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Japan and the “Metabo Law”Mark J. ManansalaWhy Japan and Obesity?I just remember seeing this silly news story online about Japanese companies doingmandatory waist line measurements of their employees in an effort to curb obesity. Afterdoing the research on the topic, it revealed some really interesting information about thestate of health care in Japan. Even though, it’s known for being pretty healthy whencompared to the rest of the world, they are facing some challenges ahead.
Japan and the “Metabo Law”Mark J. ManansalaJapanese history is rich in mythology, and has influencesfrom China. It’s first emperor was believed to be a directdescendant of the sun. After centuries of isolation,Japan first opened its ports to the west when it signedthe Treaty of Kanagawa with the United States in 1854.Since then, it has strived to find a balance betweencenturies of tradition and modernization.(History of Nations, 2004, CIA, 2012) Tokyo, Japan
Japan and the “Metabo Law”Mark J. Manansala Health Care System2012Total GDP: $4.617 trillionHealth expenditures: approx $387 billion (9.3% of GDP) In the 1960s, Japan instituted a national public health insurance system that is funded by: 1. government subsidies 2. insurance premiums 3. individual copayments There are approximately 3,500 private insurers and government municipalities that provide insurance for the population. (CIA, 2012) The Two Broad Groups of Beneficiaries: 1. Employees and their dependents under the age of 75 (65%) 2. Self-employed, unemployed, and elderly (35%) (Matsuda, 2012)Employee Health Insurance (EHI)Civil Health Insurance (CHI) *see slide notes to compare to American health care system
Japan and the “Metabo Law”Mark J. Manansala DemographicsPopulation: 127 million (10th)Growth Rate: -0.077% * Population is shrinking. Declining for the third year in a row, and on pace to beLife Expectancy: 83.91 years (3rd) halved by the end of the century (Traphagan, 2012).Median Age: 45.4 yearsObesity Rate: 3.1% (US: 33.9%) (CIA, 2012) * Population is also aging, with people over 65 making up almost a quarter of the population and teens only 13% (Traphagan, 2012).
Japan and the “Metabo Law”Mark J. Manansala Looming Demographic CrisisPopulation: 127 million (10th)Growth Rate: -0.077% * Population is shrinking. Declining for the third year in a row, and on pace to beLife Expectancy: 83.91 years (3rd) halved by the end of the century (Traphagan, 2012).Median Age: 45.4 yearsObesity Rate: 3.1% (US: 33.9%) The current health care system is held together, because much of the services are paid for by the working population – (CIA, 2012) approximately 4% of their salaries plus the 30% co-payments (Oda, 2011). As many of these people begin to retire, there will be an increased demand for medical services. When there are not enough working people that contribute to the health care system, and pay for this new influx of health care demands, a deficit will be created. Oda (2011) compares the situation to the current health care crisis in America as baby * Population is also aging, with people boomers switch from “being contributors to the system to being over 65 making up almost a quarter of beneficiaries” (p. 261). the population and teens only 13% (Traphagan, 2012).
Japan and the “Metabo Law”Mark J. Manansala Metabolic Syndrome a collection of factors that increase the risk of cardiovascular disease and diabetes: • abdominal obesity • hypertension • elevated blood glucoseJapan’s Ministry of Health, Labor, andWelfare released a study finding that • high cholesterolhalf of all men and 1 in 5 women (Onishi, 2008)between the ages of 40 and 74showed signs of metabolic syndrome.The report caused a public outcryagainst metabolic syndrome – dubbed“metabo.”(Singer, 2008) 56 million citizens (age 40-74)
Japan and the “Metabo Law” “Metabo Law”Mark J. ManansalaThe report from the Ministry of Health, Labor, andWelfare led to legislation, passed on April 1, 2008(Singer, 2008). The “Metabo Law” refers to a set ofguidelines officially called the Standards ConcerningImplementation of Special Health Examinations andSpecial Public Health Guidance, under the Ministry ofHealth, Welfare, and Labor Order 159 (Oda, 2011).With a goal of shrinking the overweight population by10% over the next 5 years and by 25% over the next 7years, these guidelines call for local governments andemployers to conduct mandatory annual examinations,including measurement of waistlines for people Basically…between the ages of 40 and 74 – representing 56million or 44% of the entire population (Onishi, 2008).For individuals that exceed the maximum waist line of33.5 in (85 cm) for men and 35.4 in (90 cm) for women, People between the ages of 40 anddoctors will consider other diagnostics to determine the 74 are required to get annual waistseverity of the metabolic syndrome; those in the highest line measurements.category will be required to attend counseling sessionsover the next three months to lose weight and make If they exceed the maximumlifestyle changes (Oda, 2011, p. 265). Employers are measurement, they get counseling.required to ensure a minimum of 65% participation withthe exam and 25% reduction in obesity within 7 years, Their insurers and employers areor face penalties of up to 10% of the current payments responsible for achieving at least 65%which will go to fund elderly care (Oda, 2011). compliance and a 25% reduction in obesity by 2015, or face fines that will go on to fund elderly care.
Japan and the “Metabo Law”Mark J. Manansala Who is Affected? 56 million citizensThere are no incentives or repercussions age 40-74 now “required” to get annual examsfor those that fail to get their waist linemeasured. There is also no penalty forrefusing to follow the treatmentrecommendations after “failing” the exam.Companies will pay fines if they do notmeet the 65% compliance and 25%reduction of obesity by 2015.Those fines will go toward paying for healthcare for the elderly. Oda (2011) suggests that the whole set of guidelines isMeanwhile, childhood obesity numbers a clever way to benefit…continue to rise; now at 20% (Rohana &Aiba, 2012). “not the 3% of Japan’s population considered obese so much as it is the scores of elderly Japanese endangered by a healthcare system going bankrupt” (p. 269).
Japan and the “Metabo Law”Mark J. Manansala Legislating Health Around the World In 2011, Denmark passed a “fat tax” that implemented an across-the-board tax on all foods with saturated-fat content above 2.3% (Kliff, 2012). Instead of causing consumers to make healthier food choices, people bought their fatty foods online or in neighboring Germany (Kliff, 2012). By 2012, the Danish government announced that it would abolish the tax. In America, the Safeway Amendment that allows employers to offer insurance incentives and discounts to people who take steps toward better health (Borrell, 2011). The amendment got its name from the Safeway Chief Executive Steve Burd, who wrote of his company’s Healthy Measures program was “proof that incentives could cut our nation’s healthcare costs by 40%” (as cited in Borrell, 2011, para 3). The goal is to keep workers healthy, reduce sick time, and ultimately reduce health care costs. However, critics said that the program was poorly designed and created inequality by benefiting those that are already healthy at the cost to those who are unhealthy, and unfairly to those who are unhealthy despite efforts to improve their healthy (Borrell, 2011).
Japan and the “Metabo Law”Mark J. Manansala Pros & ConsPros: Cons:“Metabo” has become a cultural phenomenon Currently, less than half of the 56 million people between the– leading to an increased awareness of health ages of 40 and 74 are attending their “required” annual check-and fitness. ups. If this number does not reach the 65% goal of the law byJapan is still one of the thinnest countries in 2015, companies will face heavy fines. A large company likethe world with an obesity rate of 3.1% (CIA, NEC said that it could face up to $19 million in penalties2012). (Singer, 2008)Fines from the 2015 deadline will fund health Only 12.3% of those that receive counseling follow throughcare for the elderly, maintaining universal with the medical advice (Lhuillery, 2013).health care in Japan. Does not address rising childhood obesity rates.Companies are offering healthier food choices Companies may start to discriminate against overweightand metabo-education for employees and their people to avoid paying fines.families. The waist line measurements conflict with recommendations of the International Diabetes Federation.