Global Strategies for the Prevention and Control of Infectious Diseases and Non-Communicable Diseases

Nakatani, Hiroki

This section will discuss the challenges and opportunities of these changes, as well as contributions from the Japanese public health community. For Japan, the greatest challenge is aging. Beginning in 2010, we have witnessed a gradual decline in the Japanese population, together with a sharp increase in the ratio of persons over 65 years old, particularly those exceeding 75 years. Japan has a very large population of centenarians aged over 100 years. Keio University has studied a cohort of centenarians 10 and monitored their health status changes to investigate factors contributing to and impeding longevity. Indeed, longevity poses many challenges, not only for public health, but also for other social aspects. For example, persons with cognitive impairment face difficulties in making rational decisions, which are a fundamental aspect of our society. If we look at the prospect of population aging, more than 30% of the Japanese population already exceeds 60 years of age. Other Asian countries are following the same course, particularly the Republic of Korea, Singapore, and Taiwan. China and Thailand are aging rapidly as well. Such population aging is a global phenomenon, and not exclusive to Asia, Europe, and North America; Chile, for example, is also seeing remarkable aging of its population. In other words, aging is a common challenge for all APRU member countries. The Japanese experience of response to population aging can serve as a relevant case study for the world, Pacific Rim countries in particular. In the 1950s, the Japanese focus was on tuberculosis control. In 1952, 25% of the national medical expenditure was allocated to tuberculosis treatment, and 50% of all national hospital beds were occupied by TB patients. After a sharp decline in tuberculosis, Japan then transformed such service infrastructure to NCD control, particularly to the prevention and treatment of stroke. The Osaka University group, 11 now headed by Professor Iso, has reported the evidence for public health interventions for stroke prevention and control. A second contribution from Japan could be our experience in policy development, as shown in Figure 4 . 12 Japan started to prepare for the growing elderly population from the 1970s. Our experience offers case studies of both success and failure. For example, free medical care for the elderly was introduced in 1973, triggered by a very populist governor. As governor of a big city with a small aging population, this politician thought that his policy was both affordable and sustainable. However, it soon became obvious that the free medical care program was very difficult to continue when the urban population aged and economic slowdown decreased tax revenue. Nevertheless, every politician who raised the possibility of discontinuing the program paid a great political cost at election time. The program was finally discontinued only after several elections.