Determinants of Longevity — Can Japan stay at the top of the list?

Historically, Japan has sat at or near the top of world rankings of life expectancy at birth. A PHS 795 student calls our attention to an article that examines some of the determinants of population health in Japan and questions whether their position will hold:

Around the world, Japan is among the highest ranking countries with longer life expectancy and it seems as if they are playing all of their cards right. The US however is among the lowest among OECD comparable countries. This sounds great for Japan, but it’s a little more complex than that. According to a TIME magazine article, the medical Journal Lancet published a special issue and it’s not all-good news. I thought it helpful in understanding the differences in population demographics, health system and healthcare system and their impact.—-how-long-will-it-last/



4 thoughts on “Determinants of Longevity — Can Japan stay at the top of the list?

  1. There are a few things I find interesting about this article. The first is that the “bad news” described is simply a slowing in improvement of longevity in comparison to other developed countries. Although I understand that the optimal (in traditional public health terms) trajectory for Japan would be to continue a rapid increase in longevity, based on the title I expected the article to describe a plateau or decline in life expectancy rather than simply a slowing rate. This struck me as additionally odd given the fact that the article later sites a major problem on the horizon for Japan being its growing elderly population. Given that their universal healthcare infrastructure cannot handle such an upswing it seems that rapid increase in longevity would only exacerbate the issue.

    I’m not trying to argue that Japan’s health problems leading to a slower decline in adult mortality is a good thing, but I think the article would have had a more powerful impact if it focused on the fact that Japan’s rising health issues and increasing elderly population are posing threats to the sustainability of their current healthcare system. Instead, the authors chose to focus on other countries passing Japan in the race to have the longest life expectancy, which I think is the more trivial concern here. If Japan does not have the healthcare infrastructure to support its citizens, then the country is in for far greater problems as the population grows and longevity increases (even if it’s at a declining rate).

    Additionally, this article is a good demonstration of how Universal Healthcare, while important, is only one factor of many that must be addressed for the health of a nation. I feel as though we often spend a lot of time talking about how Universal Healthcare will be the greatest possible step for the health of the United States, and although I think it’s extremely important, this article shows that Universal Healthcare does not solve all of a country’s problems. There are certainly other determinants of health in play in Japan that must be addressed, and although they are certainly leagues above the United States, they still have a ways to go in perfecting their healthcare systems for their citizens. It will be extremely interesting to continue to track Japan’s health status and see what policies and interventions are successful, or what determinants are causing these surges in unhealthy behavior.


  2. I think some of Joe’s points above are really interesting, especially the first point he made about the fact that they’re going to be outpaced by other countries… they’re still doing great things now and that should be acknowledged. It was, I guess, but the focus turned right to how they’re not doing well in other respects – I’d like to learn more about how they got to the point they are at now, especially given the country’s relatively tumultuous history.

    What struck me most was that beyond the lack of capacity for the universal health care system to continue working as well as it does now… was that some of the reasons it will no longer work is because the Japanese public have, in essence, been “Americanized.” The quotes below are what I am referring to: “Researchers believe that relatively high rates tobacco use, changes in diet that have raised body-mass index, and the rising rate of suicide are contributing to Japan’s slowing declines in rates of adult mortality.
    …Still, the biggest health challenge facing the Japanese are related to lifestyle factors like cigarette smoking, obesity and uncontrolled blood pressure — all of which contribute to chronic health problems that tax the public health care system.”

    The chronic health problems that the American public have become all-too-familiar with are some of the reasons Japan will no longer succeed by these measurements, despite their incredible universal health care system. This article made me think about how globalization has allowed the increased prevalence of noncommunicable diseases, mostly preventable, to spread throughout the rest of the world and reach Japan – and other countries not focused on in this article of course. I am interested to see how Japan structures its systemic changes to meet the challenges ahead. They are ahead of us on universal healthcare, maybe they’ll be ahead on combating our highest causes of disease too and we can learn from them in the near future.


  3. I think this article does a great job of reflecting multiple important points. First off all, it demonstrates that that the quality of health and health systems is context dependent. While Japan was once a leader in longevity, that was proportional to the health determinants present in their society and the ability of their health system to address those determinants.

    Secondly, it quite succinctly demonstrates that universal health care is not an all-encompasses solution. While universal health care can address multiple social determinants of health, there are numerous other aspects of the health system as well as the factors of population health that affect the adequacy and efficiency of a solution. As the health statuses and needs of populations become more complex, so too do the systems and programs needed to address them.

    Finally, we as readers can see a great example of the increasing burden of non-communicable/chronic diseases. I am glad that mental health is also brought up in this article, as this seems to be something that is continually stated as important but rarely expanded upon. It is interesting to see the effect of increasingly common health risks on a country that was once considered to be at the top of the health/healthcare game. If they are able to adapt to these issues, they certainly have the potential be an example of effective solutions for other countries.


  4. I appreciate that this article recognizes that healthcare access isn’t the only contributing factor to health. Health behaviors are mentioned, such as smoking and obesity, but also mentioned are socioeconomic status, suicide and injuries. Addressing mortality rates isn’t a quick fix. A huge variety of factors contributes to increased mortality rates, and focusing efforts on one thing (e.g., universal health care), won’t get the population very far.

    This being said, I think the article undermines the overall success Japan is having. They still have the highest life expectancy in the world, and eventually these rates are bound to slow or plateau. I also dislike how the article makes life expectancy a competition among countries. While, yes, every country should strive to improve and having these rankings is a great idea for countries to realize where they are lacking, countries should also collaborate and learn from each other. We can improve upon global health if we unionize our efforts and learn from the successes and shortfalls of other countries.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s