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Sir, to tackle major challenges to its health system, Japan has enacted recent legislation to create integrated community-based comprehensive services (ICCS)1 of which, as Wilson articulated in his commentary,2 oral health is an essential part. The committee organised by the Japan Ministry of Health, Labour and Welfare recently recommended the promotion of inter-professional collaboration, oral care in the context of ICCS, and preventive oral health care.3 The Japanese government is currently developing a new vision for oral healthcare along this line.
We think, however, that holistic care is not sufficient as the health system should be rebuilt in the future as a new 'social system' which is integrated to provide values to patients. In 2015, an advisory panel appointed by the health minister of young experts in their 30s and 40s, developed a vision of health care: Health Care 2035.4 Sakata City (100,000 population) is a unique rural community in Japan, having a model with this point of view. Since 1980, a group of dentists (re-educating themselves and other dentists nationally to become 'oral physicians' rather than dental surgeons), hygienists, specialists, community nurses, school teachers and government officials have collaborated with the private sector, academic institutions and civil society. The group has gradually developed a new social system to enhance oral care in a holistic manner with an emphasis on the patients' values.5
Local industries have started to pay for preventive oral care, which benefits employees and their family members and enhances productivity. The group has developed a consortium with large companies to advocate and facilitate the continuum of quality care after patient transfers. The consortium has developed a cloud-based, people-centred health information system. This system integrates various personal data and facilitates a personalised approach to health promotion and disease prevention by empowering each individual to design their own life style, with an ambitious goal, namely 'KEEP 28' to keep all of your own teeth for your general and oral health even for a 100-year life span. In 2016, Sakata City legislated for a holistic approach to oral care,6 obviously being influenced by these activities of the group. Professor Wilson's proposed advancements in oral health along with the Health Care 2035 vision are already taking place in a rural town in Japan.