In order to control the NCD prevalence that is expected to be on the rise, it is important to design a bottom up general healthcare system that can response to the existing local needs in healthcare and their healthcare delivery systems.

The activities in Japan Heart Foundation and its future prospect

Dr. Paul D. White from the Cardiology Division at Massachusetts General Hospital and Harvard University made the following comment during the Cardiology Conference in 1964, “As the eating habits changes and so on, wouldn’t Japan face the same challenge that we have with the major issues in cardiovascular disease in the future?” (American Heart Association (AHA) is an association that equipped with both functions of academic society and foundation.)
In response to the recommendations of Dr. White, Japan Heart Foundation was set up in 1970 through private donations as a result of the collaborations between the Federation of Economic Organizations and the Japanese Circulation Society. Today, Japan Heart Foundation had been active for 42 years.
The foundation aims to foster independent young researchers in their works for the cardiovascular etiology research, treatment and prevention. Since its establishment, we have given out a total research grant of 500 million yen. Absolutely, we have conducted the work to date without receiving any public subsidies. In the research of new treatments and clinical epidemiology, it is easier to get research funding because we can produce an outcome through these researches. However, getting donations for disease prevention and public awareness is a difficult task.

Besides research, Japan Heart Foundation also works on raising awareness of cardiovascular disease prevention by focusing on three areas: Don’t Smoke, Walk and Walk, and No Fat. We also collaborate with World Heart Day and support the developing countries in various ways. In contrast to development of new treatments and clinical epidemiology research, immediate visible outcomes are almost impossible. As I became the president, the issue had always been how should we work on to promote disease prevention?　What we are doing now as to collect private donations, we make video messages and distribute them to the medical associations and so forth.

Japan Heart Foundation had become famous as we promote the prevention of sudden cardiac death. Sudden cardiac death is not only limited to the elderly people, but it is also seen in sports athletes and school children. As AED is available, it is unreasonable why people are not using it. There are many people who may feel scared of AED, for instance it might results an electric shock by mistake. Yet, if you can only understand that AED is safe because it is an external defibrillator with integrated electrocardiogram that correctly detects and analyses heart rhythm automatically. In comparison to the annual 4900 death per year due to the traffic accidents, sudden cardiac death is 60000 year. It is an overwhelming frequency compared to the traffic death. We had also implemented a low cost intervention, by creating a doll model that will cry when the lower sternum is pressed with an appropriate strength, and held lessons in many elementary schools and private companies, so that everyone including children and adult can perform heart massage if necessary. We would like to put more focus in school educations in particular. Although we would like to focus on education in schools in particular, we will need more ideas because the time of school education is often so tight.

Cooperation with other related organizations

In the prevention of lifestyle-related diseases, we are in cooperation with the Japanese Circulation Society and The Japanese Association for Cerebro-cardiovascular Disease Control.
On the Healthy Heart Day August 10, we provide free screening with volunteer doctors from the Japanese Circulation Society, and the expenses of the screening were not covered by any existing donations. However, if we are planning to make these kinds of activities more widely available as an event of the foundation, I think we should solicit donations for this purpose.

Movement into policy proposals in the framework of NCD in Japan

I agree with the idea to draw a national framework proposal concerning the number of beds and functional classification of hospitals. Yet, we need to understand that medical care is fostered by the local regions, and it is impossible to draw a uniform system nationwide. In fact, the healthcare situations are different from one place to another.  It is impossible to carry out a national policy that is designed top-down. It is necessary to design a bottom-up healthcare system in response to the local healthcare needs.
 
While we started to work on NCD5 (the combination of five diseases included in NCD), some part of the local medical plans had done quite a good job. The effort where the local core hospitals are recognized and financial support is received, had contributed much to the equal accessibility of healthcare. Also, it is important to knit in the social gaps occurred in the local areas and their specific characteristics into the national healthcare plan. In Japan, we often mention ‘national and government hospitals’ as a general term, yet the national hospitals and government hospitals are totally two different things. The government hospitals play a main role in community healthcare plan; however the level of control is different with the national hospitals. A national hospital is independent from the Ministry of Health and Welfare, yet the final say at a government hospital belongs to the local government, which makes it difficult for the hospital director to set his/her parameters and controls. As it is difficult to maintain communication with the local government, it is feared that there would be a great possibility that the plans and the management of hospitals could be run by people who do not have an actual knowledge of the actual situation in medical field. I pledge that the government hospitals will be made into the center of community healthcare program nationwide. It is necessary for people to be more readily in recognizing the importance of government hospitals, and the process of building an effective healthcare delivery system.

As for human resource development, the National Hospital Organization began to train Nurse Practitioners (NP) (Nurse Practitioner: advanced practice nurses). To date, 20 people are trained, and reputations of these NPs are high. The good feedbacks are not only from the doctors and patients but also from other nurses. It is possible that we can continue to train more people in this area, and as we gain recognition from the general public, we can set policies to legalize the medical practices of nurses. I think we should build a system where it pleases the patient. I think bringing up the NPs in the National Hospital Organization should be made into the first priority. And we need to ensure that evaluation will be made. Being a NP, is not only about attending graduate school, it is always about the on-the-job training, where they brush up their skills. When we have a certain number of NPs, then we can work on the process of evaluation, and it will lead us to establish certain system. As for now, we will still need to be patience about it.

Meaning to create the NCD network in Japan

I think this is desired by most people. And the foundation will support in what we can offer.