The policy recommendations “Establishing an integrated care system for pain from the perspectives of people with lived experience” compiled by Health and Global Policy Institute was featured in the Iri Sangyo Shimbun.

The recommendations call for the need to establish an integrated care system for pain under primary health care and the community-based integrated care systems in Japan, in order to provide a variety of interventions recommended by the latest evidence, based on the needs of each individual. It also summarizes the five perspectives required to implement such a system.

This article introduces the content of our policy recommendations as an important theme for medical device industries.

For more information on the recommendations, please click here.

For the content of the article on Iri Sangyo Shinbun, please click here. (Content in Japanese only)

The 123rd HGPI Seminar featured Professor Kensuke Kawai, President of the Japan Epilepsy Society, who discussed current circumstances surrounding epilepsy in Japan and overseas, as well as past developments in and future prospects for epilepsy policy.

<POINTS>

• Epilepsy is among the most common neurological disorders, but it is difficult to diagnose. Epilepsy treatments are determined according to how the condition is classified.
• Social stigma caused by a history of prejudice and discrimination toward epilepsy has resulted in a “treatment gap” in which people are not connected to treatments despite their availability.
• Patients, their families, healthcare providers, and the government are collaborating in all aspects of epilepsy care, including raising awareness toward epilepsy, improving access to care, and elevating care quality.
• On the international level, the World Health Organization (WHO) has adopted a resolution on epilepsy. Japan is making progress on domestic epilepsy treatment policies, but they must be made even more vigorous in the future.

Epilepsy is classified after taking both disease type and the seizure type are taken into account during diagnosis, after which treatment options are selected

According to the World Health Organization (WHO), over 50 million people worldwide live with epilepsy, making it one of the most common neurological disorders. Epileptic seizures are caused by the uncontrolled electrical activities of nerve cells in the brain. Anyone can develop epilepsy at any age. In addition to epileptic seizures, epilepsy can have various neurophysiological, cognitive, psychological, and sociological effects, and it sometimes carries the risk of early death.

The WHO defines epilepsy as a “chronic disorder of the brain characterized by recurrent seizures” due to excessive electrical discharges in cerebral neurons. There are two major classes of seizures: focal onset, which occurs when a part of the brain is excited; and generalized onset, which occurs when most or all of the brain is excited. Seizures that begin and end in one part of the brain without spreading to both sides do not cause generalized convulsions, making them difficult to recognize as epileptic seizures. These seizures have motor symptoms, such as twitching of the face or limbs; sensory symptoms such as blurred vision; autonomic symptoms such as palpitations ; and symptoms related to memory and emotions, such as anxiety.

Epilepsy is classified by epilepsy type and the seizure type at a given point in time. We must note that these classifications do not always have a 1:1 correspondence. These classifications are used to select antiseizure medications (ASMs) and to determine the indications and methods of surgery. Epilepsy classifications are revised every five to ten years and progress is being made on treatments as new knowledge is incorporated. The estimated prevalence of epilepsy is 0.5% to 1%. In children, it is often congenital. Epilepsy associated with stroke, brain tumors, and Alzheimer’s disease becomes more common among people 65 years of age and over.

Epilepsy is diagnosed using interviews and examinations including EEGs and MRIs. During interviews, physicians basically ask patients, their family members, or someone else close to them about seizure symptoms. The EEG test is used to detect “epileptiform abnormalities” or “epilepsy waves” to consider the possibility of epilepsy. Abnormal waves can sometimes appear in people without epilepsy, and they sometimes do not appear in people with epilepsy. This means that EEGs must sometimes be taken repeatedly and over long periods of time before abnormal waves can be detected. MRI scans are used to detect organic lesions or abnormalities on the brain that cause epilepsy. However, epilepsy is caused by electrical activity, so the presence or absence of lesions detected with MRI may be unrelated to epilepsy. For these reasons, epilepsy is difficult to diagnose and is sometimes misdiagnosed or goes undetected. When epilepsy is suspected, an epileptologist should be consulted as soon as possible to conduct a video EEG test so they can examine brain waves during an actual seizure. However, the number of epilepsy centers and other facilities providing specialized epilepsy testing is limited.

The main goal of epilepsy treatment is to control epileptic seizures, but treatment goals should be established while considering improvements to overall quality of life. These improvements include the control of related disorders such as brain dysfunction and developmental disabilities, as well as support for related disorders that impact social participation and education. Epilepsy treatments include pharmacotherapy, surgery, lifestyle guidance, and rehabilitation.

ASMs prevent seizures by inhibiting abnormal electrical activity in neurons. When using ASMs, increasing the dose can also suppress normal neurotransmission, causing side effects like drowsiness and lightheadedness. As it is vital for these medications to be used appropriately, physicians must provide precise guidance on the use of ASMs and monitor blood levels to ensure they are being taken as instructed. When prescribing ASMs, patients must be provided with sufficient explanations that cover the need to take them for life, factors that can trigger seizures when using ASMs, and the side effects of ASMs. It is also important for patients to be provided with explanations and guidance on items related to daily life, like driving or social welfare programs. ASMs are selected according to the Clinical Practice Guidelines for Epilepsy, but those guidelines are not revised annually, so there is sometimes a delay before they include the newest ASMs. Both new and existing ASMs suppress seizures but do not cure epilepsy, but with fewer side effects and fewer drug interactions, newer ASMs are safer.

Approximately 50% of patients experience seizure freedom with their first dose of their first ASM, but after that, the expected value decreases rapidly. If a second ASM is ineffective, the patient is diagnosed with drug-resistant epilepsy and surgical intervention is considered. Surgical treatment may include removal of the portion of the brain causing epilepsy or the implantation of a device that provides electrical stimulation. While surgical treatment carries a risk of complications, it is less risky than continued seizures, so the use of surgery is expanding around the world. There is also growing use of palliative treatments that aim to reduce seizure frequency and severity as much as possible rather than preventing seizures altogether.

The treatment gap in epilepsy caused by stigma, and efforts that aim to overcome that gap through collaboration among patients, their families, healthcare providers, and the government

The WHO and many countries classify epilepsy as a neurological disorder, but in Japan, it is classified as a mental disorder. There are various forms of administrative support for epilepsy in Japan. Adults are covered by the Medical System for Services and Supports for Persons with Disabilities, the System of Certification for Persons with Psychiatric Disabilities, and the Disability Pension System. Children are covered by the Research Program for the Treatment of Specific Pediatric Chronic Diseases, the Medical Treatment and Education Handbook system, the Special Child Rearing Allowance, and the Welfare Allowance for Children with Disabilities.

Epilepsy has historically been the subject of prejudice and discrimination, and there is social stigma toward the condition. This has resulted in a “treatment gap,” in which people are unable to access treatments despite their availability. This gap exists in both developed and developing countries. Efforts to disseminate health information and raise awareness for epilepsy that should have already advanced in Japan have been hindered by this stigma. This has allowed the lack of knowledge and information about epilepsy to persist unchecked. If a person living with epilepsy is provided with the appropriate treatments and there is nothing preventing safe driving, they can also drive cars. This fact is not fully understood, so society must be provided with accurate information to build understanding toward epilepsy symptoms and the challenges that people living with epilepsy encounter in daily life.

The Japan Epilepsy Society (JES) is one organization that is dedicated to informing the public about epilepsy. JES provides a wide range of the information that people need to understand, diagnose, and treat epilepsy, and is a global leader in this area. In addition to hosting scientific conferences and meetings with councils in each region to share information and promote collaboration, JES also publishes a journal and guidelines, certifies epileptologists and technical specialist physicians, and accredits training facilities and specialized health institutions. JES has over 3,000 members that include physicians from a variety of fields such as pediatrics, psychiatry, neurology, and neurosurgery as well as members who are not physicians. Epilepsy care is classified as psychiatric care as a matter of national health policy, so JES once had a great number of psychiatrists, but there are now more pediatricians. As for groups representing the parties most affected, Japan Epilepsy Association (JEA) fosters societal understanding of epilepsy, engages in social support activities for people living with epilepsy, and conducts surveys, research, and nationwide campaigns aimed at improving epilepsy policy. JEA bases its approach on self-help activities and, as a social movement, emphasizes activities that foster an accurate understanding of epilepsy. JEA has approximately 5,000 members nationwide that include patients and their families as well as physicians and other specialists. JEA also serves as the Japanese branch of the International Bureau for Epilepsy (IBE). As for other players that are active in this area, the Ministry of Health, Labour and Welfare (MHLW) and the Japan Epilepsy Center Association (JEPICA) each play a role in raising awareness, improving care access, and enhancing care quality.

Domestic policies, global trends, and future prospects

Starting in 2015, the MHLW has been advancing a project called “Establishing an Integrated Community Care System for Epilepsy” which aims to achieve an equitable epilepsy care system throughout Japan. At its launch, eight health institutions across Japan were designated as core epilepsy hospitals. These hospitals have served as the foundation of efforts to reinforce collaborative systems in their respective regions. Currently, 29 prefectures have hospitals that have been designated as collaborative centers for epilepsy care. While there has been progress in gradually expanding this system, compared to other diseases that affect similar numbers of people, there is still little financial support for epilepsy. Another issue is the lack of awareness of this system. A survey of physicians practicing outside of urban areas found that awareness of epilepsy centers outside of urban areas is low.

In 1997, the WHO conducted an awareness campaign called “Out of the Shadows” to shine a light on epilepsy and raise awareness that it is a common, treatable condition that should not have a treatment gap or be the subject of stigma, prejudice, or discrimination. The WHO Resolution on the Global Burden of Epilepsy was approved at the 2015 World Health Assembly, which sent a message on ensuring understanding of epilepsy and promoting social acceptance for people living with epilepsy. Later, the Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders (IGAP) was adopted at the World Health Assembly in 2022. The global targets for 2031 set by IGAP include increasing epilepsy service coverage by 50% from 2021 coverage for all countries, and developing or updating legislation to promote and protect the human rights of people with epilepsy in 80% of countries. It also set an objective called the “90-80-70 Cascade Target for Epilepsy.” This target aims to ensure that 90% of patients are aware that their condition is treatable; that 80% have access to affordable, appropriate, and safe ASMs; and that 70% will achieve adequate seizure control.

Of the six regions of the International League Against Epilepsy (ILAE), Asia has both the largest population and number of people living with epilepsy. As many countries in Asia have significant treatment gaps, the Asia Oceania Chapter of ILAE is engaged in a variety of educational and awareness-raising activities. For example, many countries in Asia are lagging behind in providing surgery to people with drug-resistant epilepsy, so the Asia Oceania Chapter’s Epilepsy Surgery Task Force provides guidance in real-world care settings or hosts physicians from overseas to provide guidance on surgery in Japan. A Japanese EEG manufacturer is also providing training on diagnostic EEG in Indonesia.

Every day, advances are being made in R&D on new ASMs, and use of Japan’s first ASM is growing around the world. The introduction of robot-based testing methods to determine the safest and fastest surgical procedures means advancements are being made in testing. On top of this, diagnosis and treatment methods utilizing new technologies are rapidly developing and spreading globally. Expectations are high for Japan to expand policy support systems for more vigorous activity in diagnosis and treatment in the field of epilepsy from R&D to real-world application so these new technologies can be introduced promptly in Japan, as well.

[Event Overview]

• Speaker: Prof. Kensuke Kawai (Professor, Department of Neurosurgery, Jichi Medical University; President, The Japan Epilepsy Society)
• Date & time: Wednesday, March 6, 2024; From 18:30 to 19:45 JST
• Format: Online (Zoom Webinars)
• Language: Japanese
• Participation fee: Free
• Capacity: 500 participants

■Speaker profile:

Prof. Kensuke Kawai (Professor, Department of Neurosurgery, Jichi Medical University; President, The Japan Epilepsy Society)

Professor Kensuke Kawai is a neurosurgeon specializing in epilepsy and conducts research on brain function. He previously served at Tokyo Metropolitan Neurological Hospital, the University of Tokyo, and NTT Medical Center Tokyo before assuming his current position at Jichi Medical University in 2016. In addition to improving epilepsy treatment in Japan in his capacity as President of the Japan Epilepsy Society, he has worked to expand community epilepsy care as Director of the Jichi Medical University Hospital Epilepsy Center, which is a collaborative center for epilepsy care in Tochigi Prefecture. Professor Kawai also served as Board Member at the Asia and Oceania chapter of the International League Against Epilepsy, where he chaired the Epilepsy Surgery Task Force. Recently, he has been working to support efforts to establish an epilepsy care system providing epilepsy surgery in Mongolia.

On March 5, 2024, Health and Global Policy Institute (HGPI) Manager Ms. Yui Kohno presented at the UK-Japan Multistakeholder Meeting “The Future of AMR – Policy and Investment”, hosted by the British Embassy Tokyo and supported by HGPI.

This meeting was held with the overarching theme of the links between policy, investment, and science in AMR. Views of the United Kingdom (UK) and Japan were presented with topics that touched on Japan’s policy and future plans for tackling AMR and how to get the most out of the UN high-level meeting this year. Following the presentations, panelists discussed 1) The role of policymakers in tackling AMR and developing antimicrobials and 2) How best to invest for the future of AMR. Participants of the meeting included policymakers, academic societies, clinicians, industry, and civil society experts from Japan and the UK.

*Discussion points from this expert meeting will be published in due course.

[Program] (Titles omitted)

16:15-16:20	Opening Remarks
	Margaret Tongue (Minister-Counsellor, British Embassy Tokyo)
16:20-16:50	Keynote Lectures
	Lecture 1 “Links between policy, investment and science on AMR”
	Kazuhiro Tateda (Professor, Department of Microbiology and Infectious Diseases, Toho University)
	Lecture 2 “Japan’s policy and future plans for tackling AMR”
	Eiji Hinoshita (Assistant Minister for Global Health and Welfare, Ministry of Health, Labour and Welfare (MHLW), Japan)
	Lecture 3 “How to get the most out of the UN HLM”
	Dame Sally Davies (Special Envoy on Antimicrobial Resistance for the United Kingdom)
17:00-17:45	Panel Discussion
	Panelists: Kenji Fuma (CEO & Founder, Neural Inc.) Yui Kohno (Manager, Health and Global Policy Institute) Alicia Demirjian (UK Health Security Agency (UKHSA) / Consultant, Evelina London Children’s Hospital) Claire Oxlade (Private Secretary to the UK Special Envoy on Antimicrobial Resistance, Dame Sally Davies / Department of Health and Social Care, UK) Gerald Bloom (Fellow, The Institute of Development Studies (IDS)) Moderator: Margaret Tongue (Minister-Counsellor, British Embassy Tokyo)
17:45-18:00	Closing Remarks
	Yasuhisa Shiozaki (Member of the Global Leaders Group on Antimicrobial Resistance / Former Minister of Health, Labour and Welfare)

*Please note that this program is available in Japanese only

The Health Policy Academy (HPA) is a public lecture series for citizens who want to learn about health policy. It is offered by Health and Global Policy Institute (HGPI), a non-profit, independent think tank. Since the first session in 2015, the HPA has been attended by nearly 400 people. The course has provided content for beginners in health policy through a variety of programs, including lectures by opinion leaders from the public and private sectors, and discussions between students with diverse backgrounds.

The 13th term will be offered under the theme of “Citizenship and Health Policy .” In recent years, there have been many textbooks and courses on health policy, and it has become possible to engage in various opinion exchanges and access content online. On the other hand, health policy is diverse in perspectives among stakeholders, and consensus-building can be challenging. However, the aim of the various systems surrounding healthcare is to support our lives and health and enable us to lead a high-quality of life. At the Health Policy Academy, in line with HGPI’s  mission of “Achieving citizen-centered health policy by bringing stakeholders together as an independent think-tank,” we aim to provide an opportunity for students to go beyond their daily positions and engage with health policy as individuals and consider its future direction.

Building on the curriculum renewed in the 12th term, we will offer a curriculum that incorporates more practical content. In addition to the theoretical aspects such as ethics, norms, and how to deal with evidence that form the basis of policy, we will cover practical themes such as the medical service fee schedule and healthcare delivery systems, as well as advocacy activities to convey the direction that healthcare policy should take from the perspective of citizens. Through discussions and group work with students from various backgrounds, you will have the opportunity to experience the ways of thinking necessary for actual policy formation, such as adjusting and reaching consensus among different perspectives.

■Language
Japanese Only

■ Event Format
This event will be held in person at the Global Business Hub Tokyo

■ Location
Global Business Hub Tokyo (Grand Cube 3F, Otemachi Financial City, Global Business Hub Tokyo, JAPAN)

■Registration Start
Thursday, May 9, 2024 at 12:00 PM

For more information, please visit the Japanese website.

Health and Global Policy Institute (HGPI) has begun accepting applications for the 2024 Global Health Education Program (G-HEP). This program, titled “Fostering multilateral collaboration among young leaders to address planetary health challenges,” is co-organized by the Emory University Rollins School of Public Health and the Mahidol University School of Public Health, bringing together young leaders from various countries. We will develop human resources for global health through fieldwork in Thailand and Nagasaki Prefecture. Interested students and working adults are encouraged to apply.

If you wish to participate, please review the application guidelines and complete the application form (Google Form) at the link at the bottom of this page by Sunday, May 12, 2024, 23:59 (Japan time).

Please note that there is a possibility that change about the projetc contents.

■Program Overview
Climate change, biodiversity loss, and environmental pollution are global threats facing the world in the 21st century. Human activities are not only causing unprecedented global changes in natural systems such as the climate, oceans, and biosphere, but are also affecting human health. For this reason, activities based on a planetary health perspective, which protects human health, the environment, and social systems as a whole, are increasingly sought after both domestically and internationally. In particular, collaboration across national and sectoral boundaries is essential, with the United States and Japan taking the lead in addressing climate change domestically and internationally, and Thailand, despite its limited resources, promoting such efforts and possessing the knowledge to do so.

This program is designed to foster young people from various backgrounds in Japan, the U.S., and Thailand who will be active globally in the future through mutual understanding and cooperation through the program. The program will also compile concrete proposals for solutions as policy recommendations and disseminate them both domestically and internationally.

■Purpose
Through this program, participants will acquire knowledge and problem-solving methods related to public health and global health and develop human resources engaged in solving global health issues by building cross-disciplinary human resource networks and relationships of trust. The program aims to deepen mutual understanding among participants and provide them with meaningful experiences that will contribute to their motivation to design their future careers.

 ■Program Implementation Guidelines (Details)
Period: June 2024 to November 2024
Location: Online, Bangkok, Thailand; Nagasaki, Japan

Program Description and Schedule (tentative):
The program will last approximately 6 months and consist of 4 phases.

“Phase 1” and “Phase 2” is scheduled to be held every Wednesday from 10:00-12:00 from mid-June to the end of July.
“Phase 3” is scheduled to be held in early August in Bangkok, Thailand, and thereafter schedules will be adjusted and set within each group.
“Phase 4” is scheduled to be held in late November in Nagasaki, Japan.

※ Please note that schedules may change depending on the situation.

■Number of applicants
4 persons
(4 participants from Japan, 4 from the U.S., and 4 from Thailand, for a total of 12 people)

■Qualifications
Applicants must meet one of the following criteria and be able to conduct discussions in English:

・Undergraduate and graduate students (including international students who are not Japanese nationals and Japanese students who belong to overseas universities/graduate schools) who are interested in the fields of global health, planetary health, and epidemiology.
・Young people with practical experience in the above fields (researchers, medical professionals, working people in related fields, etc.)

*Participants who have participated in the Global Health Summer Program (GHSP: Global Health Summer Program) or Global Health Education Program (G-HEP) sponsored by JHU in the past are not eligible to apply.

■Screening
Selection will be made by document review and interview. Applicants are required to submit an application form (in Japanese or English), and will be selected based on their English ability and answers to questions.

■Selection Method and Notification of Results
1) First round: Preliminary screening of documents
Please send us your answers to each question and essay assignment along with your resume (Word or PDF) via Google Form.

The essay topics are as follows:
(A) Identify some of the planetary health issues affecting Asia that need to be addressed on a global scale and discuss them using examples. In your response, please consider the following points. (1000 words or less)
・Leadership and contributions expected from Japan or your country on the issue
・Multilateral and multisectoral approaches (collaboration), public-private partnerships, etc. necessary to resolve issues
・Anticipated challenges in the problem-solving process

(B) Please explain why you are applying for this program and how this program will help you with your future career goals. (1000 words or less)

(C) What do you expect from this program? What do you hope to gain through this program? (1000 words or less)

Successful applicants for the first round will be notified by email no later than May 16, 2024.

2) Second round: Online interview
 Interviews will be held between Monday, May 20 and Friday, May 24, 2024. Interviews will be conducted online using Zoom, will last approximately 30 minutes, and will be scheduled between 10:00am and 6:00pm. For applicants whose interview schedule does not match, we will make separate arrangements, so please let us know your availability at the time of the initial selection.

3) Announcement of final selection
Final results will be announced by e-mail by Wednesday, May 29, 2024.

■ Participation Fee
Participation fee: 80,000 yen (40,000 yen for international students from low- and middle-income countries).
Successful applicants must pay the participation fee by bank transfer by the end of May 2024 (exact date will be announced by e-mail).
Please note that a cancellation fee will be charged for cancellations made after the announcement of acceptance.

Items included in the participation fee:

• Round trip airfare between Tokyo (Japan) – Bangkok (Thailand) and Tokyo (Japan) – Nagasaki (Japan)
• Fieldwork expenses (hotel, domestic transportation, group meals in Bangkok and Nagasaki)

Not included in the registration fee:

• Passport and visa fees
• Domestic transportation from Tokyo airports (Haneda or Narita) to your home
• Personal meals, personal travel, souvenirs
• Overseas Travel Insurance
  
  

■About Passport
Japanese passport holders do not need an entry visa, but according to international treaties, passports must be valid for at least 6 months from the date of arrival in Thailand and have at least two unused pages.

*If you do not have a Japanese passport, please check in advance.

■ About Visa
A Thai entry visa is required depending on nationality. It may take some time to apply for a visa. Please start the procedure as soon as possible after receiving the acceptance letter. Japanese passport holders do not need a visa.

■Application Deadline
Sunday, May 12, 2024, 23:59 (Japan time)

■Co-organizers and Secretariat
Health and Global Policy Institute (HGPI)
Emory University Rollins School of Public Health
Mahidol University School of Public Health

To apply for the G-HEP program, click “Apply Here” below, complete the Google Form, and submit.

■Contact us for more information
Health and Global Policy Institute (HGPI)
Mail: info@hgpi.org (Hiraka, Igarashi)

This project is supported by The Japan Foundation.

Health and Global Policy Institute (HGPI) hosted an installment of 30-minute Health Policy Update, a series of briefings for Diet Members on key health policy issues. This installment was titled, “Community Development for Senior Health: From Establishing Evidence to Social Implementation.”

This briefing featured a lecture from Professor Katsunori Kondo (Project Professor, Center for Preventive Medical Sciences, Chiba University) on promoting health and reducing dementia risk for older adults. In addition to describing the effectiveness of community designs for social participation, sharing case studies of such communities, and establishing evidence for such practices, Professor Kondo also explained methods of implementing initiatives for better senior health in society through frameworks such as Pay For Success (PFS) systems, in which payments are linked to results.

Sharing many questions and insights, Diet Members took the opportunity to engage in a robust exchange of opinions during the Q&A session following the lecture.

Key points of the lecture

• Older adults who live in areas with more opportunities to participate in social activities are less likely to develop the need for long-term care. Long-term care prevention is now transforming from a system in which “the government provides services and community members receive them” to one in which “community members lead the administration and the government supports their efforts.”
• The Pay for Success (PFS) model is one method of providing financial resources for reimbursing successful industry, government, academia, and civil society initiatives and maintaining community member-operated community gatherings. In this context, “success” refers to efficiency gains in terms of social cost. Social Impact Bonds (SIBs) are a type of PFS that use private funding. While steps must still be taken to evaluate how effective these agreements are in the medium- to long-term, SIBs allow funding to reach effective service providers while avoiding ineffective ones, so they are likely to serve as a useful tool for optimizing administrative spending.

Program (Titles omitted)

Explanatory introduction and overview of HGPI policy recommendations

Shunichiro Kurita (Senior Manager, HGPI)

Greetings

Hayato Suzuki (Member, House of Representatives)

Lecture: The Potential of Pay for Success (PFS) Models to Help Build Healthy Communities

Katsunori Kondo (Project Professor, Center for Preventive Medical Sciences, Chiba University)

＜POINTS＞

• In Scotland in 2021, the Scottish Government committed to working with local, regional and national stakeholders, including patient groups to develop a national approach to service delivery for chronic pain acknowledging the high prevalence of chronic pain and its impact and the importance of prioritising policy development.
• A large number of people with lived experience participated in Scotland’s National Advisory Committee for Chronic Pain within the government to discuss policies aligned with the needs of people living with pain.
• Surveys, the activities of the third sector, and the active engagement of patients and health care professionals in meetings illuminated the diverse needs of individuals from various backgrounds, integrating them into the policymaking process.
• Policy discussions encompassed a spectrum of pain causes, addressing both complex pain and less complex pain, which often presents alongside one of more other long-term conditions.
  

Introduction

In recent years, advancements in neuroscience have led to a better understanding of the pain mechanisms and the accumulation of evidence for pain management. On the other hand, it has been a global public health challenge to reflect this new evidence into service delivery. Mainly in developed countries, there is a growing movement to reassess previous pain management services and formulate national strategies pertaining to pain, with the aim of promoting pain treatments tailored to each individual’s condition based on the latest available evidence in pain science.

In Japan, a parliamentary group on chronic pain management was established in 2014, engaging in ongoing discussions with the goal of enacting the Basic Law for Chronic Pain Management. Additionally, starting from the fiscal year 2023, there has been an increase in momentum for establishing national strategies in Japan, chief of which can be seen in the petition aiming at enacting the law. On the other hand, stakeholders related to pain management exhibit a diverse range of interests, making it challenging to reach a consensus. Treatments and care for pain-triggering diseases, diversely ranging from complex pain such as fibromyalgia, to common diseases such as cancer, orthopaedic diseases, neurological diseases and autoimmune diseases, are supplied by various medical departments and health professionals.

How did countries that successfully establish national pain strategies navigate dialogues with stakeholders holding different orientations and formulate policies? This column will introduce the case of Scotland, which in 2022 compiled a national framework entitled “Framework for pain management service delivery”[i] and subsequently an Implementation Plan for the Framework.[ii]

Summary of the Scottish Government’s Framework and Scotland Service Model

Scotland Service Model[iii]

The Scottish Service Model for Chronic Pain, announced in 2014, stratifies pain care at different levels within Scotland, taking into account the complexity of pain and the diverse providers of care. This model has been adopted by the Scottish government, serving as the cornerstone of Scotland’s approach to chronic pain policy.

• Level 1: Care in communities based on the patient’s self-management.
• Level 2: Care provided by local general practitioners (GPs) and therapists for low-complexity pain.
• Level 3: Specialised and interdisciplinary treatment for moderate-complexity pain.
• Level 4: Advanced pain management programmes for high-complexity pain.

Figure 1: Model of care. (Gilbert S, Holdsworth L, Smith B. The Scottish model for chronic pain management services. British Journal of Healthcare Management December 2014;20(12):568-577.)

Scottish Government’s Framework

To strengthen the delivery of care based on the individual’s need, “framework for pain management service delivery – implementation plan” compiled the voices of people with lived experience into the four actions needed:

A: Patient-cantered care
B: Access to care
C: Safe and effective support
D: Improvement of the quality of services and care

Enablers of the National Framework Development

1. Establishment of a platform for multi-stakeholder discussions

Platform for discussions at the Cross-party Group (CPG) on Chronic Pain

The Cross-party Group (CPG) on Chronic Pain in Scotland was founded in 2001. It is dedicated to actively promoting awareness of the ongoing challenges confronted by individuals experiencing chronic pain. Its primary objective is to enhance the provision of speedy and appropriate treatment and care. Under the leadership of parliamentarians, over 200 individuals and organisations, including a broad range of patients and citizen groups, healthcare providers, academia, and industry stakeholders, have been involved, paving the way for diverse stakeholders to engage in discussions. Even after the Scottish Government responses to chronic pain initiated the CPG remains a vital forum for discussions. This ensures the voices of the diverse stakeholders of chronic pain are heard.

Platform for discussion in the Scottish Government

Following debates within the parliamentary group, in 2014, the Minister of Public Health founded the National Chronic Pain Improvement Group. Subsequently, in 2017, a committee within the Scottish Health Department, known as the National Advisory Committee for Chronic Pain (NACCP), was established. These committees comprise individuals dedicated to the governance of public institutions and healthcare establishments, including academic professionals. Furthermore, members encompass healthcare providers of diverse specialisations and disciplines, alongside representatives of a broad spectrum of health conditions. Collectively, they have engaged in thoughtful deliberations, discussing pain treatment approaches with the aim of reaching a consensus.

Such a collaborative structure has been put into practice during the implementation stage following the 2022 framework formulation. The Pain Management Task Force, which directly provides information to the relevant ministers, involves a diverse range of stakeholders related to healthcare and welfare, including individuals directly affected by pain. In addition, measures have been instituted to ensure the inclusion of diverse stakeholder perspectives. These include the establishment of a Lived Experience Panel[iv], comprising individuals with first-hand experience in pain management, and the implementation of a reporting system through Health Improvement Scotland to articulate the voices of individuals.

Figure 2: Governance arrangements for implementation of the Framework. (Scottish Government, 2022. Framework for pain management service delivery – implementation plan.)

*SG: Scottish Government, NHS: National Health Service, HSCP: Health and Social Care Partnership, CfSD: the national Centre for Sustainable Delivery, HIS: Health Improvement Scotland, AHP: Allied Health Professional

2. Contributors to delivering voices of patients with different diseases to policies

Collecting diverse voices through civic organisations

In the United Kingdom, charitable activities led by civic organisations, “the Third Sector”, are actively taking place. For example, Pain Concern, which held a commissioner role at NACCP, disseminates information about pain in an understandable format for patients and citizens, and also provides consultation support for those experiencing pain. The Third Sector plays an important role in channelling the collective voices of people with lived experience through consultation support services, thereby influencing policies. Simultaneously, it makes individual contributions to each person living in pain. Such initiatives by the third sector, including those by Chronic Pain Australia in Australia and counterparts in other countries, contribute to advancing policies from the perspective of the third sector that works closely to those directly affected.

Epidemiological Surveys on Chronic Pain

Throughout these processes, a diverse array of stakeholder voices has shaped policy influence. However, there is a growing awareness that the voices heard in these processes only reveal a small part of the whole picture, underscoring the need to understand the existing circumstances of a broader range of patients. To reinforce that, epidemiological research has contributed to understanding epidemiology and associated factors of chronic pain. As an example, a review on chronic pain epidemiology in population-based studies were published in 2019[v]. It reported the high prevalence and incidence of chronic pain as well as summarised various factors of chronic pain which include demographic, lifestyle and behaviour, clinical and other factors. Understanding the diverse factors of chronic pain calls for the comprehensive management of its causes and effects, which can be other health conditions including mental health and other multi-morbidities, at both individual and population levels.

Implications for Japan

In Japan, similar initiatives have taken place to get across the collective perspectives of patients with various diseases through the involvement of patient organisations. This includes active participation in parliamentary groups and petition campaigns, supported by multiple patient organisations. To make further policy advancements in the inclusion of patients and citizens, Japan is expected to institute a specialised consultation support system dedicated to pain management, amplify individual voices and visualise the needs of those navigating pain by drawing inspiration from existing initiatives.

[i] Scottish Government. Chronic pain service delivery – draft framework: consultation. 2022. Available from: https://www.gov.scot/publications/draft-framework-chronic-pain-service-delivery/pages/1/ (Viewed on February 24, 2024)
[ii] Scottish Government. Framework for pain management service delivery implementation plan. 2022. Available from: https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2022/07/framework-pain-management-service-delivery-implementation-plan/documents/framework-pain-management-service-delivery-implementation-plan/framework-pain-management-service-delivery-implementation-plan/govscot%3Adocument/framework-pain-management-service-delivery-implementation-plan.pdf (Viewed on February 24, 2024)
[iii] Gilbert S, Holdsworth L, Smith B. The Scottish model for chronic pain management services. British Journal of Healthcare Management December 2014;20(12):568-577.  Available from: https://doi.org/10.12968/bjhc.2014.20.12.568 (Viewed on February 24, 2024)
[iv] Scottish Government, 2022. Scottish Government Pain Management Panel. Available from: https://www.gov.scot/binaries/content/documents/govscot/publications/independent-report/2022/11/scottish-government-pain-management-panel/documents/scottish-government-pain-management-panel/scottish-government-pain-management-panel/govscot%3Adocument/scottish-government-pain-management-panel.pdf (Viewed on February 24, 2024)
[v] Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019 Aug;123(2):e273-e283. Available from: http://doi.org/10.1016/j.bja.2019.03.023 (Viewed on April 1, 2024)

Acknowledgement

We sincerely appreciate Dr Blair H. Smith, Professor at University of Dundee; the former National Lead Clinician for Chronic Pain, Ms Nicola Rhind, Clinical Specialist Physiotherapist, Grampian Pain Management Service; the National Lead Clinician for Chronic Pain, and the Scottish Government Chronic Pain Policy Team for their kind supports when compiling this column.

Authors

Takahiro Sakauchi (Manager, HGPI)
Yuri Isoda (Intern, HGPI)

On Tuesday, March 26, 2024, Health and Global Policy Institute (HGPI) CEO and Board Member Mr. Ryoji Noritake delivered a presentation at the summit for international leaders in the dementia field at the World Dementia Council (WDC) at the Francis Crick Institute in London. Noritake presented in a session focused on the practical ways to prevent dementia treatments from expanding inequalities between and within countries.

The 2024 World Dementia Council Summit, titled “The next 10 years: from therapies through to brain health”, was hosted by WDC, rooted in the pressing need to accelerate the progress in dementia diagnosis and treatment. Joined by politicians, policymakers, the research community, industry, care providers and advocates as speakers, it also covered health humanity challenges, such as how to combat health inequalities resulting from disparities in available treatments for individuals. Recognising the trend of rapidly ageing populations worldwide, it addressed how to maintain brain health and prevent disease, how to diagnose earlier and treat better; and how to keep people well for as long as possible for as long as possible.

For further information, please visit here.

(Photos: Pete Jones @pjproductions)

In celebration of Earth Day, April 22, a day to support environmental protection of the planet, Health and Global Policy Institute (HGPI) is pleased to officially announce that it has joined the Alliance for Transformative Action on Climate and Health (ATACH) as a partner. 

ATACH was established based on the COP26 Health Programme, which was launched at the 26th Conference of the Parties (COP26) to the United Nations Framework Convention on Climate Change (UNFCCC) in 2021. The program places human health at the forefront of climate change measures and calls on participating countries to commit to building “climate resilient health systems” and “sustainable low carbon health systems.” ATACH was established to translate these commitments into action, with the World Health Organization (WHO) as the Secretariat of ATACH.

As of April 2024, over 80 countries and areas have made ATACH commitments at the Minister of Health level, and ATACH has more than 30 participating partners, including ministries of health in countries that have made commitments. These partners can participate in the following five working groups;

• Financing Working Group (FIN-WG)
• Climate Resilient Health Systems Working Group (CRHS-WG)
• Low Carbon Sustainable Health Systems Working Group (LCSHS-WG)
• Supply Chain Working Group (SC-WG)
• Climate Action and Nutrition Working Group (I-CAN-WG)

HGPI will be participating in CRHS-WG, LCSHS-WG and SC-WG.

On January 27, 2024, at the 154th World Health Organization (WHO) Executive Board in Geneva, the Japanese government delegation expressed formal interest in ATACH. A formal commitment and participation in the partnership by the Japanese government are expected, and HGPI will provide as much support as possible to promote understanding among domestic stakeholders.

■About Alliance for Transformative Action on Climate and Health (ATACH):

ATACH was established at the request of member countries with WHO as its secretariat to share opinions and information; to reinforce technical and political cooperation; and to encourage making climate change a global priority. Its functions include monitoring, financing, and knowledge sharing, as well as coordinating access to technical assistance for participating governments and organizations.

Health and Global Policy Institute (HGPI)’s Planetary Health Team and Antimicrobial Resistance (AMR) Team submitted their written opinion on the draft of “The Sixth Basic Environment Plan (“the Plan”)” by the General Policy Committee of the Central Environment Council that was hosted by the General Policy Division of the Minister’s Secretariat within the Ministry of the Environment.

As stated in the G7 Climate, Energy and Environment Ministers’ Communiqué on April 16th, 2023, the triple global crisis of climate change, biodiversity loss and pollution has led to worsening of economic and social disruptions, health threats and energy crises. Japan must achieve the transformation towards a net zero, circular, and nature positive economy and society to ensure “healthy and cultured living” not only for the present but also for the future generation, and to contribute to the well-being of people all over the world.

In order to advance and contribute to healthy and cultured living for both the present and the future generations of Japan and the well-being of mankind through environmental conservation, the ” Basic Act on the Environment ” was enacted in November 1993. The Plan, which is to be reviewed approximately every six years, has been adopted on the basis of this law and is under consideration for amendment.

The public comment includes the following perspectives

• HGPI welcomes the inclusion of the concept of “planetary health” in the introduction of the Plan, which explores the mechanisms by which the Earth’s environment and human health interact.
• Planetary health should be mainstreamed in each measure and it is necessary to contribute to the well-being of all citizens, especially those who are vulnerable to environmental impacts such as displaced persons, older persons and women.
• The implementation of the initiatives described in this plan should be based also on other plans and strategies, including the “SDGs Implementation Guiding Principles” that contains viewpoints of planetary health, the “Global Health Strategy” of Japan and the “National Action Plan on AMR.”
• For example, an integrated solution to the “Triple Planetary Crisis” (climate change, biodiversity loss and pollution) and other global challenges such as natural disasters and health emergencies should be implemented, which is emphasized in the “SDGs Implementation Guiding Principles”.
• In particular, the healthcare industry, such as hospitals and pharmaceutical industry, needs to discuss and promote concrete actions to tackle with global environmental crisis, while enduring sustainability of healthcare and long-term care services.
• Regarding AMR measures, surveillance should be strengthened for antimicrobial-resistant bacteria and residual antimicrobial in the environment, and education and training of professionals should be promoted.

Furthermore, to promote the principles of the Plan, cross-ministerial efforts are essential. It is also important to incorporate planetary health approach into higher level policies such as the “Basic Policy on Economic and Fiscal Management and Reform 2024.”

For more information on this public comment, please click here (only available in Japanese).

Around the world, alcoholic beverages have played a vital role in shaping local food cultures and are an important source of revenue for governments. However, in addition to mental disorders like alcoholism, alcohol consumption is a known factor for a number of serious non-communicable diseases (NCDs) like cancer, liver disease, and cardiovascular diseases (CVDs) and can lead to social harms such as traffic accidents and violence. In response, some people are calling for action to address Health Problems Caused by Alcohol.

Driven by concern toward the health and social consequences of alcohol, the World Health Organization (WHO) adopted the “Global strategy to reduce the harmful use of alcohol” at the World Health Assembly in 2010. Later, in 2013, the WHO presented a plan aiming to prevent NCDs caused by alcohol consumption titled the “Global action plan for the prevention and control of noncommunicable diseases 2013-2020” (currently the Global Action Plan 2022-2030). In response to these developments, Japan enacted the Basic Act on Measures against Health Problems Caused by Alcohol in December 2013. Based on this law, the Government of Japan formulated the Basic Plan for Promotion of Measures against Health Problems Caused by Alcohol (hereinafter referred to as the “Alcohol Basic Plan”). This is how all of Japan began taking steps to promote measures against alcohol-related health problems. The Alcohol Basic Plan is currently in its second phase (2021-2025) and outlines priorities and ten basic measures to drive progress in reducing alcohol-related harm. In response to that plan, guidelines titled, “Guidelines on Alcohol Consumption Considering Health Issues” were formulated in February 2024 to promote the dissemination of information regarding the risks associated with alcohol consumption.

For the upcoming 125th HGPI Seminar, we will host Dr. Sachio Matsushita, who chaired the study group that prepared the “Guidelines on Alcohol Consumption Considering Health Issues.” Dr. Matsushita will share the history and current state of domestic measures for reducing alcohol-related health problems, the background to the preparation of the “Guidelines on Alcohol Consumption Considering Health Issues,” and future prospects for efforts in this area. In 2025, Japan is set to revise the Alcohol Basic Plan, and on the global stage, NCDs will be discussed at the Fourth High-level Meeting of the United Nations General Assembly (HLM4). At HGPI, we will continue holding discussions on controlling alcohol-related harm and other NCDs like CVDs and kidney disease. We would like for this seminar to be an opportunity to discuss with all those present what measures can be taken to reduce alcohol-related harm within Japan’s health policy.

[Event Overview]

• Speaker: Dr. Sachio Matsushita (Director, National Hospital Organization Kurihama Medical and Addiction Center and Visiting Professor, Department of Neuropsychiatry, Keio University School of Medicine)
• Date & Time: Friday, May 24 , 2024; from 18:30-19:45 JST
• Format: Online (Zoom Webinar)
• Language: Japanese
• Participation Fee: Free
• Capacity: 500 people

■Profile:

Dr. Sachio Matsushita (Director of Kurihama Medical and Addiction Center and Visiting Professor, Department of Neuropsychiatry, Keio University School of Medicine)
After graduating from Keio University School of Medicine, he began his career as a psychiatrist at Kurihama Medical and Addiction Center in 1988. Post-doctoral fellow at the National Institute on Alcohol Abuse and Alcoholism from 1993 to 1995. After returning to Kurihama Medical and Addiction Center in 1995, he received a Ph.D. in psychiatry from the Keio University School of Medicine in 2010. He became deputy director in 2011 and has served as director since 2022. He has chaired the committee of the development of the first drinking guideline in Japan.

The Public and Private Sector Co Creation Hub, Health and Global Policy Institute (HGPI) and SENSHO-GUMI co-hosted the second Young Professionals’ Roundtable for Public-Private Opinion Exchange on Social Security and Healthcare Policy, titled “Considering How to Build Relationships Between The Public and Private Sectors So We Can Devise Solutions Together.”

To begin the roundtable, Mr. Jun Fukuyoshi (CEO and Founder, Cancerscan Inc.) and Mr. Tadayuki Mizutani (Director, Policy Planning Division for Pharmaceutical Industry Promotion and Medical Information Management, Health Policy Bureau, Ministry of Health, Labour and Welfare) shared knowledge from both the public and private sectors and talked about experiences in conversations aimed at thinking together while introducing key points for building relationships between the public and private sectors. After their talk, participants shared best practices and items they recognized as challenges based on their own experiences and deepened the discussion on how to best shape public-private partnerships to achieve better health policy.

Introducing the Public and Private Sector Co Creation Hub

The Public and Private Sector Co Creation Hub engages in projects related to environmental improvement, facility operations, and supporting and encouraging collaboration and engagement among alliance organizations to generate new value to provide society through public-private co-creation. To achieve this, the Hub provides opportunities for conversations to be held among representatives of both the public and private sectors (including those from government and municipal offices, local governments, administrative bodies, corporations, universities, NPOs, and civil society) spanning a variety of fields. The Public and Private Sector Co Creation Hub has been commissioned by Chuo-Nittochi Co., Ltd. to conduct a trial project for the Toranomon Innovation Center concept in which it is responsible for supporting initiatives for public-private co-creation at the Public and Private Sector Co Creation Studio.

Introducing Health and Global Policy Institute (HGPI)

HGPI is a Tokyo-based independent and non-profit health policy think tank established in 2004. In its capacity as a neutral think-tank, HGPI involves stakeholders from wide-ranging fields of expertise to provide policy options to the public to successfully create citizen-focused healthcare policies. While holding fast to its independence to avoid being bound to the specific interests of political parties and other organizations, HGPI generates policy options that will be effective in Japan and around the world and actively pursues solutions to global health and health policy challenges.

Introducing SENSHO-GUMI Co., Ltd.

Established in January 2020 by Mr. Yasuhiro Sensho, a former health ministry bureaucrat at the Ministry of Health, Labour and Welfare (MHLW) Health Policy Bureau, SENSHO-GUMI Co., Ltd. is a consulting firm focusing on health and long-term care. With the addition of Mr. Takakiyo Nishikawa, formerly an assistant manager at the MHLW, the company thrives on a wealth of experience. The focus of SENSHO-GUMI Co., Ltd. is to deliver top-tier consulting services in the realms of healthcare, long-term care, and public welfare. Committed to making a difference, they are actively engaged in disseminating and proposing means for citizens to see their needs reflected in policy.

In his capacity as CEO, Mr. Sensho engages in a variety of public activities, encompassing public speaking, writing articles, and serving as a council member of the Cabinet Office and the Ministry of the Environment. Notably, Mr. Sensho also publishes articles on m3.com, one of Japan’s most prominent information websites for healthcare professionals. He has also spoken at seminars organized by HGPI, The Federation of Pharmaceutical Manufacturers’ Associations of Japan, and the Japan Hospital Association.