Book Reviews

The Structure of Healthy Life

Determinants: Lessons from theJapanese Aging Cohort Studies
Hoshi, T., & Kodama, S. (eds.). (2018). Springer (169 pp.).
ISBN: 978-9-8110-6628-3.
Reviewed by Tim Murphey
Kanda University of International Studies
The Structure of Healthy Life Determinants (Determinants hereafter) was written
by a group of three Japanese researchers and three Chinese researchers using
structural equation modeling (SEM) statistics to obtain a picture of how we cangrow old better with better health and well-being. Their answer is in their Final
Model of Causal and Structural Relationships to a Healthy Life (Figure 1). The
figure consists of the five contributing elements, or determinants, to a better andlonger life, which are socio-economic status (SES), environmental conditions,and the psychological, physical, and social health.
Determinants starts with a 3-page preface by the editors with Figure 1
capturing the causal relationships that they argued exists between the fivedeterminants. The 11 chapters that follow examined in detail one or more ofthese determinants. Kodama, in chapter 9 for example, described correlations
between SES, dietary quality, emotional well-being, and five years of subjectivelife in middle age. Chapter 11, by Hoshi, researches an elderly group in Okinawa,brings much of the other research together to support their Model which showsthat while environmental conditions have a big impact on psychological health,
SES conditions impact physical health. They concluded that both physical and85

Murphey

Figure 1. Final model of causal and structural relationships to the healthy life.

social health have the biggest impact upon longevity and a healthy life.
Shuo Wang wrote well about the connections between SES, Social
Interaction and Health Status in chapter 6 showing how they are statisticallyinterrelated. Wang found “the mediating influence of social interaction
performed more pronounced among elderly women” (p. 96) and concluded thatsocial interaction was heavily influenced by SES. She pointed out that “peoplewith an advantageous SES are more inclined to interact with others, for severalreasons”, for instance, “contact[ing] friends, participat[ing] in community
volunteering and leisure activities require adequate financial support” (p. 97).
Wang argued, based on previous studies, that being active socially protectedagainst physical function decline, cognitive decline. Thus, she indicated thatthe key towards higher achievement of self-rated health (SRH) was increasing
opportunities for more exercise and access to information about health andhealth–related behaviors, providing emotional support for coping with stress,
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The Structure of Healthy Life Determinants, OnCUE Journal, 12(1), pages 85-89

and offering tangible help. In her study, it was noted that “social interaction had agreat effect on health status, suggesting that people with better social interaction
have better SRH and high-level performance ability” (p. 97).
While the editors start Determinants by telling us what we already know:
Japan has the highest life expectancy and healthy life expectancy in the world(World Health Organization, 2016). They caution this good news with thegap between the two. It appears that women can expect the last 12.5 years of
their lives to be not healthy and men the last 9 years of their lives, with women
typically living to be 80 and men to 74 (p.1).
While many of us have suspected it, the research in Determinants shows
clearly that having a healthy SES (think enough money, education, and workstatus) in Japan can greatly determine your health over time and your longevity.
Determinants should be taken seriously by the Japanese government, but it
is also a wake up call for any government that cares about the well-being of its
aging population. The editors cite Social Determinants of Health, (Marmot andWilkinson, 2006) and call social determinants of health “solid facts” (p. v )which should be taken as seriously in the same manner as nutrition and exercise.
They then proceed to introduce other factors, such as "the three health-related
dimensions, i.e. physical, mental and social well-being, [which] are key elements
as intermediary determinants into the causal relationships between SES andhealthy life expectancy" (p.2-3) . Social well-being is different from SES in that it
depends on close family, friends, and colleagues rather than enough money andwork status.
Finally, the editors have a short afterword in Determinants in which theybasically do away with our mothers’ simplistic order to eat our veggies, allowing
us to see that things are much more complex than they seem, but at the sametime much more controllable than we have previously imagined. A long life is notdependent just on the food you eat, it depends more on who you might be eatingwith (loved ones), where (in a backyard garden or by a lake), your ability to playwith your grandkids, and to giggle like a 4-year old. The authors encourage us(and make it possible for us to) make “desirable smart lifestyle choices” (p. 193).
This short Afterward is worth quoting:87Murphey

The main characteristic of this work is the revelation of … the cause and effectstructure of more fundamentally important socio-economic factors.
In particular, this study points out that it is not the case that lifestyle habits
including and ideal diet directly provide for healthy life expectancy, but that thereis the possibility that major socio-economic factors, environmental conditions,and the three essential health factors [mental, physical, and social] are, in fact,
confounding factors.
The essence of the results of this study is that, as a plan for extending life expectancy
in Japan, we cannot expect that our research will have a direct effect on healthy
life expectancy; however, we sincerely hope this might influence a more positive
lifestyle to occur as a result by progress in work, physical, psychological and social
health, as well as the necessity to emphasize the preservation of income andenvironmental conditions.
Those who wish to unreasonably control lifestyle habits, with their resulting
factors, should take note of prior research concerning younger deaths.
Consequently, to improve lifestyle habits—including a desirable diet—is torecognize that these are the resulting factors of socio-economic causes and threeessential health factors of socio-economic causes and three essential health factors.
To push for the initiation of better overall health education that focuses on setting
up a health supporting environment can definitely help people’s lives by making
smart lifestyle choices. (Hoshi & Kodama, 2018, p. 193)
There are a few awkward phrases that I think could be smoothed out, but
this happens even with native speakers. One aspect that I would recommend tothe editors is an acronym list on a few pages in the back. Thus, when reading, forexample, the direct effect of EWB on DQ, we do not have to go back many pages
looking for the original words (EWB = emotional well being; DQ = dietary
quality).
For general purpose teaching, the information given in this book review
may be enough for many students to read and talk about. It should be of special
interest to medical students and those studying sociology through CLIL/CBI
type courses in their later and graduate school years. I regularly share it withstudents in my positive sociology classes and other classes when the topics of the88

The Structure of Healthy Life Determinants, OnCUE Journal, 12(1), pages 85-89

elderly and social good come up. Finally, for graduate students taking statistics
courses and interested in learning about structural equation modeling (SEM),
concrete examples can be seen in this book.

References

Marmot, M., & Wilkinson, R. (2006). Social determinants of health (2nd ed.).
New York, NY: Oxford University Press.
World Health Organization. (2016). World health statistics 2016. Retrieved fromhttps://www.who.int/gho/publications/world_health_statistics/2016/en/

Author bio

Tim Murphey has studied and taught in Europe for 15 years and in Asia foranother 30. At present, he teaches at Aoyama University, Kanda University ofInternational Studies, and graduate school at Wayo Women’s University, Nagoya
University of Foreign Studies, and Kanda. He researches positive sociology, student
voice, motivation, and Vygotskian sociocultural theory. He loves teaching, juggling,skiing and finding positive ways to teach and learn. mitsmail1@gmail.com
Received: July 7, 2019
Accepted: September 18, 201989