or disability, non-infectious chronic disease, and infectious disease or viral infection. The survey found that the two leading causes of Absenteeism and Presenteeism among workers were pain (including chronic back or neck/shoulder pain, migraine, arthritis and other causes of pain) and mental illness, including depression.
TYPE OF HEALTH ISSUES THAT CAUSED RESPONDENTS TO TAKE SICK TIME OF DISABILITY LEAVE
The survey also found that the top five future medical concerns among people in Japan in descending order are cancer, chronic back or neck/shoulder pain, stroke, influenza, and diabetes. The survey indicates that a significant proportion of Japanese people are not fully aware or taking advantage of the benefits of screening, prevention and early detection. It also showed low participation rates in many relatively easy prevention and early detection measures, such as regular exercise and annual health checkups, despite a general interest in more information and increased participation.
HEALTH AS A COMPETITIVE ADVANTAGE
The “Survey on Prevention, Early Detection and the Economic Burden of Disease in Japan” was released in conjunction with major ACCJ Healthcare White Paper called “Investing in Health as a Competitive Advantage.” This report covers twenty-seven disease areas, ranging from hepatitis and breast cancer to chronic pain and healthcare associated infections. The White Paper offers an analysis
of ways to improve government healthcare policy and includes a number of case studies of successful policies in other countries.
ACCJ Healthcare Committee Chair William Bishop says the policy recommendations were made “in conjunction with the Chamber’s own Growth Strategy Taskforce initiative and based on the belief that investing in the health of the Japanese people would not only result in a higher quality of life, but would also result in an increase in labor productivity and boost economic competitiveness.”
“Further, we believe these policies could boost the efficiency of healthcare spending and prevent excessive increases in healthcare costs,” says Bishop.
The White Paper’s overarching goal is well stated in the following excerpt, “Japan is well known for having one of the lowest infant mortality rates and the longest life expectancy in the world. Although life expectancy in Japan continues to rise, the often diminished quality of life during the later years places a burden on patients, families, healthcare practitioners, healthcare systems, society and the economy. These burdens can be relieved through programs to promote prevention, early detection and wellness. However, as in many other developed countries, the healthcare systems and health policies in Japan have traditionally focused on the treatment of medical conditions after they occur, rather than on their prevention.”
The policy recommendations in the Heathcare White Paper: “Investing in Health as a Competitive Advantage” are aimed at helping employees take fewer sick days off (less absenteeism) and being more able to better perform while at work (less presenteeism). Other benefits would come from decreasing the burden of care on family members and by avoiding an increase in the burden of health care costs.
Citing World Health Organization (WHO) estimates, the report says that chronic diseases are the leading cause of disability and death in Japan. Treatment of chronic disease also accounts for the majority of healthcare spending, mostly involving older patients with two or more chronic diseases. In 2009, medical expenses for people aged 70 or older amounted ¥15.5 trillion, or 44% of the nation’s total. In 2012 the Japanese government will finalize the next round of Kenko Nippon 21 (Healthy Japan 21) initiative, a national campaign designed to raise awareness, to promote the benefits of health and wellness and motivate the public to take action, set to be rolled out in 2013.
A main thrust of the White Paper advocacy will be to provide evidence-based global base practices as policy recommendations during the final phase of drafting. As part of this effort, the ACCJ White Paper recommends that the Japanese government create further incentives for people to change their behavior, in conjunction with more traditional public health and wellness educational efforts which have been principally aimed at raising awareness building. Incentives should also be created in the health insurance system to “motivate more people to undergo health risk assessments and adopt healthier lifestyles and behaviors long before the onset of illness and while the risk of disease can be reduced.”
The White Paper is in many ways a series of preventive interventions spanning the preventive health and wellness continuum, from diet, and wellness to vaccination, screening and environmental infection control. At the ACCJ Press Conference held on November 25th, several sections of the White Paper were highlighted. The following is a series of brief snap shots of each.
GREATER UTILIZATION OF HEALTHCARE INFORMATION TECHNOLOGY
With the massive growth of the elderly population, coupled with the shortage and uneven distribution of physicians and other healthcare practitioners, Japan must consider a fundamental change in how healthcare services are delivered to its citizens. healthcare information technology (IT) will be at the core of this change, producing improved efficiency, better outcomes, and higher quality of life. Many governments outside of Japan are investing heavily in healthcare IT, and are already gaining tangible benefits.
During the aftermath of the Tohoku disasters, many believed that, had there been an efficient electronic healthcare record (EHR) system in place, emergency medical care would have been much easier for doctors and patients.
One area where enhanced use of IT would be of benefit is in addressing the emergency needs of stoke victims. The most frequent causes of death in Japan are cancer, stroke, and heart disease.
Stroke alone accounts for 10% of total medical costs, and the number of patients is expected to grow from 1.5 million to 3 million by 2020. Stroke patients must receive thrombolytic therapy (“clot busting”) with a tissue plasminogen activator (TPA] within three hours for it to be effective, but the rate of usage in Japan is less than 2%. The shortage and uneven distribution of physicians, coupled with inadequate utilization of IT, often results in uncoordinated emergency care. If not afforded access to expert care, stroke victims can be left immobile, incontinent, and unable to speak. As a result, stroke patients account for 40% of bedridden care in Japan. Challenges also exist in sharing information between physicians and caregivers on rehabilitation needs, which can have a significant impact on a patient’s quality of life after suffering a stroke. Stroke care creates a significant economic burden and lost productivity for the supporting families and their communities as a whole.
Eriko Asai, Chair, Health IT Subcommittee, summed it up by saying, “Japan has the potential to establish a world class program for stroke prevention and as the world’s leading IT economy has the potential to innovate and lead the future of healthcare IT globally.”
INCREASING CERVICAL CANCER SCREENING LEVELS
Early detection and early intervention are critical for the prevention of cervical cancer. In Japan, out of the 8,000 cases of cervical cancer diagnosed annually, roughly 2,500 women will die. Japan has seen a sharp rise in the number of patients with cervical cancer in their twenties and thirties, and a growing mortality rate. Cervical cancer is the only type of cancer whose incidence can be reduced with a vaccine that is already in use in more than 100 countries and has recently become available in Japan.
Because the human papilloma virus (HPV) is the dominant cause of cervical cancer, regular Pap testing, early HPV testing when recommended, and early vaccination can work together effectively to prevent cervical cancer. In the United States, regular Pap testing has been successfully adopted and recognized as one of the most effective cancer screening tests. The cervical cancer screening rate in Japan was 24.3% in 2010, which is less than half the Organization for Economic Co-operation and Development (OECD) average of 64%.
Frank Florio, President and Representative Director, Nippon Becton Dickinson Company says, “Uniquely, there is no drug, device or diagnostic lag in the case of cervical cancer prevention in Japan. Japan now has all the tools necessary to fight and win. There is however a considerable degree of confusion by many women on how best to prevent cervical cancer which was further substantiated in the recent Health Survey.
There is a real need to better promote the use of the latest technologies to fight cervical cancer in Japan, including HPV vaccination, HPV testing when recommended and, most critically, the latest Pap Testing technology using liquid-based cytology cancer cell screening to increase accuracy and reduce the amount of retesting for cervical cancer.”
INCREASE EARLY DETECTION THROUGH COMPREHENSIVE EYE EXAMS
In Japan, based on Japanese medical standards, 1.64 million people are visually impaired and 188,000 are blind. Of the total, 72% are aged 60 or older. According to a September 2009 study released by the Japan Ophthalmologists Association (JOA), vision problems result in estimated social costs and labor productivity losses of ¥8.8 trillion per year. The JOA estimates that by 2030, the number of people with vision problems and the resulting social costs are expected to increase by roughly 25%.
Comprehensive eye exams by ophthalmologists are important for far more than just determining the prescription for vision correction. They are also important for the detection and diagnosis of eye diseases, including glaucoma, diabetic retinopathy, macular Degeneration, cataracts and eye coordination problems that can cause a range of problems from blurry vision to blindness.
Early detection and timely treatment is crucial to prevent visual impairment and progression of conditions leading to blindness, especially for children under the age of six and adults aged 40 and older. Comprehensive eye exams by ophthalmologists are also valuable for detecting signs of systemic health problems that show early warning signs in the tiny blood vessels and optic nerves in the eyes, including hypertension, diabetes, high cholesterol and heart disease. A recent survey showed that, although 82% of adults in Japan have had some type of vision or eye test, only 28% have had a comprehensive eye exam performed by a physician.
The reasons given by adults for not obtaining eye exams are that they have not thought about it (33%), they do not have time (33%), or they believe they have no vision problems (29%).
According to David R. Smith, President, Johnson & Johnson Vision Care Japan, “The problem in Japan is that the current Kenko Nippon 21 does not include any goals related to eyes and vision though these are included in similar initiatives in the US and other developed countries. There is a real need to add goals for eye and vision health topics to governmental health policy to improve healthy vision.”
PROMOTION OF A HEALTHY JAPAN
ACCJ Healthcare committee members present the survey to Japanese health minister Yoko Komiyama
On November 28, members of the ACCJ Healthcare Committee submitted both the “Investing in Health as a Competitive Advantage” report and the “ACCJ Survey on Prevention, Early Detection and the Economic Burden of Disease in Japan” to Japan Minister of Health Yoko Komiyama.
“The economic burden of disease is likely to increase as Japan’s society continues to age. But by investing in health, Japan could increase productivity and lengthen the average healthy life span (before the need for home nursing care) in a way that supports economic growth,” says Bishop.
“We sincerely hope our Survey and White Paper are seen as a solid contribution to the healthcare and economic policy debate in Japan.”
[The full contents of the White Paper and Survey results are available to view or download in both English and Japanese PDF files on the ACCJ website]
