Japan: A Portrait of An Aging Society
While driving from my home in the Boston suburbs to Logan International Airport on the morning of December 5, 2013, I prepared to take the journey of a lifetime and to realize one of my childhood dreams. I was on my way to Kobe, Japan, where I would be presenting research at an international conference on muscle wasting diseases. Although I have a Ph.D. and postdoctoral training in Chemistry and am a scientist by profession, my favorite subjects throughout elementary school and high school were always geography and English. My dream was to travel around the world and write about all of my adventures. While heading into Logan Airport, that dream was about to become reality. It didn’t take very long after arriving at Kansai International Airport outside of Osaka for me to become overwhelmed by the incredible beauty of the Land of the Rising Sun and its people. There were times when I felt that I had lived in Japan for my entire life. Though I could not speak a word of Japanese beyond “Konnichiwa”, I felt so comfortable wandering the streets of Kobe at night and traveling by the Port Liner monorail. Perhaps I had lived here in a previous life? Perhaps I was in utopia…
But after a couple of days I realized that Japan is not utopia. Although Japan has one of the highest standards of living in the entire world, it is a country with complex problems. Japan is an aging society. According to 2014 data, one-third of the Japanese population is above the age of 60. Why is Japan an aging society? The reasons are complicated. During the 1980s when I was an elementary school student in Sarnia, Canada, Japanese corporations were the darlings of Wall Street. Of course, I was too young to understand even the first thing about Wall Street. What I did understand was that so many of the consumer electronic products in our home came from Japan, including our Hitachi television and VCR, Panasonic walkman and Sanyo dual cassette recorder. In the 1980s, it was not uncommon for women to spend an entire month’s salary on a cashmere coat. Fast forward to 2017 and you will find that many young women in Japan are satisfied with scrounging through their mother’s closet for ‘hand-me downs’ rather than buying expensive clothing. Japan has suffered through two decades of poor economic growth and so there is an entire generation that has not experienced anything other than low and stagnant wages, high unemployment and deflation, the continuous falling of prices. As a result, young people in Japan are putting off marriage and bringing children into the world. Hence, the Japan of 2017 is an aging society which faces challenging problems from a public health standpoint.
It was somewhat ironic that an international conference on sarcopenia research was taking place in Japan. Sarcopenia is the progressive loss of lean muscle mass that occurs as a result of aging. The fundamental causes of sarcopenia are multifactorial and not completely understood. Some of the causes include hormonal changes, inactivity, poor diet and nutrition and inflammation. There is no doubt that sarcopenia is a major public health problem. We depend upon our muscles to maintain balance. As one lose muscle mass as you age, one’s ability to maintain balance decreases and the odds of suffering a fall increase substantially. Falling is not such a big deal when you are young. It seems that my 21-month-old daughter falls several times a day and yet she manages to pick herself up again every time as if nothing had happened. But when one becomes older, bones are not as strong as they once were and falling can lead to fractures that result in unnecessary pain, suffering and a loss of mobility and independence. Sometimes falls can lead to head injuries which can be very serious and even life threatening. Even if one is successful in avoiding falls and fractures, reduced muscle mass and quality still leads to reduced mobility. It is also well understood among clinicians that the odds of successfully battling many major illnesses decline with reduced muscle mass. One of the physicians at the conference, a respected nephrologist (a kidney specialist) from California, presented data that illustrated that the survival of chronic kidney disease patients on hemodialysis was correlated to their mid-arm muscle circumference. A former colleague of mine, a cardiothoracic surgeon, told me that he could tell which patients were likely to make the best progress after cardiothoracic surgery, as frail patients typically had poorer outcomes.
Yet, the fact that Japan is an aging society is not necessarily something that has to be mourned. According to World Health Organization (WHO) data from 2015, the life expectancy for males in Japan was 80.5 years while the life expectancy for women was 86.8 years. These are some of the highest life expectancies for any highly developed nation in the entire world. Japan has managed to cut its obesity rates down to 3.5 percent. On the other hand, obesity rates are approximately 30 percent in my country, the United States. The Japanese government has taken a very aggressive approach towards combating obesity; such methods would probably have difficulty gaining acceptance in the United States. Japan along with the rest of the world is a much better place in 2017 than it was in the 1980s when I was growing up. We have made incredible strides in treating cancer, heart disease, diabetes and many infectious diseases such as Hepatitis C. An HIV positive diagnosis is not a death sentence anymore and neither is a multiple myeloma diagnosis. Hence, people are living much longer today. My hope is that both of my children will not only live to be well past 100 years, but that they will also make exercise and nutrition a key priority in their lives so that they can enjoy an excellent quality of life during their golden years.
Figure 1: Photograph taken from the Kobe Luminarie, a spectacular display of lights that takes place in Kobe every December to commemorate the lives that were lost during the Hanshin Earthquake of 1995. The lighting display is a gift to the Japanese people from the Italian government.
Figure 2: Heading towards the Kiyomidzu Temple in Kyoto.