『保健医療科学』 2022 第71巻 第5号 p.397-407（2022年12月）
特集：健康日本21（第二次）最終評価―都道府県等健康増進計画のためのメッセージ― ＜解説＞
健康日本 21(第二次)最終評価の方法
―目標に対する実績値の評価法を中心に―
横山徹爾
国立保健医療科学院生涯健康研究部
Methods for the final evaluation of Health Japan 21 (the second term): Focusing on the method of evaluating health indices against targets
YOKOYAMA Tetsuji
Department of Health Promotion, National Institute of Public Health
抄録
「健康日本21(第二次)」の最終評価は，(1)目標に対する実績値の評価，(2)諸活動の成果の評価， (3)21世紀の健康づくり運動全体としての評価と次期国民健康づくり運動プランに向けての課題の整理，の3点について行われた. 本稿では都道府県等で健康増進計画の評価を行う際の参考となるよう に，(1)の方法を中心に解説する.
「健康日本21(第二次)」では基本的な5つの方向性に基づいた具体的な「目標項目」が53個ある. 各目標項目について具体的な「指標」が設定され(1つの目標項目に性・年齢別など複数の指標が設 定されることもある)，目標値に向けた指標の実績値や取組の評価を行い，その際，指標の値の動きや特徴的な取組について，図表等のより“見える化・魅せる化”の工夫をした. また，信頼区間の算出や， 統計学的検定が可能なものは検定を行い，必要に応じて年齢調整も行った. 目標値に対する指標の実績値の評価は，A目標値に達した，B現時点で目標値に達していないが，改善傾向にある(このうち，設定した目標年度までに目標到達が危ぶまれるものを「B*」)，C変わらない，D悪化している，E評価困難に区分した. また，個別指標だけでなく目標項目としての総合評価も同様にA ~ Eに区分した. 評価分析結果は目標項目ごとの「評価シート 様式 1 」に，目標値に対する指標の推移，データの出典と算出方法等，分析結果(調査分析上の課題を含む)，指標の評価と目標項目の総合評価を整理した. そのうえで，「評価シート 様式 2 」で，1目標項目の評価状況のまとめ，2関連する取組の整理，3各目標項目の評価に係る分析及び領域全体としての評価，4今後の課題，5新型コロナウイルス感染症の影響を踏まえた今後の課題について，詳細な評価分析結果を記載した.
さらに，(2)諸活動の成果の評価では国，地方公共団体，企業・団体等の取組状況の整理・評価を行い，(3)では各領域での(1)(2)も踏まえて，健康日本21(第二次)の総合的な評価を行うとともに，健康 日本21から続く大きな流れの中で我が国の健康づくり運動を評価し，次期国民健康づくり運動プランに向けての課題を整理した.
これらの“見える化”や年齢調整・検定などについて，同様の分析が可能なツールのいくつかを国立保健医療科学院のWEBサイトで提供し，研修でも扱っているので，都道府県等で健康増進計画の評価を行う際には，必要に応じて参考にしていただきたい.
キーワード : 健康日本21(第二次)，健康増進計画，評価，PDCAサイクル，見える化
Abstract
The final evaluation of “Health Japan 21 (the second term)” was carried out in 3 stages: 1) evaluation of the target items against the target values; 2) evaluation of the results of various activities; and, 3) evaluation of the health promotion movement as a whole in the 21st century, and clarification of the issues that exist for formulating the next National Health Promotion Plan. This paper primarily explains the methods for stage 1), so that it can be used as a reference when evaluating the health promotion plans of local governments.
“Health Japan 21 (the second term)” has 53 specific “target items,” based on five basic directions. One or more specific “indicator(s)” are set for each target item, and the actual values of the indicators against the target values, as well as related efforts are evaluated. To better understand the trends of the indicators by segment, the data were presented in a visual and attractive manner using charts and figures. In addition, confidence intervals were calculated for the values of indicators, a statistical test was performed, and adjustments for age were made if necessary and possible. By comparing the actual value of each indicator against the target value, an evaluation was made by classification into the following categories: A) achieved the target value, B) improved, C) unchanged, D) became worse, or E) difficult to evaluate. In addition to the individual indicators, the overall evaluation of each target item was similarly classified into A to E. The results of the evaluation and analysis for each target item were summarized in the “Evaluation Sheet - Form 1,” which included annual trends in the indicators against target values, data sources and calculation methods, analysis results (including issues regarding the survey), and the evaluations of the individual indicator(s) and target items. In the “Evaluation Sheet - Form 2,” the results of the evaluations were reported in more detail, consisting of a summary of the evaluation status of the target items, the organization of related efforts, analysis related to the evaluation of each target item, future issues, and the impact of the spread of the COVID-19 infection. Furthermore, in stage 2), the efforts of the national government, local governments, companies, and organizations were organized and evaluated. In stage 3), in addition to the evaluation of Health Japan 21 (the second term), the major flow of movement of Japanʼs health promotion, continuing from Health Japan 21 was comprehensively evaluated, and the issues for the next National Health Promotion Plan were sorted out.
For convenience in evaluating the health promotion plans in local governments, PC tools that enable the same data analysis, such as age-adjustment, statistical tests, figures, and charts, that are used for the evaluation of “Health Japan 21 (the second term)” are provided on the website of National Institute of Public Health, and are also used in the training programs. When evaluating the local health promotion plans in prefectures and municipalities, it is advisable to refer to them, as necessary.
keywords : Health Japan 21 (the second term), health promotion plan, evaluation, PDCA cycle, visualization
