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Health Equity Assessment and Response Tool (HEART)
developed by JAGES
Katsunori Kondo, PhD, MDCenter for Preventive Medical Sciences, Chiba University
Department of Gerontological Evaluation, National Center for Geriatrics and Gerontology
1
Contents
• Necessity of HEART• Developing process• Overview of JAGES HEART
–Use case and usefulness –Remaining challenges
Health Equity Assessment and Response Tool
Recommendations of CSDHCommittee on Social Determinants of Health
(WHO 2008)
Background & Purpose• Scientific evidence accumulated
– Health Inequality by Social Determinants of Health – We need measurement and assessment systems
which induce responses
• We developed a prototype of measurement (benchmark) system for Age Friendly Cities /Communities (AFC) policy collaborated with WHO Kobe Center (WKC).
JApan Gerontological Evaluation Study (JAGES)
• One of the few population-based gerontological surveys in Japan
• Focused on social determinants of health (SDH) and social environment
• Collaborated with municipalities as insurers of public long term care
• In 2010- 112,000 older people across 31 municipalities responded (response rate: 66.3%)
• In 2013- 138,000 older people responded. (RR: 70.3%)
• In 2016- about 200,000 in 39 municipalities responded. (RR: 70%)
Collaboration between WKC + JAGES
http://www.doctoral.sakura.ne.jp/WebAtlas/
JAGES: Japan Gerontological Evaluation Study
http://www.doctoral.sakura.ne.jp/WebAtlas/JAGES_HEART/23000_Chita/Double/atlas.html
http://www.who.int/kobe_centre/ageing/j_ages_heart/en/
Management Cycle
• Neighbourhood walkability• Accessibility of public spaces and buildings• Accessibility of public transportation vehicles• Accessibility of public transportation stops• Affordability of housing
• Positive social attitude toward older people• Engagement in volunteer activity• Engagement in paid employment• Engagement in socio-cultural activity• Participation in local decision-making• Availability of information• Availability of health & social services• Economic Security
• Quality of life
• Difference between two reference groups• Difference between population average and
highest attainable level of outcome
Accessible Physical Environment
Inclusive Social Environment
Impact on Well-being
Equity Measures
WHO Monitoring Framework & Core Indicators for AFC
JAGES‐HEART 2014
One block represents rank of one municipality
% of depression (GDS>=5)Limited to 65‐74 y.o.
% of depression: 14.9~34.5%
Participant rate of volunteer
Resources should be allocated or developed in this area Risks & Resources
are visible
4~15%
School districts with higher sports-group participation rates = lower rates of fall among aged 65–74
Sports group participation rate
Rate of elderly who fell at least once in the previous year
Fall
Sports group participation
R = -0.55
Can we facilitate social participation and it reduces the incidence of functional decline?
We need intervention trials
How to use the benchmark system
Lunch club for older people living alone
Setting the agenda
Sharing the results Community meeting
Developing programFostering volunteers
Visualizing status
Poor health and difficulty of shopping are detected in area A
Implementing the program
Needs of shopping are simultaneously filled by mobile shop invited
M. Yamaya, et. al. 2015
Enjoyable Social Programs←Ping-Pong
Game→
Just chatting is very popular!
Taketoyo town project since 2007
Various programsMaking a Short Poem→led by volunteers
Physical Exerciseinstructed by volunteers
(人) (%)
年度 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016サロン数 3 5 7 8 8 10 10 11 11 13
401583 637
727794
894 875965 932
1063
90133 151 177 195
226256 247
282328
5.4
7.47.7
8.79.1
9.89.4 9.7
9.110.2
6.1
8.4 8.7
9.910.3
11.1 10.8 11.1 10.511.7
0
5
10
0
200
400
600
800
1000
実参加者数 ボランティア数 65歳以上参加率 65歳以上(要介護者除く)参加率
persons%
Trend of Number & rate of Participants
No. of site3 5 7 8 8 10 10 11 11 13
Source: Taketoyo town
for 65 y.o.and +Rate of Participation
volunteerparticipants
volunteer
participants
for independent and 65 y.o.and +
Participants Rate by Education
010203040506070
<6years
6-9 10-12 13+0
5
10
15
20
25
<6years
6-9 10-12 13+
Health Check Up The New Program
Educational Attainment
%
The program reduced inequalities in social participation
%
Participants keep functions
02468
10121416
Participants Not Participants
% of persons function declined%
Comparison between Participants and Non-Participants in Taketoyo Project
6.3% point reduction during 5 years followed up
Taketoyo project, 2014
N = 2178 312
Hikichi, H., Kondo, N., Kondo, K.,et. All: Effect of community intervention program promoting social interactions on functional disability prevention for older adults: propensity score matching and instrumental variable analyses, JAGES Taketoyo study.Journal of Epidemiology and Community Healthdoi: 10.1136/jech-2014-205345
Incidence of dementia reduced
0
0.2
0.4
0.6
0.8
1
1.2
Participants Not Participants
OR of Incidence of dementiaOdds ratio
7 years follow upDementia rank ≧1
Taketoyo project
N = 152 1885
Hikichi, H., Kondo, K., Takeda, T., and Kawachi, I.: Social interaction and cognitive decline: Results of 7-years community intervention. Alzheimer's & Dementia: Translational Research & Clinical Interventions 3 (1): 23-32, 2017.
0.73
JAGES HEART Using comparative statistics, it supports; 1. to make the health inequalities more
easily visible2. to support setting priorities and targets
for local policies3. to analyze possible factors relating to
policy targets such as participation in sports clubs for fall prevention
4. to monitor changes in time and effects of intervention.
Conclusions• JAGES HEART is useful to find the determinant of healthy aging communities. – social participation seems to be a good for prevention of fall, depression, and functional decline, etc.
– It provides response tools tackling health inequalities.
• Remaining challenges are– To validate indicators– To collect more go od practices– To increase number of municipalities/countries which use these kind of HEART systems