予防とリハビリテーション : 行政の立場から

Stroke is the third leading cause of death and a leading cause of adult disability in theJapan and the Tokushima Prefecture. Preventing stroke is the most important strategy forreducing the mortality from this disease, the suffering number of disability and also thedisability-related cost.Major modifiable causal risk factors for stroke include hypertension, diabetes, cigarettesmoking, alcohol consumption, atrial fibrillation and obesity.Current policies and practices for stroke prevention include both high-risk andpopulation-wide components. The high-risk approach requires detection and managementof these risk factors, once established in the affected individuals. The population-wide approachuses interventions intended to shift the distribution of risk favorably in those populationsin which a given risk factor has become prevent. The approach of the Health andMedical Service Law for Elderly (Rou-jin Hoken Hou) is the former. The approach of thenew policy of health promotion (Kenkou Nippon 21) is the latter. “Kenkou Nippon 21” is theprevention agenda for the nation. It is designed to achieve the goal, increase quality andyears of healthy life.Rehabilitation is the essential medical service for after stroke patient. The goal of a rehabilitationprogram for the patient is to provide for optimal physical, psychologic, physiologic,and social adaptation. It is important in this regard that the physical restoration activitynot be terminated abruptly at discharge, but that maintenance program be developedwhich can be continued by the patient on his return home. Namely, it is important toestablish the care system for stroke patient in the community following hospital discharge.The ten-year strategy to make up the framework of Tokushima prefecture in 21 century“Shin Chouki Keikaku” was established in 1997. It was designed to improve the health,welfare and medical service systems include the rehabilitation system in community.