How Adachi’s Vege-tabe Life changed people’s eating habits

In 2010, a university professor asked four Tokyo municipalities for their help to conduct research on health disparity. Rather than just take his findings back to the office and move on, he instead explained the results to local officials, hoping that they would use them to improve community health. One municipality did. And its award-winning program to increase residents’ vegetable consumption is providing a model for how to change people’s daily habits.

Among Tokyo’s 23 wards, Adachi has the second-highest percentage of people on welfare. According to the University of Tokyo, the healthy life expectancy there is about two years shorter than the average span in Tokyo and across Japan. The healthy life expectancy is defined as the number of years a person is expected to be in good health.

“We tried hard to nail down why our healthy life expectancy was so low, compared with the national and Tokyo levels,” shared Yuko Baba, head of the mental and physical health promotion section of the Adachi municipal government.

As they investigated, they found that diabetes was the largest contributor to the ward’s medical expenditures. “It became clear that diabetes is the most pressing health issue the ward faces.” Baba said.

Having determined the problem, they then had to work out how to fix it. So they looked again at the professor’s data.

Educational backgrounds affects diets too

The research by Hideki Hashimoto, a professor at University of Tokyo’s School of Public Health, showed a pattern in each community. Respondents with college degrees were found to be more health-conscious than those without. Educational backgrounds affected personal vegetable intake, and their families’.

“The amounts of brightly colored vegetables consumed were marked differently between households where mothers had a college degree and ones where they didn’t,” said another professor Norito Kawakami.

With the revelations from the research data, Adachi ward officials decided to try a new approach. They realized their awareness-raising seminars are not having much effect. This is because they were focusing on just a small percentage of the population that was already health conscious. They decided to focus on diabetes prevention, specifically by improving residents’ diets.

Baba first consulted Hashimoto on her plan to increase vegetable consumption among the ward’s residents in 2013. Since then, he has continued to offer advice and conduct follow-up research.

The Adachi Vege-tabe Life project

Thus began the Adachi Vege-tabe Life project (‘tabe’ refers to the Japanese verb ‘to eat’). The Organization for Economic Cooperation and Development (OECD)  in February 2019 cited it as an example of “innovative, multi-sector community-based intervention that bring together different local stakeholders.”

In its review of public health in Japan, the OECD said, “The programme had a considerable impact. Vegetable consumption in both children and adults increased – notably in both high and low education families. Men and women aged 30 ate 69.1g and 23.6g more vegetables per day respectively, in 2016 compared to 2014.”

In November 2017, the campaign won the Japanese health ministry’s health bureau director general award, which acknowledges efforts to prevent lifestyle diseases.

Adachi’s success formula that sets an example for others

Its accurate assessment of the key problem through data was vital. Perhaps more important than the professor’s research was his motivation, and commitment to continued collaboration.

“Professor Hashimoto doesn’t put academic interests first,” said Baba. “He provides all data to us, saying we can use them as we wished. He also taught us how to interpret the data, preparing intuitive and detailed documents. This was unlike previous researchers, who only shared a small portion of their research as a token gesture.”

Becoming healthy just by living in Adachi Ward

The overall plan of the Vege-tabe project comes under the theme of “becoming healthy just by living here.” The ward makes it easy for residents to boost their vegetable intake through a variety of ways.

One of Baba’s first moves was to ask local restaurants to provide vegetables before the main dish or have vegetable-rich dishes added to the menu. These included simple options such as an entrée of vegetable sticks, or extra vegetable toppings for ramen noodle dishes. In return, the Adachi local government listed each such restaurant as a participant in the Vege-tabe project. Today, more than 600 shops are participating, which is about 10% of Adachi’s stores.

The project defines a vegetable-rich dish as one that contains at least 120 grams of vegetables — about one-third of the national daily recommended intake of 350 grams. This quantification makes it clear to restaurants what is required. It is also easy for residents to understand when considering their eating options and goals.

Furthermore, Baba convinced local retailers to sell vegetables in single-person sizes and prices. Adachi ward has also created original vegetable recipes that are available both on its website and in local supermarkets. It is teaching its children healthy eating habits early, via cooking classes at elementary and junior high school.

“The average education levels of residents in our ward are slightly lower than those in other municipalities. Professor Hashimoto’s data helped us understand it affects our residents’ health. It has given us insights on tackling the challenge. So that led us the idea of intervening by educating children. That approach is working.”

“The government is the main player” – Why the government is important

Dr. Naoki Kondo, an associate professor of social epidemiology at the University of Tokyo, is also studying the Vege-tabe Life project. He is specifically looking at the restaurants’ participation.

He told the Food Tank website that government involvement in community projects is extremely important in Japan This is because people will trust a project that the government is part of.

“The government should play the role of main player. Researchers are supporters. And the local restaurants are very close collaborators of the local government,” he said of the Adachi program.

Kondo says that governments should first gather ideas from citizens and project collaborators through conversation with local community members. In this case, they are chefs, store owners, food providers and activists. They don’t need to do “something new” by themselves.

The Adachi Vege-tabe Life project illustrates the importance of long-term collaboration in policy execution. The research revealed what the health-policy priorities were for Adachi Ward, which then allowed quantitative and clear actions to be determined. The project shows that broad-based campaigns need to be flexible, allowing changes and adaptation to meet specific, local needs. It also shows the importance of committed people with the courage to do things differently.