Health promotion in the workplace in Japan was substantially improved when the Occupational Health and Safety Law was amended in 1988 and employers were mandated to introduce health promotion programs (HPPs) in the workplace. Although the law as amended makes no provision for penalties, the Ministry of Labor at this time began actively encouraging employers to establish health promotion programs. For instance, the Ministry has provided support for training and education to increase the numbers of specialists qualified to work in such programs; among the specialists are occupational health promotion physicians (OHPPs), health care trainers (HCTs), health care leaders (HCLs), mental health counselors (MHCs), nutrition counselors (NCs) and occupational health counselors (OHCs). While employers are encouraged to establish health promotion organizations within their own enterprises, they can also elect to procure service from outside, especially if the business is small and it cannot afford to provide a program in-house. The Ministry of Labor furnishes guidelines for the operation of such service institutions. The newly conceived and mandated occupational health promotion program authorized by the Japanese government is called the “total health promotion” (THP) plan.
Recommended Standard Health Promotion Program
If an enterprise is sufficiently large to provide all the specialists listed above, it is strongly recommended that the company organize a committee comprising those specialists and make it responsible for the planning and execution of a health promotion program. Such a committee must first analyze the health status of the workers and determine the highest priorities that are to guide the actual planning of an appropriate health promotion program. The program should be a comprehensive one, based on both group and individual approaches.
On a group basis various health education classes would be offered, for example, on nutrition, life style, stress management and recreation. Cooperative group activities are recommended in addition to lectures in order to encourage workers to become involved in actual procedures so that information provided in class can result in behavioral changes.
As the first step to the individual approach, a health survey should be conducted by the OHPP. The OHPP then issues a plan to the individual based on the results of the survey after taking into account information obtained through counseling by the OHC or MHC (or both). Following this plan, relevant specialists will supply the necessary instructions or counseling. The HCT will design a personal physical training program based on the plan. The HCL will provide practical instruction to the individual in the gym. When necessary, an NC will teach personal nutrition and the MHC or OHC will meet the individual for specific counseling. The results of such individual programs should be evaluated periodically by the OHPP so the program can be improved over time.
Training of Specialists
The Ministry has appointed the Japan Industrial Safety and Health Association (JISHA), a semi-official organization for the promotion of voluntary safety and health activities in the private sector, to be the official body for conducting the training courses for health promotion specialists. To become one of the above six specialists a certain background is required and a course for each specialty must be completed. The OHPP, for instance, must have the national license for physicians and have completed a 22-hour course on conducting the health survey that will direct the planning of the HPP. The course for the HCT is 139 hours, the longest of the six courses; a prerequisite for taking the course is a bachelor’s degree in health sciences or athletics. Those who have three or more years’ practical experience as an HCL are also eligible to take the course. The HCL is the leader responsible for actually teaching workers according to the prescriptions drawn up by the HCT. The requirement for becoming an HCL is that he or she be 18 years of age or older and have completed the course, which covers 28.5 hours. To take the course for the MHC, one of the following degrees or experience is required: a bachelor’s degree in psychology; social welfare or health science; certification as a public health or registered nurse; HCT; completion of JISHA’s Health Listener’s Course; qualification as a health supervisor; or five or more years’ experience as a counselor. The length of the MHC course is 16.5 hours. Only qualified nutritionists can take the NC course, which is 16.0 hours long. Qualified public health nurses and nurses with three or more years of practical experience in counseling can take the OHC course, which is 20.5 hours long. The OHC is expected to be a comprehensive promoter of the health promotion program in the workplace. As of the end of December 1996, the following numbers of the specialists were registered with the JISHA as having completed the assigned courses: OHPP—2,895; HCT—2,800; HCL— 11,364; MHC—8,307; NC—3,888; OHC—5,233.
Service Institutions
Two kinds of health promotion service institutions are approved by JISHA and a list of the registered institutions is available to the public. One kind is authorized to conduct health surveys so that the OHPP can issue a plan to the individual. This type of institution can provide comprehensive health promotion service. The other kind of service institution is only permitted to provide physical training service in accordance with a program developed by an HCT. As of the end of March 1997 the number qualifying as the former type was 72 and that as the latter was 295.
Financial Support from the Ministry
The Ministry of Labor has a budget to support the training courses offered by JISHA, the establishment of new programs by enterprises and the acquisition by service institutions of equipment for physical exercise. When an enterprise establishes a new program, the expenditure will be supported by the Ministry through JISHA for a maximum of three years. The amount depends on size; if the number of employees of an enterprise is less than 300, two-thirds of the total expenditure will be met by the Ministry; for businesses of over 300 employees, financial support covers one-third of the total.
Conclusion
It is too early in the history of the THP project to make a reliable evaluation of its effectiveness, but a consensus prevails that THP should be part of any comprehensive occupational health program. The general status of Japanese occupational health service is still undergoing improvement. In advanced workplaces, that is, chiefly those of the large companies, THP has already developed to a level that an evaluation of the degree of health promotion among the workers and of the extent of improvement in productivity can be done. However, in smaller enterprises, even though the major part of the necessary expenditures for THP can be paid for by the government, the health care systems that are already in place very frequently are not able to undertake the introduction of additional health maintenance activities.