Japan: A glimpse into a hyper ageing future society
Everyone dreams of healthy longevity. But is it really a blessing when the delicate, older leaves on the tree are relying on ever fewer strong, young branches?
Japan’s centenarian population recently hit a new record. According to Japan’s Ministry of Health, there are now over 90,000 Japanese centenarians over the age of 100. That’s over 70 people per 100,000; 1 in about 1,400. There has been an increase by 6,060 in the country since 2020. The oldest person in the world, Kane Tanaka, aged 118 years, currently lives in Japan. In the blue zone island of Okinawa alone there is now almost double the number of centenarians per 100,000 people in 2015, as there were in Japan as a whole.
Everyone dreams of healthy longevity. But is it really a blessing when the delicate, older leaves on the tree are relying on ever fewer strong, young branches?
Every aspect of Japan's life is being forced to adapt to the growing, unsupported elderly population. The nation’s public spaces, business strategies, labour market, private homes, and social policies are now being re-designed for the old. This is happening all over Japan as the birth rate continues its decades-long decline. Japan’s population peaked in 2010 at 128 million. Last year, its population was down to 125 million. At first glance, this is still staggeringly high. California, with the same approximate land mass, has a population of less than 40 million. So what’s the problem? The Japanese population is projected to decrease further over the next four decades, but, at the same time, Japan is living longer now than ever - on average 87.6 years for women and 81.5 years for men. Japan’s population is already the oldest in the world, only second behind the small principality of Monaco. This problem is set only to worsen.
What is happening in Japan is merely a foreshadowing of what’s coming in many other parts of the world. China, South Korea, Italy, and Germany are on similar trajectories; so too is the United States, although at a slower pace. Five years ago, the world reached an ominous milestone: for the first time in history, adults 65 and older outnumbered children under five years old. In many ways, Japan is the world’s laboratory for drawing policy lessons on ageing populations with a shrivelling youth.
With great longevity comes great responsibility. Meeting the challenges posed by an ageing population will not be easy. However, considering Japan’s experience and its exceptional attention to detail and design to grapple with extreme ageing - longevity will also inspire an era of innovation across the world. In 2020, Japan’s health ministry launched 8 “living labs’’ dedicated to developing nursing-care robots amongst other innovations that will help keep the old supported for as long as possible while also easing the burden of care for society’s frailest.
If Japan is any guide, ageing will change the fabric of society in ways both obvious and subtle. There will need to be greater investment in elder care, and countries will need to deal with the growing strain on care workers by raising their pay, recruiting retirees, increasing incentives for young people to opt for nursing as a career, and integrating technology into care provision. Like Japan, governments across the world will contentiously raise the retirement age - demographics will leave no other option.
Japan’s present challenges are our collective global future. Why? Simple adherence to ever more sophisticated pharmaceuticals alone is extending our lifespan and birth rates are going down, both being symptoms of economic prosperity. This problem is not going away. The inevitable advances in longevity biotech may increase healthspan and compress morbidity at end of life, but this science is several decades away from solving the ageing population crisis.
For many post-industrial societies including the US, UK, and Europe, who are not as healthy as Japan, the problem is going to be a whole lot worse. With many nations experiencing a rapid rise in the proportion of over-65’s, yet with healthspan decreasing for many reasons, policy and public health messaging must adapt fast.
Japan is no longer an outlier. As a harbinger, it prompts us to redefine retirement and the value that senior members of society provide. This of course doesn’t happen unless we maintain health and independence, mentally and physically as we age. Japan is quite good at that. Most of the world is not.
Can we live long and prosper?
In 1975, Dr, Makato Suzuki started The Okinawa Centenarian Study - the world’s longest continuously-running study of centenarians. Dr. Suzuki’s team has studied more than a thousand 100-year-olds to understand the genetic and environmental lifestyle factors responsible for healthy ageing. Their team published a book in 2001 sharing their findings on how Japan’s centenarians seemed to have clean arteries, low cholesterol, low risk of hormone-dependent cancer, and 80% less chances of developing breast and prostate cancer than North Americans. Damn. They had stronger bones, with half the rates and risk of hip fractures of North Americans. They also generally had lean and fit bodies and remarkable mental clarity for their age.
Japan is a great example of a society where alongside lifespan there is also a visible increase in healthspan. This is resulting in more productivity, happiness, and reduced risk of suffering from cancer or cardiovascular diseases in old age.
Following are a few key insights from Dr. Suzuki’s research on approaching longevity the Japanese way:
1. Practise ‘hara hachi bu’ - eat like your life depends on it, because it does.
‘Hara hachi bu’ is a common practice across Japan, where people only eat until they feel 80% full. Older Okinawans believe that the body is like a temple and that it shouldn’t be polluted. Hence, alcohol is consumed in moderation and people generally don’t smoke much. Their diet is mostly plant-based and not calorically dense. Dr. Suzuki’s study has reported that centenarians in Japan often eat over a kilogramme of vegetables, fruits, and legumes in a day and the chief form of carbohydrate tends to be sweet potato, which is generally low in glycemic load. Their meals tend to be rich in colourful flavonoid compounds that can help with overall health and slow ageing processes. Does this translate perfectly into everyones’ body and the way we want to live our lives? Maybe not, but there are nutrition lessons to be learned.
2. Practise happiness and find your ‘ikigai’/ sense of purpose.
The study reported that all centenarians interviewed seemed to have a positive attitude. They were generally optimistic and had a sense of laissez-faire, or at least didn’t take small things in life too seriously. They also had something called ‘ikigai’, which is the Japanese word for a sense of purpose. However, it’s important to note that not everyone’s ikigai hinged on grand ideas of changing the world. For instance, one man in the study was 102 years old and his ikigai were two prize bulls – he just went to see them every day, to take care of them. Other people’s ikigai may be family or faith. Without question, healthy levels of serotonin and dopamine through positive attitude and purpose are universally beneficial. That said, a wonderful, humble, local existence does not befit the minds of ambitious change agents focused on large-scale impact and activism which also brings a different kind of joy and purpose, but often at a cost. There is no such thing as a free lunch.
3. Redefine your retirement.
There is no word for retirement in the Okinawan language, and until recently, it simply wasn’t a concept. If you were a farmer, you would farm till the age you couldn’t. Once you stop physically farming, you don’t stop mentally until you’re no longer able to share your wisdom and teachings. To use the title of Ry Cooder’s 1979 album, you “bop till you drop”. Not retiring, at least not in the modern sense, helps people derive a sense of satisfaction from their lives and decreases public healthcare costs as people stay mentally and physically active for far longer into their old age. The issue in today’s Western world is that if, as we do, we’ve spent the previous 70 years living unhealthily, there’s far less chance of staying mentally and physically active without arthritis, dementia, or financial insecurity. Farming stimulates your body and your brain, and you become better the more seasons you practise. A lifeform designed and selected for tilling the soil or hunting and gathering won’t last as long in a technological age, where you’re most likely sitting on your backside bent over a screen, living the digital utopia. This is not fertile ground for a fruitful non-retirement. Perhaps more of our work, and therefore retirement, must involve satisfying physical and cognitive activity.
[I have hence taken up Japanese landscape gardening.]
4. Join or create a ‘moai’, social group.
Japanese, and Okinawans in particular, tend to have large families and strong social support networks. Social gatherings are held in groups known as 'moai'. They chat about everyday matters, drink green tea, and maybe have a little dessert, perhaps until they’re 80% full. Gossip in Harari’s ‘Sapiens’ was critical to human evolution. It seems to play a role in healthy longevity too. It is also worth noting that the island of Okinawa had the lowest healthcare costs in all of Japan, despite being the poorest. In 2000, Japan implemented the Long-Term Care Insurance Program throughout the country – and it involved paid daycare for adults. Okinawans, being the most social, made the most of the program. It drove down healthcare costs over the long term because people with more social contact were seen to be happier and healthier. This may allude to the power of social fabric and the role of oxytocin and other less, well-studied neurohormones of human connection. We have heard of people who lose their lifelong partner and rapidly decline living alone. Loneliness is a big killer. Social cohesion is a vital nutrient for healthy longevity. Our social networks are currently stretched beyond their limits rather than being intimate and meaningful. Hence there is little argument against applying our own versions of ‘Moai’ in our modern lives. See those you love more often… preferably with real photons, not pixels.
These are but a few key insights from Dr. Suzuki’s extensive research. The recent 85-year-long Harvard longevity study echoes much of the same, with an American population. Japan is an outstanding blueprint for extending a society’s health span. It can’t sustain this without addressing the ageing demographic problem. But it’s coping pretty well despite the odds against it.
We to look to Japan for inspiration in not just living longer and healthier lives, but reinforcing our structural branches to support our precious populations of ageing leaves.
By Dr Jack Kreindler with Shivaji Mishra, and Sophia Roesler