The International HPH stands for the “International Network of Health Promoting Hospitals and Health Services”. It is made up of hospitals and clinics contributing to health promotion of local communities. Called for by the World Health Organization, 897 institutions (as of August 2012) are now part of the network.
All of the nine HPH member institutions in Japan are affiliates of Min-Iren (as of December 2012.) Dr. Hanne T?nnesen, the CEO of the HPH Secretariat (Professor, Lund University, Skaane University Hospital, Sweden) said in her message, “Min-Iren’s work, with their kyodososhiki, the local supporter group, is a great example of the HPH activity.”
So, what is the HPH? Set below is the interview with Dr. Funakoshi Mitsuhiko, Chair of the HPH Promotion Committee of Chidoribashi Hospital in Fukuoka City, which has become the first HPH in Japan. Dr. Funakoshi also serves as the Vice-Chair of Min-Iren’s Disease Prevention and Health Promotion Commission.

Changing roles of hospitals with “structural change in diseases”
What is the HPH?

Question: What kinds of medical institutions are defined as the HPH?
Funakoshi: They are the hospitals actively working in local communities to promote health among patients and residents. In Min-Iren’s terms, they are “Creating health involving the entire community.”
It was the Ottawa Charter of 1986 adopted by the WHO that triggered the birth of the International HPH Network. The Charter upheld the concept of “health promotion” and defined it as a “process that contributes to ‘enabling people to increase control over, and to improve their health'”. The international network was launched in 1990 in order to develop and increase hospitals world-wide that would undertake the health promotion activities at a local level.
Chidoribashi Hospital, taking the opportunity of the major renovation of its facilities, conducted an in-depth discussion over “what kind of health care should be provided to people in the local community.” In this process, we focused our attention on the health promotion, and joined the international network in 2008.
The largest number of affiliates in Asia is found in Taiwan, province of China. Other affiliates are also in Singapore, Thailand and Republic of Korea. Not only hospitals but also clinics can join the network.

We should not just wait for patients at clinics

Q: What was the background of the WHO upholding health promotion?
Funakoshi: Globally, we can observe the structural change in diseases and rapid aging of population. Until the first half of the 20th century, our greatest challenge was to cure infectious diseases, including tuberculosis. In the post-WWII world, most infections were overcome, and the focus of our efforts shifted to chronic disorders such as high blood pressure and diabetes, which would cause cerebral strokes and cardiac arrests, and also to cancers. More and more people now live with different illnesses and disabilities, which has changed the roles expected of medical institutions.
The central role of hospitals is, of course, to treat patients. But rather than staying inside the examination room and wait for them to come, hospitals are now called for to actively support the patients to live a healthy life after they leave the hospital. This is the major reason why health promotion and HPH were proposed.

Three pillars of the HPH activities

Q: What are the main activities of the HPH?
Funakoshi: Focusing on the importance of changing the environment for humans to live a healthy life, we are carrying out our activities in three major fields.
First, we give support to our patients in order for them to live a healthy life on their own initiative. For example, we are helping all the inpatients to quit smoking. If a patient overcomes the illness through hospitalization and also stops smoking, it’s like a kill-two-birds-with-one-stone solution. For smoking is known to be harmful to health in many aspects. Apart from cancer, it can cause arterial sclerosis or respiratory diseases.
A report from one research says that quitting smoking for even a short period of time prior to surgery would lower the possibility of causing postoperative complications such as bacterial infection (Figure 1). Support for non-drinking or exercise is also effective in suppressing the incidence of postoperative complications and shortening the time for recovery (Figure 1). This means the combination of surgery and heath promotion could yield a very positive result. Non-smoking support program for outpatients is also part of the health promotion activities.
Activities in local communities are the second major pillar of the HPH. Private companies are encouraged to stop the practice of overwork and create a worker-friendly workplace. In schools, education should not only cover academic subjects, but also provide information on promoting health. And we at medical institutions should work together with these companies and schools to conduct health examinations and health consultation for building a healthy community.
Responding to people’s wish to “stay healthy and live in the community without anxiety” in partnership with local people, is also part of the HPH activities. The activities carried out by Min-Iren and kyodososhiki, such as holding health group meetings, walking tours, building circles of friends and checking on our streets and cityscape, also form good part of the HPH activities. These practices have drawn attention of the International HPH Network, described as the “great example of the HPH activity”.
The third pillar is to create an environment in hospitals/clinics where workers themselves can work and stay healthy. Introducing a device or technique to help reduce burden on their physical health or tackling with their mental health issues also form important part of the HPH activities.

Having another look at our role in local communities
In cooperation with condominium management societies

Q: What kind of issues has Chidoribashi Hospital worked on so far?
Funakoshi: As one of the requirements of joining the International HPH Network was to designate a person in charge of promoting the HPH activities in the institution, we launched the HPH Promotion Committee.
The Network also has the “Self-Evaluation Manual” for each hospital to check on its practices. In accordance with one of the items listed in the manual, which says, “HPH should be incorporated in the ideal/principle of the hospital”, we revised it. In order to help our patients know and share our ideal/principle, it is displayed inside the hospital building.
In our local community, in cooperation with a condominium management society of a large-scale apartment complex near the hospital and residents’ association of the community, we have carried out inquiry surveys, health-checks, health consultations, door-to-door safety confirmation of residents, etc. There are many elderly people living in this condominium, and 4 cases of unattended deaths have been recorded in the past. The president of the management society, sharing his desire to “stay healthy and live long, and to prevent unattended deaths”, is actively working together with our hospital.

Reducing hospital staff’s backache

Funakoshi: Regarding the improvement of workplaces for the sake of hospital staff’s health, we are making effort to implement the health promotion in each workplace. Among the nursing staff in hospital wards, lifting of inpatient’s body was a major cause for backache. In partnership with Shiga University of Medical Science, we started in 2011 a “No-Lifting” scheme. Making use of a “sliding sheet”, we now slide patients’ bodies onto the sheet to move from one place to another, rather than lifting them. As a result, the backache problem among nursing staff is reportedly reduced in 3 hospital wards.
We also attend the “International Conference” sponsored by the International HPH Network. The purpose of the conference is to share the experiences, practices and researches in different parts of the world. It was held in the U.K. in 2010, in Finland in 2011 and in Taiwan, province of China in 2012.
At the conference in Taiwan, we learned that in one hospital, there was a walking course marked and patients were able to conduct exercises even inside the hospital. In the U.K., we received a question on the health system in Japan. The participants in the conference seemed surprised to know that the financial burden of medical cost on patients in Japan, a developed country, was so heavy.

Need of creating a network to defend people’s right to health

Q: What is your aspiration for the future?
Funakoshi: Personally, joining the International Network greatly broadened my perspective over where I work and live. In learning from the examples in many institutions in different countries and also from the world standard of health promoting activities, I have realized that a lot of things can be done in our sphere and that there are unlimited amount of tasks to be tackled, if we have a will.
In the European Union, there is an attempt to fill the health gap caused by poverty. In the community near Chidoribashi Hospital (Chiyo district), there are many low-income households, where the take-up rate of welfare benefit well exceeds 10 %. The rate of dependence on smoking and drinking is high among poor families, and the incidence of domestic violence, child abuse and teenage pregnancy is also high. We need to establish a network linking community people, schools, private corporations and hospitals, to promote health in the community. As our hospital has been built specifically in this deprived area, we will make maximum use of free or low-charge medical care scheme or other social assistance programs to support the financially-troubled people.
We also want to put more emphasis on quantifying the achievements of the health promotion activities. In a non-smoking program, it is not sufficient just to tell patients to stop smoking. We need to really motivate the patients to produce good results.
There was a study in Denmark on supporting emergency patients who were heavy smokers and drinkers to stop smoking and drinking. When an ordinary nurse was in charge of supporting them, only 47 out of 100 patients followed the advice. But when a well-trained nurse was in charge, 97 out of 100 patients were successful. We in Chidoribashi will also discuss how to effectively promote health, and develop the “PDCA Cycle”(*) proposed by the International HPH Network.
We need more HPH member hospitals in Japan and deepen exchanges among them. Hospitals not affiliated to Min-Iren should also join the HPH, while there are many Min-Iren institutions still not part of the network. We want to increase members in Fukuoka City and also in China and Korea.

Working together with kyodososhiki

Funakoshi: In the General Assembly Meeting last year, national Min-Iren adopted the action program, which included the effort to defend people’s “health right”. Working together with kyodososhiki members, we want to strengthen our efforts to build a community where people in the community are closely linked with each other and they can “stay and live healthy without anxiety”.

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Note (*) The Cycle to plan → do → check → act.

HPH designated hospitals in Japan Kin-Ikyo Sapporo Hospital (Hokkaido) Kensei Hospital (Aomori) Misato Kenwa Hospital (Saitama) Tokyo Kensei Hospital Oizumi Co-op Hospital (Tokyo) Kamiina Co-op Hospital (Nagano) Hiroshima Kyoritsu Hospital Chidoribashi Hospital (Fukuoka) Tatara Rehabilitation Hospital (Fukuoka)