『保健医療科学』 2022 第71巻 第5号 p.416-431（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― ＜総説＞
自治体の健康増進計画に関する国立保健医療科学院の研修
石川みどり，横山徹爾
国立保健医療科学院生涯健康研究部
Training at the National Institute of Public Health for health promotion plans for local governments
ISHIKAWA Midori, YOKOYAMA Tetsuji
Department of Health Promotion, National Institute of Public Health
抄録
本稿の目的は，1.健康日本21(第二次)における自治体の健康増進計画に関する国立保健医療科学院(以下，科学院)の研修について，平成25年度から令和4年度までの(1)研修のテーマの変遷ならびに，(2)研修を進めた方法をふりかえること，2.科学院研修を受講した自治体の健康増進計画の推進への効果を，受講者数が多い・少ない自治体群それぞれの状況を，厚生労働省が健康日本21(第二次) 最終評価の際に行った，自治体の取組状況の評価のための調査，国民健康・栄養調査の公表結果を活 用して比較分析すること，3.科学院研修の課題と今後の展開について考察することとした.
健康日本21研修の主テーマは，優先度の高い健康課題に関連する食事・食生活の課題解決に向けた 対策の企画と体制づくりであった. 研修を進めた方法は，(1)行政栄養士業務指針において，成果のみえる栄養施策に向けた要素を示した. (2)行政栄養士業務指針を実践するための資料集を作成した. (3) 既存データ健康増進計画等のモニタリング・評価・見直しのために各種資料・関連ツールを作成し，活用して統計学的分析を行った. (4)科学院長期研修(研究課程)において自治体が上記分析を進めるための支援を行った. (5)栄養・食生活課題改善のための対策についてワークシートを用いて計画，調整を行った. さらに，(6)科学院研修内容を深め，普及のために，日本公衆衛生協会，日本栄養士会等， 他組織と協力した事業を行った.
自治体の健康増進計画の状況への効果については，受講者数が多い群は，少ない群に比べ，地域間の格差を確認した市区町村，在勤者への施策を実施した市区町村の割合が有意に多かった. また，国民健康・栄養調査の分析の結果，男性のBMIは，平成24年に両群の差はなかったが，平成28年に，受講者数が多い群が有意に低かった. 女性の歩数は，平成24年には両群の差はなかったが，平成28年に，受講者数が多い群が有意に多かった. 一方，女性の食塩摂取量は，両群ともに減少したものの，平成28年に，受講者数が多い群で有意に多かった. 野菜摂取量，習慣的な喫煙者の割合は，男女とも両群間の各年の値と変化に有意差はなかった.
いくつかの限界はあるものの，科学院研修の長期的な評価のために，既存調査の公表データを用いて評価できる可能性が示唆された. その為には，都道府県・市区町村の健康増進計画の各種指標の状況が，策定時，中間・最終評価時に調査され，適切なデータが継続的に公表される必要があるだろう. また，今回は， 2つの短期研修における長期的評価の試みを行ったが，科学院研修全体における標準的な長期的評価の方法の検討が必要であろう.
キーワード : 自治体，健康増進計画，国立保健医療科学院，研修，健康日本21(第二次)
Abstract
The purpose and methods of this paper are as follows: 1) First, the training courses at the National Institute of Public Health (NIPH) related to Health Japan 21 (the second term), which ran from 2013 to 2022, were reviewed. The review focused on (1) changes in the themes and issues of the training programs, (2) progress in the training methods and contents, and (3) project-related collaborations with other organizations as well as dissemination; 2) Next, the outcomes for the local governments that participated in the NIPH training were identified. This focused on comparisons of (1) progress in health promotion plans, between the group of local governments with a large number of participants, and the group with a small number of participants, and (2) certain indicators for Health Japan 21 (the second term), between the group of local governments with a large number of participants, and the group with a small number of participants, using published data from the National Health and Nutrition Survey; and, 3) Finally, future training at the NIPH was discussed.
The results were as follows:
1) The main theme for the Health Japan 21 Training course was “the planning of countermeasures and the creation of a system for resolving nutrition and dietary habits related to high-priority health issues;”
2) The training methods were conducted as follows: (1) The elements for nutritional measures to produce achievements in administrative dietician guidelines were shown, and (2) materials were presented for putting the guidelines into practice; (3) For the monitoring, evaluation, and review of health promotion plans, materials for understanding various survey results and tools for statistical analysis were created, and health issues were confirmed using them; (4) To proceed with the above analysis in local governments, long-term training at the NIPH was provided; (5) Measures were planned and coordinated using worksheets to improve nutrition and eating habits related to health issues; and, (6) In cooperation with other organizations (such as the Japan Public Health Association and the Japan Dietetic Association), programs were carried out to deepen and disseminate the training content of the NIPH.
3) The training courses had the following effects on the health promotion plans of local governments: (1) the group of local governments with a large number of participants identified disparities between areas and conducted a health promotion plan for working persons; and, (2) With reference to the effects of the indicators of Health Japan 21 (the second term), no difference was seen in the average BMI between the two groups in 2012. However, it was significantly lower in the group of local government with a larger number of participants in 2016. In addition, while no difference was seen in the average number of steps between the two groups in 2012, it was significantly higher in the group of local governments with a larger number of participants in 2016.
Although there are some limitations, it is thought that it is possible to evaluate the long-term effects of training at the NIPH using published data from existing surveys. For this purpose, it will be necessary to investigate the status of various indicators of health promotion plans of prefectures and municipalities at the time of formulation and interim and final evaluation, and to publish appropriate data continuously.
In addition, in this investigation, we attempted a long-term evaluation of two short-term training courses. However, it may be necessary to consider a standard long-term evaluation method for the entire range of training courses at the NIPH.
keywords : Local government, health promotion plan, National Institute of Public Health (NIPH), training, Health Japan 21 (the second term)
