Community-based efforts to reduce blood pressure and stroke in Japan

March 2013

Community-based programmes, including regular health check-ups and targeted health promotion campaigns on healthy lifestyle, have contributed to a reduction in raised blood pressure and strokes in Japan.

For much of the 20th century, strokes were the number one killer in Japan. But since 1960, when the Ministry of Health and Welfare began measuring the death rates for stroke, cancer and heart disease, the number of strokes has fallen by more than 85%.

Health promotion volunteers support prevention and control of raised blood pressure
Chikusei City Health Promotion Volunteer group

The main trigger for stroke is raised blood pressure – or hypertension. A stroke, or "brain attack," occurs when blood circulation to the brain fails. Lack of blood and the resulting lack of oxygen coupled with bleeding into the brain can kill brain cells. This, in turn, can lead to disability or death.

Stroke risk increases with age, but strokes can – and do – occur at any adult age.

How has Japan been able to achieve the impressive reduction of the number of strokes in its population?

Regular health check-ups

According to Japanese public health experts, a variety of factors have contributed. One was the introduction of universal health care in 1961 and an expansion of health services for older people in 1982. Another important element has been community-based noncommunicable disease programmes kicked off by the Government.

“People at high risk and people over 40 are benefitting from the free, community-wide screening and health education.”

Professor Hiroyasu Iso, Osaka University Graduate School of Medicine

“Our studies show that regular health check-ups and health guidance from nurses and physicians in the community have been key to fighting hypertension and stroke,” says Professor Hiroyasu Iso from the Osaka University Graduate School of Medicine. “In particular, people at high risk and people over 40 are benefitting from the free, community-wide screening and health education.”

Eating healthy and staying active

Health workers and volunteers make regular house visits or calls on middle-aged and older neighbours to inform them about upcoming health check-ups. They also remind people to take their medication as prescribed if they already suffer from raised blood pressure. Everyone is encouraged to exercise on a regular basis and to participate in joint walking sessions.

The programmes target individual adults and also families and schoolchildren as well as food associations and municipal health services. Based on WHO guidelines and recommendations, the goal is to raise awareness of the need to have a healthy and balanced diet and to cut down on salty staples, such as miso soup and pickled vegetables. The Organization recommends that adults reduce their daily sodium consumption to 2 grams, which is equivalent to just under a teaspoon (5 grams) of salt.

Summer cooking schools

Summer cooking schools help change eating habits of parents and children.
Chikusei City Government

“An important aspect of our campaigns is our cooperation with school teachers and restaurant owners,” says Mr. Satoshi Ueno, head of the Municipal Education Committee in Chikusei City, Ibaraki Prefecture. “Particularly successful are the healthy cooking schools that we organize during summer. Both children and parents report that they changed their cooking and eating habits afterwards.”

Increased life expectancy

It is expected that by 2050 39% of the Japanese people will be over 65 in a population shrinking from 127 million to 97 million. The large reduction of stroke contributed to an increase in the already high life expectancy in Japan. A baby girl born in Japan today can expect to live to 86 and a boy to nearly 80.

Building on this positive experience, the Japanese Government now hopes to use the same community-based approach to address the increased prevalence of overweight and diabetes.