Japan's High Life Expectancy Holds Lessons for the West

Researchers at the University of Tokyo (Japan) explored factors contributing to Japan's healthy population, including post-World War II changes to the healthcare system--such as greater control of intestinal and respiratory infections--as well as increased use of vaccines for preventable diseases. The basis for this change was set by the establishment of free, mandatory primary education and a social insurance system before World War II and the establishment of universal healthcare in 1961, facilitating access to primary care prevention services.

There were also sharp drops in mortality rates for cancers and ischemic heart disease over the last 61 years. For instance, from 1965 to 1980, the reduction in the mortality rate for stroke in people ages 60-74 boosted life expectancy at birth by 1.1 years for men and one year for women. This drop continued steadily through the 1990s and the authors attributed it to a favorable lipid profile and glucose metabolism, low body mass index (BMI), moderate alcohol intake, and healthy diet.

Additionally, more than 70% of Japanese men aged 45-54 undergo some form of health check-up annually, often done as part of a program called “Ningen,” during which people stay at a clinic or hospital for several days for a whole-body systemic exam.

Government-sponsored health education strategies have also been well received in Japan, such as a program to lower the incidence of stroke centered on blood pressure screening for people at high risk, and a population-wide education program on reducing dietary salt intake. Japan was also able to provide far-reaching health coverage at a cost of less than 10% of the gross domestic product (GDP). However, the country does face several health-related challenges in the 21st century, including a graying of the country, with 23% of the population checking in at 65 years and older in 2010. A larger pool of seniors will put a financial strain on a health system that has already been hard hit by a general economic downturn. Additionally, the long-term effects of the natural disasters of 2011 on Japan's health and healthcare system also remain to be seen.

“The Japanese how have the longest life expectancy after birth in the world and the percentage of Japan's population aged 65 years or older has increased nearly four-fold from 6% to 23% over the past 50 years,” concluded lead author Kenji Shibuya, MD, and colleagues. “The increase in longevity in large part was due to decreased mortality rates for communicable diseases in children and young adults, and stroke mortality reduction associated with control of hypertension.”

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