Intended for healthcare professionals


Japan’s answer to the economic demands of an ageing population

BMJ 2012; 345 doi: (Published 16 October 2012) Cite this as: BMJ 2012;345:e6632
  1. Yohsuke Takasaki, deputy director1,
  2. Ichiro Kawachi, professor of social epidemiology and chair2,
  3. Eric J Brunner, reader in epidemiology and public health3, visiting professor4
  1. 1Health Sciences Division, Minister’s Secretariat, Ministry of Health, Labour and Welfare, Japan
  2. 2Department of Society, Human Development and Health, Harvard School of Public Health, Boston, USA
  3. 3Department of Epidemiology and Public Health, University College London
  4. 4Osaka University Graduate School of Medicine, Osaka, Japan
  1. Correspondence to: Y Takasaki takasaki{at}
  • Accepted 14 September 2012

Japan’s ageing population and prolonged recession are putting enormous strain on the national budget. Yohsuke Takasaki, Ichiro Kawachi, and Eric Brunner explain the problems and what the government is doing to tackle them

The Japanese response to snowballing social security and health expenditure and massive national debt is to gradually raise the rate of sales tax from 5% to 10%. Prime Minister Yoshihiko Noda has said he will stake his political life on the success of the policy, which has proved contentious. More than 50 politicians left Noda’s Democratic Party of Japan (DPJ) in protest when the tax proposal was voted through in the House of Representatives (the lower house of the Japanese legislature, called the Diet) in June. We examine the problems that led to the policy and why sales tax was chosen as the solution.

Health and wealth

Japan is admired for having the world’s highest longevity,1 although it ceded the top position in 2011 as a result of the massive earthquake and tsunami that damaged the Fukushima nuclear power plant. In 2011, life expectancy at birth was 79.4 years for men and 85.9 years for women.2 Japanese healthcare is another, perhaps less widely appreciated success, with the World Health Organization rating the system number one in the world in 2000.3 The universal insurance based scheme operates on a modest budget (box), considering the large numbers of older people. Expenditure on health in 2009 was at the average for countries in the Organisation for Economic Cooperation and Development (OECD), 9.5% of gross domestic product (GDP), compared with 9.8% in the United Kingdom and 17.7% in the United States.4

Population health is driven by many factors besides a well functioning healthcare system. The ingredients of Japanese longevity include adherence to traditional diets, high levels of education …

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