What are the Secrets to a Long, Healthy Life? From Japan's Longest-Lived Prefecture, Nagano

JFS Newsletter No.169 (September 2016)

Building a society with a healthy lifestyle, where even the elderly can lead active lives, is a central challenge worldwide. As of 2014, the average lifespan in Japan for both men and women, is the world's longest -- men there live 80.50 years on average, while women top them at 86.83 years.

Among Japan's 47 prefectures, Nagano has the longest average life expectancy for both men and women. It leads Japan not only in terms of average life expectancy, but has also garnered attention for "healthy life expectancy," meaning the number of years a person can live a normal life without nursing care or, worse, becoming bedridden. This is a crucial concept for promoting wellbeing among the elderly. Nagano ranks among the best in terms of healthy life expectancy in Japan. While Japan tops the world in longevity, Nagano's citizens enjoy the longest and the healthiest life span in this country. What are Nagano's secrets?

One secret is that Nagano, whose population exceeds two million, has over 10,000 health promotion volunteers organized throughout the prefecture who work every day. In this article, we will introduce initiatives of theirs that are indispensable to Nagano's healthy community building.

Founding and Activities of the Health Promotion Volunteers

The Health Promotion Volunteers initiative was launched in 1945, in response to calls by housewives in the former village of Takaho (currently part of Suzaka) asking how they could help public health nurses. The poor hygienic environment during the war cost many infants their lives from infectious diseases such as tuberculosis and dysentery. Under such circumstances, the Suzaka Health Promotion Volunteer (HPV) Association was voluntarily organized by housewives in the community to assist public health nurses, who were struggling alone to protect people's lives.

To eliminate the sources of parasitic insects and infectious diseases that were epidemic at that time, their activities included campaigns to dry futons and stop people from eating with their hands. This spread from the HPVs, who were mainly housewives, to each home and thus to all areas. To prevent strokes, the top cause of death at that time, they focused on blood pressure control by having people measure it for themselves. At times they also conducted nutritional surveys, beginning with measuring salt in miso soup, and there were campaigns to reduce salt.

After the village was incorporated into Suzaka, the activities continued, aiming for "one HPV per family." The HPVs played an important role in the city's health promotion declaration of 1987 that encouraged citizens to build healthy lives for themselves.

The volunteers are not special, but ordinary local mothers. They are recommended to serve as board members by the head of the community, for terms of two years. One feature is that they are replaced every two years, so that the number of experienced health promotion volunteers increases. Currently, 269 members serve in the 30th term of Health Promotion Volunteers, with each member in charge of 71 households on average.

The HPVs have two main activities. The first is to learn and then put what they have learned into practice in their daily lives. Monthly study group meetings are held on each block, where they learn about health through practice, including walking methods and dietetics such as salt and dietary balance. They also study the city's health issues and lifestyle- related diseases. Practice is just as important as learning, so they wear pedometers and exercise in ways that are easy to continue daily. They cook a balanced, reduced salt diet together with their family, and participate in HPV health classes.

Their other main activity is to spread what they have learned among their community. For instance, they offer health consultations at community events and demonstrate calisthenics at the city's health festival. In addition, upon request, they offer support to child-rearing parents by organizing "child-raising plazas" and providing other opportunities for mothers and children to meet up and interact each other. They also offer similar opportunities for the elderly to gather, talk and enjoy hobbies.

In addition, they cooperate with the city's health and welfare activities, helping as staff at medical examinations and promoting checkups by distributing applications when the city recommends checkups for citizens.

In FY2014, Suzaka and Toho University jointly conducted the Suzaka City Health Survey, to clarify factors in citizens' good health and improve health further using the survey results. They learned the following things from the survey.

People with HPV experience had a higher degree of vitality. In other words, fewer of them had a low capacity for activities such as shopping, preparing meals, making trips to the bank, or reading newspapers or books than those without HPV experience. People with HPV experience had lower per capita medical costs and were less of a national health insurance burden, and they exhibited a higher rate of specific health checkups and various cancer screenings compared to those without HPV experience. Furthermore, among men in households where someone had HPV experience, fewer people had low subjective health levels (health self-examination), while many of them maintained desirable health-related habits.

To publicize the benefits of HPV activities, Suzaka has solicited comments from HPV veterans, who talk about changes they have made in lifestyle and habits, such as cooking with lighter seasonings after learning about reduced-salt cooking, eating more vegetables, trying to balance their diet, and cultivating the habit of walking and other exercises.

Another major benefit they mention is networking with new people. Some say, "I enjoy meeting up with HPV friends who have worked with me to build good health," and "Even after my HPV term was over, I kept working as a caregiver and member of the Dietary Life Improvement Promotion Association."

Comments such as "By working as an HPV, I could learn about the community," "I could get to know local people, strengthening communal ties," and "After serving as an HPV, I set up a Suzaka exercise group and continue exercising," show that HPV activities build social capital locally.

They also mention benefits to local communities including increased awareness of health issues in the community, increased number of towns where people have greater health awareness because of courses being offered, as the HPVs have conducted an anti-smoking campaign, and have become concerned about separation of smoking areas or have improved smoking conditions at public facilities, a larger number of people with better awareness of low salt and balanced diets, and more chances for people to link up with others through opportunities to learn and gather.

The Suzaka Health Promotion Volunteer Association developed the Suzaka Exercise, a calisthenics routine consisting of seven types of exercises easy for anyone anywhere to do while singing songs known to people of all ages, from childhood to the golden years. Singing while engaging in multiple movements simultaneously increases the stimulation to the brain, thereby also preventing dementia.

Suzaka Exercise in English:
For an English video of the Suzaka Exercises, go to
http://suzakajapan.city.suzaka.nagano.jp/exercise.php

This site is almost entirely in Japanese (and the "Translation" button at the top only goes to a different page), but scroll down below the videos to find in orange letters: "Suzaka Exercises [WMV: 86 MB]." Clicking that initiates a download. This 15 minute video provides audio and subtitles both in English, with a lovely Suzaka representative performing a clear example of the exercise motions.

HPV Activities Extending across Nagano Prefecture

The HPV framework, which started in Suzaka, is spreading across the prefecture. Each municipality has its own name for it, but currently about 11,000 HPVs and similar groups are working as voluntary citizens' organizations protecting the health of communities in almost all of the prefecture's municipalities. Under a slogan translating as "Let's build and protect our health for ourselves," these HPVs provide learning opportunities and engage in health-related activities such as recommending physical examinations or health screening at the prefectural, affiliate and district levels.

As noted at the beginning, Nagano has the highest average longevity, both male and female, in Japan, a country noted for long lives. The prefecture says the reasons for that are the low mortality rate from cancer or heart disease, well-established preventive actions by HPVs and others in daily life supporting that, and the ability of HPVs and others to take turns acquiring knowledge about health promotion activities as a shared role in the community. It notes, "With knowledge, people behave differently and encourage wider health promotion among families and communities. Apparently, the many years of efforts have been supporting long lives in modern Nagano."

The total number of people with HPV experience in Nagano is about 250,000, which only reflects the number since 1973 when statistics became available. Recently, more and more men have become involved, but the majority is still women, with one out of five women in the prefecture having HPV experience. All of these people gain knowledge in their communities, implement the knowledge at home and then spread it to their communities. There are other regions in Japan where similar activities are held, but it is said that only Nagano has prefecture-wide activities.

In the spring of 2016, the Suzaka Health Promotion Volunteer Association received the Medal with Green Ribbon (awarded to morally remarkable individuals who have actively taken part in serving society). In 2014, the association's health promotion activities via the HPVs to "build and protect our health by ourselves," aiming for citizens' health, won the highest place in the Third Award for Extending Healthy Longevity, presented by the Minister of Health, Labour and Welfare. Activities in Matsumoto, another city in the prefecture, also won the Award of Excellence in the First Award for Extending Healthy Longevity in 2013. These activities are receiving attention across Japan.

The late Ms. Miyoshi Ooba, the public health nurse who founded the health promotion volunteer system, left the following words: "Soon, the housewives of all households in the city will complete the two-year volunteer training course. Then, our city will be a healthy city established by the residents on their own." Her vision is taking shape exactly as she said and supporting the health and happiness of residents in the long-lived prefecture of Nagano.

Written by Kazuko Iijima and Junko Edahiro