1. Presenting the ACCJ-EBC
Health Policy White Paper 2013
May 31, 2013
Lengthening Healthy Lifespans
to Boost Economic Growth

2. Laurence W. Bates
ACCJ President

3. About American Chamber of Commerce in
Japan
Established
1948
Committee structure drives Chamber
activities around three pillars:
• Information
• Networking
• Advocacy
Approximately
2700 members
representing
1000 companies
Over 500 events
per year in three
chapters across
Japan
Approximately
half of members
are Japanese

4. Achieving Growth Together
Japan Economic
Growth
ACCJ Membership
Growth
ACCJ Member
Personal Growth
ACCJ’s Three Primary Areas for Growth
成共
長就

5. Preventive Health Investment Drives Growth
Japan’s aging is rapidly increasing healthcare utilization
Worker productivity is key to sustain healthcare and grow
the economy
• Disease costs Japanese economy 3.3 trillion yen per year in lost
productivity (2011 ACCJ National Survey)
A shift to prevention and early detection is necessary to:
 Increase healthy life years
Lower economic burden of disease
Support economic growth

6. • Gaps between average life expectancy and healthy life expectancy
represent an unhealthy period with daily life constraints
• There may be medical andnursingexpenses during this period
70.42
79.64
60
73.62
86.39
65 70 75 80 85 90
Year
9.22years
12.77years
Average life expectancy Healthylifeexpectancy(Nodailylifeconstraints)
Gapbetweenaverageandhealthylifeexpectancy
Male
Female
Source: Healthy Japan 21 (Second Version)
Importance of Healthier Life Expectancy

7. ACCJ-EBC Health Policy White Paper 2013
Promoting economic growth in Japan
through policies to lengthen healthy
lifespans and
reduce economic burden of preventable,
detectable and treatable diseases
36 healthcare topics
Over 150 policy
recommendations

8. Duco B. Delgorge
EBC Chairman

9. About European Business Council in Japan
Trade policy arm
of 17 European
National
Chambers of
Commerce and
Business
Associations in
Japan
Working to improve the trade and
investment environment for European
companies in Japan since
1972
Approximately 3000 local European
corporate and individual members
Approximately
400 companies
participating
directly

10. Rise in Non-Communicable Diseases Is a
Leading Threat to Global Economic Growth
WHO report: each 10% rise in non-
communicable diseases is linked to a
0.5% dip in annual economic growth;
recent global rise in NCDs is
“economically unsustainable.”
The World Economic Forum forecasts
that NCDs will cost the global economy
$47 trillion over the next 20 years.
• Stuckler D. “Population causes & consequences of leading chronic diseases: a comparative analysis of prevailing explanations.”
Milbank Quarterly, 2008, 86:273–326. Reported in Global Status Report on Noncommunicable Diseases 2010,” WHO,
http://www.who.int/nmh/publications/ncd_report2010/en/
• Working Towards Wellness: The Business Rationale. World Economic Forum, Geneva, 2008. Bloom, et al., 2011.

11. NCDs account for about 30% of national healthcareexpenditure and
about 60% of total deaths
HealthcareExpenditure
Cancers11.1%
Hypertension-
relateddiseases7.1
％
Cerebralvasculardis
eases6.3％
Diabetes4.4%
Cardiovascular
diseases2.9%
Others
68.3%
Cancers
29.5%
Cardiovasculardi
seases15.8%
Cerebral vascular
diseases 10.3%
Diabetes1.2%
Hypertension-
relateddiseases0.6％
Others
42.6%
Mortality
Source: Healthy Japan 21 (Part 2)
Non-Communicable Diseases in Japan are
Costly, Deadly and Often Preventable

12. “Every 1 year increase in life
expectancy is linked to a 4.3%
increase in global GDP.”
Sources: Stuckler D. “Population causes & consequences of leading chronic diseases: a comparative analysis of prevailing explanations.”
Milbank Quarterly, 2008, 86:273–326. Reported in Global Status Report on Noncommunicable Diseases 2010, WHO,
http://www.who.int/nmh/publications/ncd_report2010/en/.
Spending to Promote Health is a Very Good
Economic Investment

13. William Bishop
Chair, ACCJ Healthcare Committee

14. 2010
2010 Health Policy White Paper
2010

15. 2011 Health Policy White Paper
2011
Scope:
• 27 Topic Sections
• 124 Recommendations
Results:
• 46 of 124 recommendations (roughly 37%)
fulfilled “in part" or in whole
Areas of Progress:
• Continued government funding of national
cancer screening
• Substantial increased funding to enhance
infection prevention and control at hospitals
in Japan (four fold for hospitals with >300
beds).
• Expanded use of IVD Rapid Diagnostics
• Diabetes Management
• Osteoporosis Prevention
• Chronic Pain Research Funding
• Vaccination Policy
• Hepatitis Screening & Awareness Initiatives

16. Source: Inhibitex
Nearly 6 million HAIs
annually in U.S., Europe and
Japan
1.7 million cases and 99,000
deaths annually in the U.S.
In some developing countries,
more than 25% of patients
admitted to hospitals acquire
HAIs
Hundreds of millions of
patients impacted worldwide
each year
Healthcare Associated Infections (HAIs):
A Global Healthcare Issue
Millions of Infections
8
6
4
2
0
2002 2005 2009 2010 2015
5.6 5.9
6.3 6.4
6.9
Japan
Europe
U.S.

17. Q. How important do you think it is for the government to have a national
program to reduce the risk of infections associated with hospitals, clinics
or other healthcare facilities?
75.7% of General Public in Japan Think it is
Important to Have a National Program to Reduce
the Risk of HAIs (80% for population over 65)
■Important ■Slightly important■Neither nor ■Do not know ■Not very important ■Not important
52.4
48.9
48.5
43.0
37.3
31.4
29.4
40.8
40.2
40.5
27.4
30.6
32.9
36.2
36.4
39.2
38.1
35.9
34.4
35.2
7.7
12.9
11.2
12.1
15.9
17.6
18.6
14.4
14.2
14.3
10.6
5.6
5.6
5.9
7.4
7.9
7.4
6.3
7.2
6.8
1.9
1.4
1.2
2.1
1.8
2.5
6.6
2.0
2.2
2.1
0% 20% 40% 60% 80% 100%
80+ yrs old (n=208)
70-79 yrs old (n=790)
60-69 yrs old (n=882)
50-59 yrs old (n=779)
40-49 yrs old (n=800)
30-39 yrs old (n=863)
20-29 yrs old (n=678)
Female (n=2599)
Male (n=2401)
Overall (n=5000)
Is Important
75.7%
74.6%
76.6%
67.4%
70.6%
73.6%
79.2%
81.4%
79.5%
79.8%
Not Important
3.3%
3.9%
2.6%
6.6%
3.9%
3.2%
2.9%
1.8%
2.0%
1.9%
Survey on Prevention, Early Detection and the Economic Burden of Disease in Japan (2011) by The American Chamber of Commerce in
Japan. Internet survey conducted October 31 – November 2, 2011. 5,000 respondents from Rakuten Research’s registry that represent
the Japanese population.

18. 2013
2013 ACCJ-EBC Health Policy White Paper
Scope:
• 36 Topic Sections
• 156 Recommendations
Chapters:
1. General Health Themes
2. Non-communicable Disease
(NCD) Topics
3. Women’s Health Topics
4. Key Infectious Disease Topics
5. Importance of Enhanced Safety
& Infection Control
6. Special Focus Needed on
Healthcare Worker Safety

19. Danny Risberg
Chair, EBC Medical Equipment Committee

20. Deaths Caused by and Patients of
Cerebrovascular Diseases
100
125
150
175
200
0
250
500
750
1,000
1,250
1,500
1,750
2,000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
# of death
(1,000 ppl)
# of Patients
(1,000 ppl)
# of
Patients
# of
Death
Source: Ministry of Health, Labor, and Welfare (Trend of Medical Institution）

21. 76.8%
13.3%
2.4% 7.5%
Cerebral hemorrhage
Cerebral infarction
Subarachnoid hemorrhage
Others
1960
1999
Source: Ministry of Health, Labor, and Welfare (Vital Statistics)
DeathsCaused By Cerebrovascular
Diseases
23.0%
62.7%
10.8% 3.5%

22. Vessel Wall Imaging Done by MRI

23. Sleep Apnea Syndrome
(over 3 million patients)
13% have diabetes
(390,000 patients)
21% have cardiovascular diseases
(630,000 patients)
41% no complication
(1,230,000 patients)
51% have hypertension
(1,530,000 patients)
Undergoing
Treatment
（250,000 patients）
Increase Sleep Apnea Syndrome Screening

24. Eriko Asai
Chair, ACCJ Health IT Subcommittee

25. 71.5% of Japanese Back Introduction of Electronic
Health Records at Hospitals, Clinics
Support/Agree Slightly Support/Agree Neither
Don’t know SlightlyOppose/Disagree Oppose/Disagree
50.0
48.2
52.4
42.2
40.3
35.9
36.1
37.9
48.7
43.1
23.6
28.0
24.3
28.4
28.3
33.4
29.8
31.6
25.0
28.4
14.4
16.1
17.1
22.2
22.8
20.4
20.8
21.8
17.2
19.6
10.1
5.1
4.4
5.4
5.9
6.6
8.3
5.9
6.2
6.0
0.5
1.9
1.5
1.2
2.3
2.5
2.9
2.2
1.7
2.0
0% 20% 40% 60% 80% 100%
80+ yrs old (n=208)
70-79 yrs old (n=790)
60-69 yrs old (n=882)
50-59 yrs old (n=779)
40-49 yrs old (n=800)
30-39 yrs old (n=863)
20-29 yrs old (n=678)
Female (n=2599)
Male (n=2401)
Overall (n=5000) 71.5%
73.7%
69.4%
65.9%
69.3%
68.5%
70.6%
76.6%
76.2%
73.6%
Support Oppose
2.9%
2.9%
2.9%
5.0%
3.7%
2.9%
1.8%
1.8%
2.7%
1.9%
Q: Do you support or oppose the introduction of electronic health records at
hospitals and clinics in Japan?
Source: ACCJ National Survey on Prevention, Early Detection & the Burden of Disease in Japan, Nov, 2011.

26. Supporters of EHR System Expect
More Efficiency, Safer Medical Service
(n=3,574)
Q: Why do you support the introduction of an electronic health record (EHR) system
at hospitals and clinics in Japan? (multiple answers)
Source: ACCJ National Survey on Prevention, Early Detection & the Burden of Disease in Japan, Nov. 2011.

27. 24.3%
70% 75%
Breast Cancer Screening Rates Lower Than
OECD Average
Sources:
http://www.mhlw.go.jp/stf/houdou/2r9852000001igt0.html, http://www.oecdto
Mammography
screening rates
in Japan rising,
but still low
62.2%
Free National Breast Cancer Screening
Launched in 2009
Scope: Women aged 40, 45, 50, 55, and 60
Funding: 100% by central government
Japan Goal: 50% screening rate by 2011
Recruitment: Send coupons to eligible women

28.  Has a 28% survival
rate over five years
 Costs up to ¥4
million to treat
 Has 96% survival
rate over five
years
 Costs about
¥760,000 to treat
Breast cancer diagnosed
in early stages
Breast cancer diagnosed
after it has metastasized
Breast Cancer Screening:
Cost Effective and Saves Lives
 Sense no need, as have no
lump
 Lack of opportunity
 High fees
Top three reasons
women do not have
a mammogram

29. Bruce Ellsworth
ACCJ Governor
Healthcare Committee Liaison

30. Two Thirds Support a Mandated Indoor
Worksite Smoking Ban
Question: What would you think if the national or local governments legally required
a complete smoking ban in all indoor workplaces and public spaces, including
restaurants, bars and taxis, to protect the health of non-smoking workers?
Source: Japan national survey on passive smoking in the workplace for 8,000 indoor workers by Johnson &
Johnson K.K. Consumer Company, released on July 19th, 2012

31. 70% of Indoor Workers: Legal Smoking Ban
Would Not Negatively Impact Business
Question: How would your business be impacted if national or local governments
legally required a total smoking ban in all indoor workplaces and public
spaces, including restaurants, bars and taxis, to protect the health of non-smoking
workers?
Source: Japan national survey on passive smoking in the workplace of 8,000 indoor workers by Johnson & Johnson K.K. Consumer Company, July 2012

32. 322011 MHLW’ National Survey on Getting-tested status of Hepatitis Screening (Interviewed 74,000 Japanese people aged 20 thru 79 years old)
Only Half of Adults in Japan Have Been
Screened for Hepatitis
Japanese government has provided free hepatitis screening since 2002 as the
time of regular health checkup services by municipal governments. Free
screening was first provided at public health centers and later also available at
hospitals and clinics.
Need to further increase screening rate, especially for people aged 40 and over.
HCV Screening Rate: Est. 48%HCB Screening Rate: Est. 57%
Tested at time
of
surgery, pregn
ancy, blood
donation 40%
No, I have
not or do
not know
42%
Yes, I have
been tested
(self-
reported)
18%
Yes, I have
been tested
(self-
reported)
18%
No, I have
not or do
not know
52%
Tested at time
of
surgery, pregn
ancy, blood
donation 30%

33. Large Company
Employers
Small and Medium
Company Employers
Self-Employed and
Others
Type of health
insurance in which
employee enrolls
Managed by health
insurance societies or
associations
Managed by members
of Japan Health
Insurance Association
Managed by
municipalities, National
Health Insurance
associations
Provision of health
checkups based on
Industrial Safety &
Health Act
Yes, required
(Employers are required to provide)
Not required
Provision of special
health checkups based
on Law for the Welfare
of the Elderly (aged 40
or over)
Yes, provision is required
(Insurance provider is required to provide)
Rate at which hepatitis
screening is part of
special health checkup
Approx. 50% Approx. 95%
Individuals must pay ¥595
as co-payment and apply
separately for this optional
hepatitis virus testing.
Approx. 80%
Free but implementation
varies by town, city.
Screening notices usually
go to specific age groups.
Source: MHLW, “Status of implementation of Specific Medical Checkups/Health Guidance in FY2010”
http://www.mhlw.go.jp/bunya/shakaihosho/iryouseido01/info03_h22.html
Provision of Hepatitis Screening Varies
Widely According to Type of Insurer

34. 2013 ACCJ-EBC Health Policy White Paper
• Paradigm shift from treatment to prevention
 Focusing on prevention, screening, early detection and early treatment of
disease
• Efficient allocation of healthcare resources
 Enhancing productivity and reducing waste
• Evidence-based global best practices
 Recommendations with potential to yield significant positive impact
• Alignment with government growth policy goals
 Recommendations with potential to boost economic growth
Disease prevention • Cost effective interventions
• Better patient outcomes and quality of life •
Enhanced labor productivity

35. Presenting the ACCJ-EBC
Health Policy White Paper 2013
May 31, 2013
Lengthening Healthy Lifespans
to Boost Economic Growth