Health and Global Policy Institute (HGPI)
Cardiovascular Disease Control Promotion Project

Developing and Expanding Cardiovascular Disease
Control Plans in Each Prefecture– Challenges and Good Examples for Cardiovascular Disease Control

August 2023

Introduction
In Japan, cardiovascular diseases (CVDs) like stroke and heart disease are leading causes of deathand the most common conditions that require long-term care. One characteristic of CVDs is thatthe number of patients increases with age, making them a major problem for Japan and otherdeveloped countries where populations are aging. Given this backdrop, to advance all varieties ofmeasures for CVD control, the “Basic Act on Countermeasures for Stroke, Heart Disease and Other
CVDs to Extend Healthy Life Expectancies” (or the “Basic Act on CVD Measures”) was enacted in
December 2018 and came into effect in December 2019. Based on this law, the Japanese National
Plan for Promotion of Measures Against Cerebrovascular and Cardiovascular Disease was approved
by Cabinet Decision in October 2020. In accordance with the National Plan, each prefectural
government formulated a Prefectural Plan for the Promotion of CVD Countermeasures and is now
advancing efforts to promote CVD control. Furthermore, the National Plan was revised in April 2023,
and prefectures must revise their CVD control plans in the near future.
A broad variety of initiatives must be taken in the area of CVD control. These include establishingeffective systems for sharing patient treatment data and personal health records (PHRs); promoting
the health data policies and suitable outcome assessments needed for those systems; implementing
prevention measures that look forward to the needs of the next generation; advancing efforts forearly detection and risk detection; promoting cooperation among healthcare institutions; anddeveloping a healthcare provision system that provides seamless care from the acute stage to thechronic stage. In the midst of such efforts, good examples are beginning to emerge from eachprefecture, particularly those related to cultivating cooperation among local stakeholders. Many
prefectural officials in charge of CVD countermeasures have voiced the strong desire for chances
to refer to how other local governments are implementing their plans to learn about items likeformulating CVD control promotion plans, securing budgets, and obtaining subsidies.
Meanwhile, when implementing CVD countermeasures, there are a number of factors that result ingreat variance in challenges and necessary measures among regions. For example, the peak size ofthe senior population differs in each region. Geographical and cultural differences among regions
also mean that there is varying prevalence of diseases among regions. When formulating andimplementing plans that are tailored to real-world conditions in each region, it will be essential foreach region to refer to good examples from other regions to identify similarities and differences andeffectively apply what they learn.

Given these circumstances surrounding CVD countermeasures, HGPI’s Cardiovascular Disease
Control Promotion Project activities for FY2022 included creating an opportunity for sharing anddiscussing best practices and lessons learned at an event titled the “Kyushu-Shikoku Summit
on Promoting Measures for CVD Control” held in October 2022. At the Summit, which aimed topromote collaboration among prefectures and examine concrete measures for implementing
CVD control plans, administrative officials involved in creating and implementing measures for
CVD control in the Kyushu and Shikoku regions cross-referenced measures by discussing current
circumstances, pointing out noteworthy issues, and sharing best practices. We then summarized
those discussions in, “Current Issues and Prospects for Advancing Cardiovascular Disease
Control Promotion Plans in Each Prefecture.” In April 2023, we hosted another summit to review
the discussion points raised at the Kyushu-Shikoku Summit called the “Nationwide Summit for
Promoting CVD Control.” This Nationwide Summit was attended by administrative officials fromall prefectures in Japan and involved multi-stakeholders whose cooperation will be necessary
when implementing CVD countermeasures in the future, such as people living with CVDs, patientadvocate leaders, and representatives of industry, Government, academia, and civil society.
Based on discussions held at the Kyushu-Shikoku Summit and Nationwide Summit, this documentcompiles good examples and issues from three perspectives on initiatives in each prefecture,
namely: (1) formulating plans tailored to actual conditions in each prefecture and evaluating them;(2) building an integrated support system centered on “Model Projects for Integrated Centers for
Stroke and Heart Disease Support;” and (3) promoting Patient and Public Involvement (PPI) in theprocesses for formulating and implementing CVD countermeasures. It also crystallizes common
points and discusses necessary future initiatives for each perspective.

Good examples and key points for future discussion identified
during Phase 2 of the Cardiovascular Disease Control
Promotion Project01

Formulating plans tailored to actual conditions in each
02plan evaluation 03
prefecture and

The “Basic Act on Countermeasures for Stroke, Heart Disease and Other CVDs to Extend
Healthy Life Expectancies” was enacted in 2018 and obligated prefectural governments
to formulate and implement plans to promote CVD countermeasures. In response,
each prefectural government formulated a Prefectural Plan for the Promotion of CVD
Countermeasures in 2021 and 2022, and CVD countermeasures which are tailored to the realworld conditions in each region are now in the process of being implemented. As Medical
Care Plans are set to be revised in 2024, many prefectures are currently evaluating andrevisiting their Prefectural Plans for the Promotion of CVD Countermeasures so they can berevised together. Given these circumstances, the following is a summary of good examples
of initiatives and solutions for the formulation and evaluation of Prefectural Plans for the
Promotion of CVD Countermeasures from each prefecture. We have also summarized points
that prefectural governments should keep in mind for advancing Prefectural Plans for the
Promotion of CVD Countermeasures in an effective manner.

Good examples● Implementing and evaluating new projects introduced in Prefectural Plans for the
Promotion of CVD Countermeasures was difficult because there was little time between
formulation and evaluation. Given the lack of time, one prefecture started by utilizing
existing projects to advance measures and generate results while planning new initiatives
at the same time.
● Because there was little time until evaluation, in their plan’s first phase, one prefecture
focused on establishing face-to-face relationships and developing systems to facilitatesmooth planning and implementation of future measures.
● One prefecture had been using a logic model since the formulation of the seventh revisionof the Medical Care Plan and has been involving healthcare institutions and university
hospitals in discussions and efforts to build consensus. Based on those experiences,the prefectural government was able to smoothly formulate a Prefectural Plan for the
Promotion of CVD Countermeasures that is compatible with real-world conditions in clinicalsettings and that is based on a logic model.
● To ensure revisions made to Prefectural Plans for the Promotion of CVD Countermeasures
were congruent with its Medical Care Plan, positions such as “Medical Coordination
Supervisor” were created to coordinate cross-departmental efforts with an overhead viewin each prefecture. This allowed those responsible for formulating plans to focus on theirown duties.

● To facilitate collaboration among government, academia, and healthcare, in addition tocollaborating with healthcare specialists like physicians on the Council for the Promotionof CVD Measures, one prefecture made it easier to communicate and collaborate witheach stakeholder by working with coordinating departments (such as administrative or
general affairs departments) at healthcare institutions participating in the model project for
Integrated Centers.
● One prefecture held several liaison meetings per year to share challenges in communities.
They were attended by personnel at the assistant chief level of each section as well as the
project leader at the public health center.
● Working with a private company, one prefecture conducted a public awareness programon CVD countermeasures that included releasing a publicity video and other referencematerials.

Challenges● Many aspects of the measures and evaluation targets in Plans for the Promotion of CVD
Countermeasures overlap with those of other administrative plans (such as Medical
Care Plans, Health Promotion Plans, Prefectural Insured Long-Term Care Service Plans,
and Disability Welfare Plans). While the Ministry of Health, Labour and Welfare (MHLW)
issued a notification that allowed these plans to be formulated in an integrated manner(Administrative Communication “Regarding the Integrated Formulation of Medical Care
Plans and Other Plans,” March 31, 2023), doing so requires many meetings to be held anda great amount of coordination across departments to take place, so formulating plans in
an integrated manner is time-consuming.
● Because there was a short amount of time between when prefectures started formulatingplans (in 2021 or 2022) to their revision (the end of 2023), progress on individual measures
has not been made. It is also difficult to conduct plan assessments or the surveys needed
to conduct plan assessments.
The
periods for reviewing many administrative plans related to medicine, welfare, and●health will overlap in FY2024. This is likely to result in insufficient manpower for reviewingplans for CVD control and other individual diseases.
● Although one prefecture created a basic logic model while referring to recommendations
from academic societies and other organizations, it does not give sufficient consideration
to CVD countermeasures that are based on consultations with stakeholders, which is theoriginal objective. That logic model is now only presented in reference materials.
● Due to the nature of CVDs, Plans for the Promotion of CVD Countermeasures are closely
related to Medical Care Plans and other plans, especially in terms of prevention andawareness-building. However, in several prefectures, different departments are responsible
for each plan and efforts to manage progress in a coordinated manner are not progressing.
● Prefectural Councils for the Promotion of CVD Measures have different members thanPrefectural Councils for Acute Myocardial Infarction and Stroke described in Prefectural
Medical Care Plans. This can sometimes make it difficult to reconcile differences in opinion
even within a prefecture.
● In the operation of study groups, it is difficult to increase efficiency for the administrative
duties that accompany each study group. This is due to factors like the difficulty of
coordinating schedules for plan formulation meetings or the use of slightly different
formats in reference materials.

1Key points and future initiatives
We found three points in common related to formulating Prefectural Plans for the
Promotion of CVD Countermeasures: (1) securing human resources, establishingmanagement positions, and building systems for cross-departmental collaboration
at prefectural governments; (2) building systems for collaboration with external
stakeholders; and (3) planning methodologies.

Securing human resources, establishing management positions, andbuilding systems for cross-departmental collaboration at prefectural
governments
At some prefectural governments, staff numbers are falling while workloads increase. This
makes the formulation of administrative plans a major burden. In the Basic Policy on Economic
and Fiscal Management and Reform 2022 approved by Cabinet Decision in 2022, the section
titled, “A new division of duties between the national Government and local governments”
mentions that laws and regulations should keep the formulation of new plans to the bareminimum. It also states, “As long as there are no particular obstructions, then plans, etc.
should in principle be integrated with plans, etc. that have already been completed or be
developed jointly with other organizations.” In a March 2023 notification titled, “Regarding
the Integrated Formulation of Medical Care Plans and Other Plans,” the MHLW also
encouraged efforts to formulate Medical Care Plans and other plans in an integrated manner.
While progress is being made in the effort to lighten the burden of plan formulation, it has
also become clear that efforts to integrate plans face many practical barriers, such as when
jurisdiction for each plan belongs to a different department.
Many people – including both those who serve in administrative settings and community
members – would like to see the burden of plan formulation-related tasks lightened so more
effort can be devoted to services for citizens. In addition to standardizing the details of formats
used for each plan and coordinating formulation schedules, another necessary initiative will beto establish management positions (as described in the previous section, “Good examples”).

Building systems for collaboration with external stakeholders
The administration plays a key role in both policy-making and in policy implementation.
However, in an era when social issues that require a response are growing increasingly diverse,
collaborating with stakeholders outside of the government has become an essential partof carrying out policies. In particular, policy fields that demand a high level of specialized
knowledge for implementation (such as health, medicine, and welfare) also require
collaboration with professional associations, universities and other academic and research
institutions, and the people who are the beneficiaries of the policies in question, such as
patients and other affected parties.

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Furthermore, one goal in the movement toward New Public Management (NPM) is to improve
efficiency in administrative operations with an emphasis on public-private partnership-based
initiatives in all policy areas. In practical terms, utilizing private sector resources and engaging
in public-private collaboration have become essential for a Government that is faced with anever-increasing number of projects to implement and that lacks the option of expanding its
manpower. In the field of health policy, we can look forward to seeing the creation of higher
quality, more effective administrative services through the proactive utilization of private
sector ideas and know-how in areas like system development and information collaboration,
particularly for efforts to build awareness among and provide information to citizens.

Planning methodologies
One item being advanced under Prefectural Plans for the Promotion of CVD Countermeasures
is the use of logic models to systematize plan formulation and evaluation. Logic models
were invented in the U.S. in the 1970s and have since been adopted to promote EvidenceBased Policy Making (EBPM) around the world. In recent years, EBPM has been incorporated
into policy decision-making at many ministries and agencies in Japan, as well. In the field ofhealthcare, EBMP is being utilized in Medical Care Plans and in the Basic Plan to Promote
Cancer Control Programs.
In the area of CVD control, a civil society organization called the Regional Health PLAN
Evaluation Network (RH-PLANET) provides one example of a basic logic model. The Japanese
Circulation Society and the Japan Stroke Society have created and presented detailed logic
models in each field, and many prefectures are now developing their own logic models
based on their recommendations. However, many of the target outcomes included in these
prefectural logic models overlap with those of other related plans. There are also gaps
between prefectural project output and outcomes designated by academic societies andother organizations. In many cases, the development of logic models has become an objective
in and of itself, and the logic models that are developed are only being utilized as additionalreference materials. In other words, some of the logic models being created are not in linewith the intended purpose of utilizing them in policy making.
While it will be important to continue promoting the use of logic models nationwide, given
current circumstances, we must also point out that it will also be important to ensure theburden of developing logic models should not fall too heavily upon the prefectures that havebeen obligated with formulating plans. The development of logic models is not the goal;
rather, they are a method for advancing plan formulation in an effective and efficient manner.
In light of this fact, in the early formulation stages, it is safe to say that it will be necessary toallow for some discrepancy among individual project outputs and ideal outcomes, to avoid
setting too many evaluation indicators, and to consider limiting what items logic models areused for or making selective use of logic models when formulating plans. There are also highexpectations for prefectures to prevent these efforts from ending at the discussion table bycollaborating with local healthcare institutions, universities and other research institutions,professional associations, and patient advocacy organizations; and to focus on building
consensus early on in the plan formulation process, particularly when setting outcomes.

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01

02

Building an integrated support system centered on“Model Projects for Integrated Centers for Stroke and03
Heart Disease
Support” (hereinafter “integrated support
center projects”)

Under the Japanese National Plan for Promotion of Measures Against Cerebrovascular andCardiovascular Disease, integrated support centers are supposed to help establish systems
to deliver care for stroke, myocardial infarction, and other CVDs (duties which were originallyoutlined in prefectural Medical Care Plans) as well as to provide a broad variety of information
on topics like palliative care, employment support, and items that require consideration
during childhood and young adulthood. This means it will be important for integrated support
centers to collaborate with prefectures and play central roles in providing information in amanner that reﬂects past initiatives made at each facility as well as to enhance patient support
systems for their entire region. In FY2022, the first year of “Model Projects for Integrated
Centers for Stroke and Heart Disease Support,” integrated support center projects werecarried out in ten prefectures and at twelve facilities. Fifteen new prefectures and sixteen
new facilities were selected for model projects in FY2023, and they are currently preparing
to launch their initiatives. When there were no existing examples to refer to in FY2022, eachfacility and prefecture established a model project framework through mutual cooperation
among facilities, centered on academic societies. This helped lay a foundation for their future
activities. Expectations are high for the experience and knowledge accumulated over thecourse of these model projects to be utilized when other prefectures and facilities establish
new integrated support centers in the future. To this end, the Japanese Circulation Society
and other organizations are now working to compile case studies, mainly from healthcare
institutions. The MHLW also plans to establish a platform that will share best practices
for reference. Centered on joint action and initiatives from prefectural governments andhealthcare facilities when implementing integrated support center projects, the following
section summarizes good examples, challenges, and key points for achieving equity inintegrated support center projects.

Good examples● Discussions on formulating Prefectural Plans for the Promotion of CVD Countermeasuresand efforts to advance model projects are serving as a foundation for collaboration among
government, academia, and the health sector. In addition to prefectural governments anduniversity hospitals and other central healthcare institutions, this collaboration also includes
local medical associations.
● To reach out to both citizens and healthcare professionals and inform them of thesignificance of integrated support centers, one integrated support center is providing
lectures that are open to the public as well as workshops for healthcare professionals.
● One center is working to expand its consultation service user base by publicizing theavailability of the service online and in newspapers, leaflets, digital advertisements inapplications, and other forms of media.
● Officials from one prefectural government are participating in project management
meetings at the integrated support center every month, facilitating cooperation andleading to more active communication with healthcare institutions.

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● One integrated support center is being operated without a significant expansion in
manpower by having staff members including nurses, social workers, and clerical staff
hold concurrent positions at existing cancer consultation services and other consultation
services.
● Because time was short between the establishment of the integrated support center andits evaluation, one center was not assessed by number of consultations for its first-year
evaluation. Rather, the prefecture conducted a qualitative evaluation that focused onenhancing consultation support services and gathering users’ voices.
● In one prefecture, multiple healthcare institutions applied to take part in the model project.
Facilities were selected based on an equal evaluation that included comparing facilities
using the plans they submitted as well as by providing opportunities for them to givepresentations.
One
prefecture built awareness toward the importance of collaboration among facilities●
other than those selected to conduct integrated support center projects. With support
from the facility taking part in the model project, which served as an “Integrated Stroke andHeart Disease Support Desk,” a list of contact information for related facilities was created
and a consultation desk was established to promote the creation of an integrated CVD
healthcare provision system in the prefecture.

Challenges● Each prefecture must secure a budget on its own if it is to continue operating integrated
support centers after the model project period ends, but making arrangements withfinancial departments has been difficult.
● Integrated support center projects are supposed to be operated jointly with prefectural
governments, but the roles of administrative bodies are unclear and each region issearching for methods to collaborate.
● Integrated support center projects are positioned to be able to provide an extremely broad
range of functions, making it difficult to achieve a shared understanding of the direction ofthese projects within healthcare institutions as well as among prefectures and healthcare
institutions.
● Problems related to securing human resources resulted in cases where the introduction of
integrated support center projects was delayed or in which applications to participate in
the model project were denied.
● Too little collaboration among central healthcare institutions and prefectural governments
has resulted in cases where applications to launch model projects were rejected or did notproceed in a smooth manner once approved.
● In regions with many small- to medium-scale healthcare institutions, little progress has
been made in providing support for patients who have completed acute care and aretransitioning to chronic care. Expectations are high for integrated support centers to help
support smoother transitions to chronic care.

5Key points and future initiatives
We identified four common points among integrated support centers that are currently
being operated as model projects: (1) clarifying the functions of integrated support
centers; (2) promoting collaboration among Government, civil society, academia, andmedicine; (3) building systems for continuous operations; and (4) fostering mutual
collaboration among major hospitals.

Clarifying the functions of integrated support center projects
With the goal of enhancing patient support throughout each prefecture, ongoing integrated
support center projects are being utilized to provide a broad variety of support. This includes
transitional support from the acute phase to the chronic phase, psychological support, andemployment support. However, a number of drawbacks have emerged due to the scope ofthese operations. For example, some have said that undefined support targets have resulted
in a lack of focus in project operations at healthcare institutions where there is no sharedunderstanding toward the direction of the model project. While seemingly contradictory to
the concept of “integrated,” overcoming this issue requires maintaining the view that thebroad range of support defined in the model project is ideal and comparing the prefecture’s
priorities with the resources at the facilities where the integrated support center will beestablished is to identify which services should be the focus of the integrated support center.
For example, centers can provide consultation services to the general public; play central roles
in integrated community care, including in cooperation among healthcare institutions; and,for difficult cases only, provide specialized services. Identifying the priority of the integrated
support center and setting a direction beforehand is likely to foster common understanding,promote multidisciplinary cooperation within facilities, and encourage cooperation among
healthcare institutions.

Promoting collaboration among government, civil society, academia,
and medicine
To successfully build an integrated healthcare provision system for CVDs through integrated
support center projects, it is vital for there to be collaboration among each stakeholder,
including healthcare institutions in communities in addition to the institutions that implement
integrated support center projects. However, upon reviewing feedback from people serving at
the centers, there were cases in which stakeholders did not possess a common understandingof the functions and objectives of integrated support centers, meaning community-wide
support systems were not established. First, consensus and common understanding must be
fostered among institutions and prefectural officials conducting integrated support center
projects and other relevant stakeholders, such as cooperating healthcare institutions, as wellas among patients and other affected parties, who are the primary users. Given that efforts toseparate hospital care beds by function will progress in the future, expectations are high for
healthcare institutions taking part in model projects to cooperate with healthcare institutions
experiencing manpower shortages, such as small- and medium-sized institutions, and play
central roles in supporting patients during the transition from the acute phase to the chronic
phase. In addition to providing medical and long-term care, there are also high expectations
for the creation of systems that provide continuous support for patients and other affectedparties who are vulnerable to isolation by building connections among patients and otheraffected parties through activities like providing information and holding patient gatherings.

6Building systems for continuous operations
While integrated support centers will be established in each prefecture in the future, in orderfor them to function as an infrastructure for CVD control, it will be essential to build a systemthat allows them to operate in a sustainable manner. However, the national Government
only provides financial support for operational expenses for a single fiscal year. While partial
support from the national Government will continue after that year, prefectural governments
and facilities will have to secure budgets on their own. Securing budgets in prefectures will
require persuading financial departments, which means the projects must generate as many
results as possible over very short timeframes. In addition to quantitative evaluation indicatorssuch as the number of times consultation support is provided, it will be necessary to include
indicators that are based on qualitative assessments, as well. While it depends on establishingintegrated support center projects in each prefecture, it may also be possible to assign staff onother projects to concurrent roles to provide consultation support programs. Another option
is to improve consultation support systems to the greatest extent possible within existing
systems. For example, specialists at healthcare institutions designated as core cancer hospitals
could be appointed to concurrent roles as consultation support providers for the areas where
their expertise overlaps. These specialists might include counselors like nurses or medicalsocial workers as well as certified psychologists, clinical psychologists, or clerical staff. Anotheroption might be to establish a framework for developing specialist human resources like heart
failure treatment counselors. It will also be necessary to create a framework for encouraging
creativity and ingenuity in building sustainable systems, such as by establishing additional
support for the aforementioned initiatives.

Fostering mutual collaboration among major hospitals
As a general rule, integrated support center projects are being implemented at an extremely
limited number of facilities in each prefecture – in most cases, only one. This means that whena single large-scale healthcare institution applies to launch an integrated support center
project, the number of people who can lead the project after it is adopted is limited. Many said
that this allows efforts to establish integrated support centers to proceed relatively smoothly,such as when communicating with prefectural governments. Meanwhile, when multiple
healthcare institutions applied to launch a project, one prefecture created a fairer selection
process by providing opportunities for them to give presentations in addition to document
screening. When utilizing such a process, it is also important for prefectural governments tolead efforts to encourage role-sharing and cooperation by building better understanding fromthe institutions that were not selected and by having them participate in regional networks
after projects are launched. Expectations are high for the successful establishment of systems
that enable collaboration among multiple large-scale healthcare institutions when integrated
support center projects are implemented in major metropolitan areas in the future. Flexible
collaboration that leverages the unique strengths of each healthcare institution will also benecessary. For example, this might include dividing roles among facilities for heart diseaseand cerebrovascular diseases. It will also be important to maintain an awareness that creating
systems that are truly significant for patients and other affected parties is of the utmost
importance, and that establishing an integrated healthcare provision system will requiredevoted efforts from every related party.

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02

Promoting Patient and Public Involvement (PPI) in
the processes for formulating and implementing CVD
countermeasures

In recent years, patients and other affected parties who are the recipients of medical andlong-term care services have become increasingly involved in the policy formulation process,particularly in the fields of cancer and dementia. As for CVD control, Articles 20 and 21 of
the Basic Act on CVD Measures stipulate that Councils for the Promotion of CVD Measuresestablished at the national and prefectural levels must involve patients and other affectedparties. These parties are now participating on councils in many prefectures, where theopinions they express drive discussions from the perspectives of those most affected andare later reﬂected in policies and measures. However, there is great information asymmetry
between these parties and healthcare providers, who are generally specialists in medicine.
This lack of specialized knowledge prevents adequate discussions from being held. To further
promote CVD countermeasures from the perspectives of those most affected, the following
section compiles key points for the future that are based on good examples and issues fromeach prefecture and that are related to collecting and reflecting the voices of patients andother affected parties.

Good examples● Involvement from patients and other affected parties on Prefectural Councils for the
Promotion of CVD Measures made it possible for meetings to cover points that only
those most affected would notice. This led to the formulation of plans that placed greater
emphasis on the perspectives of those most affected.
● Patients and other affected parties were not accustomed to speaking up at Council
meetings and other meetings. To help them fully express their opinions and participate,detailed explanations and consultations were provided in advance.
Inaddition to getting patients and other affected parties involved in the Prefectural Council●
for the Promotion of CVD Measures, one prefecture is working to implement patient- andpatient advocate-centered measures by collaborating with an awareness-raising initiative.
● One useful method of reflecting the opinions of patients and other affected parties inan effective manner is to issue an open call for applications for patient council members.
Efforts to build awareness toward the council were undertaken with physicians and othercouncil members and successfully increased the number of applications.

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Challenges● While it would be desirable to have patients and other affected parties who took part in
the plan formulation process also be involved in other initiatives like public awarenessprograms, in some cases, this is difficult due to the need to make arrangements aroundtheir work schedules and daily lives.
CVD
countermeasures target a broad variety of diseases and patient populations, which●makes it difficult to crystallize opinions that are representative of those most affected andreﬂect them in plans. For example, people in different stages of treatment have different
needs. Furthermore, issues vary by region. It also can be difficult to identify patientadvocacy organizations, and many of the affected parties are not members of patientadvocacy organizations.
● While issuing an open call for applications increased the total number of applications,setting selection criteria was difficult.
.

Key points and future initiatives
We found three key, common points regarding the promotion of PPI: (1) identifying
people living with CVDs and other affected parties and encouraging their involvement;(2) providing support and consideration to facilitate participation in discussion forums;and (3) securing diverse methods of involvement and opinion gathering.

Identifying people living with CVDs and other affected parties andencouraging their involvement
Before Prefectural Plans for the Promotion of CVD Countermeasures can be formulated andpromoted, it is first necessary to recruit patients and other affected parties who are the targetof those plans so they can be involved. Many Prefectural Councils for the Promotion of CVD
Measures already have patient advocate council members, many of whom were recruited byphysicians who are also council members. Ideally, it would be most effective if each region
had patient advocacy organizations that could participate in council meetings and serve
as a resource for gathering opinions. In the modern era, however, people can access theinformation they need over the internet without joining a patient advocacy organization. Thisis said to be a factor that is causing membership and formation rates for patient advocacy
organizations to decline. Furthermore, many CVDs are acute diseases, so it is more difficult toform patient advocacy associations compared to chronic diseases, which people live with forlong periods of time.
Given this backdrop, more diverse methods of recruiting people for PPI should be considered.
Some prefectures have already started using open recruitment to find members of the generalpublic who can serve as patient advocate council members. While using open recruitment isa fair method of recruiting council members, the number of applications can be inﬂuenced
by the amount of publicity these efforts are given as well as the methods used. It can also be
difficult to determine selection criteria.

9Providing support and consideration to facilitate participation in
discussion forums
Various discussions on topics like healthcare provision systems and academic research arebeing held at Prefectural Councils for the Promotion of CVD Measures. For council members
to be able to participate in discussions and provide appropriate comments, they must be
familiar with specialized knowledge from each field. However, compared to specialists who
have been serving in their fields for many years, it is difficult for patient advocate council
members to acquire adequate knowledge to participate in these discussions. To help address
this, some prefectures are providing support for patient advocate council members so they
can fully participate in discussion forums, such as by holding briefings for them before council
meetings. However, some of the personnel responsible for council operations have said
that it was difficult for patient advocate council members to fully participate, even after suchopportunities were provided. While some civil society organizations are making progressin training patient advocate council members, such efforts will also require public support.
Moving forward, expectations are high for each prefecture to undertake various efforts to
support patient advocate council member training, and it is desirable that they share such
efforts with each other to improve the quality of PPI. In addition to efforts from patients andother affected parties as well as prefectural governments, it will also be important to promote
more significant PPI through efforts from all council members. For example, this might include
asking other council members to use language that is easy to understand for patient advocate
council members in attendance.

Securing diverse methods of involvement and opinion gathering
Participation in the policy formulation process is not necessarily limited to council meetingsand other discussion forums. The “Guidelines for Formulating Prefectural CVD Control
Promotion Plans” also point out the need to provide various methods for PPI, saying, “Efforts
should be devoted to reflect the opinions of patients and community members by holding
town meetings, conducting hearings and surveys among patients and community members,
and by gathering public comments.” CVD countermeasures target an extremely broad rangeof diseases and patients, so crystallizing opinions that are representative of those mostaffected is likely to be difficult in the short amount of time available for consensus-building
at council meetings. As these opinions might not fully represent the opinions of those mostaffected, such discussions should be supplemented with increased diversity.
When formulating their Prefectural Plans for the Promotion of CVD Countermeasures, many
prefectural governments also gathered public comments, which is a representative example ofone method for people to participate in the policy-making process outside of joining council
meetings. A few advanced prefectures also held town meetings. When utilizing measures likethese, there is a great amount of knowledge that can be learned by referring to when they
were used in other fields such as cancer and dementia. In the future, it will also be important
to gradually expand initiatives to introduce various methods of gathering opinions. Quality islikely to improve as know-how is accumulated.
HGPI has conducted a project on the theme of achieving patient-centered health policy. For more
information on topics related to PPI in the policy formulation process, such as initiatives in otherdisease areas and enhancing support for councils, please refer our recommendations titled, “Further
Promoting Patient and Public Involvement in the Policy-Making Process: Steps for Achieving
Healthcare Policies That Are Truly Centered on Patients and Citizens” (presented on July 1, 2022).

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Acknowledgments
The recommendations in this report were crystallized from discussions held withrepresentatives of industry, Government, academia, and civil society who participated in the“Kyushu-Shikoku Summit on Promoting Measures for CVD Control” and the “Nationwide
Summit for Promoting CVD Control,” which were held as part of the HGPI Cardiovascular
Disease Control Promotion Project. We express our deepest gratitude to the experts andadministrative officials responsible for advancing CVD countermeasures in each prefecture
who spoke at these events.

Regarding the independent nature of these recommendations
This report is based on discussions at meetings HGPI held for this project and has been
compiled in HGPI’s capacity as an independent health policy think-tank. It does not, inany capacity, represent the opinions of any participating expert, speaker, related party, ororganization to which those parties are affiliated. This report is copyright 2023 Health andGlobal Policy Institute.

Introducing Health and Global Policy Institute (HGPI)
Health and Global Policy Institute (HGPI) is a non-profit, independent, non-partisan healthpolicy 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 tosuccessfully create citizen-focused healthcare policies. Looking to the future, HGPI produces
novel ideas and values from a standpoint that offers a wide perspective. It aims to realizea healthy and fair society while holding fast to its independence to avoid being bound to
the specific interests of political parties and other organizations. HGPI will continue working
actively to generate policy options that will be effective in Japan and around the world andthat will contribute to resolving global health challenges. HGPI’s activities have received global
recognition. HGPI was ranked second in the “Domestic Health Policy Think Tanks” category
and third in the “Global Health Policy Think Tanks” category in the Global Go To Think Tank
Index Report presented by the University of Pennsylvania (as of January 2021, the most recent
report).

Author: The Health and Global Policy Institute (HGPI) Cardiovascular Disease Control
Promotion Project (in no particular order)
Shunichiro Kurita(Senior Manager, HGPI)
Shotaro Tsukamoto(Senior Associate, HGPI)Ryoji Noritake(CEO, Board Member, HGPI)

11

MEMO

Health and Global Policy Institute: Guidelines on Grants and Contributions
As an independent, non-profit, non-partisan private think tank, Health and Global Policy Institute, (the Institute) complies with the following guidelines relating to the receipt of grants and contributions.

1. Approval of Mission
The mission of HGPI is to improve the civic mind and individuals’ well-being, and to foster a sustainable
healthy community by shaping ideas and values, reaching out to global needs, and catalyzing society for
impact. The activities of the Institute are supported by organizations and individuals who are in agreementwith this mission.

2. Political Neutrality
The Institute is a private, non-profit corporation independent of the government. Moreover, the Institutereceives no support from any political party or other organization whose primary purpose is political activityof any nature.

3. Independence of Project Planning and Implementation
The Institute makes independent decisions on the course and content of its projects after gathering the opinions of a broad diversity of interested parties. The opinions of benefactors are solicited, but the Instituteexercises independent judgment in determining whether any such opinions are reflected in its activities.

4. Diverse Sources of Funding
In order to secure its independence and neutrality, the Institute will seek to procure the funding necessary for
its operation from a broad diversity of foundations, corporations, individuals, and other such sources. Moreover, as a general rule, funding for specific divisions and activities of the Institute will also be sought frommultiple sources.

5. Exclusion of Promotional Activity
In order to secure its independence and neutrality, the Institute will seek to procure the funding necessary for
its operation from a broad diversity of foundations, corporations, individuals, and other such sources. Moreover, as a general rule, funding for specific divisions and activities of the Institute will also be sought frommultiple sources.

6. Written Agreement
Submission of this document will be taken to represent the benefactor’ s written agreement with the Institute’s compliance with the above guidelines.

Project sponsors (in Japanese syllabary order):Edwards Lifesciences Limited
Novartis Pharma K.K.

Health and Global Policy Institute (HGPI)Grand Cube 3F, Otemachi Financial City, Global Business Hub Tokyo
1-9-2, Otemachi, Chiyoda-ku, Tokyo 100-0004 JAPANTEL: +81-3-4243-7156 FAX: +81-3-4243-7378
E-mail: info@hgpi.org
This report is copyright 2023 Health and Global Policy Institute.