Japan has had the highest average life expectancy in the world since 1986, and babies born in the last few years will live on average to 86 years. The first paper in The Lancet Japan Series looks at the reasons behind this phenomenal success, and, paradoxically, the problems it could cause due to the pressures arising from a rapidly ageing population. This first paper is by Professor Kenji Shibuya, Department of Global Health Policy, University of Tokyo, Japan, and colleagues.
Life expectancy increased rapidly throughout the 1950s and 60s as first infectious disease mortality dropped markedly, which was swiftly followed by stroke mortality falling. High blood pressure was also controlled through salt reduction campaigns and increased use of antihypertensive drugs and better health technologies. However, stroke mortality and high blood pressure continue to be significant burdens in Japan.
The introduction of universal health insurance coverage in 1961 enabled the provision of equal opportunities in health promotion. And the gains have largely been made throughout the population—across all regions and all socioeconomic groups. However, the downward trend in socioeconomic inequality in health has been less obvious since the 1990s, which has coincided with income inequality gradually increasing. Japan's residents today see their physician more than twice as often on average per year than residents in the UK (13.4 times versus 5.0 times)*. Many companies also pay for comprehensive health checks (known as human dry docks) that can prevent chronic diseases taking hold and also detect cancer in its early stages.
Further progress in Japan's longevity depends on the prevention of major risk factors for chronic diseases such as tobacco smoking, obesity, and uncontrolled blood pressure. A further reduction in dietary salt intake, alcohol control, and tackling Helicobacter pylori infection (high in many Asian countries) should also be prioritised. Efforts must also be made to bring down the country's high suicide rate—some 30 000
Japanese citizens take their own lives each year, 70% of them men. And the threat of natural disasters has been brought to the fore with the catastrophic earthquake and tsunami in March 2011. Yet Japan's amazing success of getting people to live longer could also be the nation's biggest challenge. Currently, 23% of the population is aged 65 years or older, yet by 2050 this will be 40%, while the population will shrink from around 127 million today to 95 million in 2050. The universal health insurance scheme was never meant to deal with such a skewing of the population's age structure.
The authors say: "With the achievement of success during the health transition since World War 2, Japan needs to tackle major health challenges that are emanating from a rapidly ageing population, causes that are not amenable to health technologies, and the effects of increasing social disparities to sustain the improvement in population health."
They conclude: "We hope [this Series] will serve as a guide that will help other countries to develop policies that fit their specific circumstances... This Series will draw attention to how Japan is unique in overcoming different and changing population health challenges in the past 50 years to achieve population longevity, and highlight how the country's experience can be an important resource for the global health community that could transcend geographical, social, cultural, and political boundaries for understanding and helping enhance population health worldwide"
Professor Kenji Shibuya, Department of Global Health Policy, University of Tokyo, Japan. T) +81 3 5841 3688 E) firstname.lastname@example.org
*Note to editors: figure for physician visits comes from paper 2
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