Nationwide Implementation of Non-Mandatory Preventive Medicine Programmes in Japanese Municipalities: A Descriptive Cross-Sectional Survey and Evidence-Practice Gap Analysis.

BACKGROUND

In Japan, much preventive medicine outside mandated national programmes is left to municipal discretion, yet the nationwide alignment between these locally administered programmes and graded evidence remains unexamined. We mapped implementation of non-mandatory preventive medicine programmes across Japanese municipalities and quantified evidence-practice gaps.

METHODS

A nationwide cross-sectional survey was administered to all 1,741 Japanese municipalities between March and August 2025. Implementation (excluding the five mandated cancer screenings under the Health Promotion Act) was defined as municipal provision or subsidisation and calculated on municipality-count and population-weighted bases. Each programme was benchmarked against USPSTF recommendation grades, and an Evidence-Practice Alignment (EPA) score was derived for each municipality (weights: A = + 2, B = + 1, D = - 2, I or ungraded = - 1). Non-response bias was assessed by comparing responding and non-responding municipalities using standardised mean differences derived from national statistical databases.

RESULTS

Valid responses were received from 467 municipalities (response rate, 26.8%) across all 47 prefectures. Implementation rates ranged from 0.2% to 92.1% (municipality-count) and 0.0% to 94.4% (population-weighted). Ten Grade A/B programmes had implementation below 50%, including folic acid supplementation (3.2%), syphilis screening (9.6%), and abdominal aortic aneurysm screening (16.1%). Conversely, hepatitis B/C (92.1%, 91.4%) and osteoporosis screening (68.5%) were widely implemented. Several Grade D or ungraded programmes showed appreciable uptake, notably young adult health checkups (86.3%; ungraded), brain/carotid screening (41.1%; Grade D), and frailty screening (26.1%; ungraded). Population-weighted coverage exceeded municipality-count rates for HIV (48.1% vs 10.1%) and syphilis (48.3% vs 9.6%) screening, indicating concentration in larger municipalities. Prefectural EPA scores ranged from - 4 to 1, with heterogeneity and no clear geographic gradient.

CONCLUSIONS

Substantial evidence-practice gaps and equity concerns coexist in Japan's municipal preventive medicine programmes. Our findings support strengthened dissemination of graded evidence to municipal decision-makers and critical reassessment of low-value screening.