What can we learn from Japan's Metabo law?
Japan has some of the lowest mean BMI values amongst high income and industrial countries, as well as one of the highest life expectancies at birth in the world. With high BMI a leading risk factor in the burden of non communicable diseases, understanding the health policies in place behind this are important worldwide. But what has this got to do with work and health?
I caught up with Dr Christina Siegel, RCSI/ US trained physician now based in Japan and Dr Yusuke Noguchi, occupational health physician based in Japan to find out more.
Context
In Japan, it is mandatory to enrol in an employment based or residence-based health insurance plan. As a result, over 98% of the population are covered through statutory health insurance, with around 60% of the population on employment-based plans. The plans involve mandatory contributions, coinsurance and some copayments for certain services. The fee schedule is set by the government and for residence-based plans a proportion of individual’s mandatory contributions are state funded. Funds for healthcare are raised through taxes as well as individual contributions and out of pocket charges.
The Metabo law
Back in 2008, concerned about slow trends towards higher BMI in the population, the Japanese government mandated that insurers carry out annual health checks and health promotion for people aged 40-75. This includes monitoring waist circumference and supporting individuals with weight loss to reduce risks associated with high BMI. This primary aim of this policy is to contain healthcare costs and helps keep a substantial proportion of the working age population healthy.
Given this cohort overlaps with people in work, the government encourages employers and insurers to collaborate on employees' health promotion planning using occupational health as a resource to achieve this. To further this cooperation, the government rewards employers with a certificate of Health and Productivity Management.
Aligning incentives
The Metabo regulation means widespread acknowledgement across society in Japan that weight management is more than just one individual’s problem. This ties in with what we know about the social determinants of health. Companies invest in keeping their workforce healthy and are actually tasked with collaboration in this regard. Organisational policies that help keep the workforce mobile and eating higher quality food will pay off- reducing the cost of intervention as well as savings made through improved workforce productivity and reduced sickness absence. It is unlikely a health promotion programme siloed from day to day life would have as much success.
What about the UK and US?
Japan has more comprehensive OH coverage compared to the US and the UK. Currently we do not have adequate work and health infrastructure across the UK or US economy to achieve this kind of collaboration. However, harnessing the role of the workplace to implement this kind of health promotion is likely to be essential in tackling non communicable disease. Viewing health, diet, exercise and BMI as separate from day to day life will not be effective in reducing rising obesity rates. Buy in from our workplaces, where we spend most of our waking hours will drive success on this initiative. Forward thinking companies should invest in programmes like this to keep their workforce healthy and productive.
Without engaging with this issue, workplaces may actually be increasing our risks of non-communicable disease through factors such as long working days/ shift work with inadequate rest, high levels of work-related stress, limited movement breaks and unhealthy food available on site. UK health and social care services themselves are not exempt from this. An analysis on data collected more than 10 years ago found that even at that time >25% of nurses and >30% of unregistered care workers were obese. Figures are likely to be worse now.
More than just Metabo
This health promotion policy should not be considered in isolation when it comes to Japan’s success at keeping the population’s BMI in range. There are many more factors at play, starting with initiatives aimed at children. This includes a ‘closed system’ for primary school mealtimes where healthy meals are prepared on site and children are not allowed to bring snacks in. There is an emphasis on education around food, where it comes from and how food and exercise relate to health. Children have to walk to school (and do so independently from the age of seven)!