Introduction

In our previous column, we reported on an international conference and introduced Canada’s new national strategy for dementia. Also, in our concluding comments, we examined the significance of comparing countries when conducting policy research.

Moving forward, we will examine the Basic Law for Dementia submitted to the Diet in June 2019. While Japan’s latest dementia policies have received coverage in the media recently, that coverage was focused exclusively on the Framework for Promoting Dementia Care presented in June 2019. However, when taking stock of principles that will drive Japan’s dementia policy in the future, the Basic Law for Dementia must not be overlooked. In preparation for its enactment, HGPI has coordinated a series of Diet Study Groups on Dementia in 2018 to heighten interest in this issue within the Diet.

In this column and our next column, we will outline the Framework for Promoting Dementia Care and the Basic Law for Dementia. Then, from the perspective of local governments, we will examine the direction of society and actions we should take after the Basic Law for Dementia is enacted. There will be a particular focus on practical measures that can be taken by local governments based on these laws.

 

Introducing the Framework for Promoting Dementia Care

Examining the third national strategy for dementia

2019 marked the start of a new era, the Reiwa era. This year was not only a major transition point for Japan, but it was also an epoch-making year for national dementia policy. On June 18, 2019, the government’s Ministerial Council on the Promotion of Policies for Dementia Care unveiled the Framework for Promoting Dementia Care. This Framework is the third national strategy for dementia in Japan after the Five-Year Plan for the Promotion of Dementia Measures (the Orange Plan) in 2012 and the Comprehensive Strategy to Accelerate Dementia Measures (the New Orange Plan) in 2015.

The fundamental philosophy of the Framework for Promoting Dementia Care is to promote policies that will advance inclusion and risk reduction. This philosophy will be pursued in five pillars: (1) Promoting public awareness and supporting efforts made by people with dementia to disseminate their stories and opinions among the public; (2) Risk reduction; (3) Providing support for healthcare, caretaking, and nursing services and caretakers; (4) Promoting the creation of barrier-free spaces and services for people with dementia and providing support to people with early-onset dementia; and (5) Promoting research and development conducted by industry and disseminating their results internationally. The central theme linking all of these elements is that the perspectives of people with dementia and their families are to be emphasized.

The Orange Plan and New Orange Plan were created by the MHLW and related ministries, but the Framework for Promoting Dementia Care was formulated through joint efforts involving the entire Japanese government. Established in December 2018, the Ministerial Council on the Promotion of Policies for Dementia Care brought together every government branch. It worked to include and unite a broad range of concerned parties in fields related to everyday life outside of healthcare and long-term care. To create the Framework for Promoting Dementia Care, this Council scaled up dementia policies outlined during discussions at the MHLW focused on healthcare, long-term care, and welfare. The position of the Ministerial Advisory Board on Dementia (Provisional Name) and Expert Meeting was declared in December 2014 by HGPI Chairman Dr. Kiyoshi Kurokawa acting as the Special Advisor to the Health and Medical Policy Office Cabinet Secretariat. HGPI has considered this an important direction since then.

 

Examining criticisms aimed at the proposed “Framework for Promoting Dementia Care”

When the proposal for the National Framework was first revealed on May 2019, its fundamental philosophy was a focus on “risk reduction and inclusion.” As covered in the second edition of this column, protecting the dignity and rights of people with dementia and their caregivers must be the top priority when creating dementia policy. Placing “risk reduction” as the first priority of the Framework works against current efforts to emphasize the importance of building a dementia-friendly society and risks creating distinctions between people with dementia and people without dementia. In response to this issue, some people voiced dissenting opinions when the Framework proposal was first announced. Around that period, I appeared on a news program as a commentator. Even then, it felt strange to say “risk reduction and inclusion.” In response to these criticisms, the wording was revised to “inclusion and risk reduction,” providing yet another reminder of the importance of being careful of word choice when drafting policy.

Also, one of the Key Performance Indicators (KPIs) included in the initial proposal was to “Delay the onset of dementia for people in their 70s by one year over the next decade.” There is no scientific evidence that suggests this was an attainable KPI. This topic received a significant amount of discussion, particularly in the media. It was ultimately changed from a KPI to a “reference value.”

While the initial proposal prioritized “risk reduction,” in response to demand from people with dementia and their families and other members of civil society, it was revised to prioritize “inclusion.” We would like to discuss the specific content of the Framework for Promoting Dementia Care in a future column.

 

The Basic Law for Dementia

Around the same time as the Framework, the Basic Law for Dementia was submitted to the House of Representatives by Diet members in the Liberal Democratic Party and the Komeito Party on June 20, 2019. Because the 198th Ordinary Session of the Diet came to a close on June 26, 2019, this bill was carried over to the next session. There are plans for it to be reexamined at an extraordinary Diet session in October 2019. Therefore, it is currently referred to as the Proposed Basic Law for Dementia.

Next, we will introduce the structure of the Basic Law for Dementia. The Basic Law for Dementia consists of five chapters, listed below.

Chapter I General Provisions
This chapter provides an overview of the law including its purpose (that it aims to create a society in which the dignity of people with dementia is upheld and they are included as full members of society while advancing measures for dementia such as risk reduction), the definition of dementia, the fundamental concept of the law, and the designation of September 21 as Dementia Day.

Chapter II Basic Plan for the Promotion of Policies for Dementia, etc.
This chapter describes the government’s obligation to form a Basic Plan for the Promotion of Policies for Dementia and the responsibilities of each prefecture and municipality (excluding special wards) to cooperate with the formulation of that plan. It also mentions the necessity of gathering the opinions of people with dementia and their families when formulating plans at the level of local government. It also states that support plans such as for community welfare and efforts related to Long-Term Care Insurance must not contradict the Basic Plan.

Chapter III Basic Measures
This chapter summarizes measures for dementia anticipated by the Basic Law for Dementia. These measures are listed below. Although there are variations in expression from what is said in the above-mentioned Basic Plan for the Promotion of Policies for Dementia, the items generally match.
1. Promotion, etc. of education on dementia
2. Promotion, etc. of barrier-free living for people with dementia
3. Ensuring opportunities for people with dementia to engage in social participation
4. Measures to reduce the risk of dementia and similar efforts
5. Establishment of facilities, etc. for providing healthcare and welfare services
6. Creation of systems to provide consultation and similar services
7. Promotion, etc. of research and development
8. Conducting studies needed to formulate measures for dementia
9. Cooperation among various groups
10. International cooperation

Chapter IV Administration of the Promotion of Measures for Dementia
This chapter describes the government’s system for promoting measures for dementia. The Prime Minister is named the chairman of the headquarters for promoting measures for dementia and the Chief Cabinet Secretary is named vice-chairman. Also, the board will include the ministers responsible for health and healthcare strategy at the MHLW and all other ministers of state.

Supplementary Provisions
The supplementary provisions state that the Basic Law for Dementia will be enforced within six months from the date it is officially announced and that the structure of the headquarters for the promotion of dementia measures will be reviewed within five years of its enactment.

Although promotion for dementia policies had mainly been centered on efforts at the MHLW, the enactment of this law has made it evident that this is now a cross-ministerial policy issue. In the past, dementia was often discussed as an issue of healthcare, long-term care, and welfare. We are now entering an era that will require multi-stakeholder discussions and collaborations that surpass the frameworks of the past.

Local governments form the basis of a dementia-friendly society. In our next column, we will look to the future after the Basic Law for Dementia is enacted to see what actions they will take and efforts to which we should devote our attention.

 

[Introducing the author]
Shunichiro Kurita (Senior Associate, Health and Global Policy Institute / Steering Committee Member, Designing for Dementia Hub)

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