Health Japan 21: A New Navigation Chart for the Super-Aged Society

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In 2025, Japan reaches a pivotal turning point. The postwar baby boomer generation, born between 1947 and 1949 and known in Japan as the Dankai generation, will all be 75 years or older. By 2050, Japan's population is projected to decline to 100 million. With that, only 51% of the Japanese will remain within the working-age demographic. The nation is now embarking on an unprecedented voyage into a super-aged society that no other country has ever experienced.

As the country prepares for this new departure, a national initiative has been launched to support the health of its citizens through a collective societal effort. This is the third term of "Health Japan 21," which began in 2024. Its vision is bold and inclusive: "Creating a sustainable society where all citizens can live healthy and fulfilling lives."

The initiative has two key concepts: Inclusion — leaving no one behind in health promotion, and Implementation — ensuring the effectiveness of actions taken.

Behind this vision lies a sobering reality. Not only is aging accelerating, but the burden of non-communicable diseases (NCDs) such as cancer, cardiovascular disease, and diabetes is rising. Widening regional health disparities come along with both.

In response, the government revised the Dietary Reference Intakes for Japanese (2025 edition) in autumn 2024. This lays the scientific foundation for future health policy. What is now urgently needed is the implementation of evidence-based policies.

Visualizing the Health Landscape

At this critical juncture, a new "health map" has emerged to guide our voyage. It comes from the Global Burden of Disease (GBD) Japan research team, led by Professor Shuhei Nomura of Keio University.

This team analyzed comprehensive data from the GBD Study 2021 to assess diseases, injuries, and risk factors across Japan and its 47 prefectures from 1990 to 2021. Its report scientifically visualizes the transformation of Japan's health landscape over the past 30 years.

New Health Map of Japan

The findings are far from simple. At the national level, Japan's health has steadily improved. Average life expectancy at birth rose from 79.4 years in 1990 to 85.2 years in 2021 — an increase of 5.8 years. Women's life expectancy rose from 82.3 to 88.1 years, and men's from 76.2 to 82.2 years. Healthy life expectancy, abbreviated as HALE, also increased from 69.4 to 73.8 years over the same period.

However, regional disparities have grown. The gap in life expectancy between prefectures widened from 2.3 to 2.9 years. Among men, the gap grew from 3.2 to 3.9 years. Similar patterns were observed for healthy life expectancy, with clear geographic inequalities.

Prefectures such as Shiga, Kyoto, and Nagano in western Japan consistently ranked among the top in both life expectancy and healthy life expectancy. Meanwhile, northern prefectures such as Aomori and Akita remained at the bottom for both men and women. This reflects a persistent east-west divide in health outcomes.

Shift in Leading Causes of Death

Japan's leading causes of death have also shifted dramatically. Alzheimer's disease and dementia, ranked 6th in 1990, became the number one cause of death by 2016. It remained so in 2021, followed by stroke, ischemic heart disease, lung cancer, and lower respiratory infections.

In terms of disability-adjusted life years (DALYs), a metric that measures the total number of years lost due to illness, disability, or premature death, lower back pain has ranked as the leading contributor since 2012. It is followed by stroke and Alzheimer's disease.

Stomach cancer was once a major cause of death. However, it has seen a dramatic decline due to reductions in Helicobacter pylori infections, improved screening, better diagnostics and treatment, and healthier diets. This is contributing greatly to extended healthy life expectancy.

Assessing Public Health and Policy

DALYs provide a standardized way for governments and global institutions to prioritize public health actions by quantifying how much healthy life has been lost due to various conditions.

*Professor Shuhei Nomura (Photographed by the author.)*

Professor Nomura explains:

"The takeaway is clear. We are entering an era where the question is no longer just 'How long can we live?' but increasingly 'How well can we live?'

The future of a super-aged society is not one where we carry painkillers in one hand and dementia drugs in the other. Broadening our perspective, we see that all of Asia is now facing a rapid aging wave. According to the Asian Development Bank, the elderly population in Asia will double by 2050, reaching 1.2 billion. Many Asian countries are now closely observing Japan's journey as a potential model for their own future."

At the Forefront of Aging

Japan is unique among post-industrial nations. It has maintained one of the lowest obesity rates while undergoing rapid economic growth. Having successfully navigated a major health transition, Japan is now at the forefront of global efforts to manage aging and chronic diseases. Its initiatives are not just a national roadmap, but a "navigation chart for the future" for all of Asia.

This is why there are such high expectations for Health Japan 21 (Third Term). With data-driven science and grounded policy implementation as its twin engines, Japan has the opportunity to remain a global leader in health innovation. The choices Japan makes will influence not only its own future but that of the entire region.

Can we build a society where everyone can live in good health and with dignity? That is the question before us. The compass to that future is now, unmistakably, in the hands of the Japanese people.

About the GBD (Global Burden of Disease)

The Global Burden of Disease is an ambitious global research initiative that systematically quantifies the human health impact of more than 80 risk factors. These range from infectious diseases to lifestyle-related chronic conditions. Conducted across 204 countries and territories, GBD tracks the progression and improvements in health outcomes over time.

Launched with support from the Bill & Melinda Gates Foundation in 2007, the project is spearheaded by the Institute for Health Metrics and Evaluation located at the University of Washington in Seattle. Each year, the findings are published in The Lancet, one of the world's most influential medical journals. They serve as a global compass for guiding national health policies and public health priorities. For additional information, you are encouraged to visit the Institute for Health Metrics and Evaluation, University of Washington.)

This report was first published on Japan 2 Earth, a JAPAN Forward website featuring Japan's initiatives on the SDGs.