Japan’s population health: A power shift in healthcare

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Japan’s population is both aging and declining at a faster rate than any other in the world. As a result, the country’s government, academic research institutions, and life science industry are highly incentivized to leverage Japan’s notable history of technical innovation to ease the aging burden. They are doing so with gusto, and the world is watching.

The government has prioritized health and healthcare innovation as it relates to aging-related diseases, among many other programs and policies. But one of the lowest-hanging and highest-impact fruits for how Japan can improve its healthcare outcomes remains unharnessed – prioritizing population health and medicine.

“Population health” is often confused with “public health,” but the two ideas are not quite the same. Public health focuses on which drugs, vaccines, or large-scale campaigns can treat or prevent a disease. By contrast, population health focuses on understanding why some people are more likely than others to get sick in the first place, and then seeks to identify the targeted, group-specific interventions that can reduce the odds that those individuals will need to turn to hospitalization or pharmaceutical intervention.

A population health approach in Japan would require the creation of a school (or schools) of population health in the country’s academic and clinical training centres. Japan’s future medical practitioners and health policy leaders will need to learn to understand, follow, and treat individuals and designated groups of individuals, while having an eye toward the larger public. Existing academic programs cover public and global health but not population health. Importantly, creating a Japanese school of population health would require the integration of science and healthcare studies with health economics and population and social policy.

In addition to training future practitioners and leaders, Japan’s health system must move away from its doctor- and pharmaceutical-centric systems and toward a model that empowers nurse practitioners and community health providers. In other words, there must be a power shift in healthcare.

Japan spends roughly half as much on healthcare as a percentage of GDP as the United States does, the Japanese health system spends about twice as much on drugs as a percentage of total healthcare costs. If young doctors are trained in a system that embraces a more affordable and effective distribution of tasks, the focus can shift to population health and away from power and ego.

In terms of policy, prevention must be prioritized in practice and not just on paper. For example, vaccination – the most tangible, most innovative prevention tool of modern medical science – lacks vocal champions in Japan.

Japan’s demographic and economic challenges require healthcare policies that ease (or at least do not exacerbate) the financial burden and increase the quality of life for the country’s rapidly aging and declining population. Effective implementation of these policies will require more domestic experts with an in-depth understanding of population health. The introduction of such expertise at scale will require the creation of a school, or dedicated programs within multiple existing schools, focused on this concept. The absence of such expertise unfortunately ensures that any Japanese effort to improve the healthcare system will fall short – possibly addressing key issues for unique groups on paper but failing in practice to address the underlying issues of the group as a whole.

Perhaps most importantly, Japan cannot afford not to do this. Government debt is higher than ever, and GDP growth is very modest. This economic reality, combined with a declining labour population due to the rapid aging of Japanese society, the resulting skyrocketing healthcare and welfare costs, and the rising prices for cutting-edge therapies like novel cancer drugs or regenerative medicine demanded more and more by older populations, means that Japan can no longer spend whatever is needed for healthcare.

The country has the highest number of MRI and CT scanners (per one million people) in the world, and three times as many outpatient visits as in the United States; hospital stays in Japan are likewise three times as long as in the United States. Life science innovation alone will not solve these problems.

Ryo Kubota is Chairman, President, and CEO of Acucela Inc., a subsidiary of Kubota Pharmaceutical Holdings. He is also a member of the Board of Directors at the National Bureau of Asian Research and a visiting professor at Keio University School of Medicine. The longer version of this commentary first appeared in Innovative Asia, National Bureau of Asian Research.

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