A focus on diet
The first step in boosting Nagano's life span was a campaign to reduce salt consumption and promote a healthier diet and lifestyle. Miso soup, served three times a day in many homes, became a prime target of health officials. Cases of hypertension and related illnesses began to decline shortly after, Sonohara says. The region of 2.1 million people now has some 4,500 volunteers who host seminars and clinics at supermarkets, shopping malls and community centers. They also conduct regular home visits to measure the salt content in daily meals and make dietary recommendations. "Our goal and our motives had nothing to do with becoming number one in life expectancy," said Sonohara. "[But] individual efforts and local initiatives gradually changed the lifestyle, and that in turn lengthened the life expectancy for the region as a whole."
At a recent cooking demonstration in a market near Nagano's main train station, volunteer Sumiko Hirano was preparing a dish of sesame pork with shiitake mushrooms and sliced pumpkin. The total salt per serving was 0.9 grams. But on this day, Hirano was exhorting a half-dozen shoppers, who had stopped to watch the demonstration, to reduce the use of cooking oil. For this recipe: just one teaspoon.
A licensed nutritionist, Hirano and several other volunteers also took time to dispense health advice to passersby. "At first it was difficult to convince people to change, but gradually it's becoming easier," says Hirano. "The government is encouraging people to maintain a healthier diet and lifestyle and organizing a lot of activities that they never had before, so that helps."
The efforts paid off with surprising speed. By 1990, life expectancy for men had risen three years in a decade in Nagano prefecture, and 3.5 years for women. Nagano life spans continued to climb until they topped all of Japan by 2010. Rates of deaths due to cancer, heart and liver disease, and pneumonia now rank well below the national average.
The private sector gets involved
As the effects of an improved diet began to be felt, the region's business community found ways to support a healthy lifestyle. In Matsumoto, the region's second largest city, a bank started offering higher interest rates and incentives like weekends at Tokyo's Disneyland for those who get medical checkups for three consecutive years. A convenience store chain has agreed to distribute health care information and host some 40 health fairs at various locations this year.
City health workers will take blood pressure readings, answer questions and distribute information on public health care services. "A lot of people never visit city hall, but they do go to convenience stores, so this is a good way to reach them," says Matsumoto's mayor, Akira Sugenoya, a surgeon.
Those preventive care efforts contributed to lower health care costs in Nagano, which came to about $2,488 per person in 2009. The per capita average in Japan was $3,120, according to a survey by the Kaiser Family Foundation. That compares with $8,233 in the United States. Japan's national health insurance program, which covers virtually all residents, including those in intensive nursing care, is funded in part by local contributions. "Preventive medicine is much less costly than having to put people in the hospital," Sugenoya says.
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