Metrics are a standard way to measure or evaluate something. WKC aims to study measures for how well countries are monitoring their progress on achieving Universal Health Coverage (UHC) – given the challenges of population ageing.







What is our focus?

  • Monitoring UHC in the context of ageing

WHO and the World Bank developed a UHC monitoring framework as a global reference to determine progress towards coverage and financial protection. Yet, this instrument may not fully capture UHC in the context of ageing populations, where health systems are adapting to the needs of older persons with more complex conditions. WKC is working with researchers to study how countries are measuring and monitoring coverage of essential health services, financial protection, quality and equity when they are facing the challenges of population ageing.

  • Adaptation and validation of metrics and monitoring tools

The Japan Gerontological Evaluation Study (JAGES) has developed standardized tools to collect information about health outcomes and the determinants of health among older populations in Japan. These findings are used to improve local and national policies. WKC has helped to document this unique instrument and lessons for other countries.  WKC is now working with researchers in Malaysia and Myanmar to adapt and validate these tools.

  • Knowledge translation

To ensure that research is put into practice at country level, the WKC will establish a knowledge hub for researchers and policy-makers so that countries can learn from each other.


Why is this important?

“What gets measured gets done.” Monitoring systems help countries focus on whether they are successful in extending access to services and financial protection for vulnerable groups.

Measuring and Monitoring Universal Health Coverage in the Context of Population Ageing


The global standard of reference for measuring and monitoring UHC is a framework developed by WHO and World Bank. It is expected that the indicators for monitoring UHC will need to be adapted to local contexts to ensure their relevance in a rapidly changing environment. Specifically, as health development and population ageing progress in countries globally, increasingly more countries, including low- and middle-income countries, will need to adapt their measurement and monitoring of UHC so that they are more relevant to assess the health systems response to population ageing.


Partners will carry out a scoping review of global literature assess how countries have approached measuring coverage and financial protection in light of population ageing. From this review, a framework will be developing using Delphi methods to gather expert opinions on conceptualizing coverage and financial protection, and the implications for low- and middle-income settings. The framework will be validated in country.





Life-Course Approach to Support Universal Health Coverage Monitoring System


The current focus of UHC is based on specific age groups or diseases, and dominated by maternal, child and infectious disease. As such, the conditions of older persons are not addressed.  Financial sustainability is also critical given that population ageing has implications for household health expenditures. The present study aims to develop a conceptual framework using a life-course approach to support UHC monitoring systems, which is also relevant to low- and middle-income countries and ageing populations.


The researchers will carry out a literature review to find the key concepts of life-course approach and UHC monitoring systems and develop an early conceptual framework. Researchers will explore data availability to confirm whether the early conceptual framework is realistic. International experts’ discussion will be carried out to sharpen the value of the conceptual framework. Subsequently, indicators will be identified.





Evidence for improving health care provision to ensure universal health coverage amid rapid population ageing in Japan

As the sustainability of universal health coverage (UHC) is coming under question in Japan, largely under the pressures of rapid population ageing, the delivery of appropriate and efficient health care informed by relevant evidence is urgently needed. Large-scale administrative data are still relatively underutilized in health research in Japan. The research team is renowned in Japan for their advanced efforts in establishing a nationwide Diagnosis Procedure Combination (DPC) data system administered by the Ministry of Health, Labour and Welfare, Japan. This study will utilize this and other large-scale health care data to examine the actual delivery of health care in Japan and to obtain evidence that can contribute to future health policy towards sustainable UHC.

Research questions

Key research questions include:
1) How efficient is outpatient care in Japan compared to other countries with similar health care systems, including France, Germany and the UK?
2) Can a policy shift from facility care to home care contain health care costs?
3) What are the lessons of the 2016 Kumamoto earthquake experience on the delivery of disaster medical care for ageing populations?
4) How equitable is acute hospital care (e.g. prescription, surgical treatment, length of hospital stay) for older people? Are there systematic differences in care based on patient’s age or mental health status (e.g. dementia, schizophrenia)?


This research aims to provide evidence for more efficient, equitable and cost-effective health care delivery in Japan at the primary and secondary care levels spanning four domains: 1) outpatient care, 2) home care, 3) disaster health care, and 4) acute hospital care. All research questions will be addressed through a cross-sectional, statistical analysis of secondary, large-scale health care data from Japan, namely DPC, medical reimbursement receipts, and the Japanese Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED).

Expected outcomes

This study will provide evidence that can guide the development of health systems and policies for ageing populations toward more efficient, equitable and cost-effective health care delivery across a broad range of clinical settings. The results will provide important implications for health policy reforms to advance UHC in Japan and ensure its sustainability. It will also offer valuable insights and lessons to other countries.

Team members

Lead Institution:University of Occupational and Environmental Health, Japan (UOEH) 
Shinichi Tomioka (PI), Assistant Professor, Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan (UOEH) 
Shinya Matsuda, Professor, Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan (UOEH) 
Tatsuhiko Kubo, Lecturer, Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan (UOEH) 
Kenji Fujimoto, Assistant Professor, Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan (UOEH) 
Yoshihisa Fujino, Professor, Department of Environmental Epidemiology, University of Occupational and Environmental Health, Japan (UOEH) 
Katsumi Honno, Department of Medical Information and Management, University of Occupational and Environmental Health, Japan (UOEH) 
Makoto Otani, Data Science Centre, University of Occupational and Environmental Health, Japan (UOEH) 
Hiroyasu Iso, Professor, Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
Kaori Honjo, Professor, Psychology and Behaviour Sciences, Osaka Medical College
Megumi Rosenberg, Technical Officer, WHO Kobe Centre


Knowledge Translation for Healthy Ageing: the Japan Gerontological Evaluation Study (JAGES)


This project sought to identify effective strategies to produce quality scientific evidence regarding the determinants of good health among older people and how to translate such knowledge into public health policy and practice. Specifically, it looked at the tools and strategies that have been instrumental for the success of the Japan Gerontological Evaluation Study (JAGES) in advancing social epidemiological research on ageing and health, and in influencing local and national government policies to be more responsive to the needs of an ageing population.

Project Background

The JAGES is the largest longitudinal survey of community-dwelling older adults in Japan. It takes a social epidemiological approach to understand the causes of health problems and inequalities in health at older age. It is especially notable for its strategic engagement with local and national governments to accelerate both the scientific research and the application of evidence to policies and programmes.

The project aimed to:

  1. Describe the strategies employed by JAGES to collaborate with local governments to conduct large-scale surveys of older adults.
  2. Review the body of scientific evidence accumulated by JAGES and its policy implications.
  3. Demonstrate effective methods for communicating research evidence to policy makers and practitioners, including the data visualization tool --JAGES Health Equity Assessment and Response Tool.
  4. 4. Illustrate JAGES’ impact across diverse municipalities using the examples of Kobe (Hyogo prefecture), Matsudo (Chiba prefecture) and Taketoyo (Aichi prefecture).


JAGES stands as a model of translating evidence to policy.

Approaches that enhanced JAGES’ success included ensuring mutual benefits for researchers and municipal administrators, offering tools to facilitate the use of research evidence in policy making, and disseminating evidence for action in policy, practice and research.

The main output of the project is a monograph detailing the JAGES research methodology and key findings with respect to knowledge translation for healthy ageing. It was produced to facilitate adaptation of the tools and strategies of JAGES to other settings. The monograph also includes illustrative examples of how these processes have worked in practice in Japan.

Research Team

Lead Institution: National Center for Geriatrics & Gerontology (NCGG)
Katsunori Kondo (PI), Director, Gerontological Evaluation Unit, Center for Gerontology and Social Science, and Professor & Director of the Center for Preventive Medical Sciences, Graduate School of Medicine, Chiba University
Hamamatsu University School of Medicine
Toshiyuki Ojima, Professor & Chair, Department of Community Health & Preventive Medicine
University of Tokyo Graduate School of Public Health
Naoki Kondo, Associate Professor, Social Epidemiology & Public Health and Chief, Department of Health Education & Health Sociology
Tohoku University Graduate School of Dentistry
Jun Aida, Associate Professor, Department of International & Community Oral Health
Nihon Fukushi University
Masashige Saito, Associate Professor
WHO Kobe Centre
Megumi Rosenberg, Technical Officer

Example of a data visualization produced by the JAGES. Inequalities in the proportion (%) of older people (65 and over)
who have been certified as eligible for and in need of long-term care by municipalities in the Kanto Region.

Project output

Monograph: Advancing universal health coverage through knowledge translation for healthy ageing: lessons learnt from the Japan Gerontological Evaluation Study

Health Metrics for Age-Friendly Environments

This project aimed to promote research and evaluation of Age-friendly Cities (AFC), and age-friendly environment initiatives more broadly. This, in turn, would lead to strengthening the evidence base for whole-of-society, multisectoral interventions to promote healthy ageing. The foundation for this work was the 2015 WKC publication, “Measuring Age-friendliness: A Guide to Using Core Indicators”. The main activities for the final year of this project were dissemination and awareness-raising through publications, presentations at international meetings and conferences, and capacity building.

For current information on WHO’s initiative on Age-friendly Environments, please visit: