March 3, 2026Open Access

Local policy governance arrangements and COVID-19-related mortality in municipalities in Japan: a cross-sectional ecological study

Key Points

COVID-19-related mortality was lower in cities that implemented suspension policies, highlighting governance impact.
Cities with suspension policies had a relative risk of 0.75 for COVID-19 mortality, indicating a significant difference.
Cross-sectional ecological analysis of 20 Japanese cities reveals patterns in mortality and policy effectiveness.
Implications stress the need for adaptable local governance to improve population health and reduce disparities.

Abstract

During the study, 5,383 COVID-19-related deaths were reported. Of the 20 cities, five had implemented the suspension decision before or during the pandemic. Cities with the suspension policy showed an adjusted mortality relative risk of 0.75 (95% confidence interval: 0.60 to 0.94) compared with cities that retained the temporary revocation policy. Conclusions: The results suggest that local governments with flexible collaborative policymaking were more successful in mitigating the COVID-19 mortality impact in Japan. The findings highlight the potentially important effect of governance arrangements on population health disparities.

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Discussion

Journals

Frontiers in Public Health

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Institutions

The University of Tokyo

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