Institute For The Future

The Non-Ancient, Non-Secrets of Japanese Health

The Japanese people are longer-lived and healthier than Americans. Currently, that information does more to sell diet books than influence policy or infrastructure development. But research suggests public policy, income and healthcare equality, and the physical and social environment are a big part of what makes Japan healthy.

A while back, I was browsing books in San Francisco’s Japantown and came across the following title, Japanese Women Don’t Get Old or Fat. It was essentially a diet book, and, initially, the title made me uncomfortable. It struck me as sort of sexist (“aging and gaining weight is the worst thing that can happen to women, for dudes it’s okay though”) and sort of racist (though the fact it’s a diet book implies otherwise, the wording of the title seems to say suggest Japanese women are inherently small and young-looking). I flipped through the book, though, and found some interesting sections. It does contain some good health advice, but more than that, I think it says something interesting about how we look at health in this country. Just as the book claims, the Japanese people are longer-lived and thinner than Americans. However, that information has mostly led us to examine the Japanese diet and, as far as I can tell, hasn’t really influenced public policy or how we approach our built environment.

Here, we tend to think about health in terms of personal decisions, but the Japanese smoke more than people in the US, yet they remain healthier. They do, however, eat better, but even that has strong environmental causes. For instance, eating lots of fish and vegetables, as the book recommends, is a lot easier in Japan simply because healthy food is more available in the physical environment. Japanese convenience stores, which are probably no more than a mile apart from each other in urban areas, tend to have relatively healthy, ready-to-go meals (fish, rice, vegetables, unsweetened tea) at a reasonable price.

The book also points to the “80 percent full rule,” (the idea that you only eat ‘til you’re 80 full). This is a cultural idea, (i.e. part of the social environment and outside the individuals control), and it’s reinforced by environment (it’s hard to find a super-sized portion of anything anywhere in Japan, and plates and dishes tend to be smaller there than in the US).

Other reasons for Japanese longevity are likely that infrastructure encourages using bicycles and public transportation, (and we’re constantly learning how unhealthy driving is).

But another major factor in Japanese health is public policy.

In fact, a series of reports analyzing 50 years of healthcare in Japan, (cited in this Guardian article,) found the relative lack of income inequality and the country’s socialized medical system as significant contributors to Japanese longevity. From one of the papers:

“Excellent health outcomes in Japan have been attributed to favourable risk factor profiles, health system performance, and universal coverage.“

In fact, governance has a lot to do with Japanese health in ways that Americans might find shocking, even comical. For instance, this law passed in 2009:

“Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups... Those exceeding government limits — 33.5 inches for men and 35.4 inches for women, which are identical to thresholds established in 2005 for Japan by the International Diabetes Federation as an easy guideline for identifying health risks — and having a weight-related ailment will be given dieting guidance if after three months they do not lose weight… To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets.”

There are two pretty huge cultural differences we see at work in this particular example. The first is the degree to which Japanese people are willing to allow the government to regulate their lives. The second is that they place the responsibility with the collective, in this case the company or local government, rather than the individual. These two things are not likely to change in the U.S., and I don't have a strong opinion on whether or not they should, but they both indicate that a diet book can only really begin to scratch the surface of what makes Japan a healthier country.

So what does all this have to do with the future of health?

We're already seeing some experiments to make this information actionable. Albert Lea, Minnesota, for instance, made a comprehensive effort to make their town an environment conducive to health. They partnered with the AARP and author Dan Buettner, who has done research into regions throughout the globe where people have exceptionally high life expectancies, to create the AARP/Blue Zones Vitality Project, aimed at extending the lifespan of the entire town—and they took a remarkably holistic approach. Among the changes: They altered the built environment to make it more walkable. They encouraged restaurants and retailers to change food labelling and promote healthy food choices. They suggested people invest in smaller plates to nudge them to eat less. They made changes to workplaces and schools. And they took a social approach to encouraging excercise. In the end, they reported that residents that took part in the initiative extended their lifespan by nearly three years.

If experiments like this continue to succeed, we could see a major shift in conventional wisdom about what makes a region healthy.