Lengthening Healthy Lifespans to Boost
The rising incidence of noncommunicable diseases such as cancer, diabetes, Alzheimer’s and cardiovascular disease, more than ever before, is an increasing economic burden and a cause of lower national productivity. This problem is gaining in severity around the world and the necessity and urgency of initiatives for prevention of the crisis are highly-publicized.
Since the 1960s, advances in research and medical technology have led to the development of new diagnostic devices and measuring techniques that enable faster and more accurate diagnostic test results and provide healthcare practitioners with more useful information. Some of these new devices and techniques may cost more to perform than older tests, but they have become recognized around the world as essential in modern medical care because they contribute to improved treatment, faster recovery and greater peace of mind for patients. They can also lead to lower total healthcare costs because they can contribute to more successful treatment, faster patient recovery times, and shorter hospital stays.
In Japan, based on Japanese medical standards, 1.64 million people are visually impaired and 188,000 are blind. Of the total, 72 percent are aged 60 or over. 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 JPY8.8 trillion per year. The JOA estimates that by 2030, the number of people with vision problems and the resulting social costs will have increased roughly 25 percent from the 2009 level.
Dental health is important not only for chewing food, but also for maintaining a good quality of life by enjoying pleasant meals and conversation. Recent scientific evidence suggests that oral health abnormalities also play a role in the deterioration of general health.
Early detection is crucial to the health and wellbeing of patients suffering from sleep apnea syndrome (SAS). In 2014, the number of patients with SAS in Japan was more than three million (a prevalence of 2 – 4 percent of adults), of whom only 300,000 (about 10 percent) were undergoing treatment. That means there is a large pool of latent patients, who are unaware of their condition and do not recognize the symptoms. SAS not only disrupts a person’s sleep, causing daily drowsiness, but also contributes to serious cardiovascular disease, such as hypertension, heart failure, stroke, and heart arrhythmia.
Pain can be divided into two types, acute pain and chronic pain. The International Association for the Study of Pain (IASP) defined chronic pain as “pain that extends beyond the expected period of healing or progressive pain due to non-cancer diseases.” Most frequently responsible for chronic pain are lower back pain, osteoarthritis, rheumatoid arthritis and osteoporosis.
The American Chamber of Commerce in Japan (ACCJ) and European Business Council in Japan (EBC) applaud the Japanese government’s amending of the existing “Foods for Specific Health Uses” (FOSHU) regulations and the implementation of revisions on functional claims pertaining to health foods and dietary supplements effective April 1, 2015. Obtaining the necessary approval for product claims under previous FOSHU regulations was deemed costly and time consuming by the Abe Administration. In 2013, in an effort to resolve some of the regulatory issues, officials recognized the need to establish a new category of claims that recognizes the health benefits of functional foods. The increased commerce facilitated by recognition of functional claims has been identified as a potential area of economic growth under “Abenomics.”
According to the World Health Organization, self-care is “what people do for themselves to establish and maintain health, prevent and deal with illness,” which includes consideration of a healthy diet, exercise, and hygiene, as well as practicing self-medication.
According to the World Health Organization (WHO), of 57 million global deaths in 2008, 36 million, or 63 percent, were due to noncommunicable diseases (NCDs). Specific NCDs cited by the WHO include diabetes; chronic respiratory disease, such as chronic obstructive lung disease (COLD); stroke; chronic heart disease; and cancer. NCDs also include Alzheimer’s disease, glaucoma, osteoporosis, rheumatoid arthritis, Parkinson’s disease, hypertension, and hyperlipidemia.
It has been scientifically proven that tobacco smoking increases the risk of many diseases — such as cancer (including lung cancer), myocardial infarction, stroke, and chronic obstructive pulmonary disease — and that abstinence from tobacco can decrease these risks and lead to health improvement. The World Health Organization (WHO) states that tobacco smoking is the single largest preventable cause of disease.
Diabetes is a disease in which preventive medicine plays an important role. According to a 2007 survey, more than 90 percent of the cases of the disease in Japan were type 2 diabetes, in which patients develop chronic hyperglycemia (high blood glucose) because of insufficient insulin secretion or a lack of insulin activity. As of 2012, 9.5 million people in Japan are strongly suspected of having diabetes, and another 11 million have the potential for developing diabetes. Thus, in addition to those already confirmed as having the disease, an estimated 20.5 million people in Japan are considered to be at risk of becoming diabetic. Significant lifestyle changes in recent years are believed to be behind the dramatic increase in the number of people who suffer from diabetes.
Prostate cancer ranks third among male cancers in Japan (2010 figures) and the incidence is growing. The most strongly associated risk factors are age, ethnicity, family history, hormones, and obesity, among others. According to data for 2004, prostate cancer is expected to increase and surpass gastric cancer into second place among Japanese males by 2020. Moreover, prostate cancer is already the second most common cause of cancer deaths in American males since 1997. In Japan, the disease still ranks sixth in cancer deaths, but the incidence is expected to increase even more by 2025.
One disease area for which early detection has the potential to reduce the mortality rate in Japan’s aging society is Abdominal Aortic Aneurysm (AAA). AAA is a disease where localized dilatation (ballooning) of the abdominal aorta exceeds the normal diameter. In many cases, the dilation occurs gradually. The risk is highest for male smokers over the age of 65 who have hypertension. The most effective means of AAA prevention is reduction of risk factors: smoking cessation, and control of high blood pressure and high cholesterol.
The most common causes of death in Japan are cancer, stroke, and heart disease. Stroke incidence and prevalence is increasing as the population is aging. It is estimated that 0.3 million new cases of stroke occur every year and there are 2.8 million stroke survivors in 2015.
Cerebrovascular diseases had been ranked as the leading cause of death in Japan for three decades after World War II. However, with public education efforts aimed at preventing high blood pressure along with the development of innovative technologies for diagnostic imaging, minimally invasive treatment and medicines, the number of deaths from these diseases has been decreasing since the early 1970s. The Ministry of Health, Labour and Welfare (MHLW) has confirmed this decline in number of deaths by and patients of cerebrovascular diseases with its stastical data (number of deaths: down by 12 percent in past 16 years, number of patients: down by 8 percent in past 16 years)
Vaccines play a major role in decreasing the incidence of infectious disease, enhancing the quality of life, and in many cases also resulting in economic benefits. As described in the “Vaccine Business Vision,” vaccines are globally recognized as highly cost-effective.
Viral hepatitis is considered to be the most common contagious disease in Japan. Of the estimated three million patients and carriers of viral hepatitis B (HBV) and hepatitis C (HCV), 1.1 to 1.4 million people (approximately one percent of the Japanese population) are thought to be persistently infected with HBV
The number of deaths from liver cancer in Japan has been rising rapidly since 1975, and now stands at more than 30,000 per year. About 80 percent of these cases are due to infection with the hepatitis C virus. The age group with the highest prevalence is those over 40 years old, estimated at 1.9 to 2.3 million carriers. Most infections in this group are due to medical procedures before the 1980s, before disposable medical implements became widespread, and infections from contaminated blood transfusions prior to 1989, when the hepatitis C virus test was introduced to check blood to be transfused. There are few subjective symptoms associated with hepatitis C infection, and the disease can progress from chronic hepatitis to hepatic cirrhosis to liver cancer without the patient being aware of it. However, the hepatitis C virus can be easily detected with a blood test. Therefore, it is important for everyone to be tested once as early as possible in life, and to confirm whether the infection is present. Those who are infected should receive prompt treatment as soon as possible in order to prevent damage to hepatic cells.
One-third of the world’s population is thought to be infected with Mycobacterium tuberculosis, and new infections occur at the rate of about one per second. Worldwide, the proportion of people who become sick with tuberculosis (TB) each year is stable or falling, but because of population growth, the absolute number of new cases is still increasing.1 In 2007, there were an estimated 13.7 million chronic active cases, 9.3 million new cases, and 1.8 million deaths, mostly in developing countries. In addition, it is more likely that people in the developed world who contract tuberculosis do so because their immune systems have been compromised due to higher exposure to immunosuppressive drugs, substance abuse, or acquired immunodeficiency syndrome (AIDS). The distribution of TB is not uniform across the globe. About 80 percent of the population in many Asian and African countries test positive in tuberculin tests, while only 5 to 10 percent of the U.S. population test positive.
The number of HIV carriers in Japan is steadily increasing. The total number of new HIV carriers has exceeded 1,000 per year since 2004, and reached 1,590 in 2013. The proportion of patients with the sudden onset of AIDS, discovered after HIV infection has already progressed to AIDS, remains at about 30 percent of new HIV carriers and shows no sign of declining. This is considered to be attributable to the failure of patients to undergo testing for early discovery. The incidence of sudden AIDS is higher in areas where both healthcare professionals and examination subjects are poorly informed and are less cautious concerning HIV infection.
The threat of drug-resistant pathogens to antibacterial drugs is becoming a worldwide issue. The U.S. Centers for Disease Control and Prevention (CDC) has reported that over two million people are being infected by drug-resistant pathogens, causing 23,000 deaths every year.
Currently, the number of patients with mental diseases who are visiting medical institutions exceeds the number suffering from the so-called four major diseases (cancer, stroke, acute myocardial infarction, and diabetes mellitus) in Japan. The number of patients in 1996, at 2,180,000, rapidly increased to 3,200,000 patients in 2011, which is approximately a 1.5-fold increase in fifteen years. Including schizophrenia, dementia among the elderly, developmental disorders among children and adults, and depression among workers mental diseases are becoming more common across the population. Therefore, the preparation of a regional environment that shares the concept of “social inclusion,” involving not only patients, but also their families, healthcare professionals, (including attending physicians), local residents, and administration, is required.
According to government estimates, the number of elderly dementia patients in Japan is expected to reach 7 million by 2025. This is one out of every five people over the age of 65. Already, our society faces severe challenges around dementia, including deteriorating quality of life for patients, burdens for families, elderly caring for elderly, traffic accidents, and fraud targeted against the elderly.
A dramatic increase in life expectancy coupled with a falling birth rate have caused an increase in the proportion of the elderly in Japan. In 2005, the percentage of people aged 65 years or over became higher than that in other major industrialized countries, and reached 23 percent in 2010. This places Japan in the category of a super-aging society, as defined by the World Health Organization. Along with the growing elderly population, Japan is facing various problems that are difficult to solve, such as the increasing social costs of long-term care insurance and medical expenses.
Today, the advancement of women is a key part of the Japanese government’s growth strategy. Japan has a significant gap in economic opportunities and advancement for women versus men when compared to other countries. Japan ranked 104 out of 142 countries in the World Economic Forum’s Global Gender Gap Index. Prime Minister Abe has recognized this gap, noting that “Women are Japan’s most underutilized resource,” and has cited the enhancement of women’s participation and advancement as one of the key pillars of Abenomics for the economic revitalization of Japan. Although the main focus of the Japanese government has been on support for working mothers with regard to childcare, and measures to increase the number of women in managerial positions, comprehensive health support is also critical to the attainment of these goals.
Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fractures. The World Health Organization (WHO) defined osteoporosis as “a disease characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.” According to the 2011 Japanese guidelines for prevention and treatment of osteoporosis, the estimated number of osteoporotic patients aged 40 or over in Japan is 12,800,000 (3,000,000 men and 9,800,000 women).
The morbidity of female breast cancer by age starts to increase from the 30s, peaks from the late 40s to 60s, then gradually decreases. Morbidity and mortality of female breast cancer has consistently been increasing year by year and statistics show that an estimated 13,400 patients died and an estimated 86,700 patients (one in 12 people) suffered from this disease in Japan in 2014. However, the rate of breast cancer screening is 80.4 percent in the United States and 74.1 percent in South Korea, but only 36.4 percent in Japan, a rate markedly lower than in other developed countries.
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 from the disease. 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, which 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 incidence of sexually transmitted infections (STIs) remains high in most of the world, despite diagnostic and therapeutic advances that can rapidly render patients with many STIs noninfectious and cure most STIs. In many cultures, changing sexual morals and use of oral contraceptives have eliminated traditional sexual restraints, especially for women, and both physicians and patients have difficulty dealing openly and candidly with sexual issues. Additionally, the development and spread of drug-resistant bacteria (e.g., penicillin-resistant gonococci) is making some STIs harder to cure.
With the massive growth of the elderly population, coupled with serious shortage of doctors, uneven distribution of specialized physicians and regional gaps in healthcare distribution, Japan must consider a fundamental change in how healthcare services are delivered to its citizens. In such circumstances, healthcare information technology (IT) will be at the core of this change, providing improved efficiency, better outcomes, and a higher quality of life. Many governments of other countries are investing heavily in healthcare IT, and are already gaining tangible benefits. The aftermath of the 2011 Great Eastern Earthquake highlighted the importance of electronic healthcare records (EHR), storage of health information, disaster preparedness, service continuity, and regional medical and long-term care collaboration. Based on this experience, and as the world’s leading IT economy, Japan has the potential to innovate and to become the global leader in healthcare IT.
Governments and healthcare providers are under significant pressure to lower the costs of delivering healthcare services. One way to achieve this imperative is to integrate new infrastructure, information systems and emerging technologies that support an increasingly broad healthcare ecosystem. Telemedicine is one such solution.
In 2012, the Japanese government forecast that the population aged 65 and over would increase from 23 percent in 2010 to 30 percent by 2025 and 40 percent by 2060. Healthcare expenditures for these persons accounted for 56.3 percent1 of the total healthcare expenditure in Japan, or JPY35.1 trillion in 2012. This is expected to increase to JPY54.0 trillion in 2025.2 In 2012, average healthcare spending was four times larger for people aged 65 than for those under 65; JPY717,200/person versus JPY177,100/person, respectively. Given that elderly people need more medical services in the absence of reforms, this rise in their number will result in a considerable strain on the financial stability of the healthcare system further.
The ACCJ and EBC applaud the Japanese government’s efforts to amplify the cutting edge regenerative medicine research being done in Japan. Translating these new innovations into commercial applications will require much more thought and attention to regulatory processes. Japan has an opportunity to lead the world in the commercial application of regenerative medicine; however, there are several aspects to the current approach that will require further attention.
Harvesting and applying “tissue or specialty cells” to the human body (such as by grafting) to combat disease and other conditions is a commonly practiced medical approach. Recently, the inclusion of progenitor or mesenchymal adult stem cells within this category of “specialty cells” and use in Regenerative Medicine-based therapy has been rapidly expanding. Efficacy of adult stem cells is supported by an increasing scientific publication record demonstrating that mesenchymal adult stem cells which mediate tissue repair often are not naturally present within that tissue, but are recruited and migrate from other tissues or regions to the damaged area. Several clinical trials are currently underway in Europe and the United States, employing transplanted adult stem cells augmenting this natural phenomenon. Many of these therapeutic applications include the use of “autologous cells” which means that the cells originated from the same patient (recipient) instead of a donor.
Healthcare-associated infections (HAIs) are infections that patients contract in a healthcare facility from bacteria, viruses, and other pathogens that are frequently resistant to antimicrobial treatment. They result in serious clinical, public health, and economic costs, including prolonged hospital stays, long-term disability, preventable deaths, increased antimicrobial resistance, excess financial costs to healthcare systems, and high costs for patients and their families. Annually, they affect hundreds of millions of patients worldwide. Fortunately, many HAIs can be prevented when public policy requires and incentivizes healthcare facilities to implement comprehensive infection prevention and control practices.
A healthcare-associated infection (HAI), also known as a nosocomial infection, is an infection that a patient contracts while receiving treatment for another condition in a healthcare facility. Patients who are hospitalized, especially patients in critical care units, are constantly at risk of developing nosocomial infections. Patients who incur these infections are hospitalized longer as a result of the infection, and require treatment, leading to higher overall costs for hospitals and payers. A recent study of stroke patients in 36 Japanese hospitals showed a HAI incidence rate of 16.4 percent. Patients who contracted HAIs paid on average the equivalent of an additional USD3,067 in medical fees and remained hospitalized for an additional 16.3 days.
Many nosocomial infections occur when medication/fluids are administered via an intravascular device. A common example of infections caused by exposure to air and contamination via intravenous (IV) systems are bloodstream infections (BSIs). BSIs have a significant influence on patient outcomes because these infections can either be the patient’s primary cause of death, or exacerbate the patient’s primary condition, which could lead to death. A surveillance study by the International Nosocomial Infection Control Consortium (INICC), conducted in intensive care units (ICUs) in Latin America, Asia, Africa, and Europe, demonstrated that the mortality rate of patients with BSIs was 29.6 percent.
According to the Report on the Burden of Endemic Health Care-Associated Infection Worldwide, issued by the World Health Organization (WHO) in May 2011, healthcare-associated infections (HAIs) continue to be the most frequent adverse event in healthcare delivery worldwide. The study also reports that, for every 100 of the world’s hospitalized patients, somewhere between seven and ten will acquire at least one HAI. The findings of this WHO report are a reminder that access to care does not necessarily imply safe care. HAIs represent a major patient-safety issue worldwide. They are the most frequent adverse events during healthcare delivery and potentially result in prolonged hospital stays, long-term disability, increased antimicrobial resistance, high additional costs for the healthcare system, financial and human-suffering burdens for patients and their families, and excess deaths. The WHO report estimates the prevalence for HAIs occurring among patients in developed countries to be 7.6 per 100 patients.
Catheter-associated infections include exit, tunnel, pocket and bloodstream infections. In the United States, when these types of infections occur, they extend the length of hospital stays by an average of 12 days and result in an additional cost of some USD18,432 per patient. As reported by the U.S. Centers for Disease Control (CDC), some 250,000 bloodstream infections (BSIs) resulting from central vascular catheters (CVCs) have been estimated to occur annually, with an estimated death rate of some 12 – 25 percent (30,000 – 62,500) as a result of catheter-related bloodstream infections (CRBSIs). The prevention of CRBSIs is important for improving patient outcomes, and depends on having appropriate medical care, product guidelines, and infection control.
Sepsis is a toxic response to infection that affects 20-30 million people annually making it one of the most common deadly diseases worldwide. It is one of the few conditions to strike with equal ferocity in the developed world and in resource-poor areas. Sepsis is the leading cause of death in U.S. hospitals with 750,000 patients affected and over 250,000 deaths each year. In the United Kingdom, it is conservatively estimated that 102,000 cases of sepsis arise annually, with 36,800 deaths as a result. More than 3,000 people die of sepsis in Australia each year, with more than 15,700 new cases treated in an ICU/year at an estimated cost per episode of AUD 39,300. Despite vaccines, antibiotics, and advances in intensive care, incidence of sepsis is on the rise. Worldwide hospitalizations have more than doubled over the last 10 years. In many countries, more people are hospitalized each year for sepsis than for heart attack. The aging population, increasing use of high-risk interventions and the advent of drug-resistant infections are contributing factors.
Single-use medical devices (SUDs) are designed to be discarded after one use and should not be reused under any circumstances. The one-time use of a SUD ensures function and sterility, while preventing cross-contamination and infection. Only SUDs that have gone through appropriate reprocessing, including cleaning, functional testing, repackaging, relabeling, disinfection and sterilization, should ever be reused. However, some healthcare personnel are unaware of, do not understand, or do not adhere to, the guidelines for the appropriate use of SUDs.
There is still room for improvement in the area of safety and infection control for patients and healthcare workers by lowering the risk of foreseeable accidents, injuries, preventable infections and preventable exposure to hazardous drugs.
Needle stick and sharp object injuries pose a serious occupational risk to healthcare workers. The provision of a safe and healthy working environment is a fundamental right of every employee in Japan. Duty of care provisions within occupational health and safety legislation aim to protect people from all types of hazards and risks arising from work activities. Therefore, it is reasonable to expect that healthcare workers should be protected from exposure to dangerous blood-borne viruses, including hepatitis B and C viruses and HIV. Even the smallest puncture of the skin can expose a healthcare worker to more than 30 blood-borne pathogens, bacteria, and parasites, any of which can cause serious and potentially life-threatening infections. The majority of these injuries are suffered by nurses and doctors and occur in patient rooms and operating rooms. However, other medical staff can also become victims. Ancillary staff such as hospital orderlies, cleaners and laundry staff, and other downstream workers also suffer needle stick injuries.
Healthcare personnel who transport, prepare, administer, and dispose of hazardous drugs can be exposed to these toxic agents in the air or on work surfaces, clothing, medical equipment, and other surfaces. As a result, both clinical and nonclinical workers are at risk for exposure when they create aerosols, mix liquids, generate dust, or touch contaminated surfaces if safe handling precautions are not followed. Frequent exposures to even very small concentrations of powerful drugs used for cancer chemotherapy, antiviral treatments, hormone regimens, and other therapies can have serious health consequences for workers who come in contact with them.