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Health Impact Framework/Research Paper

The Aging Population in Japan

Brent Stafford

Delaware Technical Community College

NUR 310: Global Health

Professor Shawntelle Winslow

April 21, 2024

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Health Impact Framework/Research Paper

The health problem chosen for this paper is the aging population of Japan. The

combination of a rapidly aging population and decline in birth rate to below the death rate, has

left Japan overburdened by its elderly community (Nakatani, 2019). Japan’s population is

decreasing in general as the birth rate has experienced as steady decline since the 1970s for a

variety of societal reasons. Japanese culture has emphasized the importance of career over

family, and many adults have opted out of having children or choose to do so later in life (Lyons,

2023). For this reason, there is a lack of younger adults joining the workforce and children

projected to someday replace them as the elderly population retires. This has left the country to

face economic distress. This paper will analyze the problem of Japan’s aging population through

the lens of the Health Impact Pyramid and its various components.

The Health Impact Pyramid

The Health Impact Pyramid provides a 5-tier framework to aid in conceptualizing global

health problems. The tiers of the pyramid are organized from those interventions thought to be

most impactful, to those thought to be least impactful in combatting the health problem. The

bottom, or base, tier includes socioeconomic factors impacting a given health problem, including

social determinants of health. The next tier involves interventions that change the context of a

health problem to make healthy choices an easier default choice regardless of social determinants

of health (Frieden, 2010). The third tier addresses one-time interventions that are protective

against a health problem and do not require follow-up care, such as immunization for example.

The fourth tier includes clinical interventions against the health problem, and often focuses on

on-going care as opposed to interventions included in the prior third tier. Last, the fifth and final
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tier encompasses counseling and education which are valuable tools against a health problem but

will likely be less impactful than other previously mentioned interventions.

Socioeconomic factors

Socioeconomic factors affect health and well-being, making inequalities a major health

concern in Japan and across the world. Japan possesses several unique characteristics; universal

healthcare, an intense and immense work schedule, specific characteristics of social support and

networking, and unique population characteristics (Kagamimori, 2009). All these factors as well

as cultural capital, impact the socioeconomic status of Japan’s population. Japan has entered a

period of breakdown from traditional social constructs that have seemed to increase

socioeconomic inequalities. An increase in commercialism and materialism, an increasingly

competitive educational system, the decline of familial traditions, a rapidly aging population, a

decrease in social solidarity and the influence of digital media are all factors that have increased

disparity (Kagamimori, 2009).

Due to the popularity of higher education, the range of levels of education that is attained

has become larger, which has been shown to have increased social inequalities in Japan. One

study suggests that individuals with low levels of education had an increased risk of death. With

a change away from the more traditional lifelong employment to a reimbursement for

performance and contract-based pay, elder employees find themselves having to work longer for

decreased pay. Population aging is partly responsible for increasing inequality as it raises the

proportion of the labor force in the 50–65-year age group, which is characterized by greater wage

variation (Kagamimori, 2009).

Changing the context to make individuals default decision healthy

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Japan has had several national health promotion strategies in the past. An earlier strategy

focused on the early detection of significant but preventable diseases and to focus on health

promotion. A new version, Health Japan 21, launched in 2000 had the aim of extending a healthy

life expectancy. When results were released in 2011, alarms were raised. The results showed that

only about 17% of the strategy’s targets had been reached. Other targets showed little progress

(42%), while others were unchanged or decreased (39%) (Nakatani, 2019). The targets that were

unchanged or deteriorated were the prevalence of metabolic syndrome, hyperlipidemia, diabetic

complications, and physical activity. All of these are significant factors for decreased life

expectancy and could be contributed to an aging population. These results led to national policy

advocation which included policies on the prevention of onset and progression of non-

communicable diseases, maintaining social wellbeing, and improving lifestyle and social

environment for nutrition, exercise, and rest (Nakatani, 2019).

Long-lasting, protective interventions

After the report on Health Japan 21 was published, the most pressing agenda faced by the

Japanese government is the sustainability of social security. The National Council of Reform of

Social Security reported concern that the universal healthcare in place was not sustainable due to

the increasing number of senior citizens and elderly population and the increasing cost of care.

The report proposed significant reform amongst pensions, medical insurance, long-term health

care insurance. According to the report, the government is looking at universal coverage of

patient-centered comprehensive health, medical and nursing care support in the community. To

say this is a large undertaking is an understatement, these reforms are still being proposed by the

Japanese government today. Once in effect, these reforms should have positive long-lasting

impact on the health and wellbeing of the aging population of Japan.

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Clinical interventions/Counseling and education

In 2015, the Japanese government changed from its primary strategy of a high-risk

identification strategy to a community-based population strategy by reforming the Long-term

Care Insurance Act (Saito, 2019). This act focuses on community-based care and identifies social

determinants of health. Interestingly, the inspiration came from a social participation invention

called ikoino saron or gathering salons for people older than 65 years (Saito, 2019). Managed by

local volunteers, these salons are held every few weeks in communal spaces (Saito, 2019).

Studies have shown that active participation in the salons was associated with a reduced

incidence in the long-term care needs and a decreased risk of dementia onset (Saito, 2019).

Evidence also suggests that financially vulnerable older adults were more likely to participate,

potentially reducing health inequalities in the aging population. At these gathering salons, older

citizens meet and interact with others through enjoyable relaxing, and educational activities such

as music listening, arts and crafts, and educational seminars, not to mention physical activity

(Saito, 2019).

Culture and Health Beliefs

The Japanese culture has many specific attributes that affect the health of their population

in all age groups. Additionally, some of these cultural norms have led to the increased aging

population with a lack of adults joining the workforce as birth rates declined. It is well known

that the Japanese generally have an unhealthy work-life balance, and many Japanese workers

report stress and unhappiness with their work life (Nemeth & Lai, 2023). Despite these facts, the

Japanese tend to value work over all else due to societal norms and the sense of pride that comes

from one’s career. The Japanese pride themselves on being hard-working and a strong work ethic

is a highly favored characteristic (Takaoka, 2024). This often leads Japanese workers to clock
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long hours and work tirelessly as it improves their sense of self. The same concept leads

Japanese citizens to work into their elder years.

Among their busy work schedules, Japanese culture also creates the societal expectation

that elderly are to be cared for by their family. On top of hectic work hours, the working

population of Japan needs to find time to care for the aging population in addition. Recognizing

this fact, Japan is working on innovations to help care for the elderly population. Some

geographic areas have adopted elderly “lodges” that instead of viewing the aging adults as

useless, gently put them to work sharing their knowledge of cooking, cleaning, and other

household skills (Venkataraman, 2023). In addition, old railroad tracks have been refurbished to

allow the elderly more accessibility to public transportation to complete their daily tasks. Some

innovations will take time to come to fruition, but the future appears bright for the elderly in

Japan as the country has come to realize their obligation to provide for the aging population.

Professional Opportunities in Global Health

The aging population affects and impacts the healthcare and long-term care systems. In

response, the Japanese government has shifted focus to the establishment of community-based

care while looking to improve health care, nursing care, preventive health, access to housing and

livelihood support (Song, 2019). This focus will require increased support from the healthcare

community. In need are health care and nursing care professionals of all levels who can

understand the elderly community (Song, 2019). All nurses are needed but the number of nurses

specializing in Gerontological Nursing and Home Care Nursing are in increased need to support

the ever-increasing aging population. Luckily there have been increased enrollment in these

areas of specialty (Song, 2019). As noted earlier, gathering salons have been shown to have

positive impacts on the aging population; volunteers are needed to organize these events—a
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great opportunity for nurses to demonstrate our set of skills. To its credit, Japan has eased some

of its strict immigration policies to allow foreign nurses into the country to care for its aging

population (Lamar, 2000).

Japan is overburdened by its elderly community through a combination of a rapidly aging

population and a decline in the birth rate. Multiple factors have been discussed as cause for the

overburden. This paper analyzed the problem of Japan’s aging population through the lens of the

Health Impact Pyramid and its various components. Notably it found that several socioeconomic

factors have affected the aging population and their cost to society. The increased importance of

higher education and the change of employment loyalty has negatively impacted birth rates as

young adults are more focused with their career. The pressure to find a solution is at its pinnacle

as the Japanese government continues to look to reform social security. It is noted that children

born today, within two decades, will be contributing to the care of Japan’s elderly through social

security. Community-based care and increased workforce of health professionals including

nurses, some specialized in gerontological nursing are just the first steps towards easing the

aging population burden in Japan.

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References

Bina Venkataraman. (2023, Aug 18,). Japan can teach the world a better way to age. The

Washington Post https://global.factiva.com/en/du/article.asp?

accessionno=WP00000020230818ej8i0001m

Frieden, T. R. (2010). A Framework for Public Health Action: The Health Impact

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595. https://doi.org/10.2105/AJPH.2009.185652

Kagamimori, S., Gaina, A., & Nasermoaddeli, A. (2009). Socioeconomic status and health in the

Japanese population. Social Science & Medicine, 68(12), 2152-

2160. https://doi.org/10.1016/j.socscimed.2009.03.030

Lamar, J. (2000). Japan to allow in foreign nurses to care for old people. BMJ. British Medical

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Lyons, E. (2023). Japan has one of the world's oldest populations, and it is shrinking at a record

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Nemeth, H., & Lai, A. (2023, Sep 8,). Gallup: Japan's Workplace Wellbeing Woes

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Saito, J., Haseda, M., Amemiya, A., Takagi, D., Kondo, K., & Kondo, N. (2019). Community-

based care for healthy ageing: lessons from Japan. Bulletin of the World Health

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