1. Purpose

Changes in the social and economic situation, such as the full-fledged emergence an aging society and rapid progress in technological innovations, are exerting a substantial impact on securing the safety and health of workers at workplaces.

Aged workers have a higher incidence of industrial accidents compared to younger workers, and the number of days aged workers are absent from work in the event of accidents tends to be longer. Many of these industrial accidents are caused by stumbling, falling from heights, etc., which suggests that a general decline in motor functions, sensing function, etc., due to aging has a substantial bearing on the occurrence of industrial accidents involving aged workers. Moreover, aged workers have a higher rate of illnesses such as high blood pressure and ischemic heart diseases, and these ailments may be influenced by the type of work in which such employees are engaged.

In addition, there have recently been a number of issues related to worker stress caused by the introduction of ME equipment, etc. In other words, cases of stress-induced job maladjustment and stress-related diseases have been seen, and issues related to worker mental health have gained increasing attention.

Accompanying the rapid aging of the workforce, moreover, there is the expectation that aged workers must assume more responsibility for the socioeconomy in the future as well. As a consequence, it has become increasingly important to prevent the occurrence of industrial accidents by creating a workplace environment that enables all workers are healthy in both body and mind and in which they can fully demonstrate their abilities.

In order to deal with these issues, the government shall assume the following roles.

[1] Determining and announcing measures for the maintenance and promotion of worker health in the industrial accident prevention program.
[2] Announcing the necessary guidelines for promoting the appropriate and effective implementation of steps taken by employer for the maintenance and promotion of worker health.
[3] Promoting the development of human resources capable of implementing measures for worker health maintenance and promotion at workplaces.
[4] Providing the necessary guidance, advice and assistance for the implementation of health maintenance and promotion measures by employer.
[5] Establishing certification standards for organizations that conduct activities for the maintenance and promotion of worker health on consignment from employer (hereinafter after referred to as "worker health maintenance and promotion service organizations"), and carry out such certification at an organization designated by the government.
[6] Providing special consideration for small and medium-sized enterprise employer on the implementation of measures to maintain and promote worker health.

In order for steps aimed at worker health maintenance and promotion, such as health education, to be appropriately and effectively implemented at workplaces, it is necessary that their specific implementation methods be firmly established at workplaces.

In order to appropriately and effectively implement steps for worker health maintenance and promotion (hereinafter referred to as "health maintenance and promotion steps") for which efforts should be made by employer at workplaces, these guidelines define the general implementation methods for said steps. It is desirable that employer follow these guidelines in implementing the health maintenance and promotion steps, as well as deals with them in a format that is suitable for the actual situation of each workplace.

2. Basic concept of health maintenance and promotion measures

Accompanying the progress of medicine in recent years, it is now known that such chronic non-communicable diseases as heart disease, high blood pressure and diabetes can be prevented by performing appropriate exercises, maintaining a healthy diet and controlling stress on a continuous basis from youth. Moreover, as the development of health guidance techniques covering both mind and body, such as health preservation and mental health care, has made considerable progress, it has become possible to conduct health maintenance and promotion activities that target many workers.

Furthermore, it is important that the maintenance and promotion of worker health requires the active and voluntary involvement of the workers themselves. However, as workplaces include certain factors that can impair health and induce stress that cannot be eliminated by workers themselves, it is necessary to positively promote health preservation implemented by employers in addition to the individual efforts of workers in order to maintain and promote worker health. Such health preservation must move a step beyond of the existing viewpoint of simply preventing health impairments, and aim at positive health maintenance and promotion covering both mind and body on a continuous and systematic basis throughout the entire period of one's working life.

Specific steps for worker health maintenance and promotion include health monitoring (meaning measuring the level of health, i.e., health monitoring for maintaining and promoting health), and providing exercise guidance, mental health care, nutrition guidance and health guidance based on the results. These measures must be promoted through the close cooperation of staff members dealing each respective discipline.

3. Health maintenance and promotion plan, etc.

(1) Determining health maintenance and promotion plan

A. It is necessary to make sure that health maintenance and promotion steps, such as health monitoring and exercise guidance, are continuously and systematically implemented from the mid- and long-term viewpoints. This means that it is necessary for the employer to make efforts to determine the basic plan for the maintenance and promotion of worker health (hereinafter referred to as the "health maintenance and promotion plan").

The matters determined in the health maintenance and promotion plan are as follows.

[1] Organizing a health maintenance and promotion structure within the workplace.
[2] Implementing health maintenance and promotion steps for workers, such as health monitoring, exercise guidance, mental health care, nutrition guidance and health guidance.
[3] Securing human resources and organizing the facilities and equipment necessary for undertaking health maintenance and promotion steps.
[4] Other steps necessary for maintaining and promoting worker health.

B. In determining the health maintenance and promotion plans, it is desirable that the employer make all efforts to bring up the matter for discussion at the health committee, etc., as well as to set up an opportunity to listen to the views of the staff to promote health maintenance and promotion measures within the workplace (see Section 3. (2) B.).

(2) Establishing a structure to further health maintenance and promotion measures within the workplace

It is necessary for the employer to make efforts to utilize and organize the following organizations, staff, etc., in order to establish a structure to further health maintenance and promotion measures within the workplace.

A. Health committee, etc.

(a) In workplaces where 50 or more workers are regularly employed, efforts should be made to positively investigate and deliberate basic measures to further worker health maintenance and promotion (hereinafter referred to as the "health maintenance and promotion measures") such as determining the health maintenance and promotion plans at the workplace health committee or safety and health committee.

In doing so, a structure that fully incorporates the views of the staff members that are responsible for furthering the health maintenance and promotion measures such as industrial physicians should be organized.

(b) Also in workplaces where fewer than 50 workers are regularly employed, efforts should similarly be made to seek employee views on the health maintenance and promotion measures when asking the workers concerned about matters related to health.

B. Staff for furthering health maintenance and promotion measures

(a) The types and roles of the staff necessary to further the health maintenance and promotion measures at workplaces are as follows.

[1] Industrial physician

Carries out health monitoring, and prepares individual guidance forms based on the results. In addition, provides guidance to other staff members that implement health maintenance and promotion by using said guidance forms.

[2] Exercise guidance personnel

Based on the results of the health monitoring, prepares specific exercise programs for individual workers and provides guidance on performing exercise. In addition, provides guidance and assistance on performing exercise based on said programs by themselves or by giving directions to the exercise and training personnel.

[3] Exercise and training personnel

Based on the exercise programs, provides guidance and assistance on performing exercises for individual workers under the direction of the exercise guidance personnel.

[4] Psychological consultant

Provides mental health care under the direction of the industrial physician in case mental health care is deemed necessary on the basis of results from the health monitoring, or in case of requests from workers at the time of inquiries.

[5] Industrial nutritional instructor

Provides nutritional counseling as necessary based on the results of the health monitoring.

[6] Industrial health instructor, etc.

Provides necessary health guidance to individual workers based on the results of health monitoring.

(b) It is necessary that these staff members have adequate knowledge and skills in their respective disciplines, as well as a full range of knowledge in industrial health and industrial physiology. Accordingly, the employer must exert efforts to develop such staff members to whom the training listed in the table is to be provided. Moreover, even in the case of employers who have difficulty in developing all of the staff required, it is still desirable to train and nurture them on a systematic and step-by-step basis.

It is desirable that the employer make efforts to encourage such staff members to participate in ongoing education aimed at improving the skills necessary for their respective disciplines even after the completion of the training mentioned above.

C. Health maintenance and promotion special committee

(a) It is desirable to establish a "health maintenance and promotion special committee" led by the industrial physician and consisting of the staff assigned to further the health maintenance and promotion measures in Item B above.

(b) The health maintenance and promotion special committee shall study and evaluate the health maintenance and promotion steps for individual workers from a professional standpoint in order to further the specific and appropriate implementation of various guidance for individual workers.

D. Implementation structure of health maintenance and promotion measures at workplaces

(a) In order to execute the health maintenance and promotion plans determined at the health committee, etc., it is important to clarify the division of responsibilities for the health maintenance and promotion measures at workplaces, and to establish an implementation structure for health maintenance and promotion measures that includes each workplace section by working in close cooperation with the health maintenance and promotion special committee.

(b) Each workplace should organize a cooperative structure by using a creative approach that will facilitate the effective diffusion and establishment of the health maintenance and promotion measures for workers, such as the utilization of a small-group activity structure.

(3) Worker health maintenance and promotion service organizations, etc.

A. The staff for assigned to the further health maintenance and promotion measures as mentioned in 3-(2)-B should be deployed within the workplace in principle. In case it is difficult for the employer to secure all the necessary staff members, however, it is appropriate to consign all or part of those measures (such as health monitoring, exercise guidance, mental health care, nutrition guidance, health guidance, etc.) that should be conducted by the employer to a worker health maintenance and promotion service organization. Such organization is capable of conducting such activities on a team basis as they include all of the following professional staff: (1) physicians with expertise in health monitoring; (2) personnel with expertise in the preparation and guidance of exercise program; (3) personnel with expertise in exercise and training guidance; (4) personnel with expertise in worker mental health care; (5) personnel with expertise in worker nutrition guidance; and (6) personnel with expertise in worker health guidance.

B. In the event that a workplace lacks only the staff for exercise guidance among all of the staff assigned to furthering the health maintenance and promotion measures as mentioned in 3-(2)-B, it is appropriate to consign such activities to an outside special organization that has (1) personnel with expertise in the preparation and guidance of exercise program, and (2) personnel with expertise on in exercise and training guidance, and can provide exercise guidance in cooperation with the industrial physician at said workplace.

C. In the event of using an outside exercise guidance special organization, it is desirable for the employer to make efforts to develop opportunities to listen to the views of the specialty staff of said health maintenance and promotion service organization in determining the workplace health maintenance and promotion plan.

(4) Evaluation of the results of implementing health maintenance and promotion measures

In order to continuously and systematically further the health maintenance and promotion measures at the workplace, it is necessary for the employer to make efforts to periodically evaluate the results of implementing said measures on a comprehensive and individual basis, as well as to prepare various materials for said evaluation and to reflect such results in new health maintenance and promotion plan in order to enhance the contents of the health maintenance and promotion measures.

(5) Other

A. Maintaining privacy

Those engaged in the clerical work of implementing the health maintenance and promotion steps shall not reveal to others the physical or mental conditions of workers or otherwise disclose any confidential information that they may come to acquire in the course their work.

B. Keeping records

In order to continuously and systematically further health maintenance and promotion measures at the workplace, it is necessary for the employer to keep records on health maintenance and promotion steps, such as the health monitoring results and the contents of exercise guidance.

C. Role of the health manager in health maintenance and promotion measures

The health manager shall provide necessary assistance in such matters as determining the health maintenance and promotion plan in close cooperation with the general safety and health manager and the staff for furthering health maintenance and promotion measures.

4. Contents of health maintenance and promotion steps

The health maintenance and promotion steps include health education and health counseling.

It is necessary for the employer to meticulously implement measures in accordance with individual workers on the following specific items of health education, as well as to make efforts to provide health counseling, etc., in accordance with individual requests from worker.

(1) Health monitoring

In furthering the health maintenance and promotion measures for workers, it is necessary for all individuals to have a full and accurate understanding of their own health condition, and to continue health preservation while receiving guidance from the staff led by an industrial physician.

"Health monitoring" means surveys concerning lifestyle conditions, medical examinations, etc., implemented to understand the health condition of an individual worker and to provide health guidance such as exercise guidance, mental health care, nutritional guidance, etc., based on the results. The objective is different from the conventional medical examination that emphasizes the early detection of diseases.

In principle, health monitoring is conducted mainly by an industrial physician. Based on these results, guidance forms are prepared that reflect the health conditions of each worker, and exercise guidance, health guidance, etc., are conducted on the basis of these guidance forms.

A. Implementation and coverage of health monitoring

In order to continuously and systematically provide various types of health guidance, health monitoring for each worker are to be periodically carried out.

The coverage of this health monitoring includes medical history inquiries, lifestyle surveys, consultations, medical examination and motor function examination.

B. Preparation of guidance forms

The industrial physician shall evaluate the results of the health monitoring and prepare guidance forms that will be used to provide health guidance such as exercise guidance, and give directions to other staff members who implement the health maintenance and promotion activities.

(2) Exercise guidance

Based on the results of the health monitoring and guidance by the industrial physician, the exercise guidance personnel shall prepare practicable exercise programs for individual workers and provide guidance in performing exercises.

In addition, the exercise guidance personnel and exercise and training personnel shall provide guidance and assistance in performing the exercises based on said programs.

In this case, it is necessary to give consideration to providing guidance in exercise programs that workers will voluntarily carry out.

A. Preparation of exercise programs

When preparing exercise programs, it is important to take into account each person's individual lifestyle, interests, wishes, etc., and that the types and contents of the recommended exercises can be performed safely, effectively and enjoyably.

B. Guidance and assistance for performing exercises

An important step in designing the proper exercise guidance is to give consideration to exercises that are suitable to each individual's health conditions, and which can become firmly rooted in one's daily life by focusing on the time spent at the workplace as a means of establishing healthy lifestyle habits.

(3) Mental health care

In the event it is deemed necessary to provide mental health care based on the results of health monitoring, or in case worker himself request such care at the time of inquiries, psychological counseling personnel shall provide mental health care under the direction of the industrial physician.

Incidentally, "mental health care" in these guidelines involve activities for people that are aimed at positive health promotion, and include measures designed to help worker become aware of stress and to provide guidance on relaxation techniques.

(4) Nutrition counseling

With respect to workers exhibiting symptoms of dietary problems based on the results of the health monitoring, industrial nutrition instructor shall evaluate not only the amount of nutritional intake but also the eating habits and eating behavior of each worker and provide guidance for improvements. Such activities will be conducted in accordance with the results of the health monitoring and guidance forms.

(5) Health guidance

In order to solve health problems caused by work formats or lifestyle habits, industrial health guidance personnel shall provide guidance and education for a healthy lifestyle, including matters such as sleeping, smoking, drinking and oral hygiene by focusing on the time spent at the workplace. Such guidance should be based on the results of the health monitoring and guidance forms prepared by the industrial physician.

Attached Table (Specialty training to develop staff members who implement the health maintenance and promotion steps)

1. Health monitoring specialty training (type of staff: industrial physician)

2. Exercise guidance specialty training (type of staff: exercise guidance personnel)

3. Exercise and training specialty training (type of staff: exercise and training personnel)

4. Psychological counseling specialty training (type of staff: psychological counseling personnel)

5. Industrial nutritional guidance specialty training (type of staff: industrial nutritional guidance personnel)

6. Industrial health guidance specialty training (type of staff: industrial health guidance personnel)