Commentary to “the Review for Promoting Evidence-based Healthcare and Welfare Policies for People with Disabilities”: Why is the “Definition of Health for a Care-focused Mature Society” we proposed needed in Japan?

"Drastic reforms in healthcare" are required in Japan. We need to ensure sustainable management of the system against increased medical costs and physician’s burden etc. Universal Health Coverage (UHC) in Japan has been highly evaluated internationally because it provides medical treatment at a relatively low cost and contributed to the longevity of the people [1]. On the other hand, since 2008, Japan has become a country in which 'population reduction and declining birthrate and aging' become simultaneous. And, the disease structure has changed significantly in developed countries. In the analysis of " Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2010" by the World Health Organization (WHO) and 7 institutions of Japan, the United States and the United Kingdom for the past 20 years (1990 to 2010), the following evidence is shown: "The disease burden of the world is , In the past premature death of children under 5 years old was the biggest factor, but now, The majority of factors are due to musculoskeletal disorders, psychiatric disorders, injuries etc., and such burden is increasing as people live longer [1]. "Healthcare 2035" [1] has been proposed to further develop healthcare and lead the world as a maturing nation. The new vision to be achieved by "Healthcare 2035" is the following: 1) Lean Healthcare; Increase the value of health care, 2) Life Design; Supporting subjective choice in society, 3) Global Health Leader; Japan will lead the world health care. In recent years, comprehensive healthcare measures against lifestyle diseases such as cancer have been applied, and the average life expectancy of Japanese people has been extended to "a level that is even regarded as a goal as a human being." In Japan where access to medical care is guaranteed by the UHC system, it can be said that the future health policy should focus on "a Care-focused Mature Society" that can aim for mature death by preventing premature death. To contribute to the new vision of "Healthcare 2035," through current situation analyses and policy review, we proposed the following two policy recommendations [1,2]: 1) "Disability Registry” construction as a prognosis/outcome indicator in medical database, and 2) "Definition of Health for a Care-focused Mature Society" : in a care-focused mature society such as Japan, the notion that "despite ‘social, physical, and mental challenges’ such as the disabilities acquired from trauma or disease, quality of life can be maintained and that one ‘is able to’ self-manage and aim for "self-actualization" should be added to the future "definition of health."