EDITOR--I read with interest the editorial by Prof Marmot, noting
that people's willingness to take action (i.e., implementation of public
health policies) influences their view of the (scientific) evidence,
rather than the evidence influencing their willingness to take
action.1 Although, in terms of public values, individual responsibility
for behaviour is important, 1 an unhealthy tension exists in Japan between
individual responsibility and the role of government.
To improve health among the nation's people, Kenkou Zousin Hou (The
Health Enhancement Act) was issued and came into force in May, 2003 in
Japan, including a specific clause for prevention of passive smoking.
Following this, many public facilities, such as schools and hospitals,
have eventually started strict regulation against smoking; i.e.,
restriction of smoking in public spaces. However, since April 1, 2004,
almost one year after the introduction of the Act, smoking has been
forbidden in the facility of the Ministry of Health, Labour and Welfare
which, in fact, made the Act. The reason was that it had been difficult
to commence the regulation because many workers (one out of 4 workers)
were still on smoking at the Ministry.
This exemplifies Prof Marmot's view that the scientific evidence
does not have much impact on the government's willingness to take action.
Perhaps, action taken by the government may influence their view of the
evidence.
The mortality due to lung cancer exceeded that of stomach cancer in
1992, and lung cancer is the highest cause of death among cancer victims,
at least among Japanese men. Nevertheless, the proportion of smokers
still remains high (over 40% in men and 24% as a whole) as, in effect,
demonstrated among the staff at the Ministry.
However, if policy makers do not understand the implication of
policies and do not take action as a model, the public who are believed to
abide by the policy may lose the fundamental message attached to it as
they are usually not accessible to the scientific evidence itself, and
become loath to follow it.
Nori Takei, associate professor (psychiatrist) and epidemiologist
Department of Psychiatry and Neurology, Hamamatsu University School of
Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan
1 Marmot MG. Evidence based policy or policy based evidence?
Willingness to take action influences the view of the evidence--look at
alcohol. BMJ 2004; 328:906-7.
Competing interests:
None declared
Competing interests:
No competing interests
22 April 2004
Nori Takei
associate professor
Dept of Psychiatry and Neurology, Hamamatsu U Sch Med, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
Rapid Response:
Does policy based evidence work in Japan?
EDITOR--I read with interest the editorial by Prof Marmot, noting
that people's willingness to take action (i.e., implementation of public
health policies) influences their view of the (scientific) evidence,
rather than the evidence influencing their willingness to take
action.1 Although, in terms of public values, individual responsibility
for behaviour is important, 1 an unhealthy tension exists in Japan between
individual responsibility and the role of government.
To improve health among the nation's people, Kenkou Zousin Hou (The
Health Enhancement Act) was issued and came into force in May, 2003 in
Japan, including a specific clause for prevention of passive smoking.
Following this, many public facilities, such as schools and hospitals,
have eventually started strict regulation against smoking; i.e.,
restriction of smoking in public spaces. However, since April 1, 2004,
almost one year after the introduction of the Act, smoking has been
forbidden in the facility of the Ministry of Health, Labour and Welfare
which, in fact, made the Act. The reason was that it had been difficult
to commence the regulation because many workers (one out of 4 workers)
were still on smoking at the Ministry.
This exemplifies Prof Marmot's view that the scientific evidence
does not have much impact on the government's willingness to take action.
Perhaps, action taken by the government may influence their view of the
evidence.
The mortality due to lung cancer exceeded that of stomach cancer in
1992, and lung cancer is the highest cause of death among cancer victims,
at least among Japanese men. Nevertheless, the proportion of smokers
still remains high (over 40% in men and 24% as a whole) as, in effect,
demonstrated among the staff at the Ministry.
However, if policy makers do not understand the implication of
policies and do not take action as a model, the public who are believed to
abide by the policy may lose the fundamental message attached to it as
they are usually not accessible to the scientific evidence itself, and
become loath to follow it.
Nori Takei, associate professor (psychiatrist) and epidemiologist
Department of Psychiatry and Neurology, Hamamatsu University School of
Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan
ntakei@hama-med.ac.jp
Competing interests: None declared.
1 Marmot MG. Evidence based policy or policy based evidence?
Willingness to take action influences the view of the evidence--look at
alcohol. BMJ 2004; 328:906-7.
Competing interests:
None declared
Competing interests: No competing interests