Date: 31 May 2013
Inequalities in Noncommunicable Disease Mortality in the Ten Largest Japanese Cities
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The burden of noncommunicable diseases and social inequalities in health among urban populations is becoming a common problem around the world. This phenomenon is further compounded by population aging. Japan faces the task of maintaining its high level of population health while dealing with these challenges. This study focused on the ten largest cities in Japan and, using publicly available administrative data, analyzed standardized mortality ratios to examine inequalities in relative mortality levels due to major noncommunicable disease at both city and subcity levels. On average, the ten major cities had excess mortality due to cancer and lower mortality due to heart disease and cerebrovascular disease compared to the country as a whole. Substantial inequalities in relative mortality were observed both between and within cities, especially for heart disease and cerebrovascular disease among men. Inequalities in relative mortality levels within cities appear to be increasing over time even while relative mortality levels are decreasing overall. The widely observed health inequalities signal the need for actions to ensure health equity while addressing the burden of noncommunicable diseases. Increasingly, more countries will have to deal with these challenges of inequity, urbanization, aging, and noncommunicable diseases. Local health governance informed by locally specific data on health determinants and outcomes is essential for developing contextualized interventions to improve health and health equity in major urban areas.
The Lancet. Japan: universal health care at 50 years. Lancet. 2011; 378(9796): 1049.CrossRef
WHO. The World Health report 2004: changing history. Geneva, Switzerland: WHO; 2001.
Statistics Bureau of Japan. Chapter 15 Social security, health care and public hygiene. Statistical Handbook of Japan 2011. Tokyo: Statistics Bureau of Japan; 2011. Available at: www.stat.go.jp/english/data/handbook/index.htm. Accessed February 1, 2012.
Global Agenda Council on Ageing. Global population ageing: peril or promise? Cologny/Geneva, Switzerland: World Econ Forum; 2012.
Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. The 2011 revision population database. 2012. Available at: http://esa.un.org/unpd/wup/unup/index.asp?panel=1. Accessed February 21, 2012.
Kjellstrom T, Mercado S. Towards action for health equity in urban settings. Environ Urban. 2008; 20: 551–74.CrossRef
The PLoS Medicine Editors. The air that we breathe: addressing the risks of global urbanization on health. PLoS Med. 2012; 9(8): e1001301.CrossRef
WHO, UN-HABITAT. Hidden cities: unmasking and overcoming health inequities in urban settings. Geneva, Switzerland: WHO; 2010.
OECD. Divided we stand: why inequality keeps rising. Paris: OECD; 2011. Available at: www.oecd.org/els/social/inequality. Accessed February 1, 2012.
Fukuda Y, Nako H, Yahata Y, Imai H. Are health inequalities increasing in Japan? The trends of 1955 to 2000. BioSci Trends. 2007; 1(1): 38–42.PubMed
Yong V, Saito Y. Trends in healthy life expectancy in Japan: 1986–2004. Demogr Res. 2009; 20: 467–94.CrossRef
WHO. WHA65.3 Strengthening noncommunicable disease policies. Geneva, Switzerland: WHO; 2012. Available at: http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_R3-en.pdf. Accessed June 21, 2012.
WHO. Political declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. Geneva, Switzerland: WHO; 2012. Available at: http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf. Accessed June 21, 2012.
WHO. World Health Statistics 2011. Geneva, Switzerland: WHO; 2011.
Ministry of Health Labour and Welfare Japan. 1998–2002 Summary vital statistics by local public health center and municipality. Available at: http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/tokusyu/hoken04/index.html. Accessed March 2, 2012.
Dey S, Hablas A, Seifeldin I, et al. Urban–rural differences of gynaecological malignancies in Egypt (1999–2002). Br J Obstet Gynaecol. 2010; 117(3): 348–55.CrossRef
Minelli L, Stracci F, Cassetti T, et al. Urban–rural differences in gynaecological cancer occurrence in a central region of Italy: 1978–1982 and 1998–2002. Eur J Gynaecol Oncol. 2007; 28(6): 468–72.PubMed
WHO. Cancer control: knowledge into action: WHO guide for effective programmes (module 2: prevention). Geneva, Switzerland: WHO; 2007.
Schulz A, House J, Israel B, et al. Relational pathways between socioeconomic position and cardiovascular risk in a multiethnic urban sample: complexities and their implications for improving health in economically disadvantaged populations. J Epidemiol Community Health. 2008; 62: 638–46.PubMedCrossRef
Whitehead M, Dahlgren G. Levelling up (part 1): Concepts and Principles for Tackling Social Inequities in Health. Copenhagen, Denmark: WHO Regional Office for Europe; 2006.
Welch V, Tugwell P, Petticrew M, et al. How effects on health equity are assessed in systematic reviews of interventions. Cochrane Database Syst Rev. 2010 (12):MR000028.
World Economic Forum, WHO. From burden to "best buys": reducing the economic impact of non-communicable diseases in low- and middle-income countries. Cologny, Geneva: World Econ Forum; 2011.
Burris S, Hancock T, Lin V, Herzog A. Emerging strategies for healthy urban governance. J Urban Health. 2007; 84: 154–63.CrossRef
Kashiwabara M, Armada F, Yoshimi I. Kanagawa, Japan’s tobacco control legislation: a breakthrough? Asian Pac J Cancer Prev. 2011; 12: 1909–16.PubMed
- Inequalities in Noncommunicable Disease Mortality in the Ten Largest Japanese Cities
Journal of Urban Health
Volume 90, Issue 6 , pp 1041-1052
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Urban health
- Noncommunicable disease
- Health equity
- Author Affiliations
- 1. Centre for Health Development, World Health Organization, I.H.D. Centre Building 9F, 1-5-1 Wakinohama-Kaigandori, Chuo-ku, Kobe, 651-0073, Japan
- 2. Graduate School of Medicine Faculty of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka, 565-0871, Japan