Long working hours and risk of 50 health conditions and mortality outcomes: a multicohort study in four European countries

Systematic review and meta-analysis of the association between long working hours and hypertension risk

BACKGROUND

Hypertension, a major public health problem worldwide, has been linked to lifestyle factors and work conditions, with conflicting evidence on the association between long work hours and risk of hypertension.

METHODS

We conducted a systematic review and meta-analysis of observational studies to investigate the relationship between working hours and hypertension or blood pressure, assessed the risk of bias and performed subgroup analyses. The protocol was registered with the International Prospective Register of Systematic Reviews.

RESULTS

The pooled OR for the association between long working hours and risk of hypertension was 1.09 (95% CI: 0.88 to 1.35) in the 15 studies that used hypertension as the outcome. In the three studies that used blood pressure as the outcome, diastolic blood pressure was higher among those with long working hours compared with those with non-long working hours (1.24 mm Hg, 95% CI: 0.19 to 2.29). In subgroup analysis, the pooled OR for the association between long working hours and risk of hypertension was 1.28 (95% CI: 1.14 to 1.44) and 1.00 (95% CI: 0.64 to 1.56) in women and men, respectively.

CONCLUSIONS

Although this study could not clearly confirm the relationship between long working hours and hypertension, the subgroup analysis suggests that long working hours may be associated with hypertension, particularly among women. More reliable research is needed to establish causality.

PROSPERO REGISTRATION NUMBER

CRD42023406961.

Long working hours, work-life imbalance, and poor mental health: a cross-sectional mediation analysis based on the sixth Korean Working Conditions Survey, 2020-2021

Background There has been growing concern about the negative mental health impact of long working hours and overwork. Our study examined how work-life imbalance (WLI) could be a mediator between working hours and poor mental well-being.Methods We included 34,968 individuals from a nationwide cross-sectional survey in Korea. Self-reported working hours per week was collected, and mental health was assessed by the WHO-5 Well-Being Index. Counterfactual-based mediation models were employed to disentangle the total effects into a direct effect (work hour - poor mental health) and an indirect effect (work hour - WLI - poor mental health).Results Out of 34,968 participants, 52.6% worked 35-40 h/week, 20.0% worked 41-48 h/week, 11.7% worked 49-54 h/week, and 15.6% worked ≥55 h/week. The odds ratios (ORs) of the total impact of working hours on poor mental health were 1.08 (95% CI: 1.01-1.16) for 41-48 h/week, 1.28 (1.17-1.39) for 49-54 h/week, and 1.60 (1.48-1.74) for ≥55 h/week in comparison to 35-40 h/week. The ORs of the indirect effects were 1.04 (1.03-1.05) for 41-48 h/week, 1.08 (1.07-1.09) for 49-54 h/week, and 1.14 (1.12-1.16) for ≥55 h/week, accounting for 51%, 31%, and 28% of the total effects.Conclusion: Our findings suggest that WLI can partially mediate the association of long working hours with mental health deterioration. Policy efforts are required to mitigate the adverse mental health effects of overwork.

Global-, regional- and country-level estimates of the work-related burden of diseases and accidents in 2019

OBJECTIVE

This study provides the global-, regional- and country-level estimates on the work-related burden of diseases and accidents for 2019, including deaths, disability adjusted life years (DALY) and economic losses.

METHODS

Data on occupational illnesses and injuries from international organizations, institutions, and public websites were used. Risk ratios (RR) and population attributable fractions (PAF) for the risk factor-outcome pairs were derived from the literature. Estimated mortality and DALY for a group of seven major diseases covering 120 risk-outcome pairs attributable to work were calculated for 181 countries.

RESULTS

Globally, 2.9 million deaths were attributed to work, with 2.58 million deaths due to work-related diseases and 0.32 million related to occupational injuries. Globally, work-related diseases with a long latency period are increasing, while the number of occupational injuries has decreased. Work-related circulatory diseases were the major cause of 912 000 deaths globally, followed by 843 000 work-related malignant neoplasms. In high-income, American, Eastern European and Western Pacific World Health Organization (WHO) regions, however, work-related malignant neoplasms comprised the biggest disease group. DALY attributable to work were estimated to be 180 million in 2019, with an associated economic loss of 5.8% of global GDP. New estimates of psychosocial factors increased the global loss.

CONCLUSIONS

The burden of work-related diseases and injuries increased by 26% from 2.3 million annual deaths in 2014 to 2.9 million in 2019. The DALY attributable to work have also substantially increased from 123 million in 2014 to 180 million in 2019 (47% increase). We found large regional and country variations.

Association between long working hours and engagement in preventive healthcare services in Korean workers: Findings from the Korean National Health and Nutrition Examination Survey

BACKGROUND

Engagement in preventive healthcare services is crucial for preventing diseases. We explored how working hours are associated with engagement in preventive healthcare services, with a focus on gender differences.

METHODS

This cross-sectional study used data from the 2007-2012 Korean National Health and Nutrition Examination Survey. The dependent variable was engagement in each of the five preventive healthcare services (health check-ups, influenza vaccination, and stomach, breast, and cervical cancer screenings). We estimated the prevalence ratios (PRs) and 95% confidence intervals (CIs) using robust Poisson regression.

RESULTS

The study analyzed 19,819 workers (9119 women). The adjusted PRs (95% CI) of the association between working ≥55 h per week and engagement in preventive healthcare services among men were 0.95 (0.90-1.00) for health check-ups, 0.86 (0.77-0.96) for influenza vaccination, and 0.95 (0.87-1.03) for stomach cancer screening compared to working 35-40 h per week. Among women, the adjusted PRs (95% CI) of the association between working ≥55 h per week and engagement in preventive healthcare services were 0.84 (0.78-0.91) for health check-ups, 0.82 (0.73-0.92) for influenza vaccination, and 0.88 (0.80-0.97) for stomach, 0.85 (0.78-0.94) for breast, and 0.82 (0.74-0.91) for cervical cancer screenings.

CONCLUSION

Long working hours were negatively associated with engagement in preventive healthcare services, and the association was pronounced among female workers. Efforts to promote preventive healthcare participation among individuals with long working hours are necessary, and it is essential to consider the unique vulnerabilities of women when developing such policies.

Prospective effects of work-time control on overtime, work-life interference and exhaustion in female and male knowledge workers

AIMS

Employee-based flexible working hours are increasing, particularly among knowledge workers. Research indicates that women and men use work-time control (WTC; control over time off and daily hours) differently: while men work longer paid hours, women use WTC to counteract work-life interference. In a knowledge-worker sample, we examined associations between WTC and overtime, work-life interference and exhaustion and tested whether gender moderates the mediating role of overtime.

METHODS

The sample contained 2248 Swedish knowledge workers. Employing hierarchical regression modelling, we examined effects of control over time off/daily hours on subsequent overtime hours, work-life interference and exhaustion in general and in gender-stratified samples. Using conditional process analysis, we tested moderated mediation models.

RESULTS

Control over time off was related to less work-life interference (βmen= -0.117; 95% confidence interval (CI): -0.237 to 0.003; βwomen= -0.253; 95% CI: -0.386 to -0.120) and lower exhaustion (βmen= -0.199; 95% CI: -0.347 to -0.051; βwomen= -0.271; 95% CI: -0.443 to -0.100). For control over daily hours, estimates were close to zero. While men worked more overtime (42 min/week), we could not confirm gender moderating the indirect effect of control over time off/daily hours on work-life interference/exhaustion via overtime. Independent of gender, effects of control over time off on work-life interference were partly explained by working fewer overtime hours.

CONCLUSIONS

Control over time off was related to lower exhaustion and better work-life balance (in particular for women). We found no evidence for men's work-life interference increasing with higher WTC owing to working more overtime. Knowledge workers' control over time off may help prevent work-life interference and burnout.

Employment Factors Associated With Long Working Hours in France

The objectives of the study were to explore the employment factors associated with long working hours, known as a risk factor for various health outcomes. The study relied on the national representative data of the 2013 French working conditions survey and a study sample of 23,378 full-time employees. Long working hours were defined by the threshold of 48 hours a week following the European Working Time Directive. The prevalence of long working hours was higher among men (13.5%) than among women (8.5%). Employees of the private sector, with permanent work contract, in small companies, and men in the services had a higher prevalence of exposure. This prevalence increased with educational and occupational levels. Our findings may help decision-makers to define preventive strategies. More research is needed to improve our knowledge of the employment factors associated with long working hours, as there may be strong differences between countries.

Sex difference in cardiac performance in individuals with irregular shift work

Background: sex differences existed in animal behavioral adaption and activity rhythms when exposed to chronic disruption of the circadian rhythm. Whether these differences extend to cardiac performance has not been fully investigated by cardiac imaging technology.

Methods

One hundred and thirty patients enrolled in this study. Patients were divided into the day shift (DS) group and the irregular shift (IRS) group based on whether involved in the night shift and the frequency of the night shift. Comparisons of clinical data and cardiac imaging parameters were performed to identify the sex difference in cardiac function in the participants with day shift work or irregular shifts.

Results

The absolute value of GLS was significantly lower in male IRS group than in male DS group. In females, no significant difference was tested in left ventricular function between the two groups. In male participants, Weekly work hours (WWH) was positively correlated with HR (r = 0.51, p = 0.02) and QTc duration (r = 0.68, p < 0.00), and weakly negatively correlated with the GLS (r = -0.38, p = 0.05). Amongst patients, there was a 2.67-fold higher relative risk (RR) for impaired GLS in males than in females, with a 95 % confidence interval (CI) of 1.20-5.61. Moreover, there was an increased risk in the male IRS group compared to the female IRS group to develop impaired GLS (RR:3.14, 95 % CI 1.20-7.84).

Conclusions

The present study suggests that chronic circadian disruption brings cardiac dysfunction in people with night-shift work. Gender differences exist in the impact of circadian rhythmicity on cardiac function and may help to guide the work schedule and breaks in shift workers and bring forward prevention strategies in response to chronic circadian disruption.

Causal effect of shifting from precarious to standard employment on all-cause mortality in Sweden: an emulation of a target trial

BACKGROUND

We aimed at estimating the causal effect of switching from precarious to standard employment on the 6-year and 12-year risk of all-cause mortality among workers aged 20-55 years in Sweden.

METHODS

We emulated a series of 12 target trials starting every year between 2005 and 2016 using Swedish register data (n=251 273). We classified precariously employed individuals using a multidimensional approach at baseline as (1) remaining in precarious employment (PE) (73.8%) and (2) shifting to standard employment (26.2%). All-cause mortality was measured from 2006 to 2017. We pooled data for all 12 emulated trials and used covariate-adjusted pooled logistic regression to estimate intention-to-treat and per-protocol effects via risk ratios (RRs) and standardised risk curves (the parametric g-formula).

RESULTS

Shifting from precarious to standard employment decreases the 12-year risk of death by 20% on the relative scale (RR: 0.82, 95% CI: 0.73; 0.93), regardless of what happens after the initial shift. However, we estimated a 12-year risk reduction of 30% on the relative scale for workers shifting from precarious to standard employment and staying within this employment category for the full 12 years (RR: 0.71, 95% CI: 0.54; 0.95).

CONCLUSIONS

This study finds that shifting from low to higher-quality employment conditions (ie, stable employment, sufficient income levels and high coverage by collective agreements) decreases the risk of death. Remaining in PE increases the risk of premature mortality. Our results emphasise the necessity of ensuring decent work for the entire working population to accomplish the 2030 Agenda for Sustainable Development.

Long working hours and all-cause mortality in China: A 26-year follow-up study

OBJECTIVES

The relationship between long working hours and the risk of mortality has been debated in various countries. This study aimed to investigate the association between long working hours and all-cause mortality in a large population-based cohort in China.

METHODS

This retrospective cohort study (N=10 269) used a large, nationally representative data set [the China Health and Nutrition Surveys (CHNS)] from 1989 to 2015. Long working hours (≥55 hours per week) were compared to standard working hours (35-40 hours per week). The outcome measure was all-cause mortality. Hazard ratio (HR) for all-cause mortality was calculated from Cox proportional hazards regression models, with stratified analyses to assess differences in mortality risk among subgroups.

RESULTS

Among the participants, 411 deaths (3.52 per 1000 person-years) occurred during a median follow-up of 11.0 (range 4.0-18.0) years. After adjusting for covariates, long working hours were associated with a significantly increased risk of all-cause mortality [HR 1.49, 95% confidence intervals (CI) 1.02-2.18]. Stratified analyses revealed that this association was present only among men (HR 1.78, 95% CI 1.15-2.75) and smoking participants (HR 1.57, 95% CI 1.05-2.57).

CONCLUSION

This study provides evidence of an association between long working hours and all-cause mortality, which is specifically observed among men and smokers. Targeted interventions should be implemented to reduce excessive working hours and identify individuals at elevated risk, with support from labor organizations, policymakers, and employers.

Hidden and Understaffed: Exploring Canadian Medical Laboratory Technologists' Pandemic Stressors and Lessons Learned

(1) Background: The COVID-19 pandemic has highlighted the critical role of medical laboratory technologists (MLTs) in the healthcare system. Little is known about the challenges MLTs faced in keeping up with the unprecedented demands posed by the pandemic, which contributed to the notable staff shortage in the profession. This study aims to identify and understand the stressors of MLTs in Canada and the lessons learned through their lived experiences during the pandemic. (2) Methods: In this descriptive qualitative study, we conducted five semi-structured focus groups with MLTs working during the pandemic. The focus group sessions were audio-recorded and then transcribed verbatim. Thematic analysis was used to inductively code data and identify themes. (3) Results: A total of 27 MLTs across Canada participated in the study. Findings highlighted four key themes: (i) unexpected challenges navigating through the uncertainties of an ever-evolving pandemic; (ii) implications of staff shortage for the well-being of MLTs and quality of patient care; (iii) revealing the realities of the hidden, yet indispensable role of MLTs in predominantly non-patient-facing roles; and (iv) leveraging insights from the COVID-19 pandemic to enhance healthcare practices and preparedness. (4) Conclusion: The study provides in-depth insight into the experiences of MLTs across Canada during the pandemic. Based on our findings, we provide recommendations to enhance the sustainability of the laboratory workforce and ensure preparedness and resiliency among MLTs for future public health emergencies, as well as considerations as to combating the critical staff shortage.

The role of work-family conflict in the association between long working hours and workers' sleep disturbance and burnout: results from the sixth Korean Working Conditions Survey

BACKGROUND

The effect of long working hours on mental health has drawn great social attention in recent years.

AIMS

We investigated how work-family conflict mediates the associations between long working hours and sleep disturbance and burnout.

METHOD

We included 19 159 individuals from a nationally representative sample of workers in South Korea. We decomposed the total effect into a direct effect (long working hours → sleep disturbance or burnout) and an indirect effect (long working hours → work-family conflict → sleep disturbance or burnout). Logistic mediation models were used.

RESULTS

Long working hours were associated with increased risks of work-family conflict, sleep disturbance and burnout. The longer the working hours, the stronger the direct and indirect effects. The odds ratios of the direct effects of long working hours on sleep disturbance were 1.64 (95% CI 1.39-1.95) for 49-54 h/week and 1.66 (95% CI 1.37-2.01) for ≥55 h/week; those of the indirect effects were 1.16 (95% CI 1.12-1.21) for 49-54 h/week and 1.27 (95% CI 1.21-1.33) for ≥ 55 h/week. Similarly, odds ratios of the direct effects of long working hours on burnout were 1.18 (95% CI 1.05-1.33) for 49-54 h/week and 1.20 (95% CI 1.04-1.37) for ≥55 h/week; those of the indirect effects were 1.11 (95% CI 1.09-1.15) for 49-54 h/week and 1.20 (95% CI 1.16-1.24) for ≥55 h/week.

CONCLUSIONS

Our results suggest that work-family conflict mediates the associations between long working hours and sleep disturbance and burnout. Longitudinal studies should be followed to confirm the causal relationship.

Association between long working hours and physical inactivity in middle-aged and older adults: a Korean longitudinal study (2006-2020)

BACKGROUND

We investigated associations for long working hours in relation to physical inactivity and high-level physical activity among middle-aged and older adults.

METHODS

Our study included 5402 participants and 21 595 observations from the Korean Longitudinal Study of Ageing (2006-2020). Logistic mixed models were used to estimate ORs and 95% CIs. Physical inactivity was defined as not engaging in any type of physical activity, while high-level physical activity was defined as engaging in ≥150 min per week of physical activity.

RESULTS

Working >40 hours weekly was positively related to physical inactivity (OR (95% CI) 1.48 (1.35 to 1.61)) and negatively related to high-level physical activity (0.72 (95% CI 0.65 to 0.79)). Exposure to long working hours consecutively for ≥3 waves was associated with the highest OR for physical inactivity (1.62 (95% CI 1.42 to 1.85)) and the lowest OR for high-level physical activity (0.71 (95% CI 0.62 to 0.82)). Furthermore, compared with persistent short working hours (≤40 hours → ≤40 hours), long working hours in a previous wave (>40 hours → ≤40 hours) were associated with a higher OR of physical inactivity (1.28 (95% CI 1.11 to 1.49)). Exposure to an increase in working hours (≤40 hours → >40 hours) was also associated with a higher OR of physical inactivity (1.53 (95% CI 1.29 to 1.82)).

CONCLUSION

We found that having working long hours was associated with a higher risk of physical inactivity and a lower likelihood of high-level physical activity. Moreover, accumulation of long working hours was associated with a higher risk of physical inactivity.

Fatal work accidents in Ecuador from 2014 to 2020: How the age of the deceased worker relates to the accidents' temporal and geographical characteristics

This article analyzes the relationship between the age of male workers deceased in work accidents and temporal (year, month, day of the week, working shifts), geographic (provinces), and economic sector characteristics in which the accidents occurred in Ecuador between 2014 and 2020. Available data on fatal accidents from the Ecuadorian Social Security Institute (IESS) were collected. The results, which report both frequencies and proportions (rates), indicate that fatal accidents have decreased in the period, although the average age of deceased workers has increased. No significant differences were found regarding the month, day of the week, and work shift, nor in the frequency of accidents or the age of the deceased workers. However, differences were found in terms of geographical areas and sectors of economic activity. This study contributes to the literature as it is the first to analyze the temporal and geographical characteristics of fatal accidents about the age of the deceased worker.

Do changes in working hours increase stress in Japanese white-collar workers?

Introduction

High stress at work is associated with negative health outcomes for workers, making stress prevention a critical challenge. Overtime work is an influential stress factor. This study, therefore, aimed to longitudinally evaluate how stress increased depending on changes in working hours among Japanese white-collar workers.

Methods

We targeted 3,874 participants who were full-time workers and were recognized as having low stress in a web-based cohort in 2018 (T1) and 2019 (T2). We performed univariate and multivariate logistic regression with the following variables: years of experience, years of education, medical background, income, and roommates.

Results

We observed a greater increase in stress among female who worked 41-50 h per week at T1 and more than 50 hours per week at T2, and those who worked more than 50 h per week at T1 and 35-40/41-50 h per week at T2, compared to those who worked 41-50 h per week both at T1 and T2, with odds ratios (ORs) and 95% confidence intervals (95% CI) of OR = 2.09, 95% CI (1.18, 3,70); OR =1.86, 95% CI (1.14, 3.03), respectively. However, no association between change in working hours and stress was found among male.

Discussion

These results show that reducing stress requires decreasing working hours as well as identifying factors that lead to high stress.

The multiple roles of life stress in metabolic disorders

The activation of stress-related neuroendocrine systems helps to maintain homeostasis, but excessive stress can damage body functions. We review current evidence from basic sciences and epidemiology linking stress to the development and progression of metabolic disorders throughout life. Findings from rodents demonstrate that stress can affect features of metabolic dysfunction, such as insulin resistance, glucose and lipid homeostasis, as well as ageing processes such as cellular senescence and telomere length shortening. In human studies, stressors in the home, workplace and neighbourhood are associated with accelerated ageing and metabolic and immune alterations, both directly and indirectly via behavioural risks. The likelihood of developing clinical conditions, such as diabetes mellitus and hepatic steatosis is increased in individuals with adverse childhood experiences or long-term (years) or severe stress at work or in private life. The increased risk of metabolic disorders is often associated with other stress-related conditions, such as mental health disorders, cardiovascular disease and increased susceptibility to infections. Equally, stress can worsen prognosis in metabolic diseases. As favourable modifications in stressors are associated with reductions in incidence of metabolic disorders, further investigation of the therapeutic value of targeting stress in personalized medicine is warranted.

Overtime work, job autonomy, and employees' subjective well-being: Evidence from China

Introduction

Chinese workers suffer more from overtime than in many countries. Excessive working hours can crowd out personal time and cause work-family imbalance, affecting workers' subjective well-being. Meanwhile, self-determination theory suggests that higher job autonomy may improve the subjective well-being of employees.

Methods

Data came from the 2018 China Labor-force Dynamics Survey (CLDS 2018). The analysis sample consisted of 4,007 respondents. Their mean age was 40.71 (SD = 11.68), and 52.8% were males. This study adopted four measures of subjective well-being: happiness, life satisfaction, health status, and depression. Confirmation factor analysis was employed to extract the job autonomy factor. Multiple linear regression methods were applied to examine the relationship between overtime, job autonomy, and subjective well-being.

Results

Overtime hours showed weak association with lower happiness (β = -0.002, p < 0.01), life satisfaction (β = -0.002, p < 0.01), and health status (β = -0.002, p < 0.001). Job autonomy was positively related to happiness (β = 0.093, p < 0.01), life satisfaction (β = 0.083, p < 0.01). There was a significant negative correlation between involuntary overtime and subjective well-being. Involuntary overtime might decrease the level of happiness (β = -0.187, p < 0.001), life satisfaction (β = -0.221, p < 0.001), and health status (β = -0.129, p < 0.05) and increase the depressive symptoms (β = 1.157, p < 0.05).

Conclusion

While overtime had a minimal negative effect on individual subjective well-being, involuntary overtime significantly enlarged it. Improving individual's job autonomy is beneficial for individual subjective well-being.

Atypical working hours are associated with tobacco, cannabis and alcohol use: longitudinal analyses from the CONSTANCES cohort

BACKGROUND

This study examined prospective associations between atypical working hours with subsequent tobacco, cannabis and alcohol use as well as sugar and fat consumption.

METHODS

In the French population-based CONSTANCES cohort, 47,288 men and 53,324 women currently employed included between 2012 and 2017 were annually followed for tobacco and cannabis use. Among them, 35,647 men and 39,767 women included between 2012 and 2016 were also followed for alcohol and sugar and fat consumption. Three indicators of atypical working hours were self-reported at baseline: working at night, weekend work and non-fixed working hours. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to atypical working hours at baseline while adjusting for sociodemographic factors, depression and baseline substance use when appropriate.

RESULTS

Working at night was associated with decreased smoking cessation and increased relapse in women [odds ratios (ORs) of 0.81 and 1.25], increased cannabis use in men [ORs from 1.46 to 1.54] and increased alcohol use [ORs from 1.12 to 1.14] in both men and women. Weekend work was associated with decreased smoking cessation in women [ORs from 0.89 to 0.90] and increased alcohol use in both men and women [ORs from 1.09 to 1.14]. Non-fixed hours were associated with decreased smoking cessation in women and increased relapse in men [ORs of 0.89 and 1.13] and increased alcohol use in both men and women [ORs from 1.12 to 1.19]. Overall, atypical working hours were associated with decreased sugar and fat consumption.

CONCLUSIONS

The potential role of atypical working hours on substance use should be considered by public health policy makers and clinicians in information and prevention strategies.

Concurrent trajectories of self-rated health and working hour patterns in health care shift workers: A longitudinal analysis with 8-year follow-up

Background

The association between health and working hours is hypothesized to be reciprocal, but few longitudinal studies have examined changes in both health and working hour patterns over time. We examined combined trajectories of self-related health and two working hour patterns (working <35 h/week and working night shifts) and the extent to which these trajectories were predicted by employees' lifestyle and mental health.

Methods

Participants of this cohort study with a 8-year follow-up were 5,947 health care shift workers. We linked self-reports of health from three repeated surveys with objective pay-roll based data on working hours. Using group-based multi-trajectory analysis we identified concurrent trajectories for self-rated health and working hour patterns. We examined their associations with baseline lifestyle-related factors (smoking, at-risk alcohol use, obesity, and physical inactivity) and mental health (sleep problems and psychological distress) using multinomial regression analysis.

Results

Three combined trajectories of self-rated health and working <35 h/week and four combined trajectories of self-rated health and night work were identified. Unhealthy lifestyle and poor mental health were associated with trajectories of moderate and declining health. Sleep problems were linked with working <35 h/week. Younger age and good mental health were associated with a combined trajectory of good health and continued night shift work.

Conclusion

Trajectories of suboptimal and declining health are associated with trajectories of reducing working hours and leaving night work, and are more common in employees with unhealthy lifestyle, sleep problems, and psychological distress.

Toward a third term of Health Japan 21 - implications from the rise in non-communicable disease burden and highly preventable risk factors

In 2000, the Japanese government launched the National Health Promotion Movement known as Health Japan 21 (HJ21), a 13-year national health promotion policy (2000-2012) aimed at preventing and controlling non-communicable diseases (NCDs) and their underlying risk factors. After the revision in 2013 (2013-2023), the target NCDs and risk factors are being reviewed and a new strategy for the third term of HJ21 is going to be discussed. Using the latest findings from the Global Burden of Disease Study 2019, this paper highlights NCDs that continue to increase health losses and preventable metabolic and behavioural risk factors. These NCDs and risk factors are associated with an increased risk of serious illness and death from the novel coronavirus disease (COVID-19). The third term of HJ21 will be formulated during the continuing threat of acute health crises like the current COVID-19 pandemic and thus offers an important opportunity to renew public health efforts to halt the growing burden of NCDs in Japan. This article may serve as one of the roadmaps for the formulation of the third term of HJ21.