Demographic Overview

Japan is an island nation in eastern Asia with an area of 377,887 square kilometers (145,902 square miles) and comprised of over 6,800 islands including, Honshu, Hokkaido, Kyushu, Shikoku, and Okinawa. There are 47 administrative divisions referred to as prefectures.

The total population exceeds 126.7 million people with over 90% living in urban areas. As of 2015, 36.3% of the total population resided in Tokyo Metropolis, Kanagawa Prefecture, Osaka Prefecture, Aichi Prefecture and Saitama Prefecture. Among these, the largest proportion was in Tokyo, with 10.6% of the total population.1

Population ageing coupled with a low birth rate are two major concerns facing Japan and Japan’s health care system.

  • Those 65 and over comprised 27.6% of the total population as of February 2017.1 This figure is estimated to approach 40% by 2060.2
  • The aged dependency ratio (ratio of persons 65 and older to persons between 15-64) in 2015 was highest in Akita Prefecture (60.7) and Kochi Prefecture (59.2). The ratio for the same year was lowest in Okinawa Prefecture (31.2) and Tokyo Metropolis (34.3).3
  • The overall fertility rate was 1.45 in 2015. The rate was lowest in Tokyo (1.24) and highest in Okinawa (1.96).3

Japan has one of the highest life expectancies in the world at 91.35 years for females and 84.95 years for males.2 Death rates amongst the nine leading causes of death in 2013 are as follows. According to the WHO, in 2014, 79% all deaths were related to NCDs. Amongst these, 30% of deaths were caused by cancers, 29% caused by cardiovascular diseases, and 12% caused by other NCDs.4

Cause of deathDeath rate (per 100,000 population)3OECD average death rate
(per 100,000 population)5 (where available)
Cancer295.5271
Heart disease156.5117
Pneumonia96.5n/a
Cerebrovascular diseases89.466
Senility67.7n/a
Accidents30.6n/a
Suicide18.519.3
Renal failure19.6n/a
Tuberculosis1.6n/a

Ageing in Tokyo

Japan is not ageing across all regions uniformly. Instead, large metropolitan areas, such as Tokyo, Osaka, and Nagoya, find themselves at the forefront of Japan’s ageing society. According to Tai Takahashi, between 2010 and 2025, the population of those 75 and older will grow by 7 million people, more than half of whom will be residing in the Tokyo Metropolis (Tokyo, Kanagawa, Chiba, and Saitama), Osaka, and Nagoya. These three regions, however, comprise 2% of Japan’s total land area (and approximately 12% of Japan’s total habitable area). The City of Tokyo already faces serious challenges as the number of care facility beds is equal to nearly half the national average.

Reference: “Regional Differences in the Peak of Healthcare Demand and the Level of Medical-Social Resources: Rebuilding a Medical-Social Service Delivery Structure,” Presentation by Professor Tai Takahashi of the International University of Health and Welfare at the 9th Meeting of the Committee on National Social Security Reform, 2013.

The main causes of DALYs (Disability-Adjusted Life Years)* lost due to disability include cancer, cardiovascular diseases, diabetes, neuro-psychiatric conditions, other NCDs, musculoskeletal diseases, injuries, and respiratory diseases and infections.6

The World Bank estimated in 2015 the under 5 mortality rate (U5MR) at 3 per 1,000 live births and the maternal mortality ratio at 6 per 100,000 live births. These figures reflect a decrease of nearly 50% when compared to data from 1990.7

It is expected that disease burden caused by life-style related diseases and degenerative diseases will increase due to slow population growth and prolonged life expectancy.

 

*One Disability-Adjusted Life Year (DALY) is considered equivalent to one year of “healthy” life lost. DALYs are calculated by combining the Years of Life Lost (YLL) to premature mortality with Years Lost to Disability (YLD) related to a health condition.8

Older Population Not Increasing: Society in the midst of population decline

Between 2010 and 2040, the population designated as “older” (those 65 and older) will increase by 9 million while the population between the ages of 0 and 64 will decrease by 30 million. After around 2040, yearly growth of the older population will begin to level off. Although frequently characterized as growth in the number of older persons, the issue lies in the drastic decrease in persons 64 and younger, a population expected to decrease by 15% by 2040. This decrease leads to an increase in the proportion, not total population, of older persons in Japan.

References

1 Statistics Bureau, Ministry of Internal Affairs and Communications (1 February 2017). Monthly report of population estimates: 2017. (accessed on 25 July 2017) Retrieved from: http://www.stat.go.jp/english/data/jinsui/tsuki/index.htm.

2 Cabinet Office (2017). Annual Report on the Aging Society. Retrieved from http://www8.cao.go.jp/kourei/whitepaper/w-2017/zenbun/29pdf_index.html

3 Ministry of Health Labour and Welfare (2017). Vital Statistics in Japan. Retrieved from: http://www.mhlw.go.jp/toukei/list/dl/81-1a2.pdf

4 World Health Organization (2014). Noncommunicable diseases country profiles 2014: Japan. Retrieved from: http://www.who.int/nmh/countries/jpn_en.pdf?ua=1

5 OECD (2015). Health at a Glance 2015: OECD Indicators. Paris: OECD Publishing, 2015.

6 World Health Organization (2015). Japan: WHO statistical profile. Retrieved from: http://who.int/gho/countries/jpn.pdf?ua=1 (accessed on 24-07-2017)

7 The World Bank (2015). Mortality rate, under-5 (per 1,000 live births). Retrieved from : http://data.worldbank.org/indicator/SH.DYN.MORT

8 World Health Organization. Metrics: Disability- Adjusted Life Year (DALY). Retrieved from: http://www.who.int/healthinfo/global_burden_disease/metrics_daly/en/ (accessed on 24 July 2017)