Beginning in the 1950s and 1960s, Japan began developing a reputation for its longevity. By the 1970s, the Japanese were the longest lived of any population in the world. Although genetic predispositions and cultural factors like diet certainly contributed to the long life span of the Japanese, it was the country’s kaihoken, or universal health care, that was largely responsible for boosting quality of life and increasing the country’s life expectancy.
In recognition of 50 years of kaihoken, the medical journal Lancet recently published a special issue exploring Japanese longevity. Unfortunately, it’s not all good news.
Even though Japan continues to have the highest life expectancy in the world, it is on track to be outpaced by other long-lived countries, like Sweden (which has high male and female life expectancy) and Italy and Australia (with high male life expectancy). 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.
“If recent trends continue, other nations are likely to achieve lower rates of adult mortality than Japan,” said Professor Christopher Murray of the Institute for Health Metrics and Evaluation, University of Washington, Seattle. He added that Japan’s universal health care system may not be sufficiently nimble enough to address mounting 21st-century health problems. “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. It will take more than universal access to a low-spending, high-volume health system to tackle these challenges.”
Physical illness is not the only drag on the country’s life expectancy: more than 30,000 Japanese people take their own lives each year, perhaps the continuing aftereffect of the 1997 financial crisis. Given the suicide rate’s close association with unemployment rates, said Professor Yutaka Motohashi from the Department of Public Health, Akita University Graduate School of Medicine in Japan, “It seems likely that this negative socioeconomic background is associated with the suicide trend in Japan.”
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. That system is already strained by the demands of an aging populace — 23% of the Japanese population is aged 65 years or older, a proportion that is projected to grow to 40% by 2050 — and by injuries associated with recent natural disasters, such as the March 2011 earthquake.
The Lancet studies offer insight into how every country must understand and adapt to its own population’s unique health challenges — especially as those challenges evolve through generations.
Meredith Melnick is a reporter at TIME. Find her on Twitter @MeredithCM. You can also continue the discussion on TIME’s Facebook page and on Twitter @TIME.