This report is the second in the OECD’s series of reports reviewing public health policies across selected OECD countries. Health care systems across OECD are increasingly under pressure from social changes – including demographic changes and aging populations – and emerging new health challenges – from a growing burden of chronic disease, to re-emerging and new communicable diseases, or a growing burden of mental ill-health – which demand a strong public health response. The OECD Reviews of Public Health provide in-depth analysis and policy recommendations to strengthen priority areas of countries’ public health systems, highlighting best practice examples that allow learning from shared experiences, and the spreading of innovative approaches.

In some ways, Japan’s public health challenges are distinct from those faced by other OECD countries. The rate of obesity is the lowest in the OECD, alcohol consumption is well below the OECD average, and the rate of smoking is slightly below the OECD average, even if this average masks a significant gender gap in smoking rates, with Japanese men smoking well above the male OECD average. Indeed, Japan’s life expectancy – 84.1 years in 2016 – is the longest in the OECD, and almost four years longer than the OECD average of 80.8 years. In other respects, though, the health challenges that Japan is facing are familiar to other OECD countries, for example a rising burden of chronic diseases. Other challenges will be felt even more acutely in Japan, in particular the rapidly aging population; in 2050 nearly 40% of the Japanese population will be over 65, and 15% will be over 80. Promoting healthy, disease-free aging must be a central priority for Japan, and attention must also be paid to the potential for rising rates of risky health behaviour, for example rising alcohol consumption, and even rising rates of obesity.

The Japanese population, the longest-lived in the OECD, is undergoing a profound transformation. Japan’s birth rate has been falling; based on OECD projections by 2050 36.4% of Japan’s population will be over 65, and 15.0% over 80, making Japan’s population older than that of all other OECD countries. In some ways, Japan’s public health challenges are unlike those of other OECD countries. Japan’s obesity rate is the lowest in the OECD (23.8% of the population was overweight or obese in 2015, compared to the OECD average of 53.9%), the rate of smoking is slightly below the OECD average (18.3% of the population were daily smokers in 2015, compared to the OECD average of 18.5), and alcohol consumption is well below the OECD average. In many other respects, though, the health challenges that Japan is facing are very familiar: in particular, a rising burden of chronic disease, and a rising number of frail and elderly persons. In addition, Japan faces some relatively unique public health risks, notably a significant exposure to natural hazards such as earthquakes, floods, typhoons, and tsunamis. In some instances, these risks have intersected – for example the frail elderly have been particularly affected by some natural hazards.

Japan, which has the longest lived population in the world is taking public health seriously as a key objective of central and local governments. Relative to most OECD countries levels of risky health behaviour are low, but like Japan’s OECD peers a growing burden of non-communicable diseases, and a growing elderly population, are significant health challenges. This chapter, which appraises the overall architecture Japan’s public health system, points to areas of strength and weakness. In particular, this chapter stresses that in a highly decentralised system, where local government has significant responsibility for delivery of public health actions, Japan must establish a careful combination of strong central strategic leadership, local autonomy and responsiveness to local needs, and sharing of best practice across regions, and across sectors.

To address the challenge of rising prevalence of non-communicable diseases (NCDs), Japan has increased the focus on primary prevention. The Health Japan 21 strategy provides a nation-wide framework to improve population health through interventions in workplaces, schools and local communities, focusing on diets, physical activity, smoking cessation and alcohol consumption. However, there exists a wide diversity in approach and focus among the isolate local initiatives, and there are few mechanisms to ensure quality or to disseminate successful practices. In addition, Japan should consider implementing population-level policies to support the impact of local interventions by creating a health promoting environment, such as banning smoking in public places, regulating food, tobacco and alcohol advertising, restricting alcohol sales, and labelling of tobacco, alcohol and food products with warning labels.

In recent decades, Japan has increased its reliance on health check-ups and tries to improve population health through early detection of diseases. Based on health check-up results, Japan also aims to promote individual’s effort to manage their own health condition by preventing the onset or severity of diseases through better lifestyles. Now, routine health check-ups are available to almost all segments of population throughout their life course. These secondary prevention strategies are unique in the OECD and their impact is not well understood partly due to its health information system. Considering the tight fiscal situation which is likely to continue due to population ageing, Japan needs to review its secondary prevention strategies and focus on developing and implementing effective and economically sound secondary prevention policies.

As an extremely disaster-prone country and a global economic hub, Japan must prepare for public health emergencies of all kinds, from natural hazards to pandemic and disease outbreaks, industrial accidents as well as security threats such as terrorism. This chapter looks at how Japan sets-up and implements public health emergency policies and at how it builds the resilience of its health system, in accordance with the OECD Recommendation on the Governance of Critical Risks and other international guidelines. This chapter suggests that there is scope to strengthen oversight of preparedness measures implemented at the local level, strengthen co-operation between Ministries, and increase the number of disaster preparedness exercises and drills.