Financial health promotion in Japan and Mongolia

Abstract

Introduction Health promotion is becoming a noticeable policy in both developed and developing countries facing a burden of both communicable and noncommunicable diseases. This paper discusses the focus of health promotion policy, financing arrangements and the perspectives of social health insurance to fund health promotion. The population health status in Japan is among the highest in the world despite an increasing incidence of cancer, heart, cardiovascular diseases and diabetes. Communicable diseases such as HIV/ AIDS and new types of influenza also pose threats to public health. In Mongolia, both communicable and noncommunicable diseases are a serious public health concern. Since 1995, cardiovascular diseases, cancer and injuries have been the leading causes of mortality. Tobacco and alcohol consumption, physical inactivity and unhealthy diet are common risk factors for many chronic diseases. Japan In 2000, Japan announced the National Health Promotion Movement in the 21st century, with the shortened name of Healthy Japan 21. This policy aims to encourage all citizens to be healthy and free of disease. It focuses on healthy dietary habits, promotion of physical activities, diagnostic tests and reduction of tobacco use. Traditionally, health promotion is regarded as a useful means to prevent disease and promote health among different social groups. Municipal governments, health centres and urban communities play a major role in implementing health promotion activities. Health promoting leaders have been identified and nominated by community members and trained to conduct health promoting activities in their communities. These include advocacy of healthy lifestyle, behaviour, attitudes, dietary habits, access to health-related information and improvement of health literacy and education at community level. Studies suggest that a community participation approach suited to the socioeconomic setting has been effective in improving health-related behaviour and promoting health in Japan. (1) Mongolia Since 2000, the government of Mongolia has approved 16 public health programmes with health promotion effects such tobacco control, health education, cancer and injury prevention, nutrition, population fitness activities, child and reproductive health. However, strong evidence is not available yet about whether these programmes have been successful in controlling and reducing risky behaviours among the population. Since 2002, there has been an increase in the reporting of unsafe sex practices. There is an increasing trend in tobacco consumption, especially among young people. It is estimated that about 65% of males and 20% of females consume tobacco, which is higher than the respective averages in developing countries. The 2006 STEP survey on the prevalence of noncommunicable disease risk factors estimated that 9 of every 10 people surveyed had at least one risk factor and I in 5 people had three or more risk factors for developing a disease. (2) Currently, the public health programmes in Mongolia are implemented at population level but other country experiences show that the effects of health promotion can be increased through action at the community and individual level. There is an acute lack of funding support for the public health programmes in Mongolia. Although the central government budget is referred to as the main funding source, no specific budgeting tools and guidelines are provided. The 2005 national health accounts estimated that the level of spending on public health services was less than 5% of total health expenditure. (3) Financing promotion schemes In Japan, local governments assumed the main responsibility for financing health promotion. In practice, the availability of local revenues to implement health promotion activities varied among the country's 47 prefectures. Therefore, the financial adjustment policy was implemented in the form of financial assistance from the national to local governments. …