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Japan has long been the world leader in longevity, but some experts are now suggesting that the island nation may soon face a drop in the rankings.
"In an era of economic stagnation, political turmoil, aging populations, and inadequate tobacco control, Japan does not seem to be effective in addressing its new set of health challenges," wrote Dr Christopher J.L. Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington.
"Without concerted action, Japan, like the USA, is likely to continue dropping in the global mortality league tables," Murray wrote in an issue of the medical journal the Lancet published Sept 1, that is devoted to exploring the reasons for Japan's health successes.
Although Japan's decline, relative to the longevity of other nations, will not be as severe as the relative decline of the U.S., "it is a cautionary tale that success in the past does not guarantee top performance in the future," Murray wrote.
Murray's prediction relies on, among other sources, a research paper in the same issue entitled "What has made the population of Japan healthy?"
In that article, researchers from the University of Tokyo found that while Japan has achieved a record life expectancy of 86 years for women, "Japan now needs to tackle major health challenges that are emanating from a rapidly aging population, causes that are not amenable to health technologies, and the effects of increasing social disparities to sustain the improvement in population health."
Japan's record-breaking longevity
Murray said that the success of Japanese health care emerged after World War II, with declining infant mortality and reduction of infectious diseases.
That was followed by a period from 1975 to 1995, during which mortality dropped in many nations, as well as Japan.
But in recent years, he said, "Japan has fallen behind Sweden, Italy, and Australia for men, and behind Sweden for women. If recent trends continue, other nations are likely to achieve lower rates of adult mortality than Japan."
Reasons for this fall include the country's suicide rate, rising body mass index and relatively high rates of smoking, Murray said.
Part of Japan's health success has been attributed to universal health coverage, accomplished at a relatively low price: the country spends 8.5% of its GDP on health care, while the U.S. spends 16.4%, and Germany spends 10.7%, Murray said.
But that adds another potential reason for the fall, Murray said.
"Although Japan has a universal health care system, the quality of the care delivered might be low," Murray said, citing the example of coverage for high cholesterol treatments that is much lower than in other high-income countries.
To further increase the country's longevity by reducing its adult mortality, Japan may need to revamp its health care system, he said.
The oldest nation on Earth
But longer life is not the only change that has come to Japan in recent decades. A declining birth rate and long lifespan have helped make Japan the oldest nation on earth, with a median age above 40.
"The aging population, smoking, metabolic syndrome and suicide are all major challenges facing the public health system in Japan," said D Craig Willcox, a professor of public health at Okinawa International University and at the University of Hawaii, who co-led the long-term Okinawa Centenarian Study.
But the nation faces the need for cultural change as well, said Willcox, who was not involved with Murray's article.
"Losing status among nations may upset the national pride," Willcox said. But "the more important issue is reforming Japanese society to make it more age-friendly, and doing away with age discrimination," he said.
Willcox said he questioned whether it made sense for most Japanese companies and institutions to have mandatory retirement age of 65 years, when 40% of the population will be beyond that age in a few decades. He noted that this retirement age doesn't apply to everyone in the country.
Willcox said he believes, however, that some of the central ideas responsible for the success of Japanese health care may help in the United States. Universal health coverage plays an important role, along with some other ideas.
"In Japan, people are taught to think of their health as not only a personal issue, but also a social responsibility," he said. For example, towns in which not enough people get health screenings may pay more in taxes. "If you don't get your health exam, the whole town could suffer, and everyone could end up paying more taxes!"
Additionally, Willcox said, the government has adapted its language in discussing health conditions such as cardiovascular disease and some age-related cancers, calling them "lifestyle-related diseases" instead of "age-associated diseases," and the public has taken to the change.
"You can see the subtle shift from something that just 'comes along with age' or something you can prevent through your lifestyle," he said. "As a specialist in public health, I thought that was a brilliant move."
© Reprinted with permission of MyHealthNewsDaily
50 Comments
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warnerbro
I wonder how chronic caesium consumption will influence this statistic.
nath
I think they left out the biggest factor: Radioactive fallout
This will have the biggest impact on the longevity of the populace of Japan. Not only the longevity but also the birth rate and thus the population decline. The impact is likely beyond our comprehension at this time. Only time will tell but the outcome cannot good.
the_sheriff
As far as I understand, the suicide rate has been more or less steady at 30,000 per year. According to this wiki article, http://en.wikipedia.org/wiki/Smoking_in_Japan smoking is actually decreasing. So that leaves rising BMI as the culprit. I really don't think Japanese people have the capacity culturally and physically to get anywhere as big as Americans.
nath
Suicides should not be counted.
And smokers should have their own category.
oberst
Imagine the outrage if Japan falls behind China in longevity.......................... LOL
wanderlust
All those 110~150 year old pensioners claiming benefits wiped off the list must have had a considerable impact on Japan's statistics.
kurisupisu
Who really gives a monkey?
japal4649
I think metabolic syndrome in Japan is on the rise due to the more processed junk foods that the japanese now eat - a phenomenon that is starting to resemble western countries like the US, UK or Australia. These processed foods are packed with sugar or high-fructose corn syrup (worse than sugar!) and vegetable oils high in omega 6 fatty acid. Plus, more and more Japaense people are eating more carbs in addition to rice, than ever before. Surely in the past, Japanese people did not eat as much bread, pasta, noodles as they do today. These developments together with an increasingly sedentary lifestyle, make people gain weight.
2020hindsights
That may be true, but I would say that 'aging population' would help maintain 'top longevity ranking'. Also, Japan has always had 'inadequate tobacco control' (what is that?!) but this hasn't been a factor before.
Metabolic syndrome (or what we call obesity in the west) does seem to be increasing, but it has a long way to go to match the US.
2020hindsights
Not sure what past you are referring to, but when I was here in 1992, they would have been eating as much of that as they do now.
taj
Good point, 2020, re: 'inadequate tobacco control'
It is much more controlled now than it was from 1975-1995, when Japan was skyrocketing to the top of the longevity charts.
japal4649
Yeah...that was a bit vague of me wasn't it. I guess I am referring to pre-WWII....when Japanese people ate little western food, processed food, sugar, wheat.
2020hindsights
Ah, well that would be true. Ramen flourished after the war when Japanese soldiers came back from China. As for processed foods - hard to find anything else in a combini. This isn't a western thing - the cup noodle was invented in Japan.
A-chan
@taj and @the_sheriff In relation to tobacco control, it takes around 30 years for wide-spread improvements to be seen (and health care cost savings to be made!) after stricter tobacco controls are implemented as it can take many decades for the body to recover from many of the effects of smoking, as well as prevent young people from taking up the habit. This is why much of the world is only now starting to see a decrease in new lung cancer and other tobacco related diagnoses after implementing various policies in the 1970s and 1980s, and many of these countries are seeing increased life expectancy as a result. Japan has a disgraceful history when it comes to tobacco control and will therefore continue to face increasing health care costs and very little improvement in life expectancy, especially for men, for decades to come. The WHO website has some very interesting information on the impact of tobacco related illness and the way in which it remains a leading cause of preventable illness and death if you’re interested. http://www.who.int/topics/tobacco/en/
As for obesity, I guess we all have to be responsible for ourselves to a point, and can only hope that the impact of radioactivity isn't as bad as some predict.
hanataro
the statictics may change. suicide in japan is number one of the world. the smoker japanese growing very fast but inother countries dropes already. and of course the fukushima accident will affect the people's health soon
2020hindsights
And yet, they have always had long life expectancy. I wouldn't expect it to rise, but I wouldn't expect it to fall based on tobacco alone...
No different than smoking.
Asagao
@japal4649. You hit the nail right on it's fat little head. Diet is the key to a healthy life, and the rice/fish/vegetables diet is on it's way out. Although radioactive contamination will cut about 2 million peoples lives out in about 20 years, weather young or old, I believe the long term effects of this and bad diet will shorten lives dramatically even in places like kyushu.
badmigraine
I do believe Japanese are long-lived, but I really wonder about the accuracy of the data that goes into these international statistics. I think collection and reporting of the data may differ by country, such as category, definition, included or excluded, data or reporting voluntary or optional, based on extrapolation from samples, etc. There are certainly financial, political and other issues that shape the collection and reporting of medical and insurance data in industrialized nations. Finally, Japan (and many other countries) are known for massaging numbers to get the best one. Take, for example, the 99% conviction rate of Japanese prosecutors. Ahem. To a man the locals I know are swollen with pride at being the #1 long livers in these annual surveys, to the point where they start saying "Nippon" instead of "Nihon", and then like the caboose of the train, the standard discourse about healthy Japanese food always follows. It would not surprise me to find out that the data and numbers are inflated.
Now to turn to this article. It galls me to read about a person from the grossly obese, factory-food-gorging US, take potshots at Japan's health and longevity figures. Also, maybe the reason for the difference in cholesterol regimes between the US and other places has something to do with eating less factory food and having far, far fewer grossly obese folks. It's jaw-dropping to visit the supermarket on my increasingly rare US trips.
CrazyJoe
The United States has about 61,000 people over the age of 100. Japan has about 15,000 people over the age of 100. But Japan's population is about half of that of the United States, so Japan should have about 30,000 people over 100 but they don't. This means less younger people are dying compared to the USA. (2009 STATS)
Virtuoso
It is interesting that the prefecture with Japan's highest longevity was, for a long, time, also its poorest in terms of per capita income -- Okinawa. With its prosperity Asia has seen an epidemic of diabetes, and that is surely having an effect on life expectancy. Also, the Boshi techo system requiring all pregnant women to inform the local health office of their condition -- something adopted from Germany back in the Taisho era -- has contributed to an extremely low infant mortality rate, on par or better than the Scandinavian countries.
some14some
Fixing the flaws in Japanese stats will be a difficult (near-impossible) task but good efforts by Dr Christopher J.L. Murray.
Frungy
Incorrect. The lung cancer rate (per 100 000) in the U.S. has been RISING since the 1970's, with the biggest rise since tobacco controls took effect (http://www.scielosp.org/img/fbpe/bwho/v78n7/7a06f1.gif). The problem is that the moment that you type in "lung cancer rate and smoking" you get a completely different set of graphs, ones showing a rise and then decrease. Both sets of graphs come from medical journals, so why does one set claim that deaths from lung cancer are rising, while the other ones (graphed against smoking) show a decline? There's a clear bias here in terms of a social agenda, and a socially acceptable answer, and common sense is being thrown out the window.
Oh, and Asia generally (yes, that area that doctors keep criticising for excessive smoking) has the lowest lung cancer rates per 100 000 population in the world, and people have been smoking for more than 30 years. Face it, the major source of lung cancer is not smoking, it's air pollution from industry. The problem is that industry doesn't want to cut emissions and so it is scapegoating smoking. ... and everyone is buying it, so nothing changes in terms of emissions controls. The same thing is happening with global warming. Industry doesn't want to control its CO2 and other emissions so it started talking about climate change as a natural phenomenon rather than a man-made phenomenon, funded tons of researchers to support their conclusions... and it has halted initiatives to cut emissions. It's the same game, time and again, and it seems like most people are just too stupid to see the pattern.
TakahiroDomingo
over recent years, Japan has adapted mcdonalds (=die young) and the USA has many sushi restaurants (=live long). this trend tends to make some sort global average (this is a trend, not a law), that extends to all developed nations. but it seems the japanese have good stuff in their genes, which doesn't wash out unless you homogenize all the human race. so yes, i think japan will always rank very high, even if it might move towards #2 or #3 one day.
gonemad
What is the source of that data? It doesn't match with the figures from the UN and the CIA which are cited on Wikipedia: http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
BurakuminDes
Diet and smoking are but two of the factors changing these trends. As the article points out, Australia has overtaken Japan in men's longevity at least. I don't suggest the Aussie diet is necessarily superior to the Japanese - yes, we do have an abundance of safe, healthy food - but there is also an abundance of junk fatty foods down under - and obese Aussies are ubiquitous now! So there are clearly many, many factors at play - environmental, prevalance of smoking and alcohol, stress, climate, exercise and hundreds more.
Tom DeMicke
They need to air "The Dr. Oz Show" in Japanese. You can learn a whole lot from that show. He's a great doctor and has a great show! Watching that show will definitely help you live longer if you heed the advice given by that doctor. Too bad Japanese people can no longer watch American Forces Network (AFN) which no longer airs over open airways. It's available only to military I.D. card holders who are the only ones who can purchase the Satellite Decoder Box needed to view AFN. Dr. Oz airs on AFN television daily.
The Munya Times
It's only interesting if longevity is significantly rising in other developed countries why the legendary Japanese is declining. Then I would say something went wrong here, otherwise it is no more than Japan is welcomed to the club. Now they live the same modern life as the others, they get the same.
On the other hand, I think longevity in the civilized, developed countries are more or less the same, the difference is just a few years or decades, i.e we all have short life just a few dozen Christmas. If in some countries or of some nations longevity were 4 or 600 years while for the others just 60, then we would have a great topic to discuss.
Now I say, life is very short for all of us.
farhaan
I don't agree with this research. The real reason for this fall is Japanese Diet (nutrition) has been changed. Japanese adopted western food and fast food slowly from last few decades. Before world war 2 Japanese relied on rice and fish and there was almost no western food, meat or fast food in Japan. Japanese diet/food was the main reason for their longevity.
saru_au
agree with wanderlust ,
very simple - all those 186 year old "nenkin mummies" found in the closet caused caused the ranking drop :)
shirokuma2011
A couple of other factors that probably come into play--one being the steady shift in population from rural to urban; today, nearly 50% of the population is concentrated in four of Japan's largest cities, and while I haven't found any studies, I wouldn't be surprised if there were statistically significant differences in health and longevity as a result of that shift.
And I still believe that universal cradle-to-grave access to even minimal health care, at affordable prices, makes an enormous difference overall, especially from a disease prevention point of view, even though it doesn't adequately address the need for more advanced treatments and technologies. With nearly 40% of its population lacking any kind of health insurance, the U.S. expends vast sums in treating disease that has gone undetected because of inadequate access to preventive care, and while longevity may be improving, infant mortality and other measures of general population health still lag well behind other developed nations.
Pukey2
Somebody please explain the logic here. Personally, my health has got nothing to do with Joe living next door ....unless I smoke and expect others to pay for treatment for medical conditions I brought upon myself.
wytrox
This article doesnt mention anything about people who are refused medical care, ambulances are rerouted to several hospitals before they agree to treat patients...by the time they get to the ER, they're near-death...it makes me think mayb thats how they're getting rid of the sick and elderly ... First do no harm is a luxury...First DO Nothing seems to be their solution...
serendipitous
Crazy Joe
Your 2009 data is correct but the number of centenarians in Japan now stands at just over 40,000 people so your claim of "less younger people dying compared to the USA" is incorrect.
Marion Wm Steele
Okinawa and Japan proper are "horses of two different hues." Willcox andW#illcox and Suzuki, wrote an excellent book called Okinawa Forum - which gives an Okinawan slant on health. Things are much better in the Ryukyu Islands, than of the main islands of Japan and one should not try to lump all thinking under Japan. Read Willcox's book and then make your decision.
browny1
Frungy - some serious faults with your smoking analysis.
A more thorough investigation will reveal significant authorative data re smoking and dis-ease.
No conspiracy, No cover-up - just facts.
Shouldn't be too hard.
Disillusioned
Gees! You don't have to be a university professor to work this out. These statistics are based on an 80 year-old lifestyle. Give it another 40 years and Japan will be one of the lowest longevity rates in the modern world. Just tobacco consumption will be enough to knock them off
smithinjapan
Anyone who thinks this is news needs to wake up and smell the crappy roses they bloom around here. The statistics for Japan's longevity are due 100% to the current centenarians, whose diet way back when was EXTREMELY different to the diet current Japanese engage in. In fact, as I've said before, many folks in Okinawa who are in their hundreds or close have already lost their children due to diseases like diabetes, heart disease, and strokes that were never part of the family history. Lifestyle has changed so completely since WWII ended that once said centenarians pass away Japan will DRAMATICALLY drop in rankings.
pawatan
You make a good point about the radical change in diet but the bulk of the age distribution is not going to be affected by 40,000 centenarians dying. That's 40,000 out of 120+ million, statistically insignificant.
There certainly will be a shift downward due to diet changes but I don't think it's going to be a dramatic shift, just more a trend toward the mean.
serendipitous
Disillusioned
Nup. The number of smokers is decreasing in Japan and has been for more than 10 years.
smithinjapan
Nup. In fact, it is estimated the number of centenarians will be more than 1 million in 2050 (a massive increase on the 40,000 today).
pawatan
Yep.
ambrosia
If the Japanese diet is supposedly the reason for their longevity then why were they only living into their 50's before the turn of the century when they were eating nothing but Japanese food? Health care and sanitation made the biggest strides in increasing longevity worldwide, including Japan. Health care, sanitation and activities levels which have surely declined over the past 100 years. Also, we're seeing more cancer and heart problems in developed countries because people are living longer making the odds of getting these kinds of diseases higher. And before we go blaming America for the supposed decline in Japanese food culture, let's not forget tempura, karagae chicken, tonkutsu, white rice, etc. are not exactly health food if you're honest about it. The amount of food served and eaten is considerably smaller in Japan which goes a long way towards explaining the smaller number of obese people in Japan. That said, skinny doesn't equal healthy. I know loads of Japanese who are thin but live off of convenience store bentos (Japanese) and have no muscle tone at all. I also know loads of western women who come here and gain weight because they can't get the salads as meals that they're used to and have a hard time fitting work outs into their schedules. Keeping crazy work hours isn't helping the Japanese either. As a final note, it's worth mentioning that when it comes to infant mortality the criteria used for considering a baby to be a stillbirth or dead within 24 hours is significantly different in Japan and the U.S. The U.S. is often cited for having a low infant mortality when in actuality it considers babies born of rather low weights who die within 24 hours to have been born alive whereas Japan and other countries consider them stillbirths. Also, the U.S. is much more aggressive in trying to save at-risk infants in-utero. The result is that the U.S. ends up with statistics that make it look like more babies die in infancy when the reality is a little more complicated. This lack of standardization is but one bit of information that skews certain statistics in Japan's favor. I'm not knocking Japan's neo-natal care, I'm just saying that the different ways of considering information changes overall statistics, including longevity.
ambrosia
Would that be at-risk fetuses in-utero? Either way, I think my point is clear.
Johannes Weber
The so-called western food of Japan is not really western style. It is the Japanese imagination of western food. I am all too often confused whether some food in Japan is considered Japanese style of western style because it has very little in common with European food. I miss vegetable-, potato- or cereal-based meals here completely and the quality of cereal products is extremely poor. Which is one of the reason why so many Japanese women suffer from chronical constipation. Doesn't sound very healthy to me.
Japan's countryside and seaside lifestyle and diet is healthy, but the fraction of the populace that still engages in such lifestyles drops swiftly towards zero. Japan profits from the fact that it has no directly neighbouring countries which could contribute strongly to the air pollution. Well, they are capable of polluting their country themselves more than anyone else could. Japan will lose many ranks in the next decades.
sf2k
are they going to verify that those in the elderly population are alive this time?
CharlieCard
This entire article is speculation, and not the reality. Japanese life span is NOT declining. The most recent report shows the lifespan continues to increase, and no australia and others have NOT overtaken Japans total longevity.
And about the rising fatness..well first of all it may be true for men but not women. Japanese women's BMI is LOWER today than it was 30 years ago. I would post a link but the last time I posted a link my comment was deleted.
Also smoking rates are decreasing and alcoholism is (very slowly) decreasing in Japan..and those are among the highest killers for japanese men.
So as of 2011 Japans lifespan is still the longest in the world and following the trend that wont be changing any time soon. Suicides and the heat of future summers may take a toll on it though (many elderly die every summer from the heat and if Japan continues having electrcitiy problems than thats definately a problem).
CharlieCard
Also keep in mind Genetic engineering and other branches of medical science are increasing exponentially, soon Obese USA will have a life span the same as Japan...and probably withint the next 2 decades there will be anti aging regenerative medicine (for example repleneshing telomeres) and within the next 50 years...immortality will probably be within our grasp.
You guys should look up the breakthrough scientists had with anti aging medicine in mouses, they replenished the telomeres and an elderly almost dead mouse "returned" to life as a young adult mouse.
Very exiting times we live in.
serendipitous
CharlieCard
Wow. I can't help but wonder whether the idea of "immortality" is exciting or depressing! Imagine being able to write, "Actually, I posted such-and-such a comment about such-and-such 357 years ago." !!!
bicultural
Disillusioned, the percentage of male smokers in Japan has been steadily going down in recent years. Now the government is contemplating raising taxes and making it 700 yen a pack. No, tobacco consumption is not the reason.
browny1
Smoking caused diseases, esp heart disease, lung cancer, diabetes complications, circulatory & respiratory diseases take a good few decades to arise.
Smoking rates going down now will not save those who have been addicted for much of their lives.
Lung cancer in Japan has passed stomach cancer as the leading cause of cancer deaths. It HAS NOT peaked yet.
Learned opinion suggests it may in a decade or so.
Disbelievers are so impatient. Wait and you will see.