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Does Japan have an ageing population?

Does Japan have an ageing population?



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I often hear Japan has a declining/ageing population. It seems to be the prime example for this kind of thought. Yet after moving to Japan and after having been there for travel several times already. And in comparison with my native country Germany as well as Europe in general, I think this concept seems questionable. While I hardly see any children outside in Germany and it's mainly parents with one child. Everywhere I go in Japan I meet a lot of children. Especially in the greater Tokyo area, if I go to restaurants there's always a bunch of kids. And usually you see at least two children per parents, if not three. I can understand that in general this concept might be true but might not be applicable for bigger cities.

Where does the concept come from? Is there any proof it's actually true?


I hate to sound rude, but you could easily answer this yourself with even the most minimal look into well-tabulated demographic information, rather than highly non-representative observations. About 13% of Japan's population is 0-14 years old, the third lowest fraction in the world. (https://data.worldbank.org/indicator/SP.POP.0014.TO.ZS ; easy to find with Google) The fraction of the population over age 65 is 28%, the highest in the world. (https://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS?most_recent_value_desc=true) The population density is high, so you'll certainly see more kids than in many other countries, though not proportionally more. I will leave it as an exercise to look up the numbers for Tokyo itself.


Countries With The Largest Aging Population In The World

An elderly Japanese couple hitting the weights. Home to many supercentenarians, 26.3% of the island nation's population is 65 years of age or older.

The world is aging rather rapidly. However, there are a few countries, such as Japan and Italy, that stand out from among the rest, due to the immense proportions of their citizens over 65 years of age. According to the World Health Organization, nearly two billion people across the world are expected to be over 60 years old by 2050, a figure that’s more than triple what it was in 2000. Because of such increases in their aging populations, some of the world’s largest economies have started facing subsequent increases in their health-care costs, higher pension costs, and a decreasing proportion of their respective citizenries active in the workforce. A major contributing factor to this trend has been diminishing fertility rates in these countries in recent decades, further compounded by longer lifespans. In order to adapt to their increasingly aging populations, many countries have raised the retirement age, reduced pension benefits, and have started spending more on elderly care. With lesser numbers of individuals entering the population and people living much longer lives, people above the age of 65 now make up an increasing share of the world’s total population. We take at look at those countries which are particularly well-known for their rapidly rising numbers of aging citizens.


Lower care bills

The conventional view is that this is bad news&colon shrinking numbers hobble economic growth and the ageing population is a major financial burden. But Eberstadt says there is another side. The proportion of Japan’s population that is dependent on those of working age isn’t unusual, he says, it’s just that it has almost twice as many over-65s as children. Consequently Japan spends less on education. And because the Japanese are the world’s healthiest, care bills are also lower than in other nations.

Japan’s economy has been growing slowly for two decades now. But that too is deceptive, says William Cline of the Peterson Institute for International Economics in Washington DC. Thanks to the falling population, individual income has been rising strongly – outperforming most US citizens’.

With 127 million people, Japan is hardly empty. But fewer people in future will mean it has more living space, more arable land per head, and a higher quality of life, says Eberstadt. Its demands on the planet for food and other resources will also lessen.

Japan isn’t alone in demographic contraction&colon Russia, Romania and Hungary all follow the trend. For many more, it is being delayed by immigration. But the global population bomb is slowly being defused. As Swedish statistician Hans Rosling first noted, the world recently reached “peak child” – the point where the number of children aged 0 to 14 around the globe levels off. Global fertility rates have halved in 40 years – they are now below 2.5 children per woman – and global population may peak soon.

So, far from being a demographic outlier, Japan is “the world leader in demographic change”, says Aoki. For some this sounds like a disaster. China last year relaxed its one-child policy fearing that predicted population decline in the 2030s would choke its economic development. But others believe that peak population is a necessary first step to reducing our assault on the planet’s life-support systems. In that case, following Japan’s example may be just the ticket.

This article will appear in print under the headline “Japan’s ageing population points to our global future”


Results

Age-specific mortality across populations and life expectancy–lifespan equality relationship

Our regression analyses yielded clear linear relationships between e0 and (varepsilon) 0 within each primate genus, mirroring the relationship observed within humans (Fig. 1A, B and Supplementary Fig. 3). Importantly, the linear relationship between e0 and (varepsilon) 0 is not a simple artefact of our modelling. For instance, Stroustrup et al. 26 demonstrated in laboratory experiments with C. elegans that changes in life expectancy occur with no change in lifespan variance. Similarly, Jones et al. 5 found no correlation between a measure of the length of life and a measure of relative variation in lifespans, across 46 species drawn from different taxa. Colchero et al. 13 found no correlation between life expectancy and lifespan equality across 15 non-primate mammal species. Aburto and van Raalte 27 showed that in Eastern European countries life expectancy and lifespan equality often moved independently of each other between the 1960s and 1980s, and van Raalte et al. 28 showed that life expectancy and lifespan equality have a negative relationship (i.e., inequality increases with life expectancy) in some human populations (Finland in the 20th and 21st centuries, in their example).

a Life expectancy and lifespan equality regression lines for females each species is represented by a different colour. b Life expectancy and lifespan equality regression lines for males. Each genus is characterised by a relatively constrained relationship between life expectancy and lifespan equality, and thus a distinct regression line colours as in a. The central lines are the predicted fitted values of the regression and the type of line (e.g. continuous, dashed, or dotted) depicts three levels for the p values of the slopes (how significantly different from 0 they are, two-sided t test, H0: β1 = 0, Supplementary Table 1), while the shaded polygons show the 95% confidence intervals of the regressions. c The relationship between the Siler mortality parameters and the resulting mortality function, given by the equation μ(x) = exp(a0a1 x) + c + exp(b0 + b1 x), where infant and juvenile mortality (blue) are controlled by parameters a0 and a1, age-independent mortality (orange) is captured by c, and senescent mortality (green) is captured by b0 (initial adult mortality) and b1 (rate of ageing). d Each box shows how gradual changes in each Siler mortality parameter modify the life expectancy and lifespan equality values (thick purple lines). The green line in each box corresponds to the regression line for female chimpanzees, shown for reference to illustrate the general trends among all genus lines. The purple curves show the changes in life expectancy and lifespan equality after varying individual Siler parameters while holding the other parameters constant. Note the striking change in life expectancy and lifespan equality that would result from changes in the ageing parameters, particularly b1. See Supplementary Fig. S3 for plots that include individual points for each population. Source data to generate the regression lines are available in Supplementary Data 3.

This linear relationship between life expectancy and lifespan equality emerged in our analysis despite considerable variation among populations of each genus in age-specific mortality, in the distribution of ages at death, and in the Siler mortality parameters (Supplementary Figs. 1–4, Supplementary Data 2). The slopes of these regression lines were statistically significant (i.e., p value < 0.05) in five of seven genus-level datasets for females and in four of seven for males (Fig. 1A, B, Supplementary Data 4). The regression lines did not reach statistical significance in analyses that included relatively few populations or that included small or heavily censored datasets. The slopes of the regression lines were statistically significantly different than the slope of the line for humans in female sifaka, baboons, guenons and gorillas, and in male guenons, gorillas and chimpanzees.

Drivers of the linear relationship between life expectancy and lifespan equality

Having confirmed that the relationship between life expectancy and lifespan equality is linear and highly regular within other primate genera, as it is in humans, we next sought possible causes for this regularity. Specifically, we asked which Siler mortality parameters best explain variation among populations in life expectancy and lifespan equality, and therefore which have a disproportionately large effect on the slopes of the regression lines. To pursue this question, we initially conducted a sensitivity analysis by simulating independent changes in each of the Siler mortality parameters (Fig. 1C) and graphically examining the effects of these changes on the life expectancy-lifespan equality relationships. Specifically, we varied one Siler parameter at a time within each genus, keeping the other four Siler parameters constant at the value found at the midpoint of the regression line.

This approach produced striking results: within each genus, simulated variation in pre-adult mortality (captured by Siler parameters a0 and a1) and in age-independent mortality (Siler parameter c) all produced lines of similar direction to the observed regression lines (Fig. 1D). That is, within the observed range of e0 values, changes in these three Siler parameters resulted in (varepsilon) 0 similar to the observed range. Therefore, consistent with theory and with the long-understood effect of averting early deaths, observed variation in life expectancy and lifespan equality within each primate genus appears to be largely accounted for by variation in the pattern of early deaths, and very little by actuarial senescence.

In stark contrast, simulated variation in the rate-of-ageing parameter (Siler parameter b1) produced lines with conspicuously different direction from the observed regression lines. Specifically, changing b1 moved the life expectancy–lifespan equality values away from the regression lines (Fig. 1D).

Sensitivity of life expectancy and lifespan equality to mortality parameters

These findings led us to postulate that, while variation in early deaths is the primary cause of observed variation in life expectancy and lifespan equality within each genus, changes in the rate of ageing in one or more populations in a genus could shift those populations towards the lines of other genera. To further investigate this possibility, we derived mathematical functions for the sensitivity of life expectancy and lifespan equality to changes in any given mortality parameter (see ‘Methods’). These sensitivity functions allowed us to obtain precise measures of the amount of change in life expectancy and lifespan equality for a unit change in any given mortality parameter at any point in the life expectancy–lifespan equality landscape (including along each of the regression lines).

The resulting vectors of change (Fig. 2A) are consistent with our graphical exploration, and they also revealed the relative magnitudes of changes that each mortality parameter produces in the life expectancy–lifespan equality landscape (Fig. 2B). Specifically, a unit change in the rate of ageing parameter b1 shifts the life expectancy and lifespan equality values in a direction almost perpendicular to the regression lines, and the magnitude of that change is disproportionately large compared to the other four parameters. We then calculated the degree of collinearity (how parallel versus perpendicular two vectors are) between the seven genus-specific regression lines for females and the vectors of change for each parameter. We found that the two parameters that govern infant mortality, a0 and a1, and the age-independent parameter c, produce vectors of change that are almost parallel to the regression lines. In contrast, Siler parameter b0 produces vectors that are intermediate between parallel and perpendicular, while the rate-of-ageing parameter, b1, produces vectors that are almost perpendicular to the regression lines (Fig. 2C). In short, changes in pre-adult mortality and in age-independent mortality tend to move a population along the regression line typical of its genus. In contrast, changes in the ageing parameters, b0 and particularly b1, will shift a population away from this line, into the space occupied by other genera in the landscape.

a Using the female chimpanzee line (bright green) as an example, vectors depict the sensitivity at the mid-point of the genus line. Each vector depicts the direction and magnitude of change in life expectancy and lifespan equality for a unit change in the corresponding Siler mortality parameter. The x- and y-axes show the life expectancy and lifespan equality values of the sensitivity vectors for a0 (light blue), a1 (dark blue), and b0 (light green) vectors for c (orange) and b1 (dark green) are particularly large, represented by broken lines (Source data are provided as a Source Data File and available in Supplementary Table 2). b Gradient field of sensitivities of life expectancy and lifespan equality to changes in each mortality parameter, showing the direction of change any population would experience for a given change in the parameter, from any starting point in the landscape. The green chimpanzee line is provided for reference. Each sensitivity vector (bright purple) can be interpreted as those in A, but calculated from different points on the landscape). c Boxplots representing the values of the seven collinearity values (one for each genus) for each of the Siler parameters for n = 7 independent genera. Collinearity is calculated between the mid-point of the genus line and the sensitivity vector for each parameter a value of 1 would imply that the vector is parallel, a value of 0 would imply that it is perpendicular. Note the relatively large collinearity values for a0 (light blue), a1 (dark blue), and c (orange), the intermediate value for b0 (light green) and the relatively small value for b1 (dark green). The boxplots indicate median (horizontal black line), 25th and 75th percentiles (box), the whiskers are extend to 1.5 the interquartile range, and the open points are extreme values (Source data are provided as a Source Data File and available in Supplementary Table 3).

Amount of change in each mortality parameter along the genus lines

If variation in pre-adult and age-independent mortality parameters account for most of the within-genus differences in life expectancy and lifespan equality, we expect the parameters that control infant and age-independent mortality to be much more highly sensitive to perturbations of e0 and ε0 than the parameters that control adult and senescent mortality, particularly b1. To test these expectations, we quantified the relative change in each parameter along each genus line by calculating the partial derivatives of the log-transformed parameter with respect to changes in e0 and ε0. (see ‘Methods’). These partial derivatives of the log-transformed parameter values represent standardised measures that allow direct comparison among parameters that differed in the absolute magnitude of change. We then calculated path integrals of these sensitivities along each genus line in order to quantify the total amount of change in each parameter for all seven genera. We found that, in agreement with our previous results, in all cases the parameters that govern infant and age-independent mortality changed orders of magnitude more than those that drive adult and senescent mortality (Fig. 3).

Pre-adult and age-independent mortality parameters (a0 a1, and c) vary several orders of magnitude more, within each genus, than the ageing parameters (b0 and b1). Colours: a0 (light blue) a1, (dark blue), c (orange), b0 (light green) and b1 (dark green). Values were calculated by numerically solving the path integral in Eq. (9) (see ‘Material and Methods’) for each parameter along each genus line. The y-axes were scaled by the logarithm base 10 to improve interpretability. ag depict results for females, and hn for males (Source data are provided as a Source Data File and available in Supplementary Table 4).


JAPAN'S BOLD STEPS

People over the age of 65 make up a quarter of Japan's population, and it's on track to reach 40 per cent. The top-heavy demographic creates huge challenges for government and the economy. Now the country is tackling the problem with innovative programs, including everything from comprehensive long-term-care insurance to robotics.

This article was published more than 5 years ago. Some information in it may no longer be current.

Update: Canada's seniors now outnumber the country's children, according to the 2016 Census.

This is part of the Globe and Mail's week-long series on baby boomers and how their spending, investing, health and lifestyle decisions could affect Canada's economy in the next 15 years. Is Canada ready for the boom?

For more, visit tgam.ca/boomershift and on Twitter at #GlobeBoomers

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T he country road leading into the small Japanese community of Asuke meanders past bamboo groves, rice paddies and traditional tiled-roof houses, some of which have trees in the yard brimming with oranges in the late October sun. The road also hints at demographic realities the town – and Japan more broadly – are currently facing: A construction crew along the route consists solely of senior citizens. In Asuke, 40 per cent of residents are over the age of 65.

But on an upper floor of the town's modern hospital, which sits between a slow-flowing river and a Shinto shrine on a forested hill, Misao Shimamura, a 93-year-old with oval glasses, is living out the golden years of her working-class life with a degree of comfort unimaginable to many other seniors across the developed world.

Ms. Shimamura worked part-time in a hotel for years, and at the age of 65 began working full-time as a janitor – retiring only when she was 85. The hands of her now-deceased husband, who worked as a barber, eventually shook too much to cut hair, and he was forced to work his last years at a local gas station. But despite these hardships, and despite living in a rural area, Ms. Shimamura now rests comfortably within Japan's long-term-care insurance program, without burdening her three children. After a formal reassessment by social workers, she was upgraded from home visits and moved to the hospital's long-term-care ward. Here, she has food, shelter, scheduled activities and the attentive care of a Filipino health care worker.

"The people here are very kind," Ms. Shimamura says.

Misao Shimamura and her caregiver. (Iain Marlow/The Globe and Mail)

Asuke is a microcosm of Japan's struggle to overcome its enormous demographic challenge. Japan is already the oldest society on earth, and the country continues to age rapidly as older Japanese continue to live longer lives and younger Japanese continue to put off having children in an era of economic uncertainty.

This has left Japanese governments with little choice but to take bold action. Unlike elsewhere, such as Canada, Japanese leaders have made radical changes to the way health care is delivered in recent decades, most notably with the introduction of long-term-care insurance in 2000. The system is far from perfect, but Japan has been unafraid to improve the system as they learned its faults, and as an economic boom gave way to zero growth.

Japan, in many ways, is now grappling with the same demographic time bomb looming before Canada and much of the industrialized West over the next 10 to 20 years. But Japan's government, businesses and society are facing these challenges earlier than others, allowing the world to learn and benefit from their stumbles, innovations and experiments.

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A Lawson convenience store in Saitama City with a special section that caters to seniors and caregivers.

Iain Marlow/The Globe and Mail

Business opportunities

Roughly 25 per cent of Japan's population is currently over the age of 65, compared to just 16.1 per cent in Canada. But in Japan, this demographic is forecast to make up a full 40 per cent of the country's population by 2060, the same percentage as in many rural areas emptied of young people today, such as Asuke, where the hospital says there are no trainee nurses.

Between 2010 and 2060, the percentage of Japanese citizens over the age of 75 will more than double from 11 per cent to 27 per cent, according to the government. The absolute number of old people will soon level off in Japan, but the proportion of the population who are young is declining rapidly: The percentage of Japanese younger than 19 years old, who constituted 40 per cent of the population in 1960, will decline to just 13 per cent in 2060. Japan's total population peaked in 2010 at around 127 million people and has already begun to decline. In 2014, the country lost a record 268,000 people, as deaths continued to outstrip births.

For corporations such as Lawson Inc., a Tokyo-based convenience store chain with 12,000 stores in Japan, the country's aging society is a reality, as well as a business opportunity.

At a Lawson store in Saitama City, the company created a hybrid store featuring a "seniors' salon" with a blood pressure monitor, pamphlets on municipal health care services and nursing homes, and on-staff social workers. The store also has a special section featuring adult diapers, special wipes for bathing the elderly, straw cups, a gargling basin and detergent that is tough on urine and perfect for bed mats and wheelchair coverings. Staff will also deliver heavier items, such as bags of rice or water, to local residents.

"This is Japan's national issue," says Ming Li, a Lawson spokesperson, as he shows off TV dinners targeted at seniors.

Japan's baby boom has also detonated within Lawson's own work force: The company had to raise its maximum age limit for franchisees, and is experimenting with lower part-time hours per employee and very limited tasks – for seniors who can only muster energy for a couple of hours, or can only clean or sweep, but still want to work.

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Prime Minister Shinzo Abe's administration is concerned about how Japan's aging and shrinking work force will slow down the national economy. One piece of Mr. Abe's so-called Abenomics revival program – which also includes getting more women in the workplace – is an emphasis on new medical technologies, including experimental regenerative medicine and cell therapy. The hope is that with two new acts governing regenerative medicine to help commercialize technologies more quickly, the Japanese government can save money on future health care costs while spurring the creation of a valuable new industry – particularly in bio-medical hubs such as the one in Kobe, which features a gleaming new mini-city of medical buildings, research centres and hospitals on a man-made island near the port city's airport.

The demographic impetus to spur new medical technologies has an intriguing Canadian connection: Vancouver-based RepliCel Life Sciences Inc. received $35-million from the Japanese cosmetic giant Shiseido Co. Ltd., which is taking the Canadian firm's cell-based therapy for baldness into a clinical trial. Shiseido faces a mature cosmetics industry, and is hoping to cash in on the grey wave in Japan. "It's a big, big market," says Jiro Kishimoto, who heads Shiseido's regenerative medicine research at the company's lab in Kobe.

Lee Buckler, RepliCel's vice-president of business development, notes that boomers in Japan and elsewhere are retiring in a concentrated wave that is creating a critical mass of consumers for new products.

"There's a lot of disposable income in that population," he says. "And they're willing to spend money not just to look good, but to perform at a higher level than geriatric people would have in the past."

Three lessons Canada can learn from the world’s oldest population

Long-term-care insurance

On a macro level, Japan's predicament is prosperity, which is always followed by lower fertility rates and higher life expectancy. At 83.4 years, Japan has the longest life expectancy at birth in the world, according to the Organisation for Economic Co-operation and Development (OECD). Many Japanese people are also fearful of the type of immigration that has sustained slow population growth in the industrialized West.

In recent years, the challenge has been heightened by changes in Japanese society: The elderly in Japan, similar to seniors across Asia, are less likely to live with their children, though in Japan this is still quite common (roughly 41 per cent of Japanese seniors live with a child, compared to about 80 per cent in 1960). And women, after decades of opting out of a career after giving birth, are also being encouraged by the government to re-enter the work force, something that may eventually help boost Japan's declining labour numbers, as the government hopes, but also prevents women from acting as caregivers.

Another reason Japan aged so rapidly is because the country's postwar baby boom between 1947 and 1949 was extremely short – cut off in part by a 1948 law that gave easy access to induced abortions – and was followed almost immediately by a prolonged period of low fertility. The young population that came from this boom were instrumental in Japan's remarkable economic recovery, and as the country's economic reconstruction gained speed, another small baby boom "echo" took place between 1971 and 1974, at the height of Japan Inc.'s prosperity. That surging economy allowed the Liberal Democratic Party to expand the country's health care system as Japan aged, but by the 1990s, the enormous price tag raised the spectre of tax hikes.

"The government realized it had to change the system," says Yoshihiro Kaneko of the National Institute of Population and Social Security Research, noting that the system will come under renewed strain as the second baby boom generation begins to retire.

Shoppers browse at a store in the Sugamo district of Tokyo. (Kiyoshi Ota/Bloomberg)

Japan chose to supplement its national pension plan with long-term-care insurance (LTCI), which was implemented in 2000. Professor Nanako Tamiya, a Japanese health care expert writing in The Lancet, called LTCI "one of the most generous long-term-care systems in the world in terms of coverage and benefits."

It is incredibly comprehensive, and removes the anxiety and unpredictable nature of elderly care elsewhere. People pay into the system starting in their 40s and are eligible to receive benefits starting at 65, or earlier in the case of illness. When they apply, applicants are interviewed by a municipal employee who feeds the resulting information into an algorithm that assigns the person a care level. That, in turn, is analyzed by an expert committee of welfare workers. A care plan is then drawn up, allowing the patient to choose between competing institutions and service providers offering everything from home visits, bathing and help getting groceries to paying for short stays in hospitals or long-term residence in nursing homes and specialized group homes for dementia patients.

The LTCI system covers up to $2,900 a month in services, as opposed to cash payment, and does require "co-payments" from patients. LTCI co-payments are capped or waived for low-income individuals, and the system saves money by providing options other than full-on institutionalization.

Around six million people are enrolled in LTCI. But the government already introduced significant reforms in 2011 that attempted to better integrate health care, prevention and long-term care. Over the years, Japan – which controls health care policy through the central government, unlike Canada – has demonstrated to other governments around the world that it pays to adjust programs before problems become systemic.

"What I'm very impressed with is they implemented it, but they were ready to change it and tweak it right away. In Canada, I find, once you have something, it almost ossifies," says James Tiessen, director of Ryerson University's School of Health Services Management and an expert on Japanese health care.

"Do they have answers?" he asks. "I think they have some."

The burden on caregivers

Like all health care systems, Japan's has its gaps.

Hajime Ikushima, who worked as a carpenter in greater Tokyo, is an example of the many self-employed Japanese who didn't pay an adequate amount into their pensions throughout Japan's strong period of economic growth. "When I had my company, the country was doing good, and I didn't pay into my pension," says Mr. Ikushima, who has moved back in with his son as he sells used shoes, watches and jewellery at a small neighbourhood market in Saitama city. "Everyone's worried."

Over the years, many poor Japanese – particularly elderly people who have no family caregivers – have become poorer as Abenomics and aggressive monetary easing devalued the Japanese yen, boosting profits for exporters but making the price of daily goods more expensive.

Ken Kato, an assistant professor at Nagoya's Fujita Health University, says Japan's policies have helped shift people from staying in institutions. Before LTCI, there were no co-payments required from patients, and staying in institutions became something of a social activity for elderly Japanese people. That has changed, Dr. Kato says, but there are still too many regional variations in the way patients are graded, the facilities that are available and the level of care.

"In general, LTCI is working," Dr. Kato says. "We need to do more."

The LTCI system was originally designed to alleviate the strain on family caregivers, but that hasn't entirely happened. Research shows that LTCI, in terms of freeing up family carers to work and have more free time for themselves, has only marginally benefited caregivers, and only then from wealthier families.

Hanae Nozawa, a 56-year-old housewife, did what has been traditionally expected of Japanese daughters-in-law: She took care of her elderly mother-in-law, who has since died. She also took care of her father-in-law, who had dementia.

Now that both of her in-laws have passed, she's looking after her 84-year-old father.

Hanae Nozawa and her father. (Iain Marlow/The Globe and Mail)

But even for caregivers like Ms. Nozawa, Japan is innovating. In Kasugai, a suburb of Nagoya, a caregiver called Makiyo Iwatsuki opened up a café for family caregivers, who are often under emotional and physical stress. "As a caregiver, I thought this place was needed. There's no place for caregivers to express their feelings in Japan," she says.

The café is also a place to exchange information about caregiving techniques, and is visited every other week by Yoko Hori, a nurse and volunteer who checks people's blood pressure and makes gentle suggestions about what to ask their doctor. Japan is facing a shortage of physicians as well, particularly in outlying areas, and many can be pressed for time. "They go to the doctor, but the doctor doesn't take time to explain this stuff to them," Ms. Hori says.

Leaders at the hospital in rural Asuke took other initiatives, as well. They surveyed the community to figure out their problems with the existing system, organized a private transit network of subsidized taxis and buses that bring elderly patients for appointments, and implemented electronic health records long before other jurisdictions in the West. The hospital even issued digital ID cards tagged with the person's medical history, allergies and illnesses to hundreds of elderly people in the district, which can be quickly scanned by emergency personnel or doctors.

Takanori Shibata and his Paro robotic seal. (Iain Marlow/The Globe and Mail)

Japan is also leading in other areas, such as robotics. Long used in industrial settings, Japanese researchers are now looking at whether robots can help as the country ages, from robot suits that help rehabilitation to fully functional humanoid robots.

One of the best examples is a robotic seal called Paro, invented by Takanori Shibata, the chief senior research scientist at Tsukuba's National Institute of Advanced Industrial Science and Technology. The fuzzy seal has been proven in various settings to reduce anxiety, stress, depression and even patients' perception of pain during chemotherapy treatments. Distributors in various countries have sold about 3,500 seals in 30 countries and they are deployed by 80 per cent of Denmark's local governments in state-run nursing homes. Dr. Shibata says the seal is especially useful for calming dementia patients and stops them from wandering around. It has often replaced heavy doses of psychotropic drugs.

Dr. Shibata explains a philosophical divide that has helped Japan develop these types of robots: In the West, robots are generally viewed with fear and are given tasks humans don't want to do, while artificial intelligence is viewed with deep suspicions in hyper-modern Japan, however, most people are fine living alongside and being helped by robots and advanced technology.

"A lot of countries can learn from the Japanese situation and from our trials," Dr. Shibata says. "We've found many difficulties in introducing technology to the welfare sector – cost, training, acceptance. [But] we have a shortage of manpower, so we need innovation. And [new technologies] and robotics have a lot of potential."

But why exactly did he choose a seal?

"I developed dog and cat robots," he explains, pointing out a kitten robot in a display case in his lab. But they didn't work out too well. "[Patients] compared the dog or cat robot to a real dog or cat. Their expectations were too high, but most people do not have live experiences with a baby seal," he explains, noting that as part of his research he even observed real baby seals on a trip to ice floes near Quebec's Îles-de-la-Madeleine in the Gulf of the St. Lawrence.

Also, perhaps understandably, he adds: "Dog lovers didn't like the cat robot. And cat lovers didn't like the dog robot."

Robotics is important enough that several experimental programs are now bankrolled by Japan's powerful Ministry of Economy, Trade and Industry. Some robotic arms allow elderly farmers to continue picking fruit in old age. There are also non-robotic, mechanical aids that can ease the strain on nurses and caregivers: The hospital in Asuke, for example, has a mechanical swing-lift that can help move patients from their bed or onto the toilet. But its price tag hints at the main problem: This relatively simple, non-robotic device costs $5,500.

The Twendy-One robot. Iain Marlow/The Globe and Mail

Real robots are much costlier. Professor Shigeki Sugano of Tokyo's Waseda University invented the humanoid Twendy-One robot, which can help seniors out of bed, grab condiments from the fridge and deliver trays of food to elderly people. But there's an obvious reason why his robot is not currently helping Japan's elderly: The sensors in its hands alone cost well over $215,000.

"Prototypes are okay," Prof. Sugano says. "But commercialization is difficult to realize."

But that doesn't stop others, such as Dr. Shibata, from envisioning a future where robots like Paro are used to help maintain Japan's legendary quality of life, as so many people age that it strains government finances.

Ueda Kaichi, a 32-year-old who founded a non-profit that helps disabled people find jobs, thinks like many young people in Japan, who are increasingly skipping pension payments. He worries that the current system operates solely for the boomers retiring now, and will change for the worse as more Japanese partake of the country's level of social services. He doubts Japan's system will be as generous or as affordable when he retires, but he is optimistic about what his country can teach the world.

"The younger generation needs to think about new developments," he says. "I don't just want to look at the current situation from a negative point of view. It's necessary to also know the positive parts of Japanese society and what [they] can contribute."


Ageing in Japan How Japan can cope with the 100-year-life society

M ORE THAN half of Japanese babies can expect to live to 100. This prospect would have horrified Yukio Mishima, a writer who thought it so important to die young and handsome that he ritually disembowelled himself after staging a pantomime “coup” attempt in 1970. It horrifies today’s pessimists, too. They worry that, as the country ages and its population shrinks, health bills will soar, the pension system will go bust, villages will empty and there will be too few youngsters to care for the elderly.

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Yet for most people, not dying young is a blessing. Those extra years can be spent learning new skills, enjoying the company of loved ones or reading blood-spattered Mishima novels. Japan’s prime minister, Shinzo Abe, says he wants his country to be a model of how to make ultra-long lives fulfilling—and affordable (see article). He talks of “designing the 100-year-life society”. But to achieve that Mr Abe, in his last three years in office, will have to adopt reforms that are far bolder than he currently envisages.

The key is to have enough people working to support those who no longer can. There are three ways to achieve this: persuade current workers to labour longer, encourage more women to enter the workforce and let in more immigrants. Japan has made progress on all three. The share of over-65s in work is the highest in the G7 the share of women in the labour force has recently overtaken that in America and the Diet (parliament) is debating a bill that would allow up to 345,000 foreign workers (called “trainees”, not immigrants) to enter Japan by 2025. Companies are eagerly investing in robots to raise productivity. Mr Abe vows to reform the public pension system to encourage even later retirement.

All this is welcome, but it is not enough. If Japanese people are going to live to 100 they will have to retire much later than 70. Women are too often stuck in part-time or badly paid jobs. Nearly 70,000 immigrants a year may sound like a lot, but Japan’s population is declining by almost 400,000 a year and there are a stunning 1.6 vacancies for every jobseeker.

Mr Abe should let more migrants in. Some fret that foreigners will make Japan less safe and harmonious, but there is no evidence of this. Others fear that they might become a burden, but with few exceptions the law lets them come only if they have jobs. Given Japan’s low fertility, importing young workers is the only way to fill potholes and change sheets in nursing homes.

Mr Abe should also create more incentives for locals to work longer, with a formula that automatically adjusts the timing and generosity of public pensions to reflect rising life expectancy and contributions. This is politically difficult anywhere, but the alternative is an inevitable debt crunch.

Last, private firms should scrap the seniority system, whereby pay increases with years of service and staff are forced to quit at around 60. This survives because the people who could change it—senior managers at large companies—benefit from it. The government can help by banning mandatory retirement ages, which would force firms to change seniority-based pay. Companies would have to reward merit instead, which would be good for productivity and for women, who lose out on promotions when they have babies.

An ageing society need not be a decrepit one. As Mr Abe notes, today’s elderly Japanese walk as fast as those ten years younger once did. But for Japan to stay solvent as it turns silver, he too must move faster than he has done thus far.

This article appeared in the Leaders section of the print edition under the headline "Coping with the 100-year-life society"


There has been evidence that muscles can continue to strengthen, even in old age, which is contrary to what we believed in – Yuko Oguma

Having a social life that doesn’t rely on young family members is a major factor in starting hobbies. Aside from active sports such as swimming (a very popular sport with the senior community due to its rehabilitative benefits), elders are engaged in various activities from traditional calligraphy, flower arrangement, sewing, to taking up musical instruments and dancing.

The same report also shows a higher cognitive ability in the Japanese seniors compared to the rest of the world. According to Yuko Oguma, associate professor in Health Management Research at the Keio Sports Medicine Research Center, athletic ability has been linked to higher cognitive ability. That is not to say that every octogenarian should climb up a mountain.

“Light exercise, whether stretching, walking daily, working out at the local community center, is effective,” says Oguma. “Not only for cognitive functions but from a social aspect as well. Compared to 10 years ago, the Japanese seniors are healthier, and have a higher quality of living. This is thought to be a combination of better medical aid and understanding of our bodies. Recently, there has been evidence that muscles can continue to strengthen, even in old age, which is contrary to what we believed in. We believed muscles deteriorate with age, but research is finding that not only can we still train and strengthen our muscles, but that it is important.”

Kimiko Nishimoto is a 90-year-old “Insta-gran” with over 220,000 Instagram followers (Credit: Getty Images)

Oguma also believes, although she says it is hard to prove, that having so many peers within the society that look out for one another, is an understated factor in ageing gracefully. “Often it is the senior citizens themselves that put together programs within the community. They work among themselves to provide activities, to be more fit or to be included socially. It is this proactiveness that strengthens them.”


Does Japan have an ageing population? - Biology

From The New York Times I’m Michael Barbaro. This is The Daily.

On yesterday’s show, Sabrina Tavernise described why, for the first time in generations, the birth rate in the United States has been falling and the long-term risks posed by that trend. One of those risks is that the U.S. could eventually follow the path of a country like Japan, where a persistently low birth rate has resulted in a shrinking population that grows smaller and smaller by the year. Today: I turn to Tokyo bureau chief Motoko Rich to understand what that change has looked and felt like inside Japan.

Motoko tell me about this town that you had visited.

So, it’s a little town called Nagoro. It’s on the island of Shikoku. And it’s pretty remote. Japan’s not that big of a country and yet it seemed to take a really long time to get here. We flew from Tokyo to this medium-sized city called Kochi. And then from there, we have to take a train and then a bus. And we’re clearly just moving further and further away from known civilization. There are no convenience stores, no gas stations, and then you finally get to this little remote village.

And what is it like there?

So, it’s kind of eerie because you’re driving into town and you’ve already been coming up these winding roads and signs of civilization have been disappearing. And you start to see these figures, one perched on a little wall on the side of the road. There’s what appears to be an old woman crouched over in a field, there looks like this guy is kind of shaking chestnut’s out a tree. There are a couple of construction workers on a cigarette break.

And it’s really, I don’t know, profoundly sort of sad and moving to see all this. As I walk around town I keep seeing these people out of the corner of my eye. And I think they’re real people.

And you see, they all have button eyes and little mouths.

They actually look quite lifelike.

And you realize, they’re all dolls.

Dolls. Yes, human-sized dolls.

Stuffed dolls. Like oversized cloth dolls.

Dozens and dozens and dozens of these life-sized dolls.

Like a mom and dad, a kid a little baby.

And what’s even more eerie is that there’s a school in the middle of the town. And just looks like a big school building with a big gravel yard in front. Then you go upstairs. And there are a couple of classrooms, and you peek in and they’re filled with dolls.

It turns out that this is a village that only has about two dozen adults and there are no children. And there’s this woman’s Tsukimi Ayano, who’s decided to kind of fill the place with dolls.

So, why is it that there are so few people in this town. How is it that it has basically become a town of dolls?

So, basically, the birth rate in Nagoro has just fallen to zero. There are no children in this town at all and there haven’t been since the last two graduated from elementary school in 2012. Most of the people there are just old. And that’s kind of emblematic of what’s going on in the rest of Japan. Japan is technically the grayest country in the world. Close to 30 percent of the population is over 65 and the population is shrinking. It’s been shrinking since 2007. And you have this overhang of a lot of old people, which in and of itself is not a problem, except that if you don’t have enough young people to work, to pay taxes, to work in the nursing homes, you’ve got this imbalance.

And how did Japan get to this stage of having such a low birth rate?

Well, I think it’s a long story. And you have to kind of back up a little bit.

Japan rose from the ashes of World War II.

So, after the war, Japan was determined to come roaring back.

It grew into the world’s second largest economy, thanks to the diligence of its people and the strong bonds between management and workers.

And the way they sort of did that was through this social contract that they had, mainly with men, which is that if you went to work for a company, you would devote your life to that. You would work morning, noon and night, as long hours as demanded by the company. And you’d become the salary man, in an exchange for which you were guaranteed lifetime employment. You knew you had job security. You knew you’d get your raises and your promotions as you got older, until you retired.

So, this is the birth of Japan’s notoriously intense work culture where people — overwhelmingly men — seem to put work at the center of their lives.

Exactly. And at the same time, you often would get married and you’d have a wife who was at home, tending the home fires, taking care of the house, taking care of the children.

And then in the 1970s, as in many other places around the world, women start to enter the workforce. Mostly unmarried women who are working until they got married. But then, there are some women who wanted to work longer than that. And then,

the economy was really doing well and going strong. And Japan was booming.

As Japanese people devoted themselves to the money game.

Japanese companies were buying up real estate in Manhattan and buying up companies all over America. And everybody was writing books about how we were going to get our lunch eaten by Japan.

The real estate and stock markets shot up, creating a bubble.

And then everything came crashing to a halt in the early 90s.

And a prolonged period of stagnation set in. It’s been called the lost 20 years.

So at that point, a lot of men who had previously had all these really cushy, secure, lifelong employment jobs, were either thrown out of their jobs or their wages were completely stagnating. And so to keep families afloat, more and more women enter the workforce.

And what does that do to the birthrate in Japan?

So, at that point the birthrate does start to fall, because instead of the woman only being at home, they’re working, helping the country try and recover from this crash, keeping their families afloat. And at first, I don’t think people see this as a particular problem. Japan is a very crowded, populous country. And fewer people being born at the time I don’t think was seen as such a big deal.

Right. It’s kind of seen as a necessary trade off.

Right. There trying to get the economy back on its feet.

So, this is a pretty long period of stagnation for Japan. They’re having a really hard time climbing out of this bust. And during this period, a lot of the men are starting to feel very insecure, because either they can’t get a good job, or even if they have what’s considered a decent job, their wages are not increasing. So, they’re feeling like, oh, maybe I shouldn’t get married because I don’t think that I can support a wife and a family. And that, of course, leads to even more decline in the birthrate.

So, suddenly more women are working, which has an impact on the birth rate. And then, it sounds like men are not working as much, or are working but are financially insecure, so they are not inclined to have children.

Exactly. And as all of this is happening, there’s one thing that isn’t changing, and this is this very deeply entrenched, cultural pattern that when couples do have children, the woman do all the work at home.

And when you say all the work at home?

So, I moved to Japan in the summer of 2016. And I’m a working mom myself. And my husband’s great. He cooks dinner and he does laundry. But of course, like any couple with two children, we sometimes argue about who’s doing what and who’s doing more.

But when I looked around, I noticed no comparison with Japanese woman. They were pretty much doing everything. And it wasn’t just that they were doing all the work at home, it was that the expectations of what moms should do were much higher than anything that I had experienced as a working mom in the States.

So, for example, at daycare one of the things that’s required is that the parents, and it’s always the mom, has to keep a log. Every morning and every evening she has to record what they ate, what their moods were, what time they went to sleep. And this is every day that you’re putting this down in a little notebook. And that just seems to me like a whole bunch of extra labor for the mom.

And then she’s also, you know, instead of sending the kid in an outfit that they might come home with paint splattered and dirt on it, they’re sending them three outfits, so that they can change. They’re washing their sneakers at the end of every week. They’re washing their whole set of change of sheets and blankets. And the other thing that you notice when you’re just walking around Japan and you look at all the apartment buildings, if you look on the balconies, everybody’s got laundry hanging out. And that’s because most middle class families, and even some fairly wealthy families, don’t have dryers. So, that makes doing a load of laundry that much more work. And so, there are all these women that are hanging laundry at night. And as a reporting project, I sort of became obsessed with really diving into this. What is it like to be a working mother in Japan? What specifically they were doing and why it was that they seemed so harried and overburdened?

And so, I spent a lot of time hanging out at daycare centers and talking to women as they came for pickup, because it usually was mostly women. And then, this one woman Kazuko Yoshida agreed to let us spend quite a lot of time with her. So, one weekday a photographer and I went to our apartment and we got there around 6:00. And she and her husband are there with two kids. And they’re getting ready for work. But I notice little things, right? He’s sitting at the table with the kids. And she’s rushing around. She’s cooking the breakfast. She’s clearing the table. She’s packing their bags. And then it comes time to take them to daycare and he says, OK, I’m going to take the kids to daycare. So, in my mind that means he’s going to take the kids daycare on his own.

It turns out that he’s going to accompany her to take the kids to daycare.

Why can’t he do it himself?

He just feels really anxious and insecure about it. And so he said, he just didn’t feel that he could handle these two young children on his own. That he could help his wife, but he couldn’t do it and by himself. The youngest is a baby. The older is a toddler. Wrangling two kids, you know, it’s a lot of work, I get it. But still, he just didn’t think he could handle it.

And so, we accompanied Ms. Yoshida to work. She takes us into her office. She’s a graphics designer. She lets us look around. And then we say, you know what? We’re going to come back and pick you up when you leave work, so we can go with you to pick-up at daycare. Because she’s going to definitely do pick-up because her husband’s going to be working late. So, we get there to pick her up. We get to the station. And we’re about to get on the train to go pick up her kids. And she’s like, let’s let a train go by. So, we let one train go by. She’s like, let’s let another train go by.

She said, this is the only time during the day that I have to myself.

It is very intense. And in fact, a lot of women who are still trying to decide what they want to do with their lives, are looking at that model and saying, I’m not sure I want that. There might be another way. And that other way means that a lot of women are either not getting married at all, or even if they’re getting married, they’re not having children.

They’re basically opting out of motherhood because of the version of motherhood that they see in the culture exactly.

Motoko, you said that a big reason why Japanese women are opting out of motherhood is because so much of the burden of parenting falls on women. So, how widespread is this opting out phenomenon?

So, the proportion of women who have never been married is higher than it’s ever been. And it’s really interesting. I started to explore this, partly because when I first came to Japan, every once in a while my husband and I would go out on a Friday night and we look around in the restaurants. And everywhere we looked it was all these groups of single women. And they look like they’re really having a great time. There were no men around. And I thought, OK, well, what’s going on here? It’s not like you never see that in the West. But I just didn’t see all that many couples, and it just seemed like there was this very segregated social life. So, I wanted to find out what was going on there.

And as I started to talk to a lot of single women, it turned out that there’s this whole kind of infrastructure that’s growing around the fact that women have decided to opt out of marriage.

They are working, so they have a good income. There are these, like, solo karaoke bars or centers, where they have women only sections with these single booths, where these women can go in and sing their hearts out. There are these restaurants, where they’re for Yakiniku, where women go and they’re kind of grilling their own meat at their table. And that used to be kind of a thing that you would do, you would go sit at a group table. But there are these restaurants now where they have these solo booths for people to sit.

There are even like these photo studios where you can go get a wedding portrait taken. Get dressed up in the wedding dress, but you’re not getting married. It’s called like a solo wedding photo.

I mean that’s a bit of an oxymoron, but I guess a celebration of a non-marriage.

Exactly. There are women who are like, I love the dress. I love the idea of being celebrated. I love the idea of looking more beautiful than I’ll ever look. I want to memorialize my youth in this beautiful dress, with this beautiful photo, but I don’t need the actual wedding to do so.

So this phenomenon is so widespread that the culture is adjusting to women not wanting to be married?

And in fairness, it’s not necessarily that they’re always saying I don’t want to be married. But they’re making these choices. They want to work. They want to have a good time. They don’t want to be trapped in these situations where they’re at home all the time and not having fun and that if they do have children, they’re doing all the work. And so, sometimes it’s more tacit, it’s more subliminal. But they are drifting away from these traditional family structures.

And I imagine all these unmarried women are, of course, not having that many children.

Right. And it’s pretty striking how many unmarried women there are now. So, 20 years ago, if you looked at the cohort of women between the ages of 35 and 39, only 10 percent had never been married. Fast forward to today, that’s nearly a quarter of those women have never been married.

Exactly. There are a lot of single women now.

So, in that prime childbearing phase of life, a full one quarter of Japanese women are unmarried and therefore, unlikely to have children.

What’s interesting about the portrait you’re painting is that up to a point, it resembles changes in the West. Women going to work, liking that work, making decisions based around the fact that they want to be co-equals in earning. And yet, that change in countries like the U.S. is accompanied by a kind of redistribution of parenting responsibilities and domestic work. And it seems like Japan only had half the revolution. The women go to work. But then, things don’t change at home the way they have in many parts of the world.

Right. So, interestingly, women are working so much that the labor force participation rate among women in Japan is higher than it is even in the United States. And yet, women are doing the vast majority of the work at home and the men are still doing so little. So, check this statistic out: Men in Japan do on average 41 minutes a day of housework and child care. And that compares to men in the U.S. who are doing just under 2 and 1/2 hours of housework and childcare a day.

Wow, so a very meaningful difference.

Yeah. And by the way, that figure for Japan is the lowest among the wealthiest countries in the world.

So in Japan right now, you have one of the highest workforce participation of women and the lowest domestic participation for men. I mean, that’s a huge disjunction.

You could probably say it’s the biggest gap in the world.

So, now that there is this phenomenon of women opting out of this gap that you have just described — not wanting to perpetuate it and therefore not have children — what are the implications of this incredibly low birth rate that you have described?

Well, one of the most obvious and biggest implications is that you suddenly have this society in which everyone is old.

According to the United Nations, its population is the oldest in the world.

There was a time when it looked like Japan would become the number one economic power in the world.

Under a million babies born, just last year.

And when you have fewer people being born —

You do not have consumption and old people do not consume.

— you have fewer people growing up to become workers. And that means you have fewer people contributing to the Social Security system that you need to sustain this growing population of old people.

The benefits going to the older generation, whereas the burden is borne by the working and young generation.

And you also have fewer people to become doctors and nurses and home health aides, caregivers.

As the elderly population increases, more staff are required to treat them. This is creating a growing financial burden for hospitals.

And is that showing up in the Japanese economy?

Absolutely. Japanese employers are desperate for workers, particularly in areas that are very labor intensive.

So, given that this demographic problem, this low birthrate, is now understood to be causing this economic problem in Japan, what is Japan doing about it?

So, a couple of things. One is that after years and years of resisting, Japan is slowly starting to open its borders and allow non-Japanese people to move here, but in a pretty limited way. So, a couple of years ago —

Japan’s parliament has passed a new law.

Opening the door to nearly 350,000 foreign workers, in a country where immigration has long been taboo.

That allowed a new category of visas for people from other countries to come in and work.

Both blue collar and skilled workers will be allowed in under different schemes.

And the conditions for coming in were pretty stark. So, people who get these visas can only stay for five years. They’re not allowed to bring their families. There’s a pretty high bar that they have to learn to speak Japanese. So, I think it’s going to be quite difficult for them to attract a lot of people to take these jobs. And even if they do, they’re only issuing 350,000 visas over five years, which is kind of a drop in the bucket for the need.

Just to be sure I understand this, despite having a population crisis, Japan is letting immigrants in, but they cannot bring their families who I imagine would help them procreate?

That’s how inhospitable Japan is to people who aren’t Japanese. It’s I think sort of a fear based idea that we don’t want people to put down roots here. Former Prime Minister Shinzo Abe would not use the word immigration. And he often would say this is not an immigration policy, it’s a foreign worker policy. So, I think it was designed specifically to allay fears that Japan would become a nation of immigrants, which is something that, I wouldn’t say in majority, but certainly a very large and vocal segment of the population does not want.

And then the other solution to the economic problem, sort of ironically, is this notion of getting more women to go to work. When Prime Minister Abe came into office, he said, one of the things he wanted to do to pull the economy out of a long period of stagnation was to push and empower women. And so, he called this policy “womenomics.”

It’s an idea that’s known as womenomics. Womenomics is the name for Abe’s policy to close Japan’s gender gap. An ambitious plan to boost the number of female managers by 30 percent in four years.

And the idea is, if more and more women are working, you have this sort of untapped pool of highly educated, talented, native born workers here in Japan. And so, he was saying we need more women to go to work. But of course, the problem with that, as we’ve seen, is that when the women go to work, they either decide that they like working so much that they don’t want to get married and have children or, if they’re working and they also have children, it’s so difficult to combine the two that is certainly not an incentive to have a lot of children.

Right. So, neither of the programs that you have just identified would seem to do almost anything to increase the birthrate. It might temporarily improve the economy, but if the long-term problem in Japan is it not enough babies are being born, neither of these things is going to do all that much to change that.

Right. So, the thing that would really change things is a dramatic shift in the culture. And we’re starting to see really tiny baby steps. Sometimes on the weekend, you’ll see dads at the playground with their kids. You hear of fathers that are learning to cook and do more housework. And then you have this politician, who’s actually the son of a former prime minister who is a pretty famous, well-known friend of George Bush: Junichiro Koizumi, his son Shinjiro Koizumi, who’s now the environment minister. And his wife was pregnant when they got married.

And he announced right before the baby was born that he was going to take paternity leave. But, when he first announced that he was considering taking paternity leave, believe it or not, he got a lot of blowback. So there were some conservative politicians who said, this is a sign that he’s not very serious about his job. And on social media, people were criticizing him for even daring to suggest that he might take paternity leave. How dare he, that kind of stuff.

So, it took him a while to actually firmly announce that he definitely was planning to do it. And then, when the baby was born, here’s what he did. He took two weeks over a course of three months and he said, he was going to be kind of telecommuting for part of that.

So, this was definitely paternity leave light.

Absolutely. A significant gesture. But like you said, paternity leave light.

And what did that episode tell you?

Well, on the one hand, it feels like there’s an effort to try. His father certainly didn’t take paternity leave. There was never any question that he would take leave when his children were born. So, the fact that his son, a prominent politician he’s mooted as potentially being a future prime minister, had decided that he would stake some of his political capital to take paternity leave is definitely a gesture of people trying to change the culture. On the other hand, the blowback that he got — the fact that he had to make a big deal of just taking two weeks off — shows how difficult it is to change this really entrenched culture of what roles men and what roles women are supposed to play.

Motoko, I’m curious. What do you expect to happen to that town, now filled with more dolls than people, that you started our conversation describing?

I think it’s going to disappear. I mean there are only two dozen people left. There’s nobody of childbearing age left, so nobody’s going to be having any more kids. And they’re all pretty old. So as they die off, the town will die off. The only people left will be adults.

Motoko, thank you very much.

The new prime minister of Japan, Yoshihide Suga, has said that raising the country’s birthrate is a major priority and has pledged to make the country’s national insurance system pay for fertility treatments to encourage families to have more children. Japan’s government now projects that unless the birth rate changes, the country’s population, which now stands at 126 million, will fall below 100 million by 2053 and fall to 88 million by 2065. We’ll be right back.

Here’s what else you need to know today. On Tuesday, Pfizer, whose Covid-19 vaccine is expected to be authorized in the coming days for adolescents between 12 and 15, said it would seek authorization to give the vaccine to children between the ages of 2 and 11 later this fall. So far, the F.D.A. has authorized Pfizer’s vaccine under a temporary emergency order and has yet to grant the vaccine full approval. During a call with investors Pfizer said it would soon seek such approval from the government.

Full approval would allow Pfizer to market its vaccine directly to consumers and could make it easier for companies, schools and government agencies to require that workers be vaccinated before returning to work in person.

Today’s episode was produced by Bianca Giaever, Adizah Eghan, Kelly Prime and Alexandra Leigh Young. It was edited by Lisa Chow and engineered by Chris Wood.


Cultural Context and Well-Being: The Need for a Life Course Perspective

A good deal of prior research has charted how conceptions and experiences of well-being vary across cultural contexts (Diener & Suh, 2000 Kitayama & Markus, 2000 Sastre 1999 Christopher, Christopher, & Dunnagan, 2000 Uchida, Norasakkunkit, & Kitayama, 2004 Taylor et al., 2004). These studies show that much cultural variation in well-being is tied to fundamental cultural differences in conceptions of self and relationships. In independent cultural contexts such as the United States, the person is regarded as separated from others and personal goals often are accorded priority over in-group goals, whereas in more interdependent cultural contexts such as Japan, the person is understood as connected to others and part of an encompassing social unit, wherein in-group norms have priority over personal needs (Markus & Kitayama, 1991).

Correspondingly, well-being in independent contexts has been correlated with high levels of autonomy (Oishi, 2000), personal achievement (Uchida & Kitayama, 2009), self esteem (Diener & Diener, 1995, Diener & Suh, 2000), and high ratings of uniqueness, self-confidence, and self-motivation (Heine et al, 1999 Kitayama & Markus, 2000). By contrast, well-being in interdependent contexts is predicted by social relational factors such as social harmony (Kang, Shaver, & Sue, 2003 Kwan Bond, & Singelis, 1997 Uchida & Kitayama, 2009), attainment of relational goals (Oishi & Diener, 2002), socially engaging emotions (Kitayama, Markus, & Kurokawa, 2000), and perceived emotional support from close others (Uchida, Kitayama, Mesquita, Reyes, & Morling, 2008).

Most prior research has not considered whether the above relationships vary by age of research participants. Indeed, much of the preceding literature has been based on college samples of young adults. Our investigation focuses explicitly on between-cultural comparisons, where distinct life course profiles of well-being seem probable, particularly in the contrast between Japan and the U.S. The rationales behind such expectations are elaborated below.

Aging and Well-Being in Japan

Demographic data show that Japan is an older and more quickly aging society than the U.S. Japan has the highest median age (41 years) and longest life expectancy (80 years) in the world (the respective numbers in the U.S. are 35 and 77) (Kinsella & Velkoff, 2001). Thus, by sheer numbers, older persons may be more salient in social policies, common practices, and everyday discourse in Japan than in the U.S. With regard to living arrangements, older Americans are more likely than their Japanese counterparts to live alone: Over a decade ago, 31% of 65+ Americans lived alone, compared to 10% of older Japanese adults. Conversely, 32% of 65+ Japanese lived with children or others, while the counterpart figure for the U.S. was 15% (Rowland, 1992). More recent data indicated that in 2001, 58% of people 60+ lived with at least one of their children, which is 3 to 10 times greater than found in comparably developed Western societies such as the U.S. (17%), Germany (15%), and Sweden (5%) (Takagi, Silverstein, & Crimmins, 2007). Such living arrangements increase the likelihood that Japanese elder, in comparison to their U.S.counterparts, give and receive more economic, instrumental, and emotional social support, which may lead to a greater sense of well-being.

In addition, aging has more benign meanings in Japan than the U.S. Japanese conceptions of aging are rooted in Buddhist, Confucian, and Taoist philosophical traditions that characterize aging as maturity. Old age is thus understood as a socially valuable part of life, even a time of “spring” or “rebirth” after a busy period of working and raising children (Kitayama, 2000 Lebra, 1976, 1984). With age, individuals are expected to gain transcendental understanding, including an accepting attitude toward death and the capacity to be an impartial contributor to social interactions (Lebra, 1984, Lock, 1998 Plath, 1980). The image of the older person as a sen-nin (wise sage) is common in popular Japanese culture. Finally, the pervasive Confucian norm of filial piety, in which children should honor their parents, promotes the importance of continued respect and care of elderly parents (Hwang, 1999).

Aging in Japan also is divided into more clearly recognized social roles and age-graded tasks than in the U.S. Many Japanese women participate in age-specific neighborhood groups that are organized and assisted by the city government (Lebra, 1984). Special celebrations mark a person’s 60 th birthday (the completion of a life-calendar cycle), as well as the 77 th , 88 th , and 99 th birthdays. Japan celebrates a Revere the Elder day on which city mayors give money to people who are over 80 years old. Age-specific terminology is used to address older people. This complex of linguistic and social practices contributes to the acceptance and appreciation of old age (Lebra, 1984 Lock, 1998 Shweder, 1998).

For women, older age (55�) in Japan may be a particularly good time of life because they are free from obligations of child rearing, have time and energy for personal pursuits, and may have more disposable income than at any other time of life. Japanese men enjoy these post-retirement benefits, but they are forced to retire from work at age 65 and, as such, many may be left without a sense of purpose (Lebra, 1984). These retired men are sometimes called “nure ochiba,” translated as “sticky fallen leaf,” meaning dependent on their wives.

The overall portrayal of older persons in Japan must be tempered with awareness of changing norms for elder respect and filial piety in East Asian countries more generally, where trends toward more egalitarian and reciprocal patterns of mutual respect between generations are increasingly evident (Ikels, 2004 Sung, 2001).

Aging and Well-Being in the U.S

Although the age-related mental and physical decline is recognized in both cultural contexts, aging in the U.S. occurs against the backdrop of cultural ideologies such as the Protestant work ethic and the American Dream, which define personal worth in terms of active engagement in work, individual achievement, and responsibility for control over one’s own actions (Quinn & Crocker, 1999 Sanchez-Burks, 2002). Shifts out of active engagement in work and toward dependency on others are seen more negatively in this context. Hence, the prevalent injunction to resist aging, or keep it at bay, as exemplified by popular book titles: Stop Aging Now (Carper, 1995), Secrets of the Superyoung (James, 1998), Age Erasers (Dollemore, 1997 Fisher, 1997), and Feel 30 for the Next 50 Years (Johnson, 1999).

The field of social gerontology reflects the American discomfort with aging. Kuypers and Bengtson (1973) formulated the “social breakdown syndrome” to describe the pernicious processes whereby the lack of meaningful roles, diminished normative guidance, and limited reference groups lead to negative self-attitudes and an internalized sense of reduced competence among the elderly. Similarly, Riley, Kahn, and Foner (1994) described the “structural lag” phenomenon, which refers to the failure of American institutions to keep up with the added years of life that many Americans now experience. These views underscore the perceived dearth of meaningful opportunities for older Americans in the realms of work, family, and leisure, and as such, may account for the downward age trajectories on eudiamonic aspects of well-being such as purpose in life and personal growth noted earlier.


Japan Religion, Economy and Politics

Most people in Japan identify with a religion, however it usually doesn't play a huge role in their everyday lives. A large majority of the Japanese consider themselves to be either Buddhist , Shintoist or both. There are also a small number of Christians in Japan.

Overall, Japan has the highest life expectancy in the world even though it is expected to fall slightly in the near future. However, with low birth rates, the population is rapidly aging but in 2007, the country announced its first significant birth rate increase in many years, so could the predictions be false?

Unfortunately, Japan has one of the world's highest suicide rates, and suicide is the leading cause of death for people under 30. Factors in suicides in the country include social pressure, depression and unemployment, and the National Police Agency found that suicides linked to job loss increased 65.4%. There was a suicide in Japan every 15 minutes, with close to 33,000 reported in 2009. Luckily, suicide rates have been on the decline for three consecutive years. This is just one of the many problems Japan will need to control to see its population and economy grow into the future.


Japan’s Deadly Combination: Climate Change and an Aging Society

Record-breaking rains this week in the country’s southernmost main island, which have killed 62, have shown the vulnerability of people living in nursing homes.

By Motoko Rich, Makiko Inoue and Hisako Ueno

TOKYO — The forecast was dire: close to nine inches of rain in a single day. Officials in Kuma, a village on the banks of a fast-moving river in southwestern Japan, urged everyone to evacuate. Yet inside the Senjuen nursing home, the 70 residents were left in place.

The decision proved disastrous. The rain that fell early Saturday was even worse than expected, a blinding downpour that soon inundated the village’s streets. Caretakers in the nursing home, which lacked an elevator, struggled to move residents to the second floor. For 14 of them, it was too late — the river breached its banks, killing them in its floodwaters.

The events at the nursing home were the deadliest in a week of floods and landslides that have killed 62 people in Kyushu, Japan’s southwesternmost main island. They represent a collision of two powerful forces shaping the country’s present and future: demographic change and global warming.

In recent years, climate change has spurred more torrential rains in Japan, causing deadly flooding and mudslides in a nation with many rivers and mountains. The people most vulnerable to the risks of this extreme weather are the elderly, of which Japan has the highest proportion in the world.

Nursing homes, especially those with small, overtaxed staffs, face particular challenges because of how difficult it can be to evacuate aging, frail people in the midst of disaster.

The rains this week, which have killed mostly people over age 65, flooded more than 50 nursing homes in Kyushu, where Japan’s Meteorological Agency ordered more than a million people within Kumamoto and Kagoshima Prefectures to evacuate. Two years ago, when flooding and landslides killed 237 people across 14 prefectures in western Japan, about three-fifths were over 65.

“Now that Japan is getting older and older and the intensity of rainfall is increasing year by year,” said Kenichi Tsukahara, a professor in the disaster risk reduction research center at Kyushu University, “we have double difficulties.”

This year, the coronavirus pandemic is adding an extra layer of complexity. As people evacuate to gyms and other community centers, social distancing can be difficult. The elderly are again more vulnerable: The virus kills older people at a far higher rate. Of the 981 people who have died from the coronavirus in Japan, more than 80 percent were 70 or older.

Fears of the virus may discourage older residents from leaving their homes, even when it is dangerous to stay. And if they do go to evacuation centers, they could be at risk for heatstroke — especially at sites with poor air conditioning — because of the need to wear masks.

It could create “a very tough situation for people to be able to breathe comfortably during heat waves,” said Hisashi Nakamura, a professor at the climate science laboratory at the University of Tokyo.

Although the Japanese gird every June and July for the rainy season — known as tsuyu — this year the rainfall has set records in Kyushu, with more rain expected to blanket central Japan by the end of this week.

Older residents accustomed to year after year of summer rains may believe they know how to ride out the downpours at home. Yet they may not understand the growing severity of the rains or the increased dangers of flooding.

“Under the emerging impact of global warming, there is an increasing risk or potential that rainfall amounts could be at a level that we haven’t experienced in the past,” Professor Nakamura said. “So I think that citizens must realize that their previous experience may no longer work. We have to act even earlier or faster than what we have experienced in the past.”

Evacuation itself can pose a risk to the elderly. Conditions in evacuation centers inevitably fall short of those in nursing homes designed for old-age care. For the frailest patients, the moves can cause injury or destabilize long-term care plans.

Facility operators have mixed feelings about evacuations, said Hajime Kagiya, a professor of disaster management at Atomi University in Tokyo. “They have to be mindful of the health conditions of the residents as well as choosing a place to evacuate to,” he said. “So they tend to take their time in making the decision to evacuate.”

The Japanese government issues standardized evacuation protocols, but they do not take into account the unique characteristics or terrain in different parts of the country, said Professor Tsukahara of Kyushu University. In rural areas, many small villages are isolated and populated by mostly aging residents, with few local resources to help with disaster planning or, in the event of a crisis, to assist with evacuation or rescue.

In the case of the Senjuen nursing home, Aki Goto, its director, told The Kumamoto Nichinichi Shimbun, a local newspaper, that she had been more concerned about mudslides than flooding. When the waters came, she added, the caregivers could not move quickly enough to move all the residents upstairs.

Six of the workers were on call the night of the floods last weekend, the newspaper reported. That still left each caregiver in charge of more than 10 aging residents, some of whom were unable to walk without help. Even with the aid of local volunteers, they could not bring everyone to safety upstairs as the floodwaters rapidly rose and deluged the ground floor.

According to Shigemitsu Sakoda, 53, the president of Land Earth, a local rafting and outdoor sports company who assisted with the rescue effort at Senjuen, only the caretakers and two local volunteer firefighters were moving residents when Mr. Sakoda arrived to help around noon on Saturday.

“It’s a really tough job for such a small number of people to carry up those who cannot walk to the second floor,” Mr. Sakoda said in a telephone interview. By the time troops from the Japan Self-Defense Forces arrived to rescue the nursing home residents from the roof, some had already died below.

Three years ago, the Japanese government revised a law that requires nursing homes, hospitals, facilities for the disabled and schools located in flood zones to develop evacuation plans and conduct regular drills. According to the Ministry of Land, Infrastructure, Transport and Tourism, just over a third of the country’s 68,000 facilities had evacuation plans on record by March of last year.

The importance of these efforts was illustrated last fall when Typhoon Hagibis, a record-breaking storm, slammed into the greater Tokyo area. As a power outage rendered elevators inoperable at a nursing home in Kawagoe, in the exurban prefecture of Saitama, 24 caregivers who had rigorously planned and drilled were able to move all 120 residents to the second floor in the middle of the night.

The following day, all of the residents — most in their 80s and 90s and many suffering from dementia — were rescued by local firefighters, prefectural police officers and national Self-Defense Forces troops.


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