Kyowa Area at Chikusei City in Ibaraki Prefecture
We participate in epidemiological researches and preventive activities, and evaluate preventive measures under cooperation with the health center and the medical association, whose purpose is prevention of lifestyle related diseases with a focus on cardiovascular diseases. The method of cardiovascular medical checkup and the way of health education have evolved into the applications on health administration.
History of half reduction countermeasure against stroke, at Kyowa Area
Now, we introduce the background of preventive measures, the actual activities and the results as follows.
Background of preventive measures from stroke
The number one cause of death was "Stroke" at Kyowa Area, former Kyowa Town, in 1981. On medical expense, cardiovascular diseases accounted for 25 percent of the total amount of the National Health Service as well. 40 bedridden people, about a half from the total of 85 people, were caused by "Stroke" in those days.
Then, the town government started "Half-reduction-countermeasure project against stroke" after explaining the actual situations to Dr. Komachi Yoshio, who was a professor at that time and is a professor emeritus at the University of Tsukuba currently, and gaining cooperation with the town medical association, Shimodate Health Center, Ibaraki Health Service Association, the University of Tsukuba, the board of education, schools, the district leader of foods association, agricultural cooperative, agricultural development and extension association, and so on.
Physical checkup
All of the residents aged more than 40 have been able to take a thorough cardiovascular examination every four years, by the way of separating the town into four areas, as a physical checkup project since two years after when the countermeasure started in 1981. As a result, the four-year-accumulated consultation rate of thorough examination be-came up to 80 percent approximately.
Basic health checkup has been performed according to Health and Medical Service Act for the Aged since 1991. The basic health checkup, intended more than 35 years old, consists of several special examinations, medical interview, physical measurement, blood pressure estimation, blood test, electrocardiography, fundus examination, nutrient diagnosis, 24-hour urine collection test, consultation and sleep apnea, which is taken by more than 3 thousand of people every year. The accumulated consultation rate stays at around 80 percent at the beginning to 70 percent recently.
Briefing session of physical checkup's results
It is the results' briefing session that is held at first as a health direction after physical checkup. Briefing sessions about results of basic health checkup are held, the individual results are attached into each health handbook and the life prescriptions based on each person's results are inserted to the handbooks. All people taking the checkup are re-quired to join in the results' briefing session. Each person will get a handbook at recep-tion, receive explanations how to see the individual result sheet at the session, then hear a lecture by medical doctor and have questions and answers. If having personal questions, the people can consult medical doctors, health nurses or dieticians individu-ally.
Health education class
On the health direction project to improve lifestyle mainly at health classes which have been held since 1982, intended hypertensive people judged to be needed caution and medical treatment at physical checkup, we recommend that someone who need medical treatment when taking medicine should visit medical institutions. It can be taken at health class that lectures and practical trainings with focus on salt reduction, well-balanced meal, exercise, rest and alcohol reduction, or individual interviews, blood pressure estimation, and so on. There are the students from 200 up to 900 every year. We confirmed that the health class led effect on the blood pressure drop by doing con-centrative health directions from 1991 to 1993 as a lifestyle improvement project and improving people's lifestyle.
District organization
To practice and advance half-reduction-countermeasure project against stroke effec-tively can be not to go well though officials of town government have made great effort. That is on the occasion which the residents do not find it worthwhile to "protect the health by all" and become disinterested. At Kyowa Town, they established district or-ganizations, one was "Health promoters" by woman officers in 1980 and the other was "Committee of preventive measure from adult diseases" by men in 1981, in order to advance the project effectively within limited members and budget of the town. These two organizations are carrying on health-making activities at each area aggressively, in cooperation each other. As their attitude meets the eyes of residents, the residents' way of thinking is getting change from passive like physical checkup obliges them to take because the government says so, to active like they should do by themselves to keep and enhance their health. It is not too much to say that it would be impossible to continue and evolve the half-reduction-countermeasure project against stroke up to the present if there were not these two district organizations.
After the municipal merger in 2003, the name changed from Kyowa Town to Kyowa Area at Chikuse City, Kyowa health-making association was begun as an alternative organization to "Health promoters" and "Committee of preventive measure from adult diseases" in 2004.
There is another district organization which is called Committee of diet direction for health-making. People who took one-year diet lecture of the town and passed through it began the organization, and are working as a voluntary society. They are strenuously performing assistance for nutritional researches when being healthy and salt-reduction activities in areas to support the half-reduction-countermeasure project against stroke on nutrition.
Activities through the media
As activities through the media, posters, banners and signs with catchphrases we made are displayed. Health calendars are printed and provided for all households as well. Also public relations project on half-reduction-countermeasures against stroke is being done to carry articles about salt reduction in public relations magazine of the town or publish monthly mini-health-magazines "Healthy Kyowa" and "Health Center News".
Activities via the town events
We have held "Health Festival for residents" in summer since 1978 for the purpose of raising the health awareness of general residents as a campaign via the town events. Especially since 1981, the subjects with focus on half-reduction-countermeasures against stroke and adult-disease prevention have been taken.
Activities at primary schools
To have an interest in health from childhood will be useful for us to make our own health when become adult. At the primary schools of Kyowa Town, the third and fourth graders take classes for making health with supplementary readers called "Diet and Health".
Health education at primary school is unique even in a series of projects. Additionally with classes by health supplementary readers, we have made various efforts since 1983 that children who are responsible for the next generation will not suffer from hyper-tension or other lifestyle-related diseases when become adult and also that young gen-eration who are parents of the children have the health awareness deeply, through parent-child summer cooking class, health-poster making or participation in health festival.
Effect on half-reduction-countermeasure project against stroke
Twenty five years have passed since the half-reduction-countermeasure project was started organizationally in 1981. The effect on project appears at each field step by step.
Altered distribution of salt concentration in Miso soup
We surveyed salt concentration in Miso soup intended all households at first. The con-centration was more or less than 1.1g at the beginning stage of the countermeasure, became 1.0g said as proper and then Miso soup with lower concentration is increasing.
Altered excretion of salt in the urine per day
Excretion of salt in the urine which shows the condition of salt intake is decreasing for both men and women.
Altered blood pressure of the residents
The average of blood pressure, both systolic and diastolic, men and women in each age, has dropped drastically.
Altered stroke's onset
When seeing differences of stroke's onset on the residents separately into the beginning, the middle and the end of period taken measures, the stroke's onset has decreased about 40 percent through the beginning to the end for both men and women. On the survival situation of which people suffered a stroke, the rate of people who is alive after suffering a stroke at the age less than 69 has increased for men and women, and been over 80 percent even after the three years.
Altered number of bedridden people
Additionally, the number of bedridden people caused a stroke has not increased so much even if the residents are more aged, and the bedridden rate of aged people against pop-ulation has decreased approx. 40 percent compared with the beginning period taken measures.
Comparison of expense of National Health Service with neighbor areas
As comparing the change of expense of National Health Service between Kyowa Town and neighbor cities, towns and villages, at Kyowa Town the medical expense has capped less than that of the neighbors since ten and a few years passed after the counter-measures had been started, and been cheaper more than 10 thousand yen per person lately. It should be the reduction of 85 million yen per year approximately whole the town as the members of National Health Service are eight thousand at Kyowa Town.
