Urban Park as “Preventive Agency” for Non-communicable Diseases
Shinichi URASAKIPark and Health Network Japan
Ⅰ. Introduction
On October 9th 2018, one material was shown by the subcommittee of the financial system confer
ence of Ministry of Finance. The material says, “It is not quantitatively clear if preventive medicine is effective for saving medical and care cost. There are some indications that the cost can even increase.”[1] Around that time, there were several arguments that preventive medicine is not effecti
ve for saving medical cost. [2] On the background of this discussion, there is the problem of increa
sing of national health care cost, and the attempt to save it by Ministry of Health, Labor, and Welf
are.
We, Park and Health Network Japan, feel strange about the argument that prevention can’t save medical cost. This is because we are trying prevention by lifestyle improvement, instead of spending
medical cost for preventive medical care. By utilizing urban parks for improving lifestyle, we can increase healthy people who don’t depend on medicine or care. As a result, this would decrease medical cost. Urban parks should take a role of prevention. This is necessary also for keeping the social system which can give enough medicine for those who need it. If medical cost decreased, we wa
nt investment from the difference, for parks and greeneries, which can produce healthy lifestyle.

Ⅱ. Making Urban Parks Preventive Agency
The biggest cause of death in Japan except for infection is smoking, the second is high blood press
ure, and the third is lack of exercise. [3] Therefore, one of our objectives is to make young people,
who will be the aged in 20-30 years, exercise regularly. The present percentage of people who exer
cise regularly is only about 30%. [4] How much we can increase this percentage will be an indicato
r. For example, if 10% of the citizens exercise regularly in a 1,000,000 population city, 33 public g
yms are needed. [5] On the other hand, urban parks are already securing space for exercising. Thi
s is why we think urban parks can make important role.
Many organizations have already tried promotion of regular exercise, the percentage is still flat. T
his shows that promotion doesn’t work as long as it depends on motivation of individuals. We are aiming for making cities which citizens can be healthy just by living in. To achieve this, in the first place, we are trying to make urban parks preventive agency.
The area comprehensive care system, which Ministry of Health, Labor, and Welfare is aiming for, is the system that people can receive medical, care, and preventive service in 30 minutes from theirresidence. Medical service is provided in hospitals by doctors, and care service is in nursing faciliti
es by care workers. In contrast with these, neither facility nor profession for preventive service is shown. We have made some attempts and promotions to make urban parks “preventive agency,” which can change individuals’ lifestyles and social factors which cause non-communicable diseases.
WHO defines “health” as “a state of complete physical, mental and social well-being and not mere
ly the absence of disease or infirmity.” [6] Referring to this, we interpret “preventive agency” as “agency which can make citizens healthy enough to live active and enjoyable life.” We think urban parks can take this role.

Ⅲ. Attempt to Make Urban Parks Preventive Agency
Our attempt mainly consists of 3 projects. First is a continuous support program of exercise, as a support which we can start in any parks. Second is arrangement of advisors to motivate individuals.
Third is education of correct exercise method.
A. A continuous support program of exercise “Healthy Joy Club”
Everyone is worrying about their own health. Fun and effective continuous program is necessary to make this worry motivation for exercise. Therefore, we conduct “Healthy Joy Club,” a continuous support program of exercise, in order to make citizens exercise regularly.
An important point is that this provides regular exercise program, not a one day event. We are conducting exercise program, such as slow jogging or yoga, 5-20 times a month in 5 parks including O
saka prefectural Yamadaike Park, Tokorozawa Aviation Memorial Park in Saitama prefecture, andOeda Park in Moriguchi city.
B. Arrangement of advisors called “Park Trainers”
While conducting Healthy Joy Club, we found that the number of participants and the retention ra
te are different between the parks, although there was no big difference in location, the skill of inst
ructors, or advertisement. This is supposed to be because, in the parks which have a lot of particip
ants, staffs make kind answers for the questions from the participants. When we conducted a healt
h consultation service in parks, we found that many people have health problems if they don’t havediseases. It seemed regular exercise can solve many of the problems.
We began arrangement of “Park Trainers.” “Park Trainers” directly communicate with park visitors, and help them begin regular exercise and live healthy lives. Trainers listen to the park visitors, check their health, and tell them improvement plans and the way how to continue that plan. Becaus
e citizens’ lifestyles are different between individuals, the effective way of making them exercise regularly is also different. Trainers need to change the methods depending on the citizens’ living spa
ces and occupations. Therefore, it is important to pattern lifestyles for the best physical activity, by analyzing various data such as cities’ region data, individuals’ lifestyles data, and physical activity
data of different business types. By utilizing patterned data, trainers can effectively teach how andwhen to exercise.
C. Patterning lifestyles by individuals’ correct amount of exercise
When you don’t get enough exercise and want to change your lifestyle, it is hard to know correct amount of exercise for you, and how much you already exercise in daily life. Then, we made an appl
ication “Park Prescription for iPhone.”
We got this idea from the discussion with Dr.Zarr, a pediatrician in Washington, D.C. In the US, doctors cooperate with parks. Doctors can advise the park visitors how to exercise, but it is hard to k
now if the visitors keep exercising afterwards. This was a hint for our application development.

This application is different from conventional application, such as pedometer applications or calory calculator applications, in the point that it can calculate the correct amount of exercise for the users and show how much of the amount they achieved. In order to maintain or develop physical str
ength, it is necessary to exercise 3 hours a week. Visualizing the amount of exercise could be effective for efficiently keeping motivation and time for exercise.

Ⅳ. The Future of Urban Parks as Preventive Agency
WHO Western Pacific Region is promoting healthy cities. They focus on not only the first place, b
ut also the second place. The first place means villages or community, which have the area compre
hensive care system Ministry of Health, Labor, and Welfare is aiming for. The second place means
schools, offices, hospitals, or markets. By adding the third place, which means open spaces in cities, we can make all these 3 types of places preventive agency. The citizens live not only in their own
residences, but also in city public spaces, such as communities, networks, and open spaces. There
are approximately 110,000 urban parks in Japan. What we need now is arrangement of trainers who can solve the social problems, and recognition of urban parks as “preventive agency.”
Ministry of Health, Labor, and Welfare and Ministry of Economy, Trade, and Industry are promot
ing health and productivity management to companies. The percentage of regularly exercising wor
king-age people is still low, because of various restrictions and low interest for exercise. It is important to utilize urban parks as preventive agency, also for making working-aged people exercise reg
ularly. Our challenge to make urban parks preventive agency has just started.

References[1] the subcommittee of the financial system conference of Ministry of Finance(2018): about social security<https://www.mof.go.jp/about_mof/councils/fiscal_system_council/sub-of_fiscal_system/procee
dings/material/zaiseia301009/01.pdf>，referred on July 26th, 2019, 18
This article was quoted from “Easy Economics” of The Nikkei, written by Prof. Hideki Yasunaga from The University of Tokyo, Faculty of Medicine.
[2] Yoshikazu Kenjo(2018): It is wrong that “Preventive medicine can save medical cost.”: TOYOKEIZAI INC.
<https://www.nikkei.com/article/DGXMZO36433480S8A011C1000000/>updated on September 14th, 2018, referred on July 26th, 2019.
Juntarou Arai(2018): Does preventive medicine save medical cost? Ministry of Finance and Ministry of Health, Labor, and Welfare debated at the “entrance.”: The Nikkei<https://www.nikkei.com/article/DGXMZO36433480S8A011C1000000/>, updated on October
17th, 2018, referred on July 26th, 2019
Naoko Iwanaga(2019): Health is not duty. Don’t make “preventive medicine” a tool for saving me
dical cost.:Buzz Feed News
<https://www.buzzfeed.com/jp/naokoiwanaga/ryuniki-3>updated on January 27th, 2019, referred on July 26th, 2019
Teruyuki Katori(2019): It is lie that “Total medical cost will be decreased” by lifestyle disease prev
ention.: PRESIDENT Online

<https://president.jp/articles/-/28240>updated on May 19th, 2019, referred on July 26th, 2019.
etc.
[3] supervised by Kenji Shibuya(2011): “50 years since establishment of a national health insuran
ce program” The Lancet Japan special number: Japan Center for International Exchange, 36.,
[4] Ministry of Health, Labor, and Welfare(2018): Ministry of Health, Labor, and Welfare defines“people who exercise regularly” as “those who exercise for more than 30 minutes a day, for more t
han twice a week, and for more than 1 year.”: report of citizens’ health and nutrition(2018), 50.,
[5] Ministry of Education, Culture, Sports, Science and Technology(2016): result of social research(2016)<http://www.mext.go.jp/component/b_menu/other/__icsFiles/afieldfile/2017/04/28/1378656_03.pdf>updated on October 2016, referred and calculated on July 26th, 2019[6] WHO(1948): Constitution of The World Health Organization<https://www.japan-who.or.jp/commodity/kensyo.html> referred on July 26th, 2019