1.1 Japan’s geography and demographics

Japan is an island nation in eastern Asia with an area of 377,887 square kilometers that is comprised of over 6,800 islands, including Honshu, Hokkaido, Kyushu, Shikoku, and Okinawa. Japan contains 47 self-governing administrative divisions referred to as prefectures.

The total population hovers around 127 million people, with about 90% living in urban areas. As of 2015, about 36.5% of the total population resided in Tokyo, Kanagawa Prefecture, Osaka, Aichi Prefecture, or Saitama Prefecture. Among these, the largest proportion was in Tokyo, which was home to 10.7% of the total population of Japan.[1]

An ageing population with a declining birthrate

An ageing population coupled with a low birth rate are two major concerns facing Japan and its healthcare system.[2][3]

Those aged 65 and over comprised 27.3% of the total population as of October 1, 2016. This figure is expected to approach 40% by 2060.
The old-age dependency ratio (the ratio of people aged 65 and over to people between the ages of 15 and 64) in 2015 was highest in Akita Prefecture (60.7) and Kochi Prefecture (59.2), and lowest in Okinawa Prefecture (31.2) and Tokyo (34.3).

The overall fertility rate in Japan was 1.45 in 2015. This rate was lowest in Tokyo (1.24) and highest in Okinawa (1.96).

Life expectancy and main causes of mortality

The people of Japan enjoy one of the highest life expectancies in the world, with the average being 91.35 years for females and 84.95 years for males.[4] Mortality rates for the top nine causes of death in 2015 are listed in the following table (according to data from the Ministry of Health, Labour and Welfare (MHLW) and the Organisation for Economic Co-operation and Development (OECD)).

According to the World Health Organization (WHO), 79% of all deaths were related to non-communicable diseases (NCDs) in 2014. Amongst these, 30% of deaths were caused by cancers, 29%, by cardiovascular diseases, and 12%, by other NCDs.[5]

<Column> Ageing in Tokyo

Japan is not ageing across all regions at the same rate. Large metropolitan areas, such as Tokyo, Osaka, and Nagoya are at the forefront of aging in Japan. According to Tai Takahashi*, between 2010 and 2025, the population of those aged 75 and over will grow by 7 million people, more than half of whom will reside in the Greater Tokyo Area (Tokyo, Kanagawa, Chiba, and Saitama), Osaka, and Nagoya. These three regions, however, comprise a mere 2% of Japan’s total land area, underscoring the urban nature of Japan’s “super-ageing society.” Takahashi also points out that Tokyo faces serious additional challenges regarding the number of care facility beds, which is equal to just half the national average. This shortage may become increasingly serious as the population continues to age.

*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.

Ranked by the burden that each disease places on the lives of sufferers as measured in DALYs (Disability-Adjusted Life Years)*, the most critical diseases within the Japanese population are cancers, cardiovascular diseases, diabetes, neuro-psychiatric diseases, musculoskeletal diseases, respiratory diseases, other NCDs, external injuries, and infectious diseases.[8] It is expected that the burden of life-style related diseases and degenerative diseases will increase alongside demographic changes such as ageing.

The World Bank estimated in 2015 that the under 5 mortality rate (U5MR) for Japan stood at 3 per 1,000 live births and the maternal mortality ratio was 6 per 100,000 live births. These figures reflect a decrease of nearly 50% when compared to data from 1990.[9]

*DALYs are an indicator of disease burden which assesses the amount of harm caused to health by specific diseases and injuries. DALYs are calculated by adding the total of years of life lost (YLL) due to premature death and the years of life lived with disability (YLD).

＜Column＞A population on track to decline, with low expectations for growth even among the population aged 65 and over

Between 2010 and 2040, the population aged 65 and over will increase by 9 million. Over the same time period, the population under age 65 will decrease by 30 million. Starting sometime around the year 2040, it is expected that growth in the older population will plateau, while the working population will sharply decrease, causing the overall population to shrink by around 15%. This will increase the proportion of people aged 65 and over in Japanese society.

References

[1] Statistics Bureau, Ministry of Internal Affairs and Communications (14 April 2017). Demographic forecast. (accessed 15 September 2017) Retrieved from: http://www.stat.go.jp/data/jinsui/2016np/index.htm#a05k28-b

[2] Cabinet Office (2017). White paper on ageing society. (accessed 24 July 2017) Retrieved from: http://www8.cao.go.jp/kourei/whitepaper/w-2017/zenbun/29pdf_index.html

[3] Director General for Policy Planning and Evaluation, Ministry of Health Labour and Welfare (2017). Vital statistics in Japan. (accessed 24 July 2017) Retrieved from: http://www.mhlw.go.jp/toukei/list/dl/81-1a2.pdf

[4] Cabinet Office (2017). White paper on ageing society. (accessed 24 July 2017) Retrieved from: http://www8.cao.go.jp/kourei/whitepaper/w-2017/zenbun/29pdf_index.html

[5] World Health Organization (2014). Noncommunicable diseases country profiles 2014: Japan. (accessed 24 July 2017) Retrieved from: http://www.who.int/nmh/countries/jpn_en.pdf?ua=1

[6] Ministry of Health Labour and Welfare (2017). Vital statistics in Japan. (accessed 2 February 2018) Retrieved from: http://www.mhlw.go.jp/toukei/list/dl/81-1a2.pdf

[7] OECD (2015). Health at a Glance 2015: OECD Indicators. Paris: OECD Publishing, 2015.

[8] World Health Organization (2015). Japan: WHO statistical profile. (accessed 24 July 2017) Retrieved from: http://who.int/gho/countries/jpn.pdf?ua=1

[9] The World Bank (2015). Mortality rate, under-5 (per 1,000 live births). (accessed 24 July 2017) Retrieved from http://data.worldbank.org/indicator/SH.DYN.MORT