Geographic Disparities in Health

This chapter highlights the geographical aspects of health disparities in Japan at different levels, from the 47 prefectures nationally to the neighbourhood level. In the post-war period, Japan has successfully attained the longest life expectancy in the world. At the same time, it has substantially reduced geographical disparities among the prefectures. This indicates that reducing such disparities in living standards may also be related to improving the health of a country’s entire population. However, disparities of health have appeared among populations living in socially segmented areas in large neighbourhoods of metropolitan regions. Such neighbourhood-scale disparities in health are associated with a number of environmental characteristics of Japanese neighbourhoods reflecting socioeconomic segregation and development histories of residential areas. In the era of a super-aging society that contains the threat of re-widening social inequalities, Japan faces challenges to build health-supportive environments for tackling multi-scale disparities.

Japan’s Miracle Decades

Since the end of World War II, the Japanese economy has experienced two types of ‘dual structure’ issues among occupational groups. The period before the war until 1950 consisted of large-scale companies stemming from zaibatsu (financial cliques) and indigenous domestic industries. The health disparities across occupational groups, often observed in the West, increased between the pre-war period and the 1950s but declined in the subsequent high economic growth period. The decline in health disparities was aided by economic democratization policies, active labour union functions, and post-war economic growth. Near-total employment was achieved, at least among male workers, in the late 1960s to early 1970s. Later, recession in the wake of the bursting bubble economy after 1991, and the subsequent economy-first policy, brought another dual structure: regular employees versus lower-paid ‘precarious’ employees. The latter group includes many women. Stressful working conditions including long working hours among specific occupational groups may cause unique patterns of health disparity among Japanese workers.

Family, Community, and Mental Wellbeing

The Japanese demographic changed rapidly after 1945. There was rapid ageing, a sharp decline in three-generation households, and a rise in solo households. Still, the Japanese family-based collective culture continues to shape individuals’ overall beliefs and attitudes within society. The demographic shift has become a significant constraint on the Japanese social care system, manifesting as ro-ro kaigo (the old caring for the older), kaigo-rishoku (leaving employment to become a carer), and ‘8050’ (parents in their eighties caring for socially withdrawn children in their fifties). The national tendency towards social detachment makes such problems difficult to address. Today, Japan is finding a way to overcome these social challenges and establish an inclusive society by re-connecting people, including the mentally ill, within communities by tapping into the culturally inherited collective mentality of its people.

Gender Inequalities in Japan

Striking gender inequalities in Japanese society are rooted in beliefs about gender division of labour. Gender-based social norms have driven employment and working practices such as long working hours. The male breadwinner model has only recently started to give way to more diverse role identities. Despite persistent gender inequalities, Japanese women have the longest life expectancy in the world. This paradoxical relationship can be explained by 1) overall women’s positive health behaviours, 2) Japan’s post-war social security programmes, protecting the vast majority of full-time homemakers, and 3) women’s roles in the household and the relation with their psychological wellbeing. The rigidity in current social programmes has failed to meet the needs of increasingly diverse Japanese society, which has contributed to rising female poverty and associated health problems.

Japan in Long View

This book brings together the work of leading researchers in the fields of epidemiology and public health in Japan. Authors reflected on the evolution of health in the population since the first Tokyo Olympic/Paralympic Games. Content is organized according to (1) stages of the life course, (2) major chronic diseases and risk factors, and (3) some significant institutional or geographical connections of Japan to the planet. This chapter summarizes a number of messages and research questions for further discussion. The array of evidence confirms a fundamental idea in social epidemiology: the importance of living conditions—economic, social, institutional, cultural—as the main determinants of the health of populations. More specifically, the official statistics and epidemiological studies based on the Japanese population provide a detailed account of the transitions from a young middle-income country to a super-ageing high-income country. Over this period of transition, including recent years of economic slowdown, Japanese health and longevity has not stopped improving.

Disaster and Health What Makes a Country Resilient?

Resilience reflects the capability of communities and individuals to resist, cope with, and continue functioning during and after a disaster. Evidence from the 2011 Great East Japan Earthquake and Tsunami suggest that maintaining community social interactions is especially important to enhance community resilience. Economic crisis is another type of disaster that challenges population health, and may affect privileged social groups, e.g. corporate managers. In the aftermath of the 2008 Global Financial Crisis, health risks for the children of impoverished households and single-parent households increased. Community preparedness and adequate social capital before disasters is important to build resilient communities. With routine monitoring of health conditions across subpopulations, we can identify groups in need of support and assess the effects of those actions. It is crucial that central government measures align with local actions to maximize support for communities affected by disaster.

Mental Health and Wellbeing in Japan

This chapter provides an overview of the history and current status of mental health and mental health care in Japan in the last 50 years. One in 37 people currently receives treatment for any mental disorder, while one in 20 people have experienced a common mental disorder in the past year. Prevalence of mental disorders may not have increased significantly during the last 10–15 years, despite the economic slowdown and social change in this period. Mental hospitals played a central role in treating people with mental disorders, isolated from the community, and the number of beds in mental hospitals per population remains greater in Japan than in other countries. Policy has shifted from inpatient treatment towards community-based care and support, however change is slow. Suicide rates have been influenced by economic factors. The male rate was high between 2000 and 2012. Rates in both sexes have recently declined, but remain above those in other countries. The Japanese have a characteristic perception of wellbeing in the family- and community-oriented collective culture, based on a sense of the meaning of life (ikigai). However, it remains unclear whether the collective culture is entirely beneficial to mental health. In the last decade, Japan has faced several behavioural problems among younger generations, at home and at school. Mental health care in Japan faces many challenges.

Cancer Inequalities in Japan

Cancer death has been Japan’s greatest public health enemy since the 1980s, after controlling infectious diseases, such as tuberculosis. Improvement in cancer survival due to the development of effective cancer treatment and the spread of screening for early detection of cancer has led to declining trends in cancer mortality. However, inequalities in cancer outcome have been observed and trends in inequalities for some cancers have widened in Japan. Socioeconomic inequalities in cancer can be partly explained by differences in the prevalence of cancer risks and screening uptakes. Issues of access to treatment and diagnostic differences still need clarification due to the lack of data in Japan. We need to understand the mechanisms of inequalities in cancer occurrence, detection, and treatment to deal with this barrier to cancer control.

Dementia and Healthy Ageing in Older People

As a front runner of population ageing, Japan faces a future that the human species has never experienced. While we rejoice in longevity, it can bring financial and social challenges resulting from loss of independence. Frailty and dementia are important in this context. To meet those challenges, the Japanese government has been making efforts to reform public health and social care systems, and to develop a trans-sectoral social policy programme for dementia. Culturally, the Japanese value seniority and family traditions of caregiving. Drastic demographic change, and the subsequent decrease in household capacity for informal caregiving, requires a cultural and normative reform in society. An ongoing dialogue between social determinants of health and policy responses in Japan can provide valuable lessons for other countries with a growing ageing population, including the UK.

Health and Financial Sustainability in Ageing Japan

As a front runner of population ageing, Japan faces a future that the human species has never experienced. While we rejoice in longevity, it can bring financial and social challenges resulting from loss of independence. Frailty and dementia are important in this context. To meet those challenges, the Japanese government has been making efforts to reform public medical and social care systems, and to develop a trans-sectoral social policy programme for dementia. Culturally, the Japanese value seniority and family traditions of caregiving. Drastic demographic change, and the subsequent decrease in household capacity for informal caregiving, requires cultural and normative reform in society. An ongoing dialogue between social determinants of health and policy responses in Japan can provide valuable lessons for other countries with a growing ageing population, including the UK.