After the end of the second World War, Japan had one of the lowest life expectancies in the world; and now it is a fact that the Japanese outlive everyone else on this planet. The men live upto 79 years of age, while the women live a little over 86. How did they manage to turn the tables so drastically? Let’s have a look:
The Japanese Way of Living
Lifestyle plays a very important role in the well-being of any country’s citizens. Traditionally, Japanese diet consists of a lot of rice, vegetables, and fish, and the way they cook it often includes steaming, broiling, pan-grilling or fermenting, thus allowing the food to be nutrient rich. Tea is an integral part of their beverage diet, which adds to their daily anti-oxidants intake.
According to the book ‘Japanese Women Don’t Get Old or Fat’ by Naomi Moriyama, in Japanese markets, food isn’t dated by the day — it’s dated by the half-hour, so it is safe to say that the food they eat is fresh.
Another important detail to note is the serving on the platter, portion control is a part of their etiquette. Eating from a small rice bowl, serving each item on its own little dish and never completely filling the plate is a part of their eating habits. In the Okinawa region of Japan, there is a saying Hara Hachi Bu which translates to “eat until you are 80% full”.
On a fellowship trip to Japan funded by Faculty of Public Health (FPH), Claire Beynon of the British Association of Community Physicians (BACP) observed certain points related to the lifestyle of the Japanese people.
She noted that 90% of the children walk to school, perform three hours of physical activity every week and part of a child’s everyday activities includes cleaning their own school, while they also get a five-minute break between each lesson to run around the play area. Claire observed that the psyche of the people is such that priority is given to pedestrians and cyclists and walking is encouraged.
The unique healthcare system:
In 1961, Japan passed a law which called for universal health coverage, which has encompassed to cover all Japanese people either by employers or the government.
The hospitals in Japan are highly privatized, with around 80% of hospitals and 94% of clinics are privately operated. The system has a fixed fee schedule, meaning that the cost of procedures and drugs are the same everywhere, regardless of whether the service is performed in a tertiary hospital or a rural clinic, by a specialist or a junior physician. Neither insurers or providers have the freedom to negotiate individually a different fee schedule. Because the prices are fixed, employers have no buying leverage to reduce insurance premiums, minimizing the impact of employers. Ambulatory care physicians are reimbursed on the basis of a negotiated fee-for-service schedule and patients have the liberty to choose the physician of their choice.
One unique feature of Japan’s healthcare system is that physicians have the authority to both prescribe and dispense pharmaceutical products, which is accountable for the country’s high per-capita consumption of drugs.
Physicians do not have any incentive or reason to withhold care out of the concern that they will not be remunerated, as they receive the same fee for any service provided to a patient. Charging patients more than the scheduled fee is strictly prohibited, and patients can be charged extra only for services like private hospital room or the use of some new technology for treatment. Thus, Japan has one of the most equitable single-tiered health care systems in the world.
University of Tokyo conducted a survey in the year 1988, where they found that an individual’s income level was not a factor in their health care expenditure or utilisation rate. Unlike other countries, money is never a factor in not visiting hospitals, as according to a 1985 survey, only 0.4% people gave economic reasons for not visiting any physician despite being ill. Also, out-of-pocket expenses for co-payments amount to only 12% of the total healthcare expenditure provided under social insurance.
Incorporation of traditional medicines:
Traditional medicines do not have a strong hold in Western healthcare system and people often turn a blind eye to them, even though the risk-benefit ratio is favourable in case of traditional medicines. Traditional Medicines often focus on the quality of life, a continual improvement of the overall health of the body and poses no side-effects. Dr Yasuhiro Suzuki, WHO Executive Director for Health Technology and Pharmaceuticals explains: “Traditional or complementary medicine is victim of both uncritical enthusiasts and uninformed sceptics”
Japan is perhaps the only country in the world where traditional medicine is fully integrated alongside modern medicine in daily practice. Originated in ancient China, Japan adopted the Kampo medicine system as their primary healthcare system for over 1500 years, prior to the Meji Restoration (1868–1912). It became integrated into the Japanese health care system — the National Health Insurance Program — 46 years ago alongside modern medicine, and the program has covered all citizens since 1961.
Because there is only one type of medical license in Japan, physicians prescribe both Kampo medicine as well as western biomedicine.
According to a study by Kotoe Katayama, University of Tokyo;. At present, 148 Kampo extracts are approved as prescription drugs. Currently, 80–90% of physicians use Kampo drugs in their daily practice.
In the study, it was also found that the prescription rate of Kampo medicine was highest (4.05%) for disorders associated with pregnancy, childbirth and puerperium.
As seen in the Chart 4 above, the disease class “XV: Pregnancy, Childbirth and Puerperium” contained the highest percentage, a reason for this could be that Kampo extracts are known to have fewer and relatively milder effects than western drugs in pregnant and postpartum women. One of the lessons we can take from this is how to incorporate traditional and modern medicine to work together.
What we can learn from this is that we should aim to look for a healthcare system which panders to the philosophy ‘Prevention is better than cure’, giving the same attention and vigour to improve our daily habits as we should to restructuring the healthcare system; and realise that even a small habit changes can benefit us in the long run.