Japan and the “Metabo Law”Mark J. Manansala

Why Japan and Obesity?

I just remember seeing this silly news story online about Japanese companies doing mandatory waist line measurements of their employees in an effort to curb obesity. After doing the research on the topic, it revealed some really interesting information about the state of health care in Japan. Even though, it’s known for being pretty healthy when compared to the rest of the world, they are facing some challenges ahead.

Japan and the “Metabo Law”Mark J. Manansala

Tokyo, Japan

Japanese history is rich in mythology, and has influences from China. It’s first emperor was believed to be a direct descendant of the sun. After centuries of isolation, Japan first opened its ports to the west when it signed the Treaty of Kanagawa with the United States in 1854. Since then, it has strived to find a balance between centuries of tradition and modernization.(History of Nations, 2004, CIA, 2012)

Japan and the “Metabo Law”Mark J. Manansala Health Care System

2012

Total GDP: $4.617 trillion

Health 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

(CIA, 2012)

There are approximately 3,500 private insurers and government municipalities that provide insurance for the population.

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%

Life Expectancy: 83.91 years (3rd)

Median Age: 45.4 years

Obesity Rate: 3.1% (US: 33.9%)

(CIA, 2012)

* Population is shrinking. Declining for the third year in a row, and on pace to be halved by the end of the century (Traphagan, 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 Crisis

Population: 127 million (10th)

Growth Rate: -0.077%

Life Expectancy: 83.91 years (3rd)

Median Age: 45.4 years

Obesity Rate: 3.1% (US: 33.9%)

(CIA, 2012)

* Population is shrinking. Declining for the third year in a row, and on pace to be halved by the end of the century (Traphagan, 2012).

* Population is also aging, with people over 65 making up almost a quarter of the population and teens only 13% (Traphagan, 2012).

The current health care system is held together, because much of the services are paid for by the working population – 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 boomers switch from “being contributors to the system to being beneficiaries” (p. 261).

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 glucose

• high cholesterol

(Onishi, 2008)

Japan’s Ministry of Health, Labor, and Welfare released a study finding that half of all men and 1 in 5 women between the ages of 40 and 74 showed signs of metabolic syndrome. The report caused a public outcry against metabolic syndrome – dubbed “metabo.”

(Singer, 2008) 56 million citizens(age 40-74)

Japan and the “Metabo Law”Mark J. Manansala“Metabo Law”The report from the Ministry of Health, Labor, and Welfare led to legislation, passed on April 1, 2008 (Singer, 2008). The “Metabo Law” refers to a set of guidelines officially called the Standards Concerning Implementation of Special Health Examinations and Special Public Health Guidance, under the Ministry of Health, Welfare, and Labor Order 159 (Oda, 2011). With a goal of shrinking the overweight population by 10% over the next 5 years and by 25% over the next 7 years, these guidelines call for local governments and employers to conduct mandatory annual examinations, including measurement of waistlines for people between the ages of 40 and 74 – representing 56 million or 44% of the entire population (Onishi, 2008). For individuals that exceed the maximum waist line of 33.5 in (85 cm) for men and 35.4 in (90 cm) for women, doctors will consider other diagnostics to determine the severity of the metabolic syndrome; those in the highest category will be required to attend counseling sessions over the next three months to lose weight and make lifestyle changes (Oda, 2011, p. 265). Employers are required to ensure a minimum of 65% participation with the exam and 25% reduction in obesity within 7 years, or face penalties of up to 10% of the current payments which will go to fund elderly care (Oda, 2011).

Basically…People between the ages of 40 and 74 are required to get annual waist line measurements.

If they exceed the maximum measurement, they get counseling.

Their insurers and employers are responsible for achieving at least 65% 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?

There are no incentives or repercussions for those that fail to get their waist line measured. There is also no penalty for refusing to follow the treatment recommendations after “failing” the exam.

Companies will pay fines if they do not meet the 65% compliance and 25% reduction of obesity by 2015.

Those fines will go toward paying for health care for the elderly.

Meanwhile, childhood obesity numbers continue to rise; now at 20% (Rohana & Aiba, 2012).

56 million citizensage 40-74 now “required” to get annual exams

Oda (2011) suggests that the whole set of guidelines is a clever way to benefit…

“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 & Cons

Pros:

“Metabo” has become a cultural phenomenon – leading to an increased awareness of health and fitness.

Japan is still one of the thinnest countries in the world with an obesity rate of 3.1% (CIA, 2012).

Fines from the 2015 deadline will fund health care for the elderly, maintaining universal health care in Japan.

Companies are offering healthier food choices and metabo-education for employees and their families.

Cons:

Currently, less than half of the 56 million people between the ages of 40 and 74 are attending their “required” annual check-ups. If this number does not reach the 65% goal of the law by 2015, companies will face heavy fines. A large company like NEC said that it could face up to $19 million in penalties (Singer, 2008)

Only 12.3% of those that receive counseling follow through with the medical advice (Lhuillery, 2013).

Does not address rising childhood obesity rates.

Companies may start to discriminate against overweight people to avoid paying fines.

The waist line measurements conflict with recommendations of the International Diabetes Federation.