Authors and collaborators have been involved in Diabetes, primary care (PC), integrative medicine (IM) and anti-aging medicine [1,2]. Concerning the developing the health movement, the perspectives of two axes seem to be necessary. They would be i) individual aspect for each private case, and ii) policy aspect for governmental local case. For some decades, adequate governmental health promotion have been found in Japan and United States. Useful information will be introduced associated with future developing perspectives in this article. In Japan, the first wave of national health promotion began in 1978, and has since expanded to the second and third waves. At the same time, the Health Japan 21 (HJ21) project began in 2000, and has continued as a long-term movement until now [3]. The main history and goals of these efforts are shown in Table 1.

Table 1: Historical Progress of National Health Plan in Japan.

Health Japan 21 (HJ21) (the second term) has been 10-year plan from 2013 [3]. It includes the basic direction for comprehensive implementation for national health promotion that was by the Ministry of Health, Labor and Welfare (MHLW) [4]. The average amount that Japanese adults eat in a day is shown in Figure 1.

Figure 1: The Average Amount That Japanese Adults Eat In a Day.

Among them, grains for 420g include 300g of rice a day, and seaweed 12g/day seems to be characteristic for Japanese. The National plan of HJ21 would aim to extend healthy life expectancy and to reduce health disparities. It has originally 9 foci and 70 targets in 9 areas. They are nutrition/diet, physical activity/exercise, rest/mental health, tabaco, alcohol, dental health, diabetes, cardiovascular disease (CVD), and cancer. The 3rd term of HJ21 has been formulated during COVID-19 pandemic, and then will become novel public health concept for growing non-communicable diseases (NCDs) burdens in the future [5].

On the other hand, some impressive concepts for NCDs have been developed in United States. The American Heart Association (AHA) has defined a novel concept of cardiovascular health (CVH) to develop a paradigm shift [6]. It means the changes from a focus only for disease to general positive health promotion for long life in the light of individuals and large populations. Successively, AHA has announced the original metrics, which was called as Life’s simple 7 including fundamental factors required for daily living [7]. Novel metrics were introduced and the age spectrum was added for considering the entire life span. Basic social factors of psychological health were recognized for crucial elements for preserving and optimizing cardiovascular health. This enhanced perspectives for adequate cardiovascular health was named as Life’s Essential 8 [8].

Figure 2: The Logo Mark of the Life’s Essential 8.

In the Life’s Essential 8, several included components were diet, physical activity, nicotine exposure, sleep health, body mass index (BMI), blood lipids, blood glucose, also blood pressure [8] (Figure 2).

Each metric showed the novel scoring algorithm with the ranges from 0-100 points. It can allow the novel cardiovascular health score for 0-100 points with unweight average of each component. It can bring adequate cardiovascular health assessment associated with longitudinal monitoring. As the potential data sources, we can promote broad development in public health, policy, clinical, medical practice, and community environments [9].

What is the difference between ver7 and ver8? The added component was healthy sleep, in which AHA updated sleep element as 8th component in the Presidential Advisory [10]. As the important perspective, the Advisory committee included the novel section of psychological aspect, where the writing group affirmed the importance of psychological aspects for achieving optimal and equitable CVH in the large population. Their reason were apparent from experimental and observational evidence for more than 40 years. Psychological health status for CVD has been extremely important for CVD onset, risk, and recurrence, associated with several opportunities of preserving and improving CVH. Various evidence were obtained from US Preventive Services Task Force and also from the consensus comments of professional organizations in AHA [11]. Among them, professionals in CVD have increasingly emphasized the inclusion of adequate care related to psychological approach in CV medical care.

Psychological point of view has multi-dimensional aspects or problems. Then, it is not clear what kind of measures of psychological health will become most important for improving CVH [12]. Similarly to physical health, the judgement or determination of psychological health has been related to various elements. They are anxiety, depression, social integration, traumatic or chronic stressful matters, among which they are usually associated with CVD risk or outcomes. It is observed that anxiety, depression and social isolation are often combined together for certain stressful affairs. On the other hand, we usually use the approach measurements that is evaluated or judged by each elements like CVD risk, such as blood glucose, HbA1c, blood pressure and blood lipid values [12]. In the case of AHA’s Life’s simple 7 and Life’s Essential 8, each individual factor is separately measured and evaluated. Furthermore, each factor is used to provide the recommended method of prevention and treatment. It seems to be under one roof. Consequently, applicable recommendations will be shown for different people including patients, clients, medical staffs, providers, policy makers and so on.

Concerning preventive health for adults of 19-64 years, screening measurement for depression and anxiety has been recommended by US Preventive Services Task Force [13]. This strategy for psychological screening has been supported by several evidence of those with elevated CVD risk [14]. Furthermore, useful and valid questionnaire seems to be efficient for primary and secondary prevention for CVH [15].

 As the basic model of Life’s Essential 8, the required approach of psychological health has been included. Consequently, Life’s Crucial 9 means the focusing the attention of providers and patients for various prevention levels [10]. For actually developing Life’s Crucial 9, various teams and specialists have to be involved, such as cardiology, nursing, pharmacy, behavioral medicine, exercise physiology. Moreover, some meaningful partnerships among clinical, patient, institutional and community groups will be required for prioritizing mutual QOL, ADL, psychological health, and cardiovascular prevention and health [11].

In summary, the perspectives of total health has been described in this article, including Health Japan 21 (HJ21), Life’s simple 7, Life’s Essential 8 and Life’s Crucial 9. We expect that this article will be useful for clinical prevention and practice, and sufficient evidence will be obtained actionably and meaningfully in the future.

Conflict of Interest: The authors declare no conflict of interest.

Funding: There was no funding received for this paper.

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