Japan has long fascinated health promoters
given its health statistics, principally life expectancy. Japan consistently
tops the league table, with life expectancy at birth standing at 82.73 (for
both sexes combined), ahead of the next three countries, Switzerland, Hong Kong
and Australia. The UK comes 23rd, with a life expectancy of 79.53
years. An article in The Lancet in 2011
suggested some causes of the rapid increase in life expectancy in Japan. See: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61055-6/fulltext
Among the reasons put forward are good
educational opportunities and good health care, with equal access to them, and
a variety of public health measures that tackled the particular problems facing
Japan, such as strokes.
Having just spent a month in Japan, I’ve
thought about these statistics and also developed some of my own ideas about
them, and about the health of Japanese society. Of course, it’s never possible
to understand another culture fully or even partially, and a month is no time
at all, but certain things were striking. Although I could begin to see why Japan’s
people might live long lives, the experience also made me query the difference
between health and wellbeing and caused me to delve into some issues and
statistics that might indicate the state of wellbeing
of Japanese society.
There are noticeably fewer overweight and
obese people in Japan, and the diet struck me as far healthier than that in
Europe of North America. The statistics bear this out – in the USA 30% of
people are classed as obese, compared with 3.5% in Japan. Portion size is a
factor and Japanese people consume 25% fewer calories than Americans. I seemed
to eat a lot and enjoyed many wonderful Japanese meals – but in fact I lost
weight during my month there. Returning to Europe, the diet struck me
immediately as being much more calorific and somehow unhealthier. If Japanese
employees’ waistlines go over a certain specified amount, they have to receive
counseling by the health insurance system.
The statistics also tell us that Japanese
people live illness- and disease-free for more years – it’s not only quantity
of years but there is quality in those extra years too, and Japan is well known
for having a higher ratio of centenarians than anywhere else in the world. There
are now 54,397 Japanese centenarians, compared with only 153 in 1963. However,
there is an emerging concern that younger Japanese people are not having
children, and the population has been declining for the last ten years. Fewer babies
were born in 2012 than in any other year on record. Media commentators talk
about a ‘flight from intimacy’ and it does appear that Japan is going through a
major social transition. A study carried out by the Japan Family Planning Association
in 2103 showed that 45% of women aged 16-24 were “not interested in or despised
sexual contact”. Another survey two years earlier showed that 61% of unmarried
men and 49% of unmarried women aged 18-34 were not in a romantic relationship,
a rise of 10% from five years earlier.
Speculating on the reasons behind these
figures is tempting. One possible explanation is that in a society where
traditional gender roles are strong, and where, as a Japanese saying goes,
‘marriage is a woman’s grave’, younger women are choosing to prioritize their
careers. Indeed, I both met and heard of women who would have been expected to
give up their careers upon marriage, even women who were in highflying academic
jobs. The Gender Equality Index just published, puts Japan as 101st
out of 137 countries, indicating that it is not within the top 100 countries as
far as equality between men and women is concerned. Although prime minster Abe
has revived plans to improve workplace conditions for working mothers and women
in general, these lag far behind what is expected in other developed countries.
70% of Japanese women leave their jobs on the birth of their first child.
Another explanation put forward for younger
Japanese to eschew intimacy lies in the preoccupation with digital technology,
which provides surrogate relationships and enables people to live in a virtual
world. In a society that values ‘deep reserve’ there is already a strong
cultural tendency towards isolation and introversion. Linked with the high
costs of living, the expectations facing married men and women and the fact
that Japanese society seems well geared up to solo living all drive the trend
to staying single. In contrast to the expectations of women’s participation in
the workforce, those on men are huge. The stereotype of salary men working all
hours is not far from the truth. The commuter trains in Tokyo are still crammed
at 9 o’clock in the evening and it’s not unusual for men to socialize with
their colleagues after work too. Japanese people are known to apologise to
their co-workers for taking their holidays, and taking leave can be interpreted
as a sign of lack of commitment. A survey by the Health, Labour and Welfare Ministry
in November 2013 showed that full time Japanese employees only take 47.1% of
their paid leave. Although entitled to an average of 18.3 days, they took only
8.6 days; men took 44.2% and women 53.4% of the holidays they were entitled to.
These figures were confirmed through my anecdotal discussion with Japanese
colleagues, and rendered redundant a typical topic of conversation among
co-workers – that is, where are you going for your holidays?
My limited exposure to health promotion in
Japan indicated that a medical model predominates; one example is the lecture I
gave to 65 young women training to become school health specialists, where
there was incomprehension, not only due to the language, but because of the
concepts, where a health inequalities discourse, a social model of health and
the idea of wellbeing seemed completely foreign. The idea of focusing on
minorities, a common preoccupation within health promotion, seems an embarrassment
within a society that emphasizes the importance of homogeneity. One proverb
perhaps illustrates something happening culturally - “if you see a nail
sticking up, hammer it down”, which relates to the idea of not sticking out, but
conforming. What is it like to be ‘different’ in Japanese society or to question
it? The Ainu people of Hokkaido are a minority that are rendered invisible and
have had to fight, and are still fighting, for their rights. The Ainu have been
systematically discriminated against and successive governments have been
reluctant to recognize their status for fear of preferring rights over and
above those given to anyone else. See: http://scholarspace.manoa.hawaii.edu/bitstream/handle/10125/21976/v1i1_02okada.pdf
The Burakumin are a group that are still
seen as the ‘untouchables’ within mainstream Japanese society yet are
genetically, linguistically and culturally the same as other Japanese people. Prejudice
and discrimination against buraka, as a hidden lower caste, continues: http://www.hurights.or.jp/archives/focus/section2/2008/06/present-day-buraku-discrimination.html
Japanese society seems ‘tolerant’ of sexual
minorities yet the government has been criticized for spending very little on
meeting the needs of gay people for information. HIV infection rates for gay
men in Japan are higher than anywhere else in the developed world.
Another proverb relates to “The fire across
the river”, meaning that the problem is over there, not here. There has been a
great deal of speculation over why, in 2011 following the tsunami, the
Fukushima nuclear plant was allowed to get to a state where there was the most
serious incident since the Chernobyl disaster, given the huge stress on health
and safety in Japan. It appeared that no-one was prepared to speak out to criticize
what was happening, plus it was seen as a problem that was ‘over there’. This
makes the secrecy bill currently going through the Japanese Parliament at the
moment all the more worrying. The government is being criticized for not saying
how they government will guarantee the public’s right to know what is going on,
how the freedom of the press will be protected, and how the government will
decide what is a state secret. Professor Noriko Hama, writing in The Japan
Times notes that what’s happening is worthy of ‘Yes Minister’ where a government
‘keeps secret what secrets it deems especially secret’: http://www.japantimes.co.jp/news/2013/11/30/business/the-secret-of-keeping-official-secrets-secret/#.UsElgyjKkRk
Certainly Abe’s premiership seems deeply
worrying to anyone with leftish politics, and the stress on nuclear energy and rearmament
are major discussion points in a country with its particular history. It was
moving to see survivors of the Hiroshima nuclear bomb turning up each day to
sit in the peace park to talk to the many school groups and other tourists
about the reality of what happened. The clock in the peace museum records how
many days it has been since the last nuclear test – when I was there is was 49
days ago. See: http://www.pcf.city.hiroshima.jp/top_e.html
In the years since 2001 when the peace
clock was put in place, it has been re-set 14 times after nuclear testing, serving as a powerful
indicator that nuclear testing and nuclear bombs are very much in evidence globally
despite the experiences of Hiroshima and Nagasaki. It was a deeply moving and very strange experience
to be standing in the place where the bomb detonated, an event so much a part
of our collective history.
Japan is often described as a country of
deep contradictions and as being inexplicable to a foreigner. For me, one major
contradiction was between the intense beauty of gardens and temples and the
stunning attention to the creation of simple pleasing vistas, and the enormous
ugliness of urban landscapes and urban sprawl that characterizes so much of the
scarce land that has been built on to house the population of 126 million. The visibility
of electricity cables in an earthquake prone country, rendering burying cables
unfeasible, doesn’t help the visual clutter. It’s not a country to visit for
wilderness experiences, even in Hokkaido, where I went to watch the red-crowned
cranes in their wintering grounds. But there is a huge amount to visit Japan
for; under the reserve, Japanese people are massively helpful and kind. The
courtesy and consideration for others are remarkable; the younger people I met
everywhere were great fun and once in a situation where they can let off steam,
such as in a bowling alley, they certainly know how to have a good time.
A glimpse at Japanese society perhaps
highlights the difference between health and wellbeing. Health statistics might
show a picture of ‘progress’ yet there are ways in which Japanese society could
be seen as deeply ‘unhealthy’. From a professional interest point of view, I’m
left with a series of questions about health and wellbeing. What explains the
very low rates of crime and the high rates of personal security? What lies
behind Japan’s supposedly high suicide rates? These rates have been questioned,
with a suspicion that some suicides are actually murders: http://www.japantimes.co.jp/news/2013/02/03/national/japans-suicide-statistics-dont-tell-the-real-story/#.UsEqMijKkRk
However, Japan is described as a ‘suicide
tolerant’ society and doesn’t have the religious taboos against it that can
predominate elsewhere. Suicide rates are three times those in the UK, and
30,000 Japanese people have taken their own lives every year for the past 14
years. See: http://thediplomat.com/2013/01/searching-for-answers-japans-suicide-epidemic/
The Tokyo underground runs efficiently and
smoothly yet I wonder about the stress caused by using it every day; as a
feminist, the geisha culture caused us endless hours of discussion – women,
it’s claimed, can earn huge amounts, empowering them to set up their own
businesses after they leave that profession, yet to me it was all about a male
gaze and an idealized form of femininity, and seemed to sum up something about
gender roles more generally; the lack of green spaces within the big cities
feels like an alienation from nature; how can we explain the obsession (of
some) with slot games like pachinko and the with the lottery?; I’m not sure
what to make of the preoccupation with ‘Japanese-ness’ and traditional culture,
and the aversion to immigration. All
personal views and thoughts – if you have any other views, please post them to
me!
