[Special Feature: The Future of Preventive Medicine] Noriyasu Hirano: The Future of Preventive Medicine Aimed for at Azabudai Hills with Keio University

2023/11/06

Azabudai Hills is the "future form of Hills," possessing overwhelming scale and impact, and incorporating everything Mori Building has cultivated in its urban development to date. With the aim of pioneering the future of preventive medicine at Azabudai Hills, Mori Building and Keio University signed a basic agreement in March 2021. Since then, while promoting research activities at the Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, we have been preparing for the expansion and relocation of the Center for Preventive Medicine. In this article, I would like to talk about the future of preventive medicine that we aim for together with Keio University at Azabudai Hills, which opens on November 24.

Azabudai Hills is a large-scale urban redevelopment project (Type 1 Urban Redevelopment Project) that has been worked on over many years together with many local residents in the Toranomon and Azabudai areas of Minato City, Tokyo. Since the establishment of the "Urban Development Council" in 1989, we have promoted the project over a long period of 35 years, engaging in persistent discussions with approximately 300 rights holders with different positions and circumstances. After four years since construction began on August 5, 2019, the opening day will finally arrive on November 24, 2023.

Azabudai Hills is adjacent to "ARK Hills," which Mori Building developed previously, and is located between the "Cultural Heart: Roppongi Hills" and the "Global Business Center: Toranomon Hills," in an area that possesses both cultural and business characteristics. The vast planned area of approximately 8.1 hectares is surrounded by overwhelming greenery, including a central square of about 6,000 square meters. The "Mori JP Tower" stands approximately 330 meters tall, with about 20,000 employees, 3,500 residents, and 30 million annual visitors, making its scale comparable to "Roppongi Hills."

Azabudai Hills integrates diverse urban functions such as offices, residences, commercial facilities, cultural facilities, educational institutions, and medical institutions within walking distance (Figure 1). Each facility has multifaceted and complex functions, and these facilities and functions intertwine and connect three-dimensionally to create a rich Hills life. It is truly the "City within a City (Compact City)" that Mori Building idealizes, and it is the "future form of Hills" into which all the knowledge cultivated in previous Hills projects has been poured.

Azabudai Hills is a new type of urban development unparalleled in the world, even in its development philosophy. "What should a city be?" "What is the essence of a city?" The project started with these questions at a time when technology is advancing and the way we work, live, and even exist is about to change significantly. Mori Building has always approached urban development with a focus on "people," but we reconsidered how a city should be so that people can live more humanely, and established the development concept for Azabudai Hills as "Modern Urban Village — A city like a 'square' surrounded by greenery, connecting people to people." The two pillars supporting this "Modern Urban Village" are "Green" and "Wellness." This means creating a city where people can live in good health, both mentally and physically, while being surrounded by rich greenery and connecting with people and nature, even while in the middle of Tokyo. After the COVID-19 pandemic, I believe its importance is increasing more than ever.

The challenge of implementing "Wellness" in this city was a new endeavor for Mori Building, and it was difficult for us to achieve alone. While thinking about how to realize it, we decided that we needed the strength of a top runner in health and medicine, and reached out to Keio University. "As a partner in urban development that will change the future of Tokyo and Japan through Azabudai Hills, would you like to create a 'Wellness' city together?" That proposal was the beginning of our partnership with Keio University.

We began dialogues with Keio University regarding the vision for Azabudai Hills in 2018. This was the year following the 100th anniversary of the establishment of the Keio University School of Medicine.

When we shared our thought that "we want to realize the wellness of the future across the entire city by utilizing the characteristics of the compact city that is Azabudai Hills, and such a challenge is necessary for the future of Tokyo and Japan," we received a positive response immediately. Keio University was also at a timing where they were considering what medical care should look like for the next 100 years.

Shibasaburo Kitasato, the first Dean of the School of Medicine and Director of the Hospital at Keio University, is known for preaching the importance of preventive medicine, stating that "the mission of medical sciences lies in preventing illness before it occurs." Returning to that origin, the further development of preventive medicine is indispensable in this super-aging society. They believed that "designing the health of each individual" is the future mission of medical care, and that Keio University must lead that effort. To do so, they felt they must not stay within the hospital but must go out into the city to expand the possibilities of medicine. It must be addressed by the entire university and society as a whole, beyond the framework of the hospital and School of Medicine. This passionate awareness of the issues at Keio University matched our feelings for Azabudai Hills, and the direction to take became clear. What kind of future preventive medicine and wellness can be realized in a city like Azabudai Hills, where various functions and uses are combined and diverse people of different ages, genders, and nationalities live? Discussions proceeded with mutual excitement.

Then, in March 2021, Mori Building and Keio University signed a basic agreement. Two decisions were made: to expand and relocate the Center for Preventive Medicine at Keio University Hospital to Azabudai Hills, and to establish the Hills Joint Research Laboratory for Future Preventive Medicine and Wellness to conduct research on future-oriented preventive medicine.

The project with Keio University is moving forward with two pillars: the expansion and relocation of the Center for Preventive Medicine and the joint research laboratory. By having the Center for Preventive Medicine, which provides next-generation preventive medical services, and the joint research laboratory, which conducts research on future-oriented preventive medicine, work together as two wheels of a cart, we aim to connect the accumulation and utilization of data in research with the social implementation of those research results (Figure 2).

● Center for Preventive Medicine

Since its establishment at Keio University Hospital in 2012, the Center for Preventive Medicine has provided comprehensive health checkups (Ningen Dock) to approximately 6,000 examinees annually, contributing to the early detection and treatment of diseases. While discussing the relocation of this facility with Keio University, we have jointly considered the mission of preventive medicine for the coming era. Not only finding and treating diseases, but also sensing changes occurring in the body to provide care before a physical disorder progresses to a disease, and supporting each individual so they can remain in a healthy state of mind and body in their daily lives. We reached the conclusion that this is what is required of future preventive medicine, and that new developments are possible precisely because it is located in the city of Azabudai Hills. Based on this thinking, the Center for Preventive Medicine at Azabudai Hills will launch a new service called "Preventive Medicine Membership." This aims to have contact with examinees on a daily basis, not just checking for the presence of disease through an annual health checkup, but considering the health of each individual over a 10-year term, intervening in daily physical and mental disorders, and providing advice according to individual health issues and goals. This is the fundamental mechanism for practicing the concept of "Personalized Preventive Medicine," which provides optimal preventive care for each individual from a medium- to long-term perspective.

Furthermore, the Center for Preventive Medicine will collaborate with various facilities in Azabudai Hills, such as restaurants, food markets, and fitness clubs, to challenge the approach to people's health from daily life, going beyond the conventional boundaries of medicine. From now on, it is important for each individual to increase their health awareness and manage their own health in daily life in order to continue living a long and healthy life. We want to implement mechanisms and systems in the city that support this in collaboration with the Center for Preventive Medicine. For example, even if it is pointed out during a health checkup that "your blood sugar levels are not good, so let's review your lifestyle habits," it is common to forget this after a few days or weeks, spend days as usual, and receive the same feedback at the next year's checkup. We aim to embed mechanisms in the city that create an environment across the entire city and change people's behavior in response to questions such as what kind of food to eat or what kind of exercise to do.

I believe that the seamless connection between preventive medicine and daily life, without them being separated, is what we aim for in future preventive medicine, and is a major purpose for the Center for Preventive Medicine coming out into the city of Azabudai Hills. Moving from an approach based on "points"—the once-a-year health checkup—to an approach based on "lines" that involve the examinee's health over the medium to long term, and further to an approach based on "planes" that include daily exercise and diet, which were lacking in conventional medicine. Realizing the spatial expansion of preventive medicine across the entire city is the vision we are aiming for with Keio University.

Furthermore, on the floor below where the Center for Preventive Medicine is located, an outpatient clinic, a dental clinic, and a pharmacy will also open. The Center for Preventive Medicine, which handles disease prevention, and local medical institutions, which handle primary care, will collaborate to protect the health of people working and living in the area. Furthermore, a network of medical institutions will be created to connect patients to Keio University Hospital, which is a hospital with specific functions, when specialized and advanced medical care is required. The regional coordination of medical function roles will likely become a new model.

● Hills Joint Research Laboratory for Future Preventive Medicine and Wellness

Mori Building and Keio University are also working to realize future preventive medicine for living long lives in good health, both mentally and physically, in the form of joint research. What is indispensable for that future-oriented preventive medicine is, above all, digital technology. Due to the development of technology such as wearable devices, the types and amounts of data related to people's lives and health have increased enormously. How to utilize that data for preventive medicine is a theme we will address in joint research. Using Azabudai Hills, where people at various life stages live and work, as a field, we will collect and analyze daily data. Keio University will analyze the results from an academic standpoint, and based on that evidence, we will implement mechanisms in the city to guide people's lives toward becoming healthier. That is what we aim for in joint research for the future. I believe this is a unique challenge that is possible precisely because Keio University is joining forces with Mori Building, which operates the entire city.

The most important factor there is the people who participate in this research and provide data. Hospitals have accumulated a large amount of data regarding diseases, but data on healthy people, which is necessary for research on preventive medicine to prevent diseases before they occur, has not been collected. How to collect and utilize that for research is a challenge. There are likely not many people who would readily provide their own health data. In such a situation, we want to create a system where people can "participate in research more easily, which not only benefits their own health but also benefits society and the future," and foster a momentum and mindset from the city of Azabudai Hills to create health together. I believe Keio University participated in Azabudai Hills because they felt the potential in this city to realize such a challenge—creating new awareness and ways of thinking among people that will change the nature of medical care. And Keio University has people who combine the vision, know-how, motivation, and ability to make that possible, and we at Mori Building can connect that to the city and society. "Creating health as a whole society." It is not an easy task, but we want to challenge ourselves to do what is possible precisely because two organizations from completely different fields, Mori Building and Keio University, have joined forces.

Since its founding, Mori Building has been engaged in urban development under the philosophy of "Create Cities, Nurture Cities." Azabudai Hills, which was planned over 35 years with local residents, is finally reaching its opening, but a city begins from the moment it is completed. We do not just create high-quality spaces and environments; we carefully nurture them together with the people who live, work, and visit there. We pour in various wisdom, experience, passion, and attention to detail so that the city remains a place that is always fresh and full of charm. That is Mori Building's urban development.

Urban development at Azabudai Hills with the theme of "Wellness" is a new challenge for Mori Building to open up the future of cities. I am very happy that Keio University, the best partner, has participated in the best possible way. We want to work together for a long time at Azabudai Hills to nurture a "Wellness" city.