Why do people live longer in Japan?

Why are Japanese people living so long? Can we learn any lessons from them? 

How long do people live to in Japan?  

  • What is the average life expectancy in Japan?
  • Is it the Japanese diet?
  • Is it the healthcare system?
  • What about social cohesion?
  • Do Japanese people exercise more?
  • Do Japanese people have better genes?
  • Downsides to the Japanese way of life – karoshi and karo-jisatsu
  • What health lessons can we learn from Japan? 

What is the average life expectancy in Japan? 

Japanese women have a life expectancy of 87.3 years – the second highest in the world after Hong Kong – while male life expectancy in Japan is the third highest internationally, well ahead of the US and UK.  

 In this article, we look at some of the possible reasons why Japan has an average life expectancy so much higher than most other countries. 

Is it the Japanese diet? 

A 2016 study in the British Medical Journal (BMJ) found that Japanese adults who followed government advice about diet had a 15% lower rate of mortality than those who didn’t follow the advice. The diet itself is high in certain carbohydrates (such as rice and vegetables), fruits, fish and meat, and low in saturated fats, processed foods.

Average food portions in Japan are quite a bit smaller than in a country like the USA.

 However, in 2011 The Lancet suggested the dietary picture is more mixed. Some aspects of the Japanese diet (like a preference for highly refined rice and bread as staples) could be responsible for increasing rates of diabetes due to low dietary fibre intake and a high glycaemic index. 

The traditional Japanese diet is also under threat as more Western food chains and Western dietary habits become popular. By 2012, the Japanese government was already concerned about the fall in the consumption of fruit and vegetable and the increase in meat consumption.

These changes have led to a rise in obesity in Japan, and as a result, an increase in the risk of hypertension (high blood pressure) as well as other adverse health outcomes, such as breast cancers. Despite this (and assisted by lower calorie consumption), obesity rates in Japan are still very low, with fewer than 5% classed as obese compared to nearly 28% of people in the UK and 36% in the USA.  

Is it Japan’s healthcare system?

Since 1961 Japan has had universal healthcare, with equal and universal access to healthcare for all through a health insurance scheme which is paid for by government, employers and individuals. As such, Japan performs well when looking at the social determinants of health (the conditions in which people are born, grow, live, work and age). 

In Japan, regular check-ups are the norm. Local government authorities provide mass screening for everyone at school, at work or in the community. Also, everyone has to fill in a medical questionnaire that asks specific questions about lifestyle. These annual check-ups may help people become more health conscious.

However, the financial and social underpinnings of Japan’s health provisions are threatened by economic decline and widening social inequalities. Together with rising costs and an ageing population, this raises the question of how long Japan’s healthcare system can remain universal.

The cost of Japan’s universal healthcare is about 11% of its GDP (gross domestic product).  That's more than the UK’s 9.8% but well below the USA’s nearly 17%. Does this mean that Japanese people are using less healthcare than their US counterparts because they are healthier, or is their healthcare system more cost effective? Either way, universal health coverage with manageable expenditure seems worth aiming for when considering the health of the nation. 

What about social cohesion?

Professor Shiro Horiuchi, in Japan’s Journal of Population Studies in 2011, identifies social cohesion as one factor providing a particular advantage when it comes to longevity. He acknowledges that there are growing inequalities in Japan, but he argues that:

The strong group orientation seems conducive to the psychological well-being of Japanese people with low socio-economic status. It gives them deep feelings of belongingness to organizations and communities, keeping them from feeling alienated in the society…. The feeling gives them relatively high self-esteem (in spite of their low ranks and salaries), and helps them to have positive perceptions, emotions and attitudes about their lives. 

Following the effects of a quarter of a century of economic stagnation, how long this social cohesion will last is now being questioned.  However, strong social cohesion seems likely to have contributed to Japanese longevity so far. 

Do Japanese people exercise more? 

Some studies suggest that the Japanese do not exercise more than people in other countries. For example, a 2009 study concluded that Japan was one of four countries where less than 20% of the adult population was in the high physical activity category.

However, some observers argue that everyday life in Japan involves more commuting by public transport than by car, meaning more daily exercise in Japan than, for instance, in the US. More recently, perhaps inspired by the anticipation of the now sadly cancelled 2020 Tokyo Olympics, there have been positive reports of higher levels of physical activity among children and young people. 

Do Japanese people have better genes? 

There is some evidence that Japanese people have good genes which aid their longevity. Studies have suggested two genes in particular – DNA 5178 and the ND2-237Met NDgenotype – help the Japanese live longer by protecting them against some adult-onset diseases. However, this effect isn’t seen across the whole population.

Other genetic factors, including personality (especially characteristics such as conscientiousness, openness and being extroverted) also seem to be important. It is suggested that they contribute to longevity through beneficial health-related behaviours, stress reduction, and adapting to the problems of growing old.

Downsides to the Japanese way of life – karoshi and karo-jisatsu

Since the 1970s, there have been discussions about karoshi: literally, death by overworking. Karoshi is brought on by heavy workloads, long working hours and stress. 

Since 1987, when companies were encouraged to limit working hours, the Japanese Ministry for Labour has been publishing figures on karoshi. It was found that the biological aspects behind these work-related deaths are linked to heart disease, high blood pressure and strokes.

Not only are there deaths as a direct result of overworking, but suicide rates in Japan, especially for men, are also very high and are also linked to overworking – a death known as karo-jisatsu.  These deaths are most common in managerial and administrative jobs, where stress levels are high, as well as in jobs with low social support, lack of control over work, and heavy workloads.

What health lessons can we learn from Japan? 

  • A healthy diet can help you live longer, wherever you live. So follow government healthy eating guidelines.
  • Universal healthcare, with equal access to all (as we also have in the UK) helps extend our lives as well.
  • We shouldn’t underestimate the value of social cohesion - the sense of belonging to organisations and communities. We need to consider how to achieve and maintain social cohesion both as individuals and as a society.
  • Avoid the factors that risk reducing longevity, such as a diet of fast food and overworking. 

______________________________ 

Other relevant articles on the Age Watch website: 

Reviewed June 2020. Next Review Date, May 2024

Information Standard

The Japanese Healthcare system

Nuffield Trust report

NB Since this report was published Japanese expenditure on healthcare has risen to around 10% of GDP 

Social Cohesion in Britain versus Japan