Key messages
• The early establishment of free compulsory primary education and a social insurance
system before World War 2 and universal health insurance coverage in 1961 enabled
the provision of equal opportunities for health promotion.
• Disparities in health across regions and socioeconomic groups are fairly small in this
homogeneous and egalitarian society and have narrowed over time with increased
average population health. However, the downward trend in socioeconomic
inequality in health has been less obvious since the 1990s, which has coincided with
income inequality gradually increasing.
• Japanese life expectancy at birth increased rapidly in the 1950s and early 1960s as a
result of decreased mortality rates for communicable diseases in children and young
adults, which was largely attributable to the government’s strong stewardship in
investing in key interventions for public health.
• Stroke mortality reduction was one of the major drivers of the sustained extension
of Japanese longevity after the mid-1960s. The control of blood pressure improved
through population-based interventions such as salt reduction campaigns and an
increased use of cost-eff ective health technologies such as antihypertensive drugs
under universal health insurance coverage.
• Further progress in Japan’s longevity primarily depends on prevention of major risk
factors for non-communicable diseases such as tobacco smoking and high blood
pressure and several cardiovascular risks. Prevention of premature mortality from
suicide is also a major challenge for population health.
• A rapidly ageing population as a result of improved survival is challenging Japan’s
health system in terms of its fi nancing and quality of care. An eff ective link between
medical and long-term care through both top–down and bottom–up approaches is
necessary to enhance the welfare of the population throughout the country.