Abstract
Cerebrovascular disease, also known as stroke, is a leading cause of death worldwide. To combat the disease, programs have been developed to control hypertension and reduce blood pressure because it is the most common risk factor in those who suffer a stroke. Japan has experienced some of the highest hypertension rates globally. In 1963, a prevention program was developed in a Japanese community to reduce the risk factors leading to stroke. The program contained several fundamental components: annual checkups, referrals to clinics for those who were considered high risk, health campaigns, and more. After only 3 years, the results demonstrated that over 86% of the town’s residents had participated in the screening program. With a reduction in severe hypertension and stroke incidence, the program was considered a success, and efforts were scaled up nationally. Over the years, the program has become the prototype for stroke prevention, including being endorsed by the World Health Organization (WHO) as a suitable program for middle-income countries.
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References
Central Intelligence Agency (CIA). (2016). CIA World Factbook. Retrieved March 14, 2018, from https://www.cia.gov/library/publications/the-world-factbook/.
Heifetz, RA., Linsky, M. (2002). Leadership on the Line. Boston: Harvard Business School Press.
Iso, H. (2008). Changes in coronary heart disease risk among Japanese. Circulation, 118, 2725–2729.
Iso, H., Shimamoto, T., Naito, Y., Sato, S., Kitamura, A., & Iida, M. (1998). Effects of a long-term hypertension control program on stroke incidence and prevalence in a rural community in Northeastern Japan. Stroke, 29(8), 1510–1518.
Komachi, K. (2007). Epidemiological studies of cardiovascular disease and development of community-based prevention programs. 40-year histories in Akita and Osaka. Tokyo: Japan Public Health Association Press. (in Japanese).
Kubo, M., et al. (2003). Trends in the incidence, mortality, and survival of cardiovascular disease in a Japanese community: the Hisayama study. Stroke, 34, 2349–2354.
Kitamura, A., Sato, S., Kiyama, M., Imano, H., Iso, H., Okada, T., Ohira, T., Tanigawa, T., Yamagishi, K., Nakamura, M., Konishi, M., Shimamoto, T., Iida, M., & Komachi, Y. (2008). Trends in the incidence of coronary heart disease and stroke and their risk factors in Japan, 1964 to 2003: the Akita-Osaka study. Journal of the American College of Cardiology, 52(1), 71–79. https://doi.org/10.1016/j.jacc.2008.02.075.
Liu, L., Ikeda, K., & Yamori, Y. (2001). Changes in stroke mortality rates for 1950 to 1997. A great slowdown of decline trend in Japan. Stroke, 32, 1745–1749.
Nomura, S., Sakamoto, H., Glenn, S., Tsugawa, Y., Abe, S. K., & Rahman, M. M. (2017). Population health and regional variations of disease burden in Japan, 1990-2015: a systematic subnational analysis for the Global Burden of disease study 2015. Lancet, 390, 1521–1538.
Ozawa, H. (1968). Death and incidence rates of cerebrovascular disease in Akita and Osaka. Japanese Journal of Public Health, 15, 23–32. (in Japanese).
Sarti, C., Rastenyte, D., Cepaitis, Z., & Tuomilehto, J. (2000). International trends in mortality from stroke, 1968 to 1994. Stroke, 31, 1588–1601.
Shimamoto, T., Iso, H., Sankai, T., Iida, M., Naito, Y., Sato, S., (1994). Can blood pressure in the elderly be reduced? Findings from a long-term population survey in Japan. The American Journal of Geriatric Cardiology, 42–50.
Shimamoto, T., Komachi, Y., Inada, H., Doi, M., Iso, H., & Sato, S. (1989). Trends for coronary heart disease and stroke and their risk factors in Japan. Circulation, 79(3), 503–515.
Ueshima, H. (2007). Explanation for the Japanese paradox: Prevention of increase in coronary heart disease and reduction in stroke. Journal of Atherosclerosis and Thrombosis, 14, 278–286.
United Nations Development Programme (UNDP). (2016). Human Development Report 2016. Retrieved March 14, 2018, from http://hdr.undp.org/sites/default/files/2016_human_development_report.pdf
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., & Himmelfarb, C. H. (2017). ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults - A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127–e248. https://doi.org/10.1016/j.jacc.2017.11.006
World Health Organization (WHO). (2013). Community-based efforts to reduce blood pressure and stroke in Japan. Retrieved March 14, 2018, from http://www.who.int/features/2013/japan_blood_pressure/en/
World Health Organization (WHO). (2014). Noncommunicable Diseases (NCD) Country Profiles: Japan. Retrieved February 28, 2018, from http://www.who.int/nmh/countries/jpn_en.pdf?ua=1
World Health Organization (WHO). (2015). Japan: WHO statistical profile. Retrieved February 28, 2018, from http://www.who.int/gho/countries/jpn.pdf?ua=1
World Health Organization (WHO). (2017). The top 10 causes of death. Retrieved February 28, 2018, from http://www.who.int/mediacentre/factsheets/fs310/en/
Yamagishi, K., Sato, S., Kitamura, A., Kiyama, M., Okada, T., & Tanigawa, T. (2012). Cost-effectiveness and budget impact analyses of a long-term hypertension detection and control program for stroke prevention. Journal of Hypertension, 30(9), 1874–1879. https://doi.org/10.1097/HJH.0b013e3283568781
Yuzuki, K. (1958). Observation of adjusted mortality of vascular damage in central nervous system by prefecture. Japanese Journal of Public Health, 5, 299. (in Japanese).
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Appendices
Discussion Questions
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1.
What factors might help explain why Japan has such a serious problem with high blood pressure and stroke?
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2.
Why was it important to screen people as young as 30Â years old for high blood pressure?
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3.
How are social determinants of health related to cerebrovascular disease (stroke)? How did this case address some of the most relevant social determinants in this community?
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4.
How was community ownership of this program promoted?
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How have larger societal changes (such as modernization) over the past few decades helped or inhibited stroke prevention in Japan? What about in other countries?
Follow-Up Reading
World Health Organization. (2017). The top 10 causes of death. Retrieved from http://www.who.int/mediacentre/factsheets/fs310/en/.
World Health Organization. (2013). Community-based efforts to reduce blood pressure and stroke in Japan. Retrieved from http://www.who.int/features/2013/japan_blood_pressure/en/.
Yamagishi, K., Sato, S., Kitamura, A., Kiyama, M., Okada, T., Tanigawa, T., Iso, H. (2012). Cost-effectiveness and budget impact analyses of a long-term hypertension detection and control program for stroke prevention. Journal of Hypertension, 30(9), 1874–79.
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Baba, S., Eshak, E.S., Iso, H. (2019). Successful Reduction of Blood Pressure and Stroke Risk in Japan. In: Withers, M., McCool, J. (eds) Global Health Leadership. Springer, Cham. https://doi.org/10.1007/978-3-319-95633-6_5
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DOI: https://doi.org/10.1007/978-3-319-95633-6_5
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