Japanese Municipalities Research Articles

Future Scenarios and Assessment of Gradual Diffusion of Renewable Energy Technologies towards 2050: Case Study of a Japanese Municipality

Future Scenarios and Assessment of Gradual Diffusion of Renewable Energy Technologies towards 2050: Case Study of a Japanese Municipality

Discussion on Participate Approaches in Local Forest Planning for Japanese Municipalities

Discussion on Participate Approaches in Local Forest Planning for Japanese Municipalities

Insights from primary care workers supporting people at risk of suicide in local communities in Japan: A qualitative descriptive study.

To identify insights for supporting people at risk of suicide in the community based on primary healthcare workers' experiences. Qualitative descriptive design. Semi-structured interviews were conducted with fifteen primary healthcare workers employed by Japanese municipalities between August and October 2019. The data were subjected to qualitative descriptive analysis. The analysis revealed eleven subthemes, clustered under the following three themes: (1) fostering 'opportunities for discovery' for people at risk of suicide by encompassing strategies such as increasing access to services and promoting a holistic understanding of the life cycle; (2) fostering 'meaningful connections' by searching for channels to reach the heart and taking approaches from different objectives; and (3) engaging in 'risk management', by understanding and coping with real-life struggles and implementing timely crisis intervention. Not only direct care targeting suicide prevention but also holistic care that includes atypical perspectives such as 'approaches from different objectives' may provide important insights for supporting people with suicide risk. Beyond the limitations of existing suicide risk screening methods, this study highlights the importance of a holistic approach that sees people at risk of suicide in the context of their daily lives and aims to alleviate the difficulties in their lives that have brought them to the point of considering suicide. By describing support focused on the difficulties that people at risk of suicide face in their daily lives, this study identified insights for supporting people at risk of suicide in communities where screening and intervention are difficult. These findings will contribute to the relief of people at risk of suicide by stimulating suicide prevention measures in primary healthcare settings. This study complied with the COREQ guidelines. No patient or public contribution.

The effects of regional goal setting on household waste

This study investigates the effects of food waste (FW) reduction goal setting on waste generation. Using a unique dataset on the status of policy response with goals for household food waste reduction across Japanese municipalities, we estimate the causal effect of setting FW reduction goals in the public plan on household waste output. The results indicate that goal setting reduces waste output by 3.38 kg per capita per year, resulting in a reduction in economic loss due to the discarding of food of approximately US$ 689 million per year. Moreover, we find that goal setting has a larger influence than other waste reducing and recycling policies that do not include reduction goals, such as collection frequency and unit-based pricing systems. Our results highlight the importance of goal setting by local authorities in designing environmental policies for common social goals.

Does participation in municipality-initiated incentivized health promotion programs promote physical activity among the physically inactive? Verification in six Japanese municipalities.

Physical activity can prevent lifestyle-related diseases, such as hypertension and diabetes. However, many people in society are physically inactive, especially middle-aged and older adults over 40. Therefore, this study examined the effects of a municipality-led incentivized health promotion program to clarify: (1) whether the average number of steps increased from the preparticipation period to the 18th month following the program; and (2) whether such increases were influenced by financial incentives. This study analyzed gender, age, step, and incentive type data from 5688 middle-aged and elderly participants in an incentivized health promotion program. The incentives were regional gift certificates that could only be used in local areas, national gift certificates, common points that could be used in department and convenience stores nationwide, and donations. The incentives were worth a maximum of 24,000 yen per year. Both the physically active group and the physically inactive group had increased the step count markedly 18 months post-participation; however those participants chosing financial incentives showed significantly higher steps after 18 months than those who opted for non-financial incentives (time: p < 0.05, time × group: p < 0.05). Municipality-led financially incentivized health promotion programs could motivate increases in the average number of steps taken by those physically inactive residents.

S10-1 Research on sub-national initiatives in HEPA policy making from Europe, Japan and the USA

Abstract The importance of local governments' engagement in physical activity promotion at local level has been acknowledged and advocated by the World Health organization in documents such as: “Promoting physical activity and active living in urban environments: the role of local governments” or “Global action plan on physical activity 2018–2030: more active people for a healthier world”. However, given the relative “youngness” of the physical activity policy research domain, the local level initiatives have been underrepresented in the scientific literature. The current symposium aims to present a number of diverse initiatives to promote health enhancing physical activity at sub-national level, each having a very unique context and approach. The paper from Eastern Michigan University presents the actions taken to implement Active People, Healthy Nation (APHN) program in geographic areas in Michigan where the priority population (Asian Americans) lives and the outcomes of this initiative. The contribution from Japan describes the process of developing and applying the L-PAT (local policy audit tool), an instrument comprising 11 items based on WHO’s HEPA Policy Audit Tool (HEPA PAT) and the results of this survey within 47 Japanese prefectures and the C-PAT (city policy audit tool), a 6 items tool, in a selection of 272 Japanese municipalities. The EU study presented in this symposium comprises the results of evaluation, using the CAPLA- Santé, a validated instrument, of local HEPA policies in 4 selected municipalities, one from each of the following countries: Finland, France, Germany, Romania and from one municipality in Japan. The responsibilities of local authorities in health promotion and protection are undeniable. The way the authorities manage to fulfil these responsibilities is gaining more and more interest from various stakeholders from local level activists to researchers and policymakers at national and international level. Local communities are increasingly stimulated to contribute to their own wellbeing, so data on the status quo and progress is needed more than ever. The initial discussion points of the symposium will focus on strengths and weaknesses of the initiatives presented, as well as the potential for knowledge exchange and replication &amp; scaling-up.

Does low urban density increase municipal expenditure? Population density as a performance target for compact city planning in Japan

In depopulating cities, vacant houses and lots are common throughout the urban area, creating low-density urban areas that can lead to inefficiencies in public services and financial deterioration for municipalities. However, despite some studies demonstrating the relationship between population density and public expenditure, no generalized conclusion regarding the essential effect of reducing public expenditure has been reached. Consequently, no method for rationally setting a population density as a performance target for municipalities when developing compact city planning has been established. Thus, this study used the cross-sectional data from Japanese municipalities and the exponentiation regression equation, to determine the strong relationship between population density and per-person public expenditure (PPPE). The findings are particularly noteworthy for municipalities that grew under a nationwide uniform city planning and accounting system, as they provide valuable insights into the generalization of the public expenditure reduction effect. Furthermore, this study developed a method using the exponentiation regression equation, which demonstrated an L-shaped trajectory indicating that PPPE increases at an accelerating rate when population density falls below a certain threshold. Municipalities can evaluate the efficiency of public expenditure simply by applying their population density to the regression equation. They can also verify population density as a performance target. Furthermore, this study revealed the turning point of population density at which the acceleration in the increase in PPPE begins, implying that municipalities can expect a grace period until the turning point.

Observation Maintenance for Bridges Using Early Detection of Deterioration Progress

In Japan, the results of inspections show that many bridges require repairs. However, Japanese municipalities do not have sufficient time and budget, and the progress of bridge repair is insufficient. Almost all the bridges managed by municipalities are short-span bridges. Therefore, a management system that selects and focuses on bridge repair based on performance evaluation would be effective. This paper presents an overview of a bridge management system that applies observational maintenance based on the early detection of deterioration, and its effectiveness is demonstrated.

Intermediary structure of paradiplomacy: examining sister-city links in Japan

ABSTRACTRecently, subnational-level international engagement, referred to as paradiplomacy, has garnered widespread attention globally. Many cities worldwide recognise paradiplomacy as an effective tool for addressing policy issues, such as world peace and climate change, unlike state-level diplomacy, which has struggled to offer solutions. Agreements and memoranda of understanding do not automatically develop while exercising paradiplomacy. In terms of implementation, it intrinsically requires two-dimensional dynamics: inter- and intra-city. Despite extensive research, few studies have argued for intra-city arrangements to implement paradiplomacy based on public administration theories stressing public policy capability. This study focused on sister-city agreements and clarified the significance of international exchange associations as intermediaries for intra-city cooperation arrangements from the perspective of policy implementation and network research. This study used multiple regression with data from a questionnaire survey on small- and middle-sized Japanese municipalities having the sister-city relationships with Australian counterparts. It concluded that an international exchange association was a significant antecedent to sister affiliation development, identifying the significance of budget size. The results of the study have theoretical and practical implications that stress the necessity of intermediary arrangements in policy implementation.

Age-Friendly Approach Is Necessary to Prevent Depopulation: Resident Architectural Designers and Constructors' Evaluation of the Age-Friendliness of Japanese Municipalities.

Japan has the world's largest old population ratio; thus, aging is an urgent societal issue. As global trends seem to be following Japan's social changes, there is an emphasis on municipalities becoming more age-friendly. Hence, we examine the age-friendliness of 135 Japanese municipalities, selecting 240 resident architectural designers and constructors to assess their municipalities using the Age-Friendly Cities and Communities Questionnaire (AFCCQ). The findings indicate that Japan lacks "outdoor spaces and buildings". Additionally, the evaluation of "housing", "community support and health services", and "transportation" in populated municipalities in the past five years was found to be significantly higher than that in depopulated ones. Age-friendliness is significantly affected by the AFCCQ total score (hereafter, Score) based on "housing", "social participation", "community support and health services", "transportation", and "financial situation" evaluations. High specificity (0.939) was found when the score was treated as a marker of depopulation; an age-friendly approach is a necessary condition for preventing depopulation. Furthermore, a lack of "communication and information" was observed in municipalities with a higher rate of single-person households aged 65 years and older. Therefore, resident architectural designers' and constructors' assessments, combined with the AFCCQ, will be a powerful tool for evaluating the age-friendliness of municipalities.

Association Between the COVID-19 Pandemic and Early Childhood Development

Although a growing number of studies have reported negative associations of the COVID-19 pandemic with academic performance among school-aged children, less is known about the pandemic's association with early childhood development. To examine the association between the COVID-19 pandemic and early childhood development. In this cohort study conducted in all accredited nursery centers in a Japanese municipality, baseline surveys of children aged 1 and 3 years (1000 and 922, respectively) were conducted between 2017 and 2019, and participants were followed up for 2 years. Children's development was compared at age 3 or 5 years between cohorts that were exposed to the pandemic during the follow-up and a cohort that was not. Children's developmental age was measured by nursery teachers using the Kinder Infant Development Scale (KIDS). Data were analyzed between December 8, 2022, and May 6, 2023. A total of 447 children (201 girls [45.0%] and 246 boys [55.0%]) aged 1 year at baseline were followed up to age 3 years, and 440 children (200 girls [45.5%] and 240 boys [54.5%]) aged 3 years at baseline were followed up to age 5 years. During the follow-up, the cohorts that were exposed to the pandemic were 4.39 months behind in development at age 5 compared with the cohort that was not (coefficient, -4.39; 95% credible interval, -7.66 to -1.27). Such a negative association was not observed in development at age 3 years (coefficient, 1.32; 95% credible interval, -0.44 to 3.01). Variations in development were greater during the pandemic than before the pandemic regardless of age. Additionally, the quality of care at nursery centers was positively associated with development at age 3 years during the pandemic (coefficient, 2.01; 95% credible interval, 0.58-3.44), while parental depression appeared to amplify the association between the pandemic and delayed development at age 5 (coefficient of interaction, -2.62; 95% credible interval, -4.80 to -0.49; P = .009). The findings of this study showed an association between exposure to the pandemic and delayed childhood development at age 5 years. Variations in development widened during the pandemic regardless of age. It is important to identify children with developmental delays associated with the pandemic and provide them with support for learning, socialization, physical and mental health, and family support.

Effect of COVID-19 vaccination on household transmission of SARS-CoV-2 in the Omicron era: The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study

ObjectivesTo evaluate the effectiveness of vaccination on reducing household transmission of SARS-CoV-2 among common household types in Japan during the Omicron variant wave. MethodsThis retrospective study was conducted using vaccination records, COVID-19 infection data, and resident registry data from two Japanese municipalities. Households that experienced their first COVID-19 case between January and April 2022 were categorized into two groups according to the presence/absence of children aged ≤11 years. We constructed multivariable logistic regression models with generalized estimating equations to calculate the odds ratios (ORs) and 95% confidence intervals for household transmission according to the vaccination statuses of primary cases and household contacts. ResultsWe analyzed 7326 households with 17,586 contacts. In all households, the OR for household transmission was <0.6 (P <0.001) when the primary case and/or contact were vaccinated. In households with children aged ≤11 years, the OR was 0.71 (P <0.001) when only the contact was vaccinated. In households with all members aged ≥12 years, the OR was <0.5 (P <0.001) when the primary case and/or contact were vaccinated. ConclusionCOVID-19 vaccination effectively reduced household transmission in Japan during the Omicron variant wave.

Continuation rates of newly prescribed donepezil among patients with Alzheimer’s disease in Japan: Life study

AbstractBackgroundAlzheimer’s disease (AD) is a major public health problem. Although donepezil is used as a first‐line pharmaceutical treatment for AD, studies from various countries have reported low continuation rates. However, the only available data from Japan are from post‐marketing observational study reports. This study investigated the continuation rates of newly prescribed donepezil among AD patients in Japan.MethodThe study was conducted using health care claims data and long‐term care claims data from 17 Japanese municipalities participating in the Longevity Improvement &amp; Fair Evidence (LIFE) Study. The study period was from April 2014 to October 2021, and the study population comprised patients who had been newly prescribed donepezil after receiving a diagnosis of AD. The treatment discontinuation was defined as a gap of ≥61 days between the last donepezil prescription and subsequent donepezil, cholinesterase inhibitors, or memantine prescription. Kaplan‐Meier curves were plotted to estimate the duration (days) from the start of a new prescription of donepezil until discontinuation, and patients were censored at the end of the observation period or death. The treatment continuation rates were also analyzed according to the patients’ certified long‐term care needs levels (ranging from levels 1‐5) at the time of the initial prescription.ResultWe analyzed 20,474 patients (mean age: 82.2 years, women: 65.7%) with a mean follow‐up duration of 483 days. The treatment continuation rates at 30 days, 90 days, 360 days, and 540 days after initial prescription were 89.1%, 79.4%, 64.5%, and 58.3%, respectively. By excluding patients with long‐term care needs levels 3‐5, we analyzed 18,924 patients with lower care needs levels (mean age: 82.0 years, women: 65.4%); their treatment continuation rates were almost identical to those of all patients (&lt;1% difference). Within 60 days of donepezil discontinuation, only 2.9% and 3.1% of patients had been switched to galantamine and rivastigmine, respectively.ConclusionThe AD patients showed a rapid discontinuation of donepezil and subsequent AD treatments by 90 days, and approximately 40% had ceased this therapy after 1.5 years. In view of the limited pharmaceutical options available for AD in Japan, this finding emphasizes the need for AD preventive measures in the pre‐clinical stage.

Green Policymaking in Japanese Municipalities: An Empirical Study on External and Internal Contextual Factors

This article examines the establishment and publication of green plans and green public procurement (GPP) policies in Japanese municipalities. The purpose of the study was to investigate these green policymaking initiatives from a contingency theory perspective. The first research question examined contextual factors for green policymaking. The second research question focused on barriers and enablers. For RQ1, through hypothesis testing and a regression analysis (n = 1663), we found that green policymaking differs by organization location, organization size, and organizational green capabilities. More specifically, we identified prefectures where municipalities score relatively higher as well as lower. Second, we found that larger (vs. smaller) municipalities undertake more (vs. less) green policymaking initiatives. Third, we observed that organizations with more (vs. less) green capabilities develop more (vs. less) green initiatives. For RQ2, through a descriptive and cluster analysis, we identified dominant barriers and enablers to establishing a GPP policy. The dominant barriers include a lack of information, lack of staff, and cost concerns, whereas manuals and example forms are important enablers. These findings are highly relevant to understanding and supporting green policymaking in Japanese municipalities.

Impact of the Comprehensive Awareness Modification of Mouth, Chewing and Meal (CAMCAM) Program on the Attitude and Behavior Towards Oral Health and Eating Habits as Well as the Condition of Oral Frailty: A Pilot Study.

Preserving sufficient oral function and maintaining aadequate nutrition are essential for preventing physical frailty and the following long-term care. We recently developed the 6-month Comprehensive Awareness Modification of Mouth, Chewing And Meal (CAMCAM) program, in which participants gather monthly to learn about oral health and nutrition while eating a textured lunch together. This study examined whether the CAMCAM program could improve attitude and behavior towards oral health, mastication, and diet as well as ameliorate oral frailty in community-dwelling older adults. Single-arm pre-post comparison study. A total of 271 community-dwelling adults (72.3 ± 5.7 years of age; 159 women [58.7%]) in 4 Japanese municipalities were recruited, of which 249 participants (92%) were assessed at the final evaluation. Participants gathered once a month at community centers to learn about oral health and nutrition while eating a "munchy" textured lunch containing proper nutrition. Oral frailty, frailty, and eating behavior were evaluated with the Oral Frailty Index-8 (OFI-8), Kihon checklist (KCL), and CAMCAM checklist, respectively. Participants were divided into Oral frailty (OF) and Robust groups according to OFI-8 scores. The differences in KCL and CAMCAM checklist results between the OF and Robust groups were statistically tested along with changes in scores after the program. KCL and CAMCAM checklist scores were significantly lower in the OF group at the initial assessment. OFI-8 and KCL findings were significantly improved in the OF group after completing the program (all P <0.05). Regarding the CAMCAM checklist, awareness of chewing improved significantly in the Robust group (P=0.009), with a similar tendency in the OF group (P=0.080). The findings of this pilot study suggest that the CAMCAM program may improve both oral and systemic frailty in addition to attitudes towards chewing, oral health, and meals, especially in individuals with oral frailty. The CAMCAM program merits expansion as a community-based frailty prevention program.

The politics of depopulation in Japanese municipalities: Ideas and underlying ideologies

ABSTRACT Recent research has tried to understand Japan’s depopulating countryside and regions through the comparative theory of “peripheralization”. Though these studies argue that a critical determinant of peripheralization in depopulating communities is a lack of political agency, few studies systematically investigate the internal and electoral politics of adapting to depopulation. This paper investigates one aspect of this process: how elected officials and candidates position themselves and contest issues concerning depopulation. We start by analyzing the ideas driving politics in two policy areas related to shrinking populations: 1) various measures aimed at attracting young families and people to relocate to the municipality and 2) the closure and merger of public schools. The article maps the key ideas and assumptions driving policies to adapt and combat depopulation. We find two ideas – what we call “populationism” and “listenism” – prevalent in the discourse. In addition, we find contestation about depopulation largely disconnected from broader ideological debates about the role and size of the state, prioritizing community over individual interests, or being more open or closed as a community, etc.

Female Assembly Members and the Adoption of Women-Friendly Policies in Japanese Local Municipalities

In Japan, lags behind both developed and developing countries in women’s political participation, the number of female assembly members is rising. However, it is unclear whether this increase has led to the adoption of more women-friendly policies. Therefore, this study empirically investigates the association between the two, focusing on local municipalities. We conducted a questionnaire survey of municipalities nationwide and found that more policies related to work–life balance were adopted when there were female assembly members than when there were not. And where more than 25% of the assembly members were women, policies on social and political participation and support for the socially vulnerable were stronger. Thus we find that in Japan’s municipal assemblies a higher proportion of female members makes the introduction of women-friendly policies more likely.

Disparities among Japanese municipalities in recommendations for routine and catch-up HPV vaccinations.

In November 2021, the government of Japan announced a reversal of its decision in 2013 to suspend the previous proactive recommendation for HPV vaccination. However, the program for young girls to receive routine and catch-up vaccinations has not necessarily developed as expected. We conducted a nationwide questionnaire survey by mail in September 2022. The survey was mailed to 133 municipalities consisting of all cities/wards of the Tokyo and Osaka Prefectures and all other prefectural capital cities. Responses were received from 82 municipalities (62.7%). Notification of routine HPV vaccinations had already been sent to 76 (92.7%) of the municipalities; 70 (85.4%) had been encouraged to promote catch-up vaccinations. The questionnaire forms for registration and pre-vaccination screening for routine immunization had been sent to 74.1% (60/81) of the municipalities and 68.8% (55/80) for catch-up immunizations. For catch-up vaccination, only 54 municipalities (65.9%) had detailed vaccination records for those eligible. In total, 10 municipalities (12.2%) had virtually no vaccination records because these had already been discarded. In addition, 61 municipalities (74.4%) had notified only women and girls eligible for a catch-up vaccination based on their vaccination record, whereas 25.6% (21/82) of the municipalities reported that they had sent, or would send, the notification to all women and girls within the targeted grades, including those who had already been vaccinated with three injections. The survey revealed disparities among the municipalities in their HPV vaccine notification processes. Future research on monitoring HPV vaccination rates and incidence rates of cervical cancer and precancerous lesions in each municipality will be desirable.

The roles and competencies of welfare commissioners supporting children with developmental disorders and their families expected by Japan's public health nurses.

Public Health Nurses (PHNs) collaborate with community volunteer welfare commissioners to support children with developmental disorders and their families lead a life without isolation. This study aims to clarify the roles and competencies that PHNs expect of welfare commissioners in supporting children with developmental disorders and their families. An online survey was administered through Survey Monkey© to 220 PHNs working in Japanese municipalities using an independently developed questionnaire regarding the roles and competencies of welfare commissioners supporting children with developmental disorders and their families expected by PHNs. Exploratory Factor Analysis (EFA) was performed to simplify the data structure and enhance understanding. The reliability of the scale was confirmed using Cronbach's α. Differences due to PHN attributes (e.g., experience collaborating with welfare commissioners) were analyzed using Welch's t-test. This study was conducted between April and September 2021. The highest scoring items were, for the role, "a welfare commissioner's role is to pass on accurate information to their successor," and for competencies, "a necessary competency for a welfare commissioner is to protect the information about children with developmental disorders, and their families learned during one's work." The EFA results revealed a two-factor structure for role items: Factor 1, "Supporting children with developmental disorders and their families and preventing abuse," and Factor 2, "Connecting to social resources." Competency items were also found to have a two-factor structure: Factor 1, "Understanding the position of children with developmental disorders and their families and connecting with local residents," and Factor 2, "Understanding developmental disorders and supporting them based on assessment." A comparison of the attributes of PHNs showed no significant differences. PHNs feel welfare commissioners should pass on the information and protect confidentiality when supporting children with developmental disorders and their families. Furthermore, PHNs expect welfare commissioners to connect children with developmental disorders and their families to the community, prevent abuse, and provide support based on assessment. PHNs had the same expectations regarding the roles and competencies of welfare commissioners regardless of their own attributes.

Developing a scale for Japanese public health nurses supporting resident groups toward community-building.

This study developed a scale for public health nurses supporting resident groups toward community-building and verified its reliability and validity. In this cross-sectional investigation, self-administered questionnaires were distributed to 1,924 public health nurses in Japanese municipalities. The questionnaire included items on the public health nurses' demographic attributes, the developmental stage of the resident groups they supported, a draft scale, and an external criterion. Reliability was verified by calculating the alpha coefficient and test-retest reliability. To clarify construct validity, we conducted exploratory and confirmatory factor analyses. We analyzed 570 questionnaires. The scale was structured using 30 items covering four factors: "Creating opportunities to connect with community residents, other groups, and governments," "Stimulating activities by improving organizational capacity," "Promoting stable organizational management," and "Providing opportunities to review community health issues and activities." The Cronbach's alpha coefficient for this scale was 0.944. The intraclass correlation coefficient was 0.923 using test-retest relativity. Correlations were noted for criterion-related validity (r=0.388, p<.01). Confirmatory factor analysis with structural equation modeling revealed a reasonable fit to the data. The scale for public health nurses supporting resident groups toward community-building was confirmed to be reliable and valid.