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

Azabudai Hills is the "future form of Hills," possessing an overwhelming scale and impact, into which Mori Building has poured everything cultivated through its urban development to date. Aiming to pioneer the future of preventive medicine on the stage of 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, preparations have been underway 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 will open 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 "City Building Council" in 1989, the project has been promoted through persistent discussions over a long period of 35 years 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 "Roppongi Hills," the cultural heart of the city, and "Toranomon Hills," a global business center, in an area that possesses the characteristics of both culture and business. The vast planned area of approximately 8.1 hectares is surrounded by overwhelming greenery, including a central square of approximately 6,000 square meters. With the "Mori JP Tower" standing at approximately 330 meters, a working population of about 20,000, a residential population of about 3,500, and an annual visitor count of about 30 million, its scale is comparable to that of "Roppongi Hills."

Azabudai Hills integrates diverse urban functions such as offices, residences, and commercial facilities, as well as cultural facilities, educational institutions, and medical institutions, all within walking distance (Figure 1). Each facility has multifaceted and complex functions, and by intertwining and connecting these facilities and functions three-dimensionally, a rich Hills life is created. 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 "people" at the center, but we reconsidered how a city should be so that people can live more humanely, and established the development concept of Azabudai Hills as "Modern Urban Village — a city like a 'square' surrounded by greenery that connects 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, why don't we create a 'Wellness' city together?" That proposal was the beginning of our partnership with Keio University.

We began dialogue with Keio University regarding the vision for Azabudai Hills in 2018. It was the year after the Keio University School of Medicine celebrated its 100th anniversary.

When we shared our thought that "we want to realize the wellness of the future throughout 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 be 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 diseases before they occur." 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 it. To do so, they must not stay within the hospital but must go out into the city to expand the possibilities of medical care. It must be addressed by the entire university and society as a whole, beyond the framework of the hospital and School of Medicine. Such passionate awareness of 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. It was decided that the Center for Preventive Medicine at Keio University Hospital would be expanded and relocated to Azabudai Hills, and that the Hills Joint Research Laboratory for Future Preventive Medicine and Wellness would be established to conduct research on future-oriented preventive medicine.

The project with Keio University for the future of preventive medicine 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 opening at Keio University Hospital in 2012, the Center for Preventive Medicine has been a facility that provides comprehensive health checkups (Ningen Dock) to approximately 6,000 examinees every year, contributing to the early detection and treatment of diseases. While discussing the relocation of this facility with Keio University, we have been thinking together about the mission of preventive medicine in 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 that they can remain in a healthy state of mind and body in their daily lives. That is what is required of preventive medicine from now on, and we reached the conclusion that new developments could be possible precisely because it is located in the city of Azabudai Hills. Based on this idea, the Center for Preventive Medicine at Azabudai Hills will develop a new service called "Preventive Medicine Membership." This aims to not only check for the presence of disease through an annual health checkup but also to consider the health of each examinee over a 10-year term, intervening in daily physical and mental disorders and providing advice according to individual health issues and goals, with the aim of maintaining contact with examinees in their daily lives. This is the basic mechanism for practicing the concept of "Personalized Preventive Medicine," which provides the optimal preventive medicine for each examinee 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 ourselves to approach people's health from their daily lives, going beyond the traditional boundaries of medical care. 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 a few days or weeks later, spend days as usual, and receive the same feedback at the next year's checkup. To address questions such as what kind of meals to eat or what kind of exercise to do, we aim to create an environment throughout the city and embed mechanisms that change people's behavior.

I believe that the seamless connection between preventive medicine and daily life without separation is what we aim for in the future of preventive medicine, and it is a major purpose for the Center for Preventive Medicine coming out into the city of Azabudai Hills. Moving from an approach at a single "point" through an annual health checkup to a "linear" approach that involves the examinee's health over the medium to long term, and further to a "planar" approach that includes daily exercise and diet, which were lacking in conventional medical care. Realizing the spatial expansion of preventive medicine throughout the entire city is the vision we are aiming for together 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, such as connecting to Keio University Hospital, which is a hospital with specific functions, when specialized and advanced medical care is required. Performing the role-sharing of medical functions through regional cooperation will likely become a new model.

● Hills Joint Research Laboratory for Future Preventive Medicine and Wellness

Mori Building and Keio University are also working on realizing future preventive medicine for living long 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 are increasing 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, 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 teaming up 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 it for research is a challenge. There are probably 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 of 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 it possible, and we at Mori Building can connect that to the city and society. "Creating health in society as a whole." It is not an easy task, but we want to challenge ourselves with what can be done 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, but 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 with the theme of "Wellness" at Azabudai Hills 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. I hope to work together for a long time to nurture a "Wellness" city at Azabudai Hills.