FORWARD

Shigeo Morioka
PresidentInternational Longevity Center-JapanThe International Longevity Center-Japan sets priority on providing information

Challenge.

both domestically and internationally. It has published “Productive Aging” and“Advocacy”, two Japanese- and English-language journals, since its founding, and it
has disseminated information via its website as well in more recent years.
These activities via an international network are an important mission of the
ILC-Japan, and we are also recognized by society as being in a unique position
to perform such activities.
Drawing on these experiences and accomplishments, we are now launching a newjournal, “Global Information Journal on Longevity and Society.”
Japan is further down the road than other countries toward becoming a super-agedsociety with a low birthrate. For this reason, Japan’s experiences and policies in thisarea are of interest to nations around the world.
The Japanese people, however, seem to be in a state of confusion. The nation’s
systems and frameworks as well as the people’s consciousness cannot keep up withthe unprecedented change in the structure of society.
We appear to have lost direction and be adrift in a deluge of information.
Today we can obtain information from anywhere in the world at the blink ofan eye. For precisely this reason, we need to know how to assess the vast volume of
information available, how to think about the information in relation to our own
lives, and how to discern the information’s value.
When reading material from countries that have a different language, climate,culture, history, as well as a different national character and set of values, it is crucial
that we know the lifestyle perspective of the people of that country. This lifestyleperspective is not apparent, however, from the material alone.
At the same time, this also means that Japan needs to pay meticulous attention
and make special considerations when releasing information internationally.
It would be a great delight for us if “Global Information Journal on Longevity andSociety” provided an opportunity for us to rethink the value of information and toreassess the quality of life of each person in a longevity society.
Shigeo Morioka
PresidentInternational Longevity Center-Japan(ILC-Japan)

Robert N. Butler, M.D.
President and CEO
International Longevity Center-U.S.A.

It is in the best interest of all nations, Japan among them, to recognize theunprecedented global aging, a huge demographic shift, is a great humanachievement. As national populations age, there tends to be a concurrent decline
in birthrates. It is true of Europe, Oceania and Japan. It would be true in U.S.A.
and Canada as well were it not for immigration. There are pundits who believe that
population aging must be met by pronatalism, that is increasing the birthrate or byimmigration. It is more realistic to promote healthy and productive aging so thatolder people remain in the workforce longer. Further, we know from various studies
that productive engagement increases both the length and quality of life.
Economists such as John Stuart Mill in the 19th century wrote about the“stationary state” by which they meant that there is a limit to productivity. Arguably,
societies decide between two attitudes, one often associated with U.S.A. and theother with Europe. It is said Americans “live to work” and Europeans “work to live.”
It is possible that both population aging and increasing leisure will reduce pressures
toward productivity and unnecessary materialism. Increased leisure augments
opportunities to participate more actively in the civil society, resulting in greater
freedom of choice and quality of life.
I hope that the ILC-Japan’s “Global Information Journal on Longevity and Society”
will serve as an innovative forum for fostering the creation of new values amid thishistoric revolution in longevity that is advancing on a global scale.
Robert N. Butler, M.D.
President and CEO
International Longevity Center-U.S.A.
(ILC-U.S.A.)CONTENTS

ROUNDTABLE DISCUSSION
1

The Lives of Older Japanese Today Viewed in
the Context of International Data
Shigeo Morioka

Yoshiharu Otsuka

President, ILC-Japan
Ex-Chairman, Yamanouchi
Pharmaceutical Co., Ltd.
(today’s Astellas Pharma Inc.)

Vice-President, ILC-Japan
Vice-President, Japanese Red Cross Society•4

Yoshio Gyoten

Hiroshi Shibata

Director, ILC-Japan
Commentator on Medical Issues

Director, ILC-Japan
Professor, Obirin University Graduate School

Takako Sodei
Director, ILC-Japan
Professor Emeritus, Ochanomizu University

2

3

Japanese Older Persons in the 21st Century
To Live with Dignity
Tsutomu Hotta

Hiroshi Miyajima

Chairman,
Sawayaka Welfare Foundation

Professor, Waseda University

Atsushi Seike

Fusako Seki

Professor, Keio University

Associate Professor,
Yokohama National University

Health and Longevity for the Future
Shigeaki Hinohara

Yoshio Gyoten

Chairman of the Board of Trustees,
St. Luke’s International Hospital

Director, ILC-Japan
Commentator on Medical Issues

Yoshihito Karasawa

Tetsuo Tsuji

President, Japan Medical AssociationVice-Minister, Ministry of Health,Labour and Welfare

•14

•26

Shigeo Morioka
President, ILC-Japan
Ex-Chairman, Yamanouchi Pharmaceutical Co., Ltd. (today’s Astellas Pharma Inc.)

4

Thinking about Life and Death in the New Era•40

Alfons Deeken

Yoichiro Murakami

Professor Emeritus, Sophia University

Professor, International Christian University

Tadateru Konoe

Rihito Kimura

President, Japanese Red Cross Society

Director, ILC-Japan
President, Keisen University

Tadaharu Goto
Director, ILC-Japan
President, Foundation of Social Development for Senior Citizens

PARTICIPANTS’ LIST

•55

Participants

Shigeo Morioka

Yoshiharu Otsuka

President, ILC-Japan
Ex-Chairman, Yamanouchi
Pharmaceutical Co., Ltd.
(today’s Astellas Pharma Inc.)

Rou
nd
tab

Vice-President, ILC-Japan
Vice-President, Japanese Red Cross
Society

le

n
ssio
scu
Di

1

The Lives of Older
Japanese Today
Viewed in
the Context ofInternational Data●

Are You Satisfied with Your Life Today?
0
Japan

20

12.2

4

Sweden■■Satisfied80

100 (%)

12.2

70.3

Germany
Note: Survey of men and women aged 60 orover, excluding those who reside in carefacilities. Survey conducted in January andFebruary 2001 in each nation.
Source: Japanese Cabinet Office, Outline of
the Results of the FY2000 International
Study on the Lives and Perspectives ofSenior Citizens (August 2001).

60

62.9

U.S.A.
South Korea

40

22.3

24.6

50.0
33.3

2.9

29.2

59.5

6.8
39.0

■■
Somewhatdissatisfied

0.9
8.6

59.1

■■
Somewhatsatisfied

2.6

0.9

1.1 0.4■■
Dissatisfied

Yoshio Gyoten
Director, ILC-Japan
Commentator on Medical Issues

Hiroshi Shibata

Takako Sodei

Director, ILC-Japan
Professor, Obirin University
Graduate School

Director, ILC-Japan
Professor Emeritus, Ochanomizu
University

The International Study on the Lives and Perspectives of Senior Citizens
is conducted by the Japanese Cabinet Office every five years. The graphfrom that survey in the page 4 describes the level of satisfaction of older
persons with their lives today.
The graph shows that more than 90 percent of older persons living in
the U.S.A., Germany, and Sweden today are “more or less satisfied” with
their lives. In Japan, the figure is 85 percent. But if we compare just thepercentage of older persons who reported that they are “satisfied” with
their lives, Japan’s figure is less than one-third of that of the top scorer,
U.S.A., and less than one-half of that of Sweden. With respect to thepercentage of older persons who reported that they are “dissatisfied” or“somewhat dissatisfied” with their lives, Japan’s figure is almost ten times
that of Sweden. Excluding South Korea, the gap between the percentage
of satisfied (including “satisfied” and “more or less satisfied”–about 22 percent) anddissatisfied (including “dissatisfied and “somewhat dissatisfied”–about 15 percent) issmallest in Japan.
Needless to say, the impression given by the data differs dramaticallydepending on the angle from which it is viewed. Japan is enjoying
unprecedented longevity, but how are we Japanese viewing the benefits ofthis treasure of long life?
What do we need to do to maximize the benefits of longevity in our daily
lives and overcome the challenges it presents without being overwhelmedby the huge amount of information available on it? Japan is considered aleader of super longevity societies, and we invited some experts to discuss
the lives of today’s Japanese older people and to give us their vision of agood life for older Japanese.

Global Information Journal on Longevity and Society 2007

5

ROUNDTABLE DISCUSSION•1
Baroness Sally Greengross, “Do
Health and Longevity Create Wealth?:
Outlook for the UK” (lecture, International Association of Gerontology[IAG] Session, Eighteenth World
Congress of Gerontology, Rio deJaneiro, June 26–30, 2005).
•2
Data from Emmanuelle Cambois,
Jean-Marie Robine, Mark D.
Hayward, “Disability-Free Life
Expectancy Differentials According to
Occupational Status in the French
Male Population: 1980–1991,”
Demography 38, no. 4 (2001):
513–24. cited in Emmanuelle
Cambois, “Occupational and
Educational Differentials in Mortality
in French Elderly People: Magnitude
and Trends over Recent Decades,”Demographic Research – Special
Collection 2: Article 11 (2004):
278–304.
•3 International Comparison ofIncome Distribution
GINI COEFFICIENT(equivalent disposable income)Rank Country
Gini Coefficient1
Denmark
0.217
2
Finland0.228
3
Sweden0.230
4Austria
0.238
5Netherlands
0.255
6
Norway
0.256
7
Japan
0.265
8
Belgium
0.272
9France0.278
10Germany
0.282
PER CAPITA NATIONAL INCOME
Rank Country
1
Norway2
Japan
3
U.S.A.
4
Denmark
5
Sweden6
UK
7
Netherlands
8
Austria9
Belgium
10
Finland

Income (US$)
35,63035,61034,28030,60025,40025,12024,33023,94023,85023,780Source: Materials for the Ninth Meeting of
the Japanese Tax Commission’s SubCommittee on Fundamental Issues (March
30, 2004).
Note: Developed by the Italian statistician
Corrado Gini in 1936, the Gini coefficientmeasures inequality in income distribution.
The range of the coefficient is from 0 to 1.
The greater the inequality the closer thecoefficient is to 1; complete equality inincome distribution is expressed as 0.

6

1

Are Japanese older persons today
happy compared to those overseas?

Morioka: The Eighteenth World
Congress of Gerontology was held
last June in Rio de Janeiro. At thatcongress, the ILC-Alliance sponsored a session entitled, “Do Healthand Longevity Generate Wealth?”
I was very surprised by the data
presented.
Baroness Sally Greengross, chief
executive of the ILC-UK, reported
that there is a clear socioeconomic
disparity on the individual level in
the UK, and that this differential
has a major impact on healthy life
expectancy. There is even somedata that indicates a difference inlife expectancy of ten or more years
between the classes. Moreover, as
they have had consecutive severe
winters, the UK mortality rate in
the winter has remained high.•1
Professor Françoise Forette, president of the ILC-France, pointed
out that there is a great differencein employment conditions (income)in France and there is a gap of
about five years in the average life
expectancy at 60 between whiteand blue-collar workers.•2 I was
surprised that socioeconomic differentials were having such a major
impact on life expectancy.
What about Japan? When compared internationally, the income
differential in Japan is small, theper capita national income is

The Lives of Older Japanese Today Viewed in the Context of International Datahigh,•3 and the health insurance,
pension, and long-term care insurance systems are well developed.
The level of security a society gives
to its vulnerable classes, including
those who are economically vulnerable or those with a physicaldisability, is a measure of the levelof happiness of that nation’s older
persons. Considered in this light as
well, I think it can be said that,
although Japan still faces various
challenges, Japanese older persons
are happy.

Shibata: Our research based on anationwide random sampling of
U.S.A. and Japanese older persons
revealed not only that Japan’s average life expectancy is longer thanthat of U.S.A., but that, when looking at healthy life expectancy, forexample, we find that Japan has amuch lower percentage of older
persons with acquired disabilities.•4
In other words, Japan has a longer
healthy life expectancy. Moreover,in regard to the percentage of paid
workers, although U.S.A. has thehighest percentage among theWestern countries, Japan’s figure isa little higher than that of the
U.S.A.•5 Therefore, Japanese older
persons are relatively healthy andJapan stands out in terms of thesocial contribution of its older persons through paid employment.
Turning to the field of medicine,undernutrition is a problem among

older persons. Undernutrition
among older persons even in developed countries follows the patternof malnutrition in developing
countries: older persons have aconsistently low level of calorie andprotein intake even when they live
in a developed nation. While thepercentage of undernourished older
persons in Japan is slightly below
ten percent, the percentage in
U.S.A. is three to four times that ofJapan, even though U.S.A. is said tobe a land of nutritional abundance.
Looking at this data, it appears
that Japanese older persons are
objectively fortunate and are relatively happy even when comparedinternationally.

Otsuka: I am intrigued by the possible large discrepancy between theimage derived from the objective
data and the subjective outlook ofJapanese older people.
Let’s look, for example, at theJapanese Cabinet Office’s international survey of the lifestyle satisfaction of older persons. If we add
together the two respondent categories of “satisfied” or “somewhat
satisfied,” this combined grouping
generally makes up about 90 percent
of respondents in all nations surveyed. Looking at the separate
categories, though, Japan has a low
percentage of older persons reporting “satisfied” and an overwhelming
majority indicating only “somewhat

satisfied” (see graph on page 2).
Prof. Shibata commented thatJapanese older persons are healthy,
but a survey of their anxiety overtheir health status indicates thatJapan has the highest percentageof people reporting that they are“concerned” about their health.
Although Japanese older persons
are healthy, virtually all the surveys
show this trend in responses.
To explain this gap between theobjective data and people’s subjective awareness, I think we need tounderstand the national characterof the Japanese people by using
theories of comparative cultures.

Shibata: Let’s consider the suicide
rate. The suicide rate among
Japanese women is always among
the top three internationally, andrecent statistics show that Japanis ranked first, ahead of Hungary.•6
In general, more men than womencommit suicide. For Japanese men,suicide tends to be high in middle
age. If we were to graph this suicide
rate with the horizontal axis indicating age and the vertical axis
referring to number of suicides,
the plotted line would curve up
like a camel’s hump during the
middle-age years. Among women,
however, suicide is high in old age.
Japanese women live the longest
in the world in terms of average life
expectancy, but they also have thehighest suicide rate and they have

•4 Comparison of Functional

Incapacity Rates between
Japanese and U.S.A. Samples■Japan ■U.S.A.
60

*

50
44.2

*

40
31.2

30
20
10

11.1

9.0

0

Women

Men

Note: = P<0.001
Source: Hiroshi Shibata, Hidehiro Sugisawa,
Shuichiro Watanabe, “Functional Capacity
in Elderly Japanese Living in theCommunity,” Japanese Journal of
Geriatrics 40, no. 2 (2003): 95–100.

*•5 Labor Force Participation

Rates of Older Persons:
A Japan-U.S.A. Comparison
No. ofLabor Force
Older Persons in Participation Rate
Labor Force of Older Persons(10,000 people)

Japan
U.S.A.

487
438

(%)

20.7
13.3

Note: Labor Force Participation Rate of
Persons Age 65 or Over = (No. of Persons
Age 65 or Over in Labor Force / Population
Age 65 or Over) X 100
Source: Japanese Ministry of Internal Affairs
and Communications, “Fiscal 2003
Statistics Topics No. 5,” International
Comparison of Labor Force Participation
Rates of Older Persons, September 2003,
http://www.stat.go.jp/data/topics/topics052.htm.

•6 OECD Suicide Rate Ranking

MALE SUICIDE RATE (OECD)(per 100,000)

Rank Country
Suicide Rate
1
Hungary
45.5
2
Japan
35.2
3
Finland32.3
4
Belgium
31.2
5Austria
30.5
6Luxembourg
28.6
7
Switzerland
27.8
8Poland26.7
9France26.1
10Czech Republic
26.0
FEMALE SUICIDE RATE (OECD)(per 100,000)

Rank Country
1
Japan
2
Hungary3
Belgium
4
Switzerland
5
Finland
6
Luxembourg
7
France8Austria9South Korea
10
SwedenSuicide Rate
13.4
12.2
11.4
10.8
10.2
10.2
9.4
8.7
8.6
8.1

Note: This is an excerpt of the top ten countries determined in a survey of 28 countries.
Source: Kanako Amano, “An International
Comparison and Analysis of Japan’s High
Suicide Rate,” NLI RESEARCH Report,
August 2005.

Global Information Journal on Longevity and Society 2007

7

ROUNDTABLE DISCUSSION

1

great anxiety about their lifestyleand health. Although objectively
they are fortunate with respect tothe level of social services and theyshould enjoy the healthiest andlongest lives in the world, they
have a groundless sense of insecurity. Although it is unclear whether
this is due to cultural factors, structural factors, or something else, thegap itself is undeniable.
Moreover, I find that Japaneseolder persons have less of a senseof their right to enjoy old age compared to older persons in the West.
This perspective may also affect the
gap between the objective data andolder persons’ subjective views.

Gyoten: A person’s sense of happiness may differ depending on theage used in the definition of “older
person.” There are also various
kinds of “older persons,” and thissegment of society cannot necessarily be defined simply by numerical age.
In our generation at least, WorldWar II has left a great impact indeed.
Compared to what we experienced
during and after the war, any circumstance could be considered as
happy. I am almost eighty years old“
8now, and I appreciate the happinessI have now while I also remember
my many friends and family members who have passed away.
The aging of society generally tends
to be portrayed as a negative, butwhat kind of impact is the aging ofsociety actually having?

Otsuka: I hesitate to mention mypersonal experience, but during thethirty years or so that I worked at
the Ministry of Health, Labour andWelfare, responding to the longlived society that was looming on
the horizon was the main focus of
the entire ministry’s work, and thiscaused us much worry. In 1970
soon after I joined the ministry, anational convention on “ensuring
fulfilling lives for older persons”
was held at Hibiya Public Hall, andI think this was the first time that
we thought about the aging ofJapanese society from the perspective of providing adequate social
security programs. It is no exaggeration to say that from that time
until the birth of the long-term careinsurance system in 2000, ourenergies were focused primarily on

Japanese older persons have less of a sense of theirright to enjoy old age compared toolder persons in the West.

The Lives of Older Japanese Today Viewed in the Context of International Data”

creating a fulfilling long-lived society by navigating through various
complications.
I am a member of the babyboom generation, and I think thatthe coming challenge of the aging
of society is the challenge of thebaby-boom generation.
Administrative policies and social
system issues are also important,
but the issue of the aging of society
will depend on how the people ofthis generation live their lives.
It is particularly important how
people use the free time they gain
after they retire and begin their
golden years. However, I am somewhat optimistic. We baby-boomers
have already had to experience“new things unknown in the past,”
and I think we will be able to adjust
to the future by using the flexibility
we already have developed.

Sodei: The mass retirement of thebaby-boom generation is talked
about a great deal these days. My
concern about Japanese men after
retirement is that, even after theystop working, their values continue
to reflect a corporate mentality. For
example, they are very particular
about formalities when they run ameeting or participate in volunteer
activities. They are insistent about
rules, hierarchy, and titles, and they
get angry if the rules are not followed. They are fixated on social
status, such as education level andposition at the workplace at thetime of retirement.
This trend is not seen very muchin women-only groups. I have theimpression that post-retirement
Japanese men are searching fortheir purpose in life and their identity by changing from “eager-beaver
businessmen” into “eager-beaver
volunteers” while retaining thesame corporate mentality.
I think many businessmen who
have a high level of education andserved in management positions attheir companies are particularly
inept at growing older; in addition
to retaining the mentality just mentioned, they worry about how tospend their spare time. There issome fragility in their life situation.
Those who outlive their wives also
tend to die young.
Mr. Gyoten mentioned earlier
the impact of the war, but I believethat the experience of being businessmen during the period of higheconomic growth has also had agreat impact on this kind of tendency among Japanese men.
These men do well when they areabsorbed in riding the wave of higheconomic growth, living only for
their work and not concerningthemselves with their families,
but when that ends, they lose
their purpose and are completelydevastated. I think that’s where thetendency to hold on to old values
comes from.

Global Information Journal on Longevity and Society 2007

9

ROUNDTABLE DISCUSSION•7
Data from David Bloom and David
Canning, “ILC: Alliance for Health &the Future,” 2005. (This paper waspresented at an ILC-UNESCO conference in December 2005.)

“
10

1

Morioka: Turning to the questionof enjoyment of life, I think ourgeneration has placed their work
first and has not even thought
about such things as designing
their own lives. In generations
younger than us, though, there are
more people who know how toenjoy their lives even if they havebeen company businesspeople.
The ILC conducts various
surveys on the impact of a longlived society. The ILC was initiallyconceived of by Dr. Robert Butler(president and CEO of ILC-U.S.A.) who
predicted that population aging
would become an important issue.
Dr. Butler was the founding director of the National Institute on
Aging (NIA) in U.S.A. Even after
leaving the NIA, he has continued
to sound the alarm in society andhas called for a change in people’s
consciousness. International
Longevity Centers were set up
as private organizations in U.S.A.
in August 1990 and in Japan inNovember of that year, with aneye toward conducting activities
from a global perspective. ILCs
were then set up in France, the UK,
and the Dominican Republic. EachILC operates independently withindependent financing in theircountry while conducting activities
through a loose collaboration
among the various ILCs. Later ILCs
were set up in India, South Africa,and Argentina, and today an ILCAlliance has been formed of the
ILCs in these eight countries.
A report compiled as part of theactivities of the ILC-Allianceincludes data showing that nations
that have a large healthy population have high economic growth
and that the GDP of a developing
country increases by four percent
if life expectancy increases by one
year.•7 Although there is a difference in the impact of population
aging between developed anddeveloping countries, this datasuggests that the gap will narrow
if the economic gap between developed and developing nations isnarrowed—in other words, if
support is provided to developing
nations. With this support, developing nations will also be able to
make a positive contribution toolder people’s issues.

Shibata: I think that the aging ofsociety is a global issue, in otherwords, a population issue. The

We must not let ourselves fall prey tothe erroneous belief that
‘older people are useless.’

The Lives of Older Japanese Today Viewed in the Context of International Data”“…the importance of every older person being
proud of their personal history as
they reach the end of their lives.

population ages in developed
nations because the people live
long and the birthrate is low.
Anyway, it can also be consideredinevitable as population control
is a fundamental policy.
Using the analogy of biology,
substances that exist in large volumes or quantities in the body play
important roles. Continuing withthis analogy, we could say that thelarger a segment of society, thegreater the function it should play.
Thus, older people who have cometo make up such a large segment ofsociety should play an importantrole in society. In the future, weshould move toward productive
aging with the awareness that older
people lead society.
Our research, as well, has produced data that people who contribute to society live long lives anddo not become ill. Having older
people lead society and experience
joy in doing so is “productivity” inthe broad sense.

Sodei: As Dr. Butler has emphasized, we must not let ourselves
fall prey to the erroneous belief
that “older people are useless.”
The concept of productive aging is”

crucial. The role that older persons
should play in society in the future
is not just the passing down of past
traditions. Rather, older persons
should apply the specialized
knowledge they have gained at theworkplace, not just for bettermentof the corporation, but also for the
betterment of society in general.
Many NPOs have difficulty with
their accounting, and many people
are baffled by legal terms that alawyer could explain with ease.
Volunteers with overseas experience are needed at international
events like the World Cup. If there
were people to link up the usefulknowledge and experiences ofolder people and the situations
where these are needed, the hidden
resources held by our older people
would be used more.

Gyoten: In addition, I would liketo emphasize the importance ofevery older person being proud of
their personal history as they reachthe end of their lives. Older persons should be proud of theirsenior status, and society should
see great importance and value inhaving older persons present.
I find that having older persons

Global Information Journal on Longevity and Society 2007

11

ROUNDTABLE DISCUSSION

1

all think, “I must be energetic,”“I must do something,” or “I must
be useful,” and having them all
stampede in that one direction, issad, lonely, and even frightening.
Japan is considered a leader in thearea of population aging issues andour nation is being called upon to bea model of a fulfilling long-lived society. Some have pointed out that Japanis not clear in presenting its philosophy on aging or the state of its population aging even though it has
actively sought to learn from othercountries. What kind of role should
Japan play in the future?

Shibata: Japanese lack the strong
will to fully and clearly state theirown views. Japan has a weak presence at international conferencescompared to other Asian countries
because Japanese are overly
focused on the language barrier,making language into a goal whenit should be no more than a means.
Even in the academic world, mastering language and being able toquickly obtain and present information from overseas is still misperceived as an academic
accomplishment. What should besought is scholarly insight in a fieldof academic inquiry.

Sodei: Since World War II,
Japanese have had the strong belief

12

The Lives of Older Japanese Today Viewed in the Context of International Data

that the West was, without question, superior in the area of social
welfare in particular. The Japanese
then started emulating foreigncountries and became disillusioned
with their own society. This has
been repeated over and overagain. Japan is not Sweden, theNetherlands, or U.S.A. If Japan
does not have a basic blueprint of
the kind of country it would like tobecome, there is not much point
even in trying to incorporate only
the good points discovered in foreign countries.

Otsuka: I agree completely. The
importance of knowing about foreign countries is to be able to lookat Japan objectively based on that
information. We shouldn’t emulatethem without question or reject
them flatly without careful consideration. It is crucial that we have an
objective understanding of theactual situation in our own country
and think about the kind of nation
Japan should be with its populationof 128 million.

Gyoten: The main reason why
Japan is such an affluent, long-lived
society today is nothing other thanbecause it has been able to enjoy
peace and has not fought a war for
more than sixty years. Only Japan
can tell the world how wonderful it
is not to have war and how great an
impact the presence or absence of

war has on population issues andnational lifestyle. Japan needs tovalue that more and tell the worldabout it.

Shibata: There is no global standard for the form of a long-lived
society. However, the idea that eachindividual should contribute tosociety may be common denominator for a desirable long-lived
society. Every older person aroundthe world can enjoy the same experience of “being in society.” Weshould respect the diversity of individuals with respect to the methodof contributing to society, however,as Mr. Gyoten mentioned before.
Regarding concrete frameworkfor supporting the lifestyles of thediverse array of older individuals,
Japan’s medical, pension, long-termcare insurance, and other social
security systems are ahead of othercountries. It is important that Japan
views itself as a leader in this area.

Otsuka: Few countries in theworld offer as equal an opportunity
for education as Japan or have hadsuch a high literacy rate sincearound the seventeenth century. I
think Japan should have more“pride in being a peaceful nation
and—at least based on the data
available to date—a country thatstands out as having limited
inequality and a country where all
people have enough education to
be able to express themselves intheir own words. The Japanese
have what it takes to play a role in
the international arena. They justneed to be aware of this.

Morioka: Aiming to be a fulfilling
long-lived society, Japan is promoting gerontology research, preventing lifestyle-related diseases andthe need for long-term care,
improving the long-term careinsurance system and its operation,encouraging volunteer activities,
and developing mutual support
within the community. Japan is tobe an international model in thearea of older persons issues, andour speaking openly about our past
successes, the tasks that remain,and our failures is the best support
we could ever give to the nations of
the world that will follow us.
(April 13, 2006)

Photos: Taku Sugawara

The Japanese have what it takes to playa role in the international arena.
They just need to be aware of this.

”Global Information Journal on Longevity and Society 200713

Participants

Tsutomu Hotta

Hiroshi Miyajima

Chairman,
Sawayaka Welfare Foundation

Rou
nd
tab

Professor,
Waseda University

le
n
ssio
scu
Di

2

Japanese Older
Persons in
the 21st Century
To Live with Dignity●

Population Trends and Outlook for Japan■■0–14 ■■15–64 ■■64 and over
Productive-age population
Population (1,000 people)
Year 030,00060,00090,000120,000
150,000
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
2010
2015
2020
2025
2030
2035
2040
2045
2050
0
20
40
60
80
100
Productive-age population (%)■■

Source: Japan’s White Paper on Health,Labour and Welfare, 2005. Statistics foryears up to and including 2000 are from the“Population Census of Japan” of theStatistics Bureau of the Ministry of Internal
Affairs and Communications. Statistics for2005 and later are from the “Population
Projections for Japan, January 2002:
Medium Variant” of the National Instituteof Population and Social Security Research.

14

Atsushi Seike
Professor,
Keio University

Fusako Seki
Associate Professor,
Yokohama National University

Robert N. Butler, M.D., established the International Longevity CenterU.S.A. (ILC-U.S.A.) in 1990 based on the concept of “Productive Aging”.
In support of this philosophy, an ILC was set up in Japan that same year.
Today, sixteen years later, the structure of Japan’s population is undergoinga drastic change at a speed not seen elsewhere in the world. Our nation is
becoming an aging society with a decline in the birthrate or, in otherwords, a super-aged society accompanied by population decrease.
We invited some experts to discuss afresh Japanese older persons’ lives in
the 21st century under the theme of “Productive Aging: Enjoying Active
Senior Years.”•1 Social Security
The term “Social Security” in Japanese
encompasses a very wide scope.
According to the Ministry of Health,Labour and Welfare, Social Security
exists to “provide income security as
well as medical and social welfare benefits in the form of social insurance
and public assistance.”
In U.S.A., “Social Security” generally refers to income security such aspensions. The Social Security Act also
addresses medical care for the elderly
and welfare for the disabled. Social
welfare services are called “Human
Services”.
“Social Security” in the UK represents income security such as pensions
and children’s allowances. “Social
Service” is a term that is conceptuallycloser to the Japanese term for “Social
Security.”
In France, “sécurité sociale”
means social insurance such as
health insurance and security for
older persons. “Protection sociale”
is wider conceptually.
•2 Committee on Social Security

First, I would like to express myrespect and appreciation for Professor
Miyajima, who chaired theCommittee on Social Security•1
Review•2 over the past two years, andask him for his feedback on the
results of the review.

Miyajima: Our Committee completed its mission on May 26 when
it submitted a report on its findings
regarding the future of Japan’ssocial security system after two
years of discussions.
The report recommends (1) thatthe social security system, as partof the social safety net, be built
based on the individual’s “selfhelp” complemented by “mutual
support” and “public support”,•3(2) that the core of social security
be a social insurance system thatpeople can receive as a right andtherefore facilitates the public’s
agreement, and (3) in particularthat the universal health insurance
and pension coverage—major features of the Japanese system—bemaintained. At the same time,
however, the report emphasizes that
future social security policy should
shift from “providing security for

Review
The Committee on Social Security
Review was established based on the
Basic Policies for Economic and Fiscal
Management and Structural Reform
2004 set by the Koizumi Cabinet.
Presided over by the Chief Cabinet
Secretary, the Committee discusses thecomprehensive reform of the tax andsocial security systems. The
Committee summarized the findings of
its eighteen meetings held over thecourse of a two-year period from July
2004 in a report entitled Kongo no
shakai hosho no arikata ni tsuite(The Future of Japan’s Social Security
System), which it submitted on May
26, 2006.
•3 “mutual support” and“public support”
In the Japanese concept of social security, “mutual support” indicates ascheme supported mutually by thesociety to prepare for future risks, i.e.
social insurance systems like pension
system, long-term care insurance system, etc.
In addition to “self-help” and “mutual support”, “public support” is carriedout for those in need by taxes. Public
support includes public assistance orsocial welfare based on income qualification, living standard, domestic conditions, etc.

Global Information Journal on Longevity and Society 2007

15

ROUNDTABLE DISCUSSION•4 United Nations World

Assembly on Ageing
Sponsored by the United Nations, theWorld Assembly on Ageing is aninternational conference to discuss theissues of aging from a global standpoint. The first World Assembly washeld in Vienna in 1982 and the second
was held in Madrid in April 2002.
With the participation of many representatives of government agencies andNGOs, the second World Assembly
saw a dynamic debate on “Building aSociety for All Ages,” the main themeof the conference.
•5 Japan NGO Council on Ageing(JANCA)In support of the UN InternationalYear of Older Persons 1999, JANCA
was formed in 1998 by NGOs and others involved in the issues of aging. A
total of 39 organizations are membersof JANCA (as of May 2006). To promote the “independence, self-fulfillment, participation, care, and dignityof older persons” (United Nations
Principles for Older Persons), JANCA
conducts dynamic activities, including
holding symposiums and publicity
campaigns.

162

risks that arise” to “preventing
risks from arising.” In other words,
the emphasis of policy should beplaced on changing the system sothat it minimizes risks and supports independence or the self-helpof individuals.
Permit me to go on a bit of anaside and mention that I initiallywanted to take the phrase “limit
the increase in demand for social
security” and restate it as “limit
excessive dependence on social
security.” Others objected sayingthat it was wrong to use the word
“dependence” when social security
was a right, so we used the word
“demand” in the end. Nonetheless,I strongly believe even now thatencouraging an independent
lifestyle where people depend on
the public social security programs
as little as possible is a very important philosophy, not just from theperspective of financial resources,
but as a matter related to humandignity and the very heart of people’s outlook on life.
Older persons in particular mustfirst become more clearly aware of
the concept of the quality of life,
which includes independence indaily living and healthy longevity.
Employment and social participation—in other words, being activein the affairs of our economy andsociety—are also crucial for older
persons.

Japanese Older Persons in the 21st Century—To Live with Dignity

How should we change people’s
mindset and society’s frameworks
and values to make the most of therich treasure of longevity?

Hotta: Let me tell you about myexperience at the United Nations
Second World Assembly on
Ageing•4 held in Madrid, Spain, in
2002. At that conference, there
were government-level sessions aswell as many exciting, informative
sessions sponsored by NGOs fromall over the world. The Japan NGO
Council on Ageing (JANCA),•5 which
Keiko Higuchi and I co-chair, helda workshop entitled, “To Share Our
Experiences on Ageing in Asia.”
Japanese delegates explained thelong-term care insurance systemthat had just started at that time.
At the same gathering, participantsfrom other countries passionately
stated that they wanted to makemoney independently, even when
they were older, and not depend on
the system.

For this reason, they wanted
opportunities to learn and acquire
skills. I was overwhelmed by thestrength of their determination.
From this experience, I became
convinced that while creating asystem to support older persons isimportant, the goal of that systemshould be to facilitate and support
the use of their own abilities. I
believe without question that thefoundation for people to live with
dignity is self-help and mutual(community) support.

Seike: We must recognize once
again that the key point to remember when thinking about the aging
of society is the change in population structure. Let’s look at the pension system, for example. With thedecrease in the number of young
workers, it is clearly impossible tosustain a structure in which
mandatory retirement is set at 60,
and older people who make up theretired generation are supported by
the working generation composed“of people in their 20s through 50s.
It is clear that older people whohave the desire and ability to work
will need to remain active membersof the working generation andstand on their own feet among
those who support Japan’s economy and society. As the scope of theworking generation expands, theburden on each individual worker
will be reduced and, at the sametime, the benefits for those truly inneed will not need to be lessened.
If we retain our current framework and mindset, we will end up
with a situation where burdens will
increase and we will be unable toprovide people who are truly inneed with the benefits they require.
The system will end up being a“system of unhappiness” where
everyone is left only with a sense of
dissatisfaction. Raising the pension
eligibility age is a natural choice inthis sense, and the mandatory
retirement age and pension system
must be changed so that they do
not hamper older people’s chances

We should develop the common mindset that
promoting an active aging society is crucial.

”

Global Information Journal on Longevity and Society 2007

17

ROUNDTABLE DISCUSSION

2

for employment.
A system that erodes people’s
desire and ability to work (or makes it
impossible to make the most of people’s desire
and ability to work) because of amandatory retirement age and pension system is inadequate. From thisperspective, we should develop thecommon mindset that promoting
an active aging society is crucial.

Seki: That said, we mustn’t create,
by making need alone the condition for receiving social security
benefits, a situation where people
are anxious about whether they
will ever be able to receive social
security benefits. The social security system is needed to provide an
ultimate sense of security, so thatpeople know that when they reacha certain age they will be thanked
for their hard work and be able toretire from the workforce.
With the increase in life
expectancy, there are more andmore healthy people in their 60s
now who have the desire and020ability to work. Perhaps we could
gradually raise the age used todefine a person as “older” (age 65).•6
In addition, being independent andworking can mean not only working as a professional but also working as a volunteer or in other ways.
Young generations are anxiousthat they may not be able to receive
anything when they get older eventhough they are paying into thesocial security system now. We
mustn’t let the framework be onethat just increases the level of anxiety for everyone, older persons andyounger persons alike.

Seike: Of course, what I was
saying does not deny the significance of having a social security
system. It is a core principle thatthe social security system should
address fundamental risks that
individuals cannot foresee or fully
cover. The question is how to set
the balance between self-help andpublic support.
A public pension system should

40

60

80

100
No response
0.1

55 and over
0.6

It depends.
6.6•6 Definition of Older Person (%)
Question: What age do you consider aperson to be “older” or “elderly”?
Source: Graph is from the Annual Report on
the Aging Society, 2006 compiled by the
Cabinet Office, Government of Japan.
Statistics are from the Cabinet Office’s“Survey of Attitudes on Age and Aging,
2003.”
Note: The survey was conducted of men andwomen nationwide age 20 and over.

18

60 and over
6.8

Japanese Older Persons in the 21st Century—To Live with Dignity

65 and over
18.5

70 and over
48.7

75 andover
12.9

80 andover
6.0

set a certain age as “expected
longevity” and cover “unexpected
longevity.” Taking this perspective,
I don’t think anyone today would
consider 65 as “unexpected
longevity.” We should raise one
step further the age at which people can start to receive their pension. In exchange, we should not
cut disbursements for people with
“unexpected longevity,” but provide benefits so that people can livewith dignity after retirement. We
must build this kind of variety into
the system.
Turning to the medical system,
medical insurance should cover
expenses incurred for diseases that
individuals cannot prevent and forwhich medical treatment is expensive. Moreover, we must also adopt
the mindset of lowering people’srisk of falling ill or requiring longterm care. In other words, it will be
important to narrow the range offundamental risk by thinking of
medical treatment not just as something one uses after one becomes
ill, but also as an investment in
one’s health.

Hotta: It is important that we discuss the social security system, but
the creation of a framework to support independence and self-help
should be seen as a prerequisite forthe system. I would like to see thefollowing ideas take root throughout the system and reflect themindset of both society and individuals: abolish mandatory retirement and have people who havethe desire and ability to work workand take care of themselves.
We must create welfare benefits
as public support that is to be used
after self-help and mutual support
have been tried. We must also
develop ways to truly rescue vulnerable members of society. I think
the current system provides anational framework for this.
I think that the current social
security system goes beyond thescope of Article 25•7 of theConstitution of Japan—which discusses the protection of vulnerable
members of society and provides
for the right to life and the social
mission of the State—and falls
under the scope of Article 13•8—which speaks of respect for theindividual, the right to the pursuitof happiness, and public welfare.
From this perspective, we mustre-envision our lifestyles, ourmindset, and our frameworks andthink about creating a new framework for self-help and mutual support that values our own humandignity.

•7 Article 25 of the Constitutionof Japan
1: “All people shall have the right tomaintain the minimum standards ofwholesome and cultured living.
2: “In all spheres of life, the State shalluse its endeavors for the promotionand extension of social welfare andsecurity, and of public health.”•8 Article 13 of the Constitutionof Japan“All of the people shall be respected as
individuals. Their right to life, liberty,
and the pursuit of happiness shall, tothe extent that it does not interferewith the public welfare, be the supremeconsideration in legislation and inother governmental affairs.”

As society ages, the decline in thebirthrate is becoming more serious.
What imbalances does Japanese society face?

Global Information Journal on Longevity and Society 2007

19

ROUNDTABLE DISCUSSION“

2

a serious social pathology in Japan today.

Miyajima: While I fully want to•10 Trends in the Total Fertility

family and a career in Japan compared to other industrialized countries. In addition, few executives
and men have a sense of urgency
about the need to create a society
where it is easy to balance both afamily and a career.

support a proactive approach
toward self-help and mutual support, I think there is something
wrong or something ill with a society in which there are so many people who do not want to getmarried•9 or who do not want tohave children.•10Over the two years that theCommittee on Social Security
Review met, a number of tragic
domestic violence incidents
occurred one after the other. I havea heavy, terrible sense about Japan’s
present situation—that the decline
in the birthrate reflects a serious
social pathology in Japan today.

Hotta: If we think about the relationship between the individual
and society, we unfortunately mustsay that a proper family life is virtually impossible in Japan. The fact isthat the strain of unnatural work
styles caused by uncompensatedovertime and other practices isrearing its ugly head here andthere.
As a measure to rectify suchstrains, I think we must create asociety where people can choose
how they work. To date, employers

Rate
1975
1990
2005

1.91
1.54
1.25

Source: Based on “Vital Statistics of Japan”
of the Ministry of Health, Labour andWelfare.

Seki: Looking at Japan from theperspective of a working woman, it
is still difficult to balance both a

80

60

Men
40

20

0

(Year)
0
1920
1930•9 Proportion of Never-Married

Men and Women by Age (%)■■25–29 ■■30–34 ■■50
Source: Compiled based on the “Population
Census of Japan” of the Statistics Bureau of
the Ministry of Internal Affairs andCommunications and the “Population
Statistics of Japan” of the National Instituteof Population and Social Security Research.
Note: The percentage of never-married people at age 50 is called the percentage of lifelong singles. For 2005, figures are theresult of preliminary sample tabulation andfigures for age 50 are the average of the two
five-year age groups of 45–49 and 50–54.

20”

The decline in the birthrate reflects

Japanese Older Persons in the 21st Century—To Live with Dignity

1940
1950
1960
1970
1980
1990
2000
2005

20

Women
40

60

80

have set the work style. I would
like to see that flipped on its headso that every individual can work
according to their own individual
abilities and their own individual
situation at that time.
If we fail to create a society inwhich it is possible to leave theworkforce to have children or to
study overseas, in other words, if
we do not create a flexible society
where a variety of work styles are
accepted, Japan will not be a country where people are happy.

inadequate with the way society istoday and that we must change it
by all working together.

Seki: I have high hopes that the

Seike: Corporations are required tokeep management strict amid
today’s tight domestic and international competition, and I canappreciate fully the difficulties ofthe present situation.
It is a fact that there is no easysolution to the conflict in values
between individuals and society.
Labor and management should
address the current situation
together based on the common
awareness that there is something“large baby-boom generation will bea catalyst for changing society. I
would like to see them create a
new, different style of relating tosociety by exploring volunteer
activities and various other work
styles after retirement. This will
stimulate the younger generations
as well and may also become an
important incentive for creating asociety where it is easy for womenand people with disabilities towork.

Hotta: There are still too few
hands in many fields of work thatdeal with people and require individualized responses, such as education and childrearing. We alsoneed opportunities for older persons to pass on to us their wisdom
concerning how to live well as
human beings and their way of

I have high hopes thatthe large baby-boom generation will bea catalyst for changing society.

”

Global Information Journal on Longevity and Society 2007

21

ROUNDTABLE DISCUSSION

2

relating to nature. Even if they have
few opportunities to be with theirown grandchildren, we can create
opportunities in society for intergenerational exchange by having
older persons assist with local afterschool daycare, for example.
Local governments withadvanced depopulation and population aging must rely, in the end,on volunteers and NPOs to provide
individualized responses. Local
governments are realizing that they
have no choice but to work together, to pool the little money they
have, and to use the energy ofNPOs and volunteers.
Whatever the catalyst, I think it
is ideal for us to redesign Japan into
this kind of caring community.
What do we need to do to welcome
our senior years actively and not
overly depend on the social security
system?

Seike: Working life used to be

based on the model of a short-distance race. Under this model, people go all out during a working lifethat lasts up to age 55 or at mostabout age 60. They focus on developing skills when they are young,and after that they occupy themselves busily with the work at
hand. If we liken life to a rectangle,
the short-distance race model
would be a rectangle that is taller
than it is long.•11 We have alreadydiscussed the fact that this does notwork in today’s 21st century society.
We must make working life into a
rectangle that is shorter in height
than it is long. We need to create aworking life where people canwork into their 70s, if possible.
For people to gain new knowledge and skills at each turning
point in their life, people musthave enough free time to reinvest
in themselves. Some people say thiskind of working life should becalled a marathon or even a
triathlon in the sense that people
are able to dramatically changeWork hours
Time invested in oneself
Traditional work
hours

Work hours inan aging society•11 From a Working Life withLong Work Hours over a Short
Number of Years to a Working
Life with Short Work Hours
over a Long Number of Years
Source: Atsushi Seike, Eiji-furi shakai wo
ikiru (Living in an age-free society) (NTT
Publishing, 2006).

22

Japanese Older Persons in the 21st Century—To Live with Dignity

Employment

Traditional Retirement age inretirement age an aging societytheir line of work or work style.
The image is one of finishing along-distance race while taking
energy drinks along the way. Thiskind of long-distance model for ourwork style and lifestyle is needed
today.

Miyajima: To borrow Professor
Seike’s words, in the past many
people thought they would welcome mandatory retirement age atthe end of a dead sprint, enjoy thesatisfaction of having given all thatthey could when they were in theworkforce, and then lead a leisurely
life after that. Fortunately or unfortunately, even men now have about
20 years after retirement until theyreach the age of the average life
span. We must consider whether
people are truly happy to depend
on social security during those
years of their lives and consider thequestion from the perspective ofthe dignity of living independently
and the pride of taking on the roleof being a contributor to society.
Japan is the only industrialized
nation with a population of over
one hundred million that has universal health insurance and pension systems as national policies.
The universal health insurance andpension systems were establishedat the beginning of the 1960s
thanks to the tremendous efforts ofthe many people involved. Today,
45 years later, we have forgottenthat effort is necessary to protect
and develop these admirable systems. Instead, the social security
system has come to be taken for
granted and I am concerned thatthe existence of the system is injuring the very basis of the systemitself, namely, the dignity and spiritof independence of both young
people and older people.

Hotta: Of self-help, mutual support, and public support, I think itis the lack of mutual support in thecommunity that has given rise toburnout and emotional dependence after retirement. Corporate
employees in particular have lived
in the world of their work, so they
are at a loss if they are suddenly
told to get involved in community
activities after retirement.
Moreover, those who have been
corporate employees for a longtime tend to wait for instructions.
From the perspective of discovering their own new abilities as well,I would like to see them explore
ways to be of assistance to otherswith the mindset that mutual assistance is providing a gentle, caring
service.
Public support in Japan is uniform nationwide, and there is a riskthat it may tend to give rise tohabitual dependence in some cases
because it is too thorough. In the
future, we will need to balance selfhelp, mutual support, and public

Global Information Journal on Longevity and Society 2007

23

ROUNDTABLE DISCUSSION

2

support and create a frameworkthat does not give rise to excessive
dependence.

Seki: People with disabilities will
be a symbol and indicator for oursociety in the future. If people withdisabilities can lead good lives,then it will be easy for Japan to
become a society that is kind to all
persons. While some advocate that
we should improve benefits forpeople with disabilities, we also
very often hear people with disabilities saying that they want to work
but cannot. If we create a society
where people with disabilities canwork independently and with dignity and receive benefits to theextent required for their disability,
then older persons and women will
also be able to live more positively.

Seike: For the will of the individual to be respected and their skills
to be used, it is crucial that wesecure the dignity of the individual.
At the same time, having the imagi-

24

Japanese Older Persons in the 21st Century—To Live with Dignity

nation to be able to respect the dignity of another is also important.
I think that it is vital that we create in society a value structure thatsays that helping others is “cool,”that we firmly internalize the concept of respect for others, and that
we create a framework and a cultural climate that rightly praises thegood aspects of people and things
in various ways.
I think that this requires not
only raising awareness of individuals but also the creation of a social
framework.

Miyajima: Public support that
ultimately guarantees people’s rightto life and social insurance as
mutual assistance is based on trustin people’s self-help efforts and solidarity. The social security system isa social system that people havecreated and developed. In thissense, it is important today that we
discuss the future of the social
security system by returning to thebasic fact that, in the end, it is thepeople who decide whether tobuild or destroy the system.
Nowadays, there is a strong
trend to leave things up to others,
as social critics do. Discussions thatwill lead us to the correct direction
for our social security system are
impossible unless people think
about this question as their own
problem, namely, whether theywant to maintain or abolish thesystem and what they will do if
there is no social security system.
I strongly believe that the factthat the politicization of social
security issue is one of the factors
confusing the debate.

for existing. Of course, we need the
security that we can live without
becoming homeless, but the question of how to deal with the desire
to apply one’s self beyond that is an
issue that cannot be resolved
through policies.
For older persons as well, thespirit to work while they arehealthy forms the foundation of
their entire life. We believe that themost important thing for people isfor them to live as they want and to
apply themselves even if they are
bedridden or have dementia. We
think we should strongly hold onto
this vision in the future as well.
(June 28, 2006)

Hotta: From my involvement in
activities to support older persons,
I can tell you that older persons usually accept our support with appreciation, but I also know very wellthat older persons as well derivehappiness from helping others.
The greatest stress for not justolder persons but also all people
comes down to having no meaning“

Photos: Masahiro Minato

The most important thing for people isfor them to live as they want andto apply themselves…

”
Global Information Journal on Longevity and Society 200725

Participants

Shigeaki Hinohara

Yoshio Gyoten

Chairman of the Board of Trustees,
St. Luke’s International Hospital

Rou
nd
tab

Director, ILC-Japan
Commentator on Medical Issues

le
n
ssio
scu
Di

3

Health andLongevity for
the Future
●
(%)

40

Source: Graphs are from the Annual Reporton the Aging Society, 2006 compiled by the
Cabinet Office, Government of Japan.
Statistics for all countries, except Japan, arefrom the World Population Prospects: The
2004 Revision of the United Nations.
Figures for Japan are from the “Population
Census of Japan” of the Statistics Bureau of
the Ministry of Internal Affairs andCommunications and the “Population
Projections for Japan, January 2002” of the
National Institute of Population and Social
Security Research.

26

The Aging Rate around the World
Comparison of Western Countries and Japan●Japan■France■Italy★U.S.A.
▲UK▲Spain◆Sweden◆Germany

(%)

40

30

30

20

20

10

10

0

Comparison of Asian Countries and Japan●Japan★China■India■Indonesia▲Philippines▲Korea◆Singapore◆Thailand01950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 (Year)

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 (Year)

Yoshihito Karasawa

Tetsuo Tsuji

President,
Japan Medical Association

Shigeo Morioka

Vice-Minister, Ministry of Health,Labour and Welfare

President, ILC-Japan
Ex-Chairman, Yamanouchi
Pharmaceutical Co., Ltd.
(today’s Astellas Pharma Inc.)

Why has Japan been able to become the world’s leading long-lived society? What about the future?
The speed of aging in Japanese society is observed with amazement byforeign countries, and many people from overseas contact the ILC-Japanwanting to research the phenomenon.
For this roundtable, we have asked experts to explore the potential of
the new proposal “Health and Longevity for the Future” from theperspectives of their various fields.

●

International Comparison of Average Life Span: Survey Results and Forecast (2004)●Japan■France■Italy★U.S.A.

(Age)

95

▲UK

▲Spain◆Sweden◆Germany

(Age)

Men

95

90

90

85

85

80

80

75

75

70

70

65

65

60

Women

60
1950〜55 1970〜75 2000〜05 2020〜25 2045〜50(Year)

1950〜55 1970〜75 2000〜05 2020〜25 2045〜50(Year)

Source: Statistics are from the World
Population Prospects: The 2004 Revisionof the United Nations.

Global Information Journal on Longevity and Society 2007

27

ROUNDTABLE DISCUSSION•1 Health Level of Persons Aged

65 or Over
25%

50%

25%

Requiring
Long-Term
Care

Independent

Particularly
Healthy3

Dr. Hinohara’s name is synonymous
in Japan with health and longevity, so
let’s hear from him first.

Hinohara: Today’s topic is of vital
5%

With Disabilities or
Residing in
Care Facilities

95%

Living at Home

Source: Shigeaki Hinohara, “Zenjin iryo no
kenchi kara mita rojin no raifusutairu ni
tsuite” (“The lifestyles of older persons
from the standpoint of holistic medicine”),
Seishin shinkeigaku zasshi (Psychiatria et
Neurologia Japonica) 104, no. 12 (2002):
1160–1166.

28

Health and Longevity for the Future

importance, and it is somethingthat the government should
address in an unified way. It is evenmore important, though, for every
individual to fully understand andrecognize the fact that one’s healthis, first and foremost, something
each person needs to take responsibility for and that it is health that
leads to longevity. In other words,
in thinking about longevity inJapan, we must not look just at
longevity in terms of numbers; wemust think seriously about how
much mental and physical health
we can enjoy during the additional
years of life that we now have.
The term “average lifespan”
indicates how long a newborn is
expected to live and is commonly
cited as an indicator of longevity.
I would like to interject here thatsome say the rapid rise in abortion
after World War II influenced theimmediate and dramatic increase inaverage lifespan in Japan at thattime. This means that Japan’s
increase in longevity in terms ofnumbers may be based on inaccurate data. I would like everyone torecognize the importance of thispoint.
Next, I would like to look at thegraph “Health Level of Persons

Aged 65 or Over•1” to obtain an
overall picture of older persons inJapan today. Seventy-five percent of
all older persons live independently. Of the remaining 25 percent, 20
percent are receiving long-termcare in some form or another and 5
percent are said to be bedridden.
The population of older persons
will increase in the future. If wethink about that, it is clear that the
crucial issue is how to decrease the25 percent that needs long-termcare and how to raise the level ofolder persons’ independence. If we
can reduce the 25 percent to 15 or
10 percent, we will at long lastenter an era where we will truly feelthat it is wonderful that we are able
to live long lives.

Gyoten: Dr. Hinohara has madesome important points. Population
projections and other elements inthe population issue are very complex, so opinions naturally vary. To
create a common platform uponwhich we can discuss the issues
today, I would like to offer a briefsummary of population issues inJapan. Of course, you may disagreewith me on some issues, but I hope
you will agree with the basic concepts I present.
First, the key feature of aging inJapan is its exceptional speed. The
number of young people in Japanrose rapidly with the return ofJapanese, particularly military

“…overconfidence about longevity andhas ended up weakening people’s
basic awareness that health is something”

the individual is responsible for maintaining.
personnel, from overseas at the endof the war in 1945. Abortions due
to social chaos, including poverty
and food hunger, are said to havenumbered 800,000 to 2 million.
These extraordinary numbers
made it impossible to accurately
determine the population of thattime. Inaccuracies in statistics during the chaotic days after war are
said to be unavoidable, as perinatal
deaths are sometimes reported andsometimes not reported. Statisticalinaccuracies are also said to haveoccurred in Italy and Germany.
The outbreak of the Korean War
in 1950 was a definitive turning
point that prompted the transformation of Japan. Economic recovery was promoted at a fast pace,and people’s livelihood stability
improved alongside that. Thisbrought about a miraculous, rapid
increase in average lifespan. As aresult, the aging rate•2 rose to 7.1
percent in the 1970s, thus making
Japan an “aging society” as definedby the United Nations. Japan
became an “aged society” in 1993
when the aging rate rose to 14.3,
thus contradicting most predictions that the “aged society” would

not arrive until the 21st century.
Such a dramatic transformation ina mere 23 or 24 years was a first in
human history. That speed hasformed people’s outlook on
longevity in a positive way. It is notdifficult to understand how themyth that Japanese longevity isalways guaranteed has become
widespread in Japan since then.
Without our being aware of it,
though, that rosy attitude has given
birth to overconfidence about
longevity and has ended up weakening people’s basic awareness that
health is something the individual
is responsible for maintaining.

•2 Aging Rate
Aging Rate = (Population of older persons / Total population) X 100
The“population of older persons” is thenumber of people aged 65 or over.
“Total population” is the registeredpopulation (sum of the population in
the Basic Resident Register and that inalien registration based on reports
from municipal authorities). The term“aging rate” is said to have originated ina 1956 United Nations report which,based on the standard at that time inWestern industrialized countries, used
the term “aged” to describe a society inwhich the aging rate was over 7 percent.
Generally, however, the term “aging
society” is used to describe a society
whose aging rate is 7 percent or higher
while the term “aged society” is used todescribe a society whose aging rate is 14
percent or higher.

Morioka: As Dr. Hinohara haspointed out, it is crucial for individuals to have the awareness anddesire to endeavor not to become
part of the 25 percent that requires
long-term care, for the sake of one’s
own life satisfaction and for thesake of society. I too make efforts tomaintain my health•3 first for myown sake. I walk, take a proper
combination of exercise and rest,
eat balanced meals, and try not tobe psychologically lazy. Because
these efforts are part of my daily

Global Information Journal on Longevity and Society 2007

29

ROUNDTABLE DISCUSSION

3

life, I do not do them with the particular intent of preventing diseaseor something.
This may show a problem in theway the media covers this issue.
Recently, “disease prevention” iscovered as something special, perhaps because of the debate about
the financial resources for medical
costs. The basic awareness thatthinking about one’s health issomething that one does for oneself, for one’s family, and in turn forsociety has gotten lost and is notclear.

that Japan is developing into a society never seen before in terms of
the speed and level of its aging.
The world is watching how
Japan will manage its super-agedsociety. The government administration and the people of Japan may
need to wake up to the fact that,like it or not, our nation is a leader
in this area.
In that sense, Dr. Hinohara’s
statement is very interesting: that
we should not be proud of theincrease in Japan’s average lifespan;what is important is the quality ofthat lengthened life. By definition,
enjoying good health into old age isthe result of the efforts one has
made up to that point. An awareness of health over the long term is
crucial on both an individual and anational level.

Tsuji: After the war, the government and experts worked together
to improve public health andreduce types and frequency of diseases. Japan today is a super-agedsociety, and there is no question

(%)

0

25

50

75

66.3

Get adequate rest and sleep.
Have a regular lifestyle.

60.5

Have well-balanced diet.

59.1
48.3

Walk or exercise.
Be as mentally positive as possible.

45.5

Have periodic health checkups, etc.

45.0
41.3

Have hobbies.
31.1

Go out as much as possible.
•3 Health-Maintenance Efforts of

Persons over Age 60
Source: Graph is from the Annual Report on
the Aging Society, 2006 compiled by the
Cabinet Office, Government of Japan.
Statistics are from the “International Studyon the Lives and Perspectives of Senior
Citizens” conducted by the JapaneseCabinet Office (2006).
Note: Survey was conducted nationwide inJapan of men and women age 60 or over.
Multiple responses were allowed.

30

Health and Longevity for the FutureParticipate in community activities.

20.3

Cut down on alcohol and cigarettes.

18.9

Take supplements and tonics.

9.1

Other efforts.

2.9

No particular efforts.

3.6

100

Dr. Hinohara, what do you think are
the factors behind health andlongevity?

Hinohara: Some excellent researchon aging•4 has been done in the
U.S.A. A ten-year study was conducted on the relationship between
genes, environment and lifestyle
habits, and aging. The hypothesisthat environment and lifestyle
habits have as important an impact
as genes on aging has been about
half proven by this study. Flies andmice live much longer if you don’t
give them much food to eat. It haseven been proven that if you dothat with chimpanzees the aging of
their skin is delayed.
It would likely also be correct toapply this thinking to humanbeings as well, so the field is heading toward recommending thatpeople have a low-calorie diet. A
Japanese Confucianist Kaibara
Ekiken who lived from 1630 to1714 advised that people eat moderately or until they feel 8/10 full.
Personally, I think that even that
may be too much. I take 1,300
calories a day. Everyone is surprised when I tell them that I eat
one meal a day and otherwise drink
milk and eat cookies, but there is
no proof that you have to havethree meals a day at morning,
noon, and night.
Four years after the U.S.A.

research ended, I launched thesame study in Japan. I was 90 at thetime. For the study, we are collecting data from the annual complete
physical exams of 450 of the members of the Society of New Elder
Citizens.•5 We look at these members’ genes with the advanceunderstanding that we will not tell
the person about their genes. Every
year, we ask these members aboutacquired environmental factors,
exercise and diet, social interaction,
personal hobbies, and enthusiasm
for life. We want to investigate theirliving and diet environments over aten-year period. If a member has
genes that indicate diabetes, arteriosclerosis, or dementia and yet
does not have the disease ten years
later, we cannot deny the possibility of an acquired environmental
factor having functioned to inhibit
the disease.
As this study progresses, wehope to be able to make recommendations that, for example,
people who have genes for arteriosclerosis or dementia will not
exhibit signs of that disease if they
are in a certain kind of environment. The study will be completed
in another four or five years so I
cannot die until I am 100!
I think it is also important to beable to adapt well. Adaptation
requires a kind of strain or stress. It
is not just a question of avoiding
stress or not straining oneself;•4 MacArthur Foundation Studyon Successful Aging
Spearheaded by Dr. John W. Rowe,this study was made possible throughfunding from the John D. andCatherine T. MacArthur Foundation, aprivate, independent grant-making
institution. This study examined theconditions for improving the mental
and physical functioning of older persons and clarified the factors for “successful aging.” The results of the study
were summarized in Successful
Aging, which was published in 1999.
The book has been translated into
Japanese as Nenrei no uso: igaku ga
kutsugaeshita mutsu no joshiki(Nikkei Business Publications, 2000).
•5 Society of New Elder Citizens
The Society of New Elder Citizens isoverseen by the Life Planning Center ofwhich Dr. Hinohara is chairperson.
Composed of people who are age 75 orover, the Society aims to support thenext generation. The Society waslaunched in 2000 and today has 18
chapters nationwide with membershipnumbering over 5,000. The Society
conducts a variety of activities under
the following four slogans: (1) To love,(2) To initiate, (3) To endure, (4)Relating with children: With the aim ofpeace and love. As part of the Society’s
activities, some members in their 80s
and 90s take part in health research
as a special cohort; their individual
mental and physical health status ismonitored.

Global Information Journal on Longevity and Society 2007

31

ROUNDTABLE DISCUSSION

3

people must shift to the outlookthat they are okay even if they are
under stress and that they are okay
even under a little strain.

Gyoten: Dr. Hinohara has mademany interesting points, but I beg
to differ slightly. The good advice
Dr. Hinohara has given us to carefor our health ourselves can beinverted to create a very harshstatement, namely, that if you fall
ill then it is your fault for nothaving safeguarded your health.
There’s only a thin line between
the two statements. I think this is avery delicate and difficult problem.
Even advice said out of thegoodness of one’s heart tends to set
off gnawing doubts in the listener’s
mind or to be perceived as meddlesome today. Also there are people
who believe that they have theright to fall ill.
What Dr. Hinohara is talking
about here is mental and physicalhealth as the basis of the happinessof the individual. I am fully awarethat this is different from maintaining one’s health for the sake of state“32

finances, but there is some room
for concern because there is a highrisk that Dr. Hinohara’s perspective
will be misunderstood with themedia’s misguided presentation ofit, as President Morioka mentioned
earlier.

Tsuji: With the current state of theeconomy, we face the task ofrestraining the increase in medical
expenses. It is true that every society must face the realities of its
economy and public finances, but
it is also true that a society is morethan just its economy and publicfinances. Today people from various sectors are concerned that
there is too strong a tendency toconsider issues by looking at thefinancial aspects first.
Real health and real healthcare
are key. In other words, it is important that people have healthierlifestyles and can receive better
healthcare. If that is achieved,
we will be able to restrain theincrease in medical expenses.
The concept of health we
propose is the philosophy that

People must shift to the outlook thatthey are okay even if they are under stress andthat they are okay even under a little strain.

Health and Longevity for the Future”everyone tries to live as healthily as
they can given their life situation;
those ill try to live the best lives
they can, and all strive for happiness. The concept of health does
not mean that those in ill healthhave done anything wrong.
This is a vague way of expressing it, but one direction in which
I think Japan should proceed has
already been expressed in this conversation today, that is, to create anationwide consensus in a way thatis not forced.
Improving the healthcare system is a
key element in supporting the aged
society. What issues does healthcare
in Japan face?

Gyoten: Healthcare is a most vitaland personal concern for people,
and people’s confidence in healthcare must never be damaged. What
I strongly sense recently, though, isthat medical facilities are not necessarily putting patients first. Simply
put, I am concerned that the situation or convenience of those
involved in providing the care isgiven too much priority.
Not just nurses and doctors, but
the specializations in charge of theindividual aspects of treatment are
too segmented and have exclusive
control over their individual areas.
There is concern that this may, as aresult, have a negative impact on

our health and our confidence andpeace of mind regarding healthcare, which supports our health.

Karasawa: I would like to talkabout the actual situation in Japan’s
operating rooms from the positionof a medical specialist. As you all
know, medical facilities and particularly operating rooms in Japan
today are fraught with many dangers. They are working without theactually required number of anesthesiologists, surgeons, and otherstaff. We need to first take measures to radically rectify this.
In addition, Japan’s fleet of surgeons is aging somewhat, and there
is a chance that they will make a
mistake during difficult surgery.
Because no measures are in place tocompensate for that, there is therisk that a mistake will result
directly in a major medical incident. Many measures must be
taken to ensure the safety ofsurgery. Having nurses perform
anesthetic techniques is one suchmeasure that will be needed in the
future. We need to create a system
where the various specialists talkfrankly about what is best for thepatient, with each specialist thinking beyond their vested interestsand seeing patient welfare as beingof primary importance.
Medical expenses are said to be
skyrocketing, but the most effective
way to reduce them is to keep

Global Information Journal on Longevity and Society 2007

33

ROUNDTABLE DISCUSSION

3

patients’ hospital stays at only a few
days and to have only a few beds.
By even doing just this, medical
expenses will most surely decrease.
Some say that medical expenses
will increase if the number of doctors rises, but that position needs tobe re-examined. On the contrary, it
would seem that if there were more
doctors, they would be able to givecare and as a result the length ofpatients’ hospital stays would beshortened. This would improve theoccupancy rate of hospital beds
and medical expenses would
decline. This would lead as a result
to the creation of a satisfactory
medical system.

Hinohara: Doctors should not be
doing everything. In the future, we
definitely need to change medical
education and train visiting nurses
to perform diagnoses and read electrocardiograms, for example. In
U.S.A., even public health physicians and psychiatrists can performa funduscopy. A system like Japan’s
where a patient must go to an ophthalmologist to gain even a preliminary assessment places too muchburden on the patient. There are“34

about 32,000 nurse anesthetists in
U.S.A. These nurses are wellrespected because they are veterans, and they cost less than an
anesthesiologist so patients choose
to have a nurse anesthetist rather
than an anesthesiologist in the
overwhelming number of cases.
If doctors acted as a team inJapan and if nurses and doctors
acted as a team, medical expenses
would decline and the shortage ofanesthesiologists and obstetricians
would also be resolved. Primarycare could be provided by nurses.
The model for primary care would
be general practitioners. To do this,nurses should be trained in how to
examine patients in a comprehensive and general way and be taught
more examination techniques.

Gyoten: This is a repeat of what I
said before, but healthcare is a key
matter that is intimately related to
our lives. When confidence inhealthcare is harmed, it can lead tosocial instability. For example,
some say that we should integrate
or consolidate medical institutions
to resolve the doctor shortage,
but the fact that healthcare is so

We need to create a system where the various specialists talk”frankly about what is best for the patient, with each specialist…
seeing patient welfare as being of primary importance.”

Health and Longevity for the Futureintimately related to our daily lives
makes the question of how toaddress the community aspect ofhealthcare and continuity inhealthcare all the more into something that cannot be answered simply by mere intellectual ideas or byplaying with numbers. Training
doctors takes a lot of time, andwe need to engage in core discussions about what kind of doctors
we want to create from now on as
well as the necessary strategy toachieve that.

Karasawa: It is important that we
separate the issues into urgent matters and matters to be addressedfrom a long-term perspective. Once
we decide which issues are urgent,
however, we should start to address
them immediately. One key issue
that we should address now is theshortage in obstetricians and theissue of emergency pediatric services.

Tsuji: The government sees theissues you have raised as very
important and is working on the
structural reform of healthcare.
The functional differentiation of“

hospitals and partnerships among
them as well as the division of roles
between hospitals and generalpractitioners and partnerships
between them are needed. The government is urgently responding to
the issue of the doctor shortage.
We are sitting down and starting todevise concrete measures, with thethought basically that the doctor
shortage must be addressed in thiskind of overall review.
As Dr. Hinohara said earlier, creating health involves making theeffort to have a low-calorie diet andto adapt actively to change, getting
a proper amount of exercise, having interactions with society, andhaving the joy of contributing tosociety. I keenly sense that havingsuch a lifestyle is the essence ofbeing human.
How to have this philosophy
take root in people’s lives fromchildhood and how to have thisconcept of health take root as“culture” are key issues. We would
like to promote this as a national
project, yet in a way that is not
obtrusive.
Although the government may
propose the concepts and system,

How to have this philosophy take root in

people’s lives from childhood and how to have this concept ofhealth take root as “culture” are key issues.

”

Global Information Journal on Longevity and Society 2007

35

ROUNDTABLE DISCUSSION

3

it should not enforce them. Instead,we want to instill their importancein future currents in society in avariety of fields.
What is needed for Japan to continue
to be a healthy long-lived society?

Hinohara: Fifty years ago when
the United Nations set “65” as theage used to define an older person,
the average lifespan in Japan was
64 for men and 68 for women.
Today the average lifespan in Japanis about 80 for both men andwomen. This means that today theage used to define an older person
should be changed to “75 or over.”It should be the case that elderlythat have enjoyed long lives serve
as models for children, but television programs are peppered withbad adults. The media should present good, uplifting topics thatinspire people. Focusing exclusively on bad things without mentioning the good things is not very
admirable.

Gyoten: I have been involved in
the media, and I fully understandDr. Hinohara’s comment and see it
as a personal caution as well. The
media jumps to cover tragic or sensational topics, but it is unfortunately undeniable that we areunable to bring together “the big
picture” and insightful views.

36

Health and Longevity for the Future

In news coverage today in particular, the media races too muchto search out the criminals: Who is
responsible? Who is wrong? It isextremely regrettable and a great
danger that everyone—media
workers and media audience
alike—end up becoming critics andlack the perspective that each of us
has a responsibility and obligation,and that the events covered in thenews broadcasts are our own problem.
Administrative Vice-Minister
Tsuji spoke earlier about the creation of a concept of health as a
gradual, yet major movement or“culture.” We are entering an era
where older persons will make up
the majority of society, and I would
like to hear about others’ views on
the efforts being made in theirfields.

Karasawa: Mr. Gyoten mentioned
community healthcare. Even today
there are older persons living alone
who reside in places in the countryside that no one can keep an eye
on even, for example, when there isa major snowstorm. Older persons
should be able to live in appropriate, safe places during midwinter atthe very least. We must create a
range of systems, like this one, forolder persons, and older persons
must be allowed to choose theoption of their liking.
The aging rate will increase moreand more from now on. In an era
where older persons make up morethan 30 million in a population of
100 million, this means that thosereceiving long-term care and medical services will total a huge number even if we assume that such
persons make up only four to five
percent of all older persons. We
must seriously consider whether
we have adequately put in place
healthcare and long-term carefor these people and a system for
healthy older people to enjoy
their lives.
Moreover, with the increase in
the number of older persons, thereality is that an increase in illness
is unavoidable no matter how
much we take measures to promotehealth. Looking at it from that kindof perspective as well, there willdefinitively be a shortage ofdoctors and the question will bewhether measures to address thisare adequate or not.
In this era of a declining
birthrate, it is crucial that westrengthen obstetrics and pediatriccare, as mentioned earlier, for people to be confident in giving birthand raising children. Moreover, it isestimated that women will makeup about 30 to 40 percent of all
doctors in 10 years’ time. Women
doctors may also want to bear andraise children. If we do not set up asystem to compensate for this,
there is the risk that suddenly atsome point there will be a shortageof doctors.
Unfortunately, there is a strong
trend among young doctors today
to avoid areas that involve danger
or risk and to choose the safe routeas much as possible, perhaps
because the young doctors areaverse to matters where they haveto take responsibility. This is resulting in the tragedy of patients being
sent around to other medical institutions or being turned away. It is
crucial that we create a system
where young doctors have thedesire to engage in high-risk, highly difficult medicine and canacquire experience in that area.
With the current state of financial resources, healthcare will not
be able to survive the next 10 or 20
years. The government authorities
will not be able to overcome thissituation alone. As a doctor in
charge of healthcare in private-sector organizations, I would like todevelop a vision.

Hinohara: More than anythingelse, I think a “transformation in
outlook” is required. A key element
in attaining the goal of health andlongevity is for us to question eventhings that have been consideredgood to date and experiment new
approaches ourselves.
To do this, it is important that
we know the physiology and functions of our body. There are many

Global Information Journal on Longevity and Society 2007

37

ROUNDTABLE DISCUSSION

3

aspirations at hospitals and otherfacilities because patients are drinking with their upper bodies uprightor tilting slightly forward, in otherwords, because medical treatment
is being given without thought tobody structure. Although it is considered common sense to sleep on
one’s back, I tested things out
myself for a variety of reasons and I
now sleep on my stomach. We
must have the flexibility to think
about everything ourselves, to try
new things out ourselves, and thento change our thinking if it does
not go well.

wonderful. It will be hard for theconcept of health to become anestablished culture, unless we teachchildren at school and other placesfrom elementary school days onthat health maintenance is something you do for yourself and forsociety and that health is an important element in life.
I attended the ILC Joint
Committee Meeting which washeld in India in August 2006.
Through my experience there, I
reconfirmed the benefits that Japan
has because of its thorough infrastructure and public health as well
as because of the level of individuals’ awareness regarding health andhygiene, the high level of educationand culture that support that, andthe provision of that education
equally to all. I think this is natural

Morioka: The idea Administrative
Vice-Minister Tsuji presented
earlier—the plan to make the concept of mental and physical healthinto a new “culture” for Japan—is

At hospital, clinic, geriatric health services facility,
midwifery center, nursing home

(%)
100

75

50

25

0
11.6

15.5
22.0
28.6
37.5
46.7
57.0
67.3
75.0
78.8

•6 Annual Trends in Place ofDeath (2004)
Source: “Vital Statistics” compiled by theStatistics and Information Department,
Minister’s Secretariat, Ministry of Health,Labour and Welfare (2004).
Note: Up through 1990, deaths “at nursing
homes” were classified as deaths “at home”
or “other.”38

Health and Longevity for the Future

At home, other(Year)
1951

0

25

50

(%)
100

75

88.4

1955

84.6

1960

78.0

1965

71.4

1970

62.5

1975

53.3

1980

43.0

1985

32.7

1990
1995

25.0
21.2

83.4

2000

16.7

83.8

2001

16.2

83.9

2002

16.1

84.2

2003

15.8

85.0

2004

15.0

85.2

2005

14.8

because India is still industrializing. It is important that we incorporate new ideas as well, though,even while expanding and preserving these good points more andmore.

to lifestyles that do not create trash.
I can’t help feeling that Japan does
not aim to achieve core, fundamental resolutions to its various problems. We do nothing more thanhave superficial discussions.

Gyoten: I would like to point out a

Tsuji: I take what you have justfew issues based on my recent visit
to Germany. Many people involved
in healthcare in Germany raisedquestions about the wisdom ofJapan’s raising the percentage of
medical costs borne by patients. As
you know, the percentage wasincreased from 10 percent to 30
percent when Japan reformed its
medical system. The issue was notthat 20 percent would have beenokay, but 30 percent was too high.
It was a question based on thethinking that taking more moneyfrom a person who was already ill
was contrary to the spirit of insurance. If financial resources are lacking, insurance premiums should beraised, they said, so that the burden
is carried evenly by all.
I have been involved in various
discussions in Japan on healthcare,but I have never heard a view basedon such essential and fundamental
principles like this.
I was also impressed with how
thorough Germany’s efforts are in
regard to environmental issues. In
addition to strict standards for
trash-sorting, they are working to
make a major social transformation

said very seriously. It is regrettablethat people have such a strong
impression that the healthcare
issue—something that is fundamental to people’s lives—is discussed only from the perspective ofrestraining the increase in medical
costs and resolving the issue offinancial resources.
The reality is that the 75-andover population will double in thenext 30 years or so. Today morethan 80 percent of Japanese die in
the hospital.•6 Is this okay? Wemust address these matters byengaging in discussions where wetruly speak our minds and think
about what kind of lifestyle weenvision for ourselves in a truly
super-aged society.
The healthcare issue is comprehensively related to a variety offields and areas. It is the mission of
those in charge of policy to continue to support the security and safety of the people while maintaining
the universal health care system nomatter what. It is with this mindset
that I approach these issues.
(October 26, 2006)
Photos: Masahiro Minato

Global Information Journal on Longevity and Society 200739

Participants

Alfons Deeken

Yoichiro Murakami

Professor Emeritus,
Sophia University

Rou
nd
tab

Professor,
International Christian University

le
n
ssio
scu
Di

4

Thinking about
Life and Death in
the New Era●

If You Had Cancer, Would You Want to Know?
■■ I would like to know regardless of whether there is a chance that the cancer can be cured.
■■ I would like to know only if there is a chance that the cancer can be cured.
■■ I would not like to know regardless of whether there is a chance that the cancer can be cured.
■■ I don’t know.

0

20

40

60

80

(%)
100

Overall
70.9

15.3

7.4

6.3

71.1

14.5

8.4

6.0

70.8

16.2

6.4

6.6

78.2

13.8

2.3

5.7

72.4

15.5

3.5

8.6

77.7

12.8

5.6

3.9

66.8

15.8

7.9

9.5

65.7

18.2

11.8

4.3

68.8

15.0

10.8

5.4

Men
Women
20s
30s
40s
50s
Source: “Survey of Views on
Hospice/Palliative Care” released by theJapan Hospice/Palliative Care Foundation(2006).
Note: Survey of men and women nationwide
between age 20 and 89.

4060s
70 andoverTadateru Konoe

Rihito Kimura

President,
Japanese Red Cross Society

Tadaharu Goto

Director, ILC-Japan;
President, Keisen University

Director, ILC-Japan;
President, Foundation of Social
Development for Senior Citizens

Death is something that everyone will face.
How do individuals, families, and society understand and face death?
Through analyses from various perspectives and comparisons with othercountries, we will consider what is needed for Japanese older persons tohave a fulfilling experience of death and how an older person’s wishes
should be reflected in the handling of his or her death.
This roundtable focuses on new issues in life and death today.

●

If a Family Member Had Cancer, Would You Tell Them?
■■ I would tell them regardless of their preferences about being informed.
■■ If the family member had a preference, I would act in accordance with it.
■■ I would not tell them regardless of their preferences about being informed.
■■ I don’t know.
■■ No response.

0

20

40

60

(%)

80

100

Overall
11.9

62.1

13.3

12.4

0.3

16.5

56.8

14.9

11.4

0.4

7.2

67.5

11.7

13.4

0.2

11.5

70.1

4.6

12.6

1.1

8.0

69.0

5.2

17.8

0

9.5

65.4

12.8

12.3

0

8.9

61.1

15.3

14.7

0

17.1

57.8

18.7

6.4

0

16.2

53.3

18.6

10.8

1.2

Men
Women
20s
30s
40s
50s
60s
70 andover

Source: “Survey of Views on
Hospice/Palliative Care” released by theJapan Hospice/Palliative Care Foundation(2006).
Note: Survey of men and women nationwide
between age 20 and 89.

Global Information Journal on Longevity and Society 2007

41

ROUNDTABLE DISCUSSION

4

Goto: First, I would like to ask
each of you to say a few words
about the thanatological topics thatyou are involved with now and theissues that you regularly encounterin your work. Dr. Deeken has dedicated much of his life to establishing thanatology in Japan so I would
like to ask him to speak first.

Deeken: Death has long been considered a taboo topic in Japan sospeaking about death has been disapproved of and viewed as something morbid. With the average life
expectancy standing at about 80
today, though, the perspective thatthinking about death is also thinking about life has finally come to be
accepted.
In German, different verbs areused to describe the death of ananimal and the death of a person.
The word used for the death of ananimal means simply “to expire”
while the verb used for the death ofa human being contains the nuanceof “being able to grow spiritually
through the process of becoming
physically weaker.” I would like topropose that a new “culture ofdeath” be created so that people
can live with vitality even as they
decline physically.
In this respect, I would like toemphasize strongly the importanceof death education. I taught thephilosophy of death for 30 years at
Sophia University. In the first lecture, I would always say to the students “the philosophy of death isalso the philosophy of life.” People
who do not think about the philosophy of death only see death as
defeat. Every human being, without exception, will die; so we mustseek to live and die in a way thatsuits us and to cooperate with oth-350

Pneumonia
300

Malignant neoplasm
250

Gastroenteritis
Tuberculosis

200

Cerebrovascular disease
Cardiac disease150

Old age•1 Annual Trends in Mortality

Rate by Main Cause of Death(of 100,000 people)
Source: Graph is from “Vital Statistics” compiled by the Statistics and Information
Department, Minister’s Secretariat,
Ministry of Health, Labour and Welfare(2005). Statistics are from the“International Study on the Lives andPerspectives of Senior Citizens” conductedby the Japanese Cabinet Office (2006).
Note: Survey was conducted nationwide inJapan of men and women age 60 and over.

42

100

50

Accident

SuicideDiabetes0(People)Thinking about Life and Death in the New Era

1905

1915

1925

1935

1947

1955

1965

1975

1985

1995

2005
(Year)

“

Looking at the situation fromthis day-to-day perspective,
I have the strong impression that”

it is hard to die well in today’s world.
ers in their confrontation withdeath.
It is important that we are notconcerned only about how long welive, but attempt to improve thequality of our lives and develop arich spiritual outlook on both lifeand death.
People generally seem to look atdeath merely as a physical phenomenon, but I look at death fromfour perspectives: physical death,
psychological death, social death,and cultural death. Even if a person
is still physically alive, it seems tome that he is already dead if he has
lost his zest for life or if his relationships with others are broken,
or if he has no cultural richness in
his life.

Goto: Dr. Murakami is a foremost
authority on the history of science.
Looking at science from the perspective of philosophy, he has
insightfully identified some issues
related to various current phenomena surrounding life and death.

Murakami: I am providing longterm care for my 102-year-old
mother. Looking at the situationfrom this day-to-day perspective, I
have the strong impression that it ishard to die well in today’s world.
One theory states that a society’s
disease structure changes in stages
as the level of civilization rises.
The first stage is gastroenterological infections, such as cholera andthe plague. Next is respiratory
infections, with the key example
being tuberculosis. The third stage
is referred to as lifestyle-relateddiseases. The fourth stage is the
emergence of deaths due to suicide
and incidents caused by a senseof being smothered or by maladaptation to today’s society where
people feel stifled and helpless.•1
I sense that we are entering an
age where disease is not justsomething physical.
At present, there is no permanent, complete cure for lifestylerelated diseases that are feared as
causes of death, and our personal
histories contain causes of illness,
including factors on a genetic level.
Thus, healthcare must shift fromtreating patients by secluding themoff from society to supporting
patients who are living in society.
At the same time, this means a

Global Information Journal on Longevity and Society 2007

43

ROUNDTABLE DISCUSSION•2 International Humanitarian

Law
International humanitarian law (IHL)
is international law and rules that provide for humanitarian treatment of victims in armed conflict (war). Formerly
known as the law of war or the law ofarmed conflict, IHL was popularized
in 1971 when it was adopted by theInternational Committee of the Red
Cross.

4change in the relationship between
doctors and patients.
As Dr. Deeken mentioned earlier,death is not just a physical phenomena, it involves the spiritualand soul level as well. This makes
me keenly feel that the existing
religions do not have the means toadapt to the new social structure.
The question of how we should
adapt and respond to the social
structure in this age and live productively in society is not easy.

Goto: There are all kinds ofdeaths. I would like to hear fromJapanese Red Cross Society
President Konoe who offers theperspective of international aid andrelief efforts.

Konoe: The statements by Drs.
Deeken and Murakami concern
death in times of peace. As you
know, the Red Cross serves people
in emergency situations throughout the world, and we mainly
encounter death under those circumstances. The international Red
Cross movement was founded by
Jean Henry Dunant, the laureate of
the first Nobel Peace Prize. The
Red Cross started by providing
assistance in time of war, and today
we conduct aid and relief activities
in three program areas, including
assistance in zones of conflict,response to large-scale natural disasters, and combat of infectious

44

Thinking about Life and Death in the New Era

diseases.
Looking first at internationalrelief efforts at times during conflict, I would like to point out thatinternational humanitarian law(IHL)•2 provides global humanitarian rules that transcend the interestsof individual States as well as raceand religion. The problem is how
to negotiate the barriers of State
sovereignty to ensure that IHL isfollowed. IHL sharply distinguishes
between combatants and civilians
and seeks different actions fromeach. Fundamentally, however, IHL
seeks not just the protection of lifeand health, but the protection of
the dignity of both military personnel and civilians as human beings.
For example, prisoners of war
are entitled to have their lives andhonor respected under all circumstances. Care is also to be made toensure fair trial and respect for religious convictions, and there are
stipulations for handling the deathof prisoners.

Goto: Dr. Kimura is a pioneer inbioethics in Japan and has conducted bioethics education for healthcare workers from the perspectiveof “patient-centered healthcare.” I
would like to ask Dr. Kimura for
his views.

Kimura: One of the reasons I
became seriously involved in thefield of bioethics was the death of

my father in the early 1970s. The
attending physician did not tell myfather that he had cancer, and so
my father was not prepared physically or psychologically to accept
death and he did not receive medication to relieve the exceptional
pain that accompanies lung cancer
even when he asked for pain relief.
This way of handling cancer wascommon in Japan at that time.
Great doubts and concerns
welled up inside me about this: myfather was unable to prepare for theend of his life because he had notbeen told that he had an incurable
disease and his requests for treatment method and pain relief went
unheeded even though it was his
life.
Later, I developed a great interestin death and dying, and I participated in a seminar held in
Washington, D.C. on the end oflife. At the seminar, there was a session where we watched films on
the various kinds of death aroundthe world, including death frompoverty, starvation, war, and disaster, and reflected on it. I wasshocked to discover that dying at a
hospital in a medically advanced
nation is a very fortunate way to die.
From this experience, I started
to see human life and death from a
global perspective. I thought that
we needed to look to the future tocreate a new ethic of life that does
not box death into specific academ-

ic disciplines, like healthcare, public policy, law, and ethics, but incorporates the perspective ofcooperative research among a
broader range of academic disciplines. I envisioned bioethics as a
new comprehensive academic
study on life and have advocated it
as a super-interdisciplinary field inJapan. Over the more than 30 years
that have passed since then,bioethics and informed consent
have been introduced gradually inclinical situations, and medical careand nursing are gradually making agreat shift to becoming patient-centered. Paternalism in healthcare
remains strong in Japan, however,and bioethics is needed to breakthrough that.

Goto: In preparation for today’sroundtable, I read some of the publications of Drs. Murakami,
Deeken, and Kimura. Many ofthem had the word “death” in thetitle, and I somehow hesitated toread them on the train without
putting a book cover on them or toleave them out half-read on a table
at home or at work. The point Dr.
Deeken made earlier is true: deathis taboo for Japanese, and we havea strong resistance to talking about
it. As I read the books more,though, I realized once again thatyou can think more sincerely aboutliving by seriously facing death.
I was an administrator at the

Global Information Journal on Longevity and Society 2007

45

ROUNDTABLE DISCUSSION•3 Measures to Support JapaneseOlder Persons(as of April 2007)
Welfare1999: Creation of community-based
welfare advocacy program
2000: Enforcement of the long-termcare insurance system
Enforcement of the adult guardianship system
2003: Creation of new-model special
nursing homes for the elderly
2006: Promotion of the creation of private rooms for all residents of special nursing homes for the elderly
System for provision of end-of-lifecare at special nursing homes forthe elderly
Enforcement of the law for the prevention of elder abuse
2007 (April)–: Creation of program toprevent isolated deathOffering of PR and symposiums
Provision of psychological care forhigh-risk older persons
Development of community support
networks
Medical care
1990: Establishment of a system ofpalliative care units
2006: Creation of clinics to support
home care
Full support of payment of medical
treatment fees to clinics that meetcertain requirements
Prompt return of inpatients to theirhomes and promotion of home death
Creation of a system whereby people can receive the medical treatment they need in their homecommunities

4

Ministry of Health, Labour andWelfare for over 30 years. The
key question for a government
administration is how to support
citizens in living. A major taskthese days is supporting people’s
independence and dignity.
Several laws have been enacted
in Japan as measures to support
older Japanese.•3 In April 2000, thelong-term care insurance system
and its counterpart, the adultguardianship system, werelaunched, and various services andprograms were started. In 2006, thelaw for the prevention of elder
abuse came into force, making
Japan one of the first countries tocreate such legislation, and Japan’s
law is comprehensive in terms ofcontent as well. In addition, services to prevent isolated deaths arescheduled to be inaugurated in
April this year.
To improve the quality of life at
facilities where older persons live
the final days of their lives, we arepromoting the creation of privaterooms for all residents of special“
Thinking about Life and Death in the New Era

Deeken: When I started the move-

The point...is true:
death is taboo for Japanese,
and we have a strong resistance totalking about it.

46

nursing homes for the elderly, andwe are starting services for people
to face death, including the provision of end-of-life care at thesenursing homes.
In terms of medical care, thehospice system was launched in1990 in Japan with the creation of
palliative care units. In 2006, wecreated a system of clinics to support home care. This system makes
it possible for people to receive
house calls 24 hours a day, and thiswill make older persons feel secureand supported in living at home. In
addition, home-visit nursing stations specializing in dispatchingnurses affiliated with these clinics’
physicians to the homes of older
persons are being establishedthroughout the country.
Even compared internationally,
Japan clearly has a high-levelsystem, but it remains to be seen
how much true support we areable to provide to people who
really need it day to day.

”“One of the essential functions of
the hospice: to give the dying
spiritual support.

ment to establish hospices in Japan,
there was only one hospice in theentire country. Today Japan has
over 171 hospices. This is certainly
good news. Unfortunately, however, there are many who still thinkthat a hospice is merely a place forpeople to die. They are unaware of
one of the essential functions of thehospice: to give the dying spiritualsupport by helping them to discern
the meaning of the life they haveled and to lessen their fear of deathand of the life that awaits them inthe beyond.
Hospices promise two things totheir residents: pain relief so thatthey will not be in pain, and care sothat they will not die alone.
In Germany, home care hospices
are very popular. There are 1,300
home care hospices. A care teamgoes to the person’s home as needed and is assisted by volunteers.

Kimura: Home hospice is commonplace in U.S.A. Japan is likely
to go that direction as well in the
future, but there is a limit to howmuch nursing care the family canprovide alone. Volunteers who support the family and other human”resource support are also needed.
For example, Arlington, Virginia,
where my family and I lived forabout 20 years, had home hospicecare through the support of thecommunity. The area churchesorganized the volunteers andassigned tasks, such as shopping
for the person’s family, driving
them to the bank and the like, andpreparing meals.
There was a Diversity AwarenessCommittee for the care of people
with different cultural backgrounds. I volunteered on thiscommittee and advised them on
how to handle the doctor-patient
relationship.

Murakami: I would like to pointout a few things using the case of
the long-term care of my mother asa case study. Thanks to the clinics
that support home care, as Mr.
Goto described earlier, she canhave medical care from a doctor
who visits her at home. That is agreat support, but providing care
365 days a year, 24 hours a day, tobe honest, has some rather taxing
aspects, as has been mentioned.
Another key issue is how much

Global Information Journal on Longevity and Society 2007

47

ROUNDTABLE DISCUSSION•4 If You Required Long-term

Care, Where Would You Like
to Receive It?
No. of responses(%)

Own home (with care provided by
spouse or relatives only) 74
28.6
Own home (using various home
services)82
31.7Child’s home (using various home
services)5
1.9
Special nursing home for the elderlyor other welfare facility 11
4.2
Hospital or other medical institution
56
21.6
Private paid home with long-term carefacilities10
3.9
No response

21

8.1

Source: “A Continued Survey on the Daily
Life of Older People” released by the ILCJapan (2005).
Note: Survey was conducted of 300 old-old
persons (inapplicable persons: 41) who
were either living alone or with theirspouse.

4

the family can welcome the carespecialists and volunteers as part oftheir “extended” family.•4

Konoe: Many people want to die athome, but I understand that only
about 12 percent actually do.•5
Even if long-term care were somehow possible through humanresource support, what makes endof-life care hard is that there arelegal issues involved. If the person
dies at home when a doctor is notpresent, the family must call thepolice to examine the body. This isquite a burden and is psychologically damaging for the average person.
Considering the practical issue
that a person’s condition may suddenly deteriorate, providing endof-life care at home is a huge
psychological burden on the family.

If the older person senses that burden, I would think he or she also
would not want to cause the family
so much trouble.

Deeken: This is a very important
topic. Although there are many
people who want to die at home,the lack of care and education forfamily members is causing a bottleneck. I propose that daycare hospices be created in every community
to serve as a place to provide information to families and for families tohave contact with other families,
and to prevent burnout among family members who are giving longterm care. We can also expect thatthe quality of life of the patient will
improve as he or she creates relationships with other people facing
the end of their life.

100

At homeHospital/Clinic

82.5

81.0

80

85.2

75.0
70.7
57.0
56.6

60

37.4

38.0

40

Death (2004)
Source: Vital Statistics” compiled by theStatistics and Information Department,
Minister’s Secretariat, Ministry of Health,Labour and Welfare (2004).
Note: Statistics exclude deaths at geriatrichealth services facilities, midwifery centers,
nursing homes, and others.

48

21.7

21.9

•5 Annual Trends in Place of

20

0

(%)

Thinking about Life and Death in the New Era

13.9

11.6

1951

1960

1970

1980

1990

2000

12.2

2005

(Year)

Konoe: I could not agree more
about the importance of improving
the quality of life in home hospicecare and educating family andmedical caregivers to make thatpossible. I would like to make asmall objection, though, regarding
informed consent, which is the initial gateway for that. In Japan,
informed consent tends to meanthat the patient is told just theprobability of death or a predictionof the number of days he or she has
left to live. With the notification ofcancer, for example, if no physicalor psychological care is given after
the announcement of the diagnosis
and the number of days a patient is
expected to live, the patient and hisor her family would just be bewildered. Giving people the plain
truth like this does not constituteinformed consent.

Deeken: Of course, it is not good
just to give the bad news to people
and then leave them to fend forthemselves. Psychological aftercare is crucial. In a 1961 survey of
U.S.A. doctors with regard to
informing cancer patients of theircondition, about 88 percent of doctors responded that they did notinform the patients of their condition.•6 By contrast, in a 1979 survey,
about 98 percent of doctors said
that they did inform the patients of
their condition.•7 A revolutionarychange obviously took place in the

U.S.A. during those 18 years or so,and views on a person’s right toknow changed. I think that deatheducation which I mentioned at
the beginning had a major impact
here. Many American universities
today offer courses on death. In
Germany, even high school students are taught about death; theyalso learn about cancer notificationand hospices.
If talk of death is taboo, as inJapan, and people do not face deathsquarely, they will be unable asadults to make mature choices
when they are notified that they
have cancer.
I think that death education isnecessary for people if they are todie in a human way. A person has
six tasks as he or she faces death.
The six tasks are (1) to let go of
attachments, (2) to experience forgiveness and reconciliation, (3) toexpress gratitude, (4) to say
farewell, (5) to write a will, and (6)to state one’s wishes regarding one’s
funeral.

•6
Data from Donald Oken, “What toTell Cancer Patients: A Study ofMedical Attitudes,” Journal of theAmerican Medical Association 175(1961): 1120–1128.
•7
Data from Dennis H. Novack, Robin
Plumer, Raymond L. Smith, et al.,“Changes in Physicians’ Attitudes
toward Telling the Cancer Patient,”
Journal of the American Medical
Association 241 (1979): 897–900.

•8 Views on Informed Consent
100
14.9

Don’t know

(%)

23.8

Informed
consent isinsufficient
Is performed,
but stillinsufficient

Already
sufficient

80
10.6

20.2

60
33.1
46.5

40

20
32.5
18.4

0
FY2002 FY1996
Source: “The Survey on HealthConsciousness of Senior Citizens” releasedby the Cabinet Office (2002).
Note: Survey was conducted nationwide inJapan of men and women age 65 and over.

Kimura: Traditionally, Japan has
not had the concept that informed
consent is needed for people tochoose how to close their life
peacefully based on the information they want.•8 Self-determination, however, started to take root
throughout the world from the1970s.
It is a big problem that cancer

Global Information Journal on Longevity and Society 2007

49

ROUNDTABLE DISCUSSION•9 Patients’ Bill of Rights
Patients’ bill of rights is a declarationof the rights of a patient in medicalcare, including informed consent andaccess to one’s own medical records.
Through this bill of rights, healthcare
providers support the active participation of patients in their medical carebased on the concept of patient-centered care.
Hospital Management Headquarters of
the Tokyo Metropolitan Government:
http://www.byouin.metro.tokyo.jp/osirase/sonota/kenri.html.

4

notifications and the like were mistakenly seen as the doctor actuallygiving up hope on the patient. Caremust not be withheld from patients
whose death is near and for whom
curative treatment is not possible.
The times are changing today:
although doctors used to make thevalue judgments in medical care,the era has arrived where patientsnow make the judgments.•9 This
must be actively incorporated inJapan as well.
I am frequently asked if, because
Westerners have faith, they arecomparatively calm when they are
told by their doctor that they willdie. But this is not just a questionof an individual’s faith. As Dr.
Deeken said, the perception ofdeath changed dramatically in the
1970s in U.S.A. To be told one will
die is a shock; that has notchanged. The important point is
the sense of security and satisfaction that one gains by obtaining
information on life and being able
to control one’s death process as
one wishes.

With respect to informed consent in U.S.A., the doctor provides
the patient with life information
both in the case of the patient who
has a chance of recovering and in
the case of the patient who does
not have a chance of recovering. If
the patient has a chance of recovering, the patient is accurately
informed of several treatment
options. If the patient does nothave a chance of recovering, thepatient is accurately informed of
the fact that they have the option of
dying in comfort by having pain
medication.
The thinking in Japan has beenthat telling the patient the truth
will make them lose the hope ofliving and so it has been thought
better not to tell them the truth.
Telling the person the truth, however, does not mean the abandonment of the patient; it should mean
providing care to the patient
through the end of their lives.
For patients to peacefully welcome the end of their lives,
patients, families, and doctors need”
50

Thinking about Life and Death in the New Era

to change their outlook so that they
can share the truth, forgive eachother, and love each other, and thepatient can leave this world inpeace. Throughout the world, there
is a trend now to take time while
one is healthy to put in writing
instructions regarding one’s wishes
regarding the end of one’s life. This
trend is becoming socially accepted, and gradually more and morecountries are creating legal provisions for it.•10

Konoe: Some people can actively
face their own death while others
cannot. I have the impression thatJapanese are passive regarding
death. As was mentioned before, inthe past older persons approacheddeath silently, seeking not to be a
nuisance to society. They were notable to actively state their wishes
regarding the end of their lives ortheir deaths.
Most nursing homes overseas
have private rooms for eachpatient, and residents are allowed
to bring their personal possessions.

“

In Japan, however, to date people
have generally been encouraged tobring as few personal possessions
as possible and they have not been
permitted to assert an individuality
to express themselves.
Amid this kind of cultural climate, society and systems arechanging to start respecting people’s self-determination, but I havethe impression that it has not yetadvanced that far on the level ofindividuals’ awareness.
At the same time, I feel that people are puzzled and bewildered
about what to seek from this point
on: what is left to seek now thatJapan has actually achieved affluence and longevity amid the peaceand material prosperity that thenation has enjoyed for the 60 or so
years since the war?
A friend of mine says that thefrequent occurrence recently ofghastly events is the price we pay
for peace, but that makes things
seem too meaningless. I think it isvery important that we offer deatheducation for youth on up, as Dr.

•10 Living Will
A living will is a document in which aperson’s wishes regarding end-of-lifecare are recorded. With the spread of
informed consent, the philosophy of
dying with dignity—and not simply
extending life—is becoming widely
known.

U.S.A. Living Will Registry:
http://www.uslivingwillregistry.com/fo
rms.shtm.

The times are changing today: although doctors used tomake the value judgments in medical care,”the era has arrived where patients now make the judgments.

Global Information Journal on Longevity and Society 2007

51

ROUNDTABLE DISCUSSION

4

Deeken proposes, and teach people
the importance of life.

Murakami: Independence and theright to self-determination areimportant without question, but towhat degree can they be universallyclaimed? Both concepts regard
death as a matter of the individual,
but we also should think about
whether death is really a questionof the individual alone. And, we
mustn’t overlook the danger that,
depending on the circumstances,the discussion of independence
and self-determination may bewatered down in the name of a predetermined harmony in the power
structure in today’s society. There isa need at times to separate oneself
from the system of self-responsibility to think about these things.

Goto: When we think about life
satisfaction, the question ofwhether one is helping someone
else or whether one has a role insociety are important factors, inaddition to just health.

“52

Thinking about Life and Death in the New Era

In times past, there was a framework in Japan where community
residents helped each other on a
voluntary basis. I have high hopesthat today, as well, a flexible social
system will be created in which theneeds of society are met while, atthe same time, people’s purpose inlife is enhanced, as a support network that provides care to older
persons in various contexts spreads
on a grassroots level throughout
the community.
The question of what the babyboom generation will do after
reaching mandatory retirement isa hot topic today. By having theseretirees work—not at conditions
that are as strict as those for
employment, but not just on apurely volunteer basis either—itwill be possible to a considerable
degree to support the lifestyles ofolder persons living alone.
Moreover, it is important not to
impose the burden of long-termcare on the family alone, as has
been repeatedly said in this discussion. There are many opportunities

I think it is very important that
we offer death education for youth on up...
and teach people the importance of life.

”

for older persons to apply theirexperience and wisdom in the fieldof caregiving as well.

Konoe: Compared to people in theWest, many Japanese want to continue to work after reaching the
mandatory retirement age. Creating
opportunities for these people towork is also an important issue.
By “work,” I do not mean they
will necessarily continue to workin their current positions with nochange. Any work that gives thema sense of being connected to society and being of assistance to others
will give them great purpose in life.

Deeken: A U.S.A. study carried out
follow-up surveys of 2,700 men
over a period of ten years. This
study found a great difference inthe mortality rate between men
involved in volunteer activities andthose not so involved. Over thatsame period, the mortality rate forthose not involved in volunteer
activities was 2.5 times higher than
the rate of those involved.•11

Murakami: I would like to present
an analysis by Alexis de
Tocqueville, a nineteenth century
French political thinker and theauthor of Democracy in U.S.A., assomething that Japan should learn
from U.S.A. When Tocquevilletraveled around U.S.A. conducting
his study in the early nineteenth

century, democracy was perceived
negatively in Europe because
democracy was associated withmobocracy.
Tocqueville invalidated thisunderstanding. According to him,
the key point is that people voluntarily create various kinds of communities in the U.S.A. Compared
to a group, a single human beingalone is weak in action as well as
judgment.

•11
Pain relief data from Gregg D. Jacobs,“Clinical Applications of theRelaxation Response and Mind-Body
Interventions,” Journal of Alternativeand Complementary Medicine 7
Supplement 1 (Dec. 2001): 93–101.

Konoe: What distinguishes
mobocracy and democracy is thecultural level of the people, but wecannot categorically say that thecultural level of the Japanese hasrisen. Although it has increased insuch areas as bioethics, there isconcern about a decline in the cultural level of the general populace,as shown in today’s climate whereanything goes provided it is not in
violation of the law. “Common
sense” is frequently translated as
joshiki or, literally, “ordinary
knowledge” in Japanese, but it isactually the common value systemor so-called conventional wisdom.
In Japan today, only knowledge
and information are advancing forward; correct common sense orcommon wisdom is not being
formed. I would like to emphasizethat refined common sense is needed for a cultural rebirth in Japan.

Deeken: There are differences in
Global Information Journal on Longevity and Society 2007

53

ROUNDTABLE DISCUSSION

4

cultural climate from country tocountry so I can understand that
the American spirit of independence probably cannot be incorporated unaltered into Japan.
In English, the words “civilization” and “culture” are often usedinterchangeably, but in German
philosophy, “civilization” refers
collectively to technologicalachievements to make our material
environment more comfortable.
The concept underlying civilization is advancement. By contrast,“culture” refers to inner self-realization linked to a human being’s
self-awareness, world view, and values. Art and music are representative examples of culture. Thus,
culture is not necessarily something that advances.
Japan is being challenged to create a uniquely Japanese “culture ofdeath” of a different hue from thatof the West with its highly defined
sense of self. Then the question will
be how to make that culture part ofthe common wisdom.
The answer to this question is
not something that will become
clear immediately. It can only bereached through continuing searchamid much trial and error.

I agree with the idea of making
Japan’s unique and deep philosophy regarding the meaning of lifeand death, rooted in its rich traditions, into a shared common wisdom. However, no philosophy that
violates principles stated in the
United Nations Universal
Declaration of Human Rights,
UNESCO’s Universal Declaration
on Bioethics and Human Rights, orother declarations that are accepted
as international standards—such as
denying the patient’s right to know,
disregarding human dignity, anddoctors’ authoritarianism—can bejustified in the name of a special
culture or custom.
I plan to continue to develop
bioethics actively in the future sothat people live fulfilling lives.
(January 16, 2007)

Kimura: If Japan’s culture of lifeand death were to make a major
contribution to today’s global civilization, what contribution wouldthat be?

54

Thinking about Life and Death in the New Era

Photos: Masahiro Minato

PARTICIPANTS’ LIST

Alfons Deeken

Shigeaki Hinohara

Rihito Kimura

Professor Emeritus, Sophia University

Chairman of the Board of Trustees, St. Luke’s
International Hospital

Director, ILC-Japan; President, Keisen
University

Born in 1911, Dr. Hinohara graduatedfrom the Faculty of Medicine of Kyoto
Imperial University. He earned a Ph.D.
in medicine from the same university. He
joined St. Luke’s International Hospitalin 1941. After serving as head of the
Department of Internal Medicine andacting director of the hospital, he waspresident of St. Luke’s College of Nursing
from 1974 to 1998. He has held theInternational Symposium on Elderly Care
since 1990 and has promoted the New
Elder Citizens Movement, a movement inwhich older persons actively support thenext generation. His publications include
Ikikata jozu (Living well) (U-Leag, 2001) andInochi no jugyo (Life lessons) (U-Leag, 2006).

Born in 1934, Mr. Kimura received a Ph.D.
(human sciences) from Waseda University’s
Graduate School of Law. He was director of
the International/Asian Bioethics Programof Georgetown University’s Kennedy
Institute of Ethics and professor at
Waseda University’s School of Human
Sciences before becoming president of
Keisen University in 2006. He was a member of the Health Sciences Council of the
Ministry of Health and Welfare, and amember of the committee administering
Japan’s National Examination for Medical
Practitioners. His publications include
Baioeshikkusu handobukku: seimei rinri wokoete (Bioethics handbook: beyond bioethics)(Houken, 2003).

Tsutomu Hotta

Tadateru Konoe

Chairman, Sawayaka Welfare Foundation

President, Japanese Red Cross Society

Born in 1934, Mr. Hotta graduated fromthe Faculty of Law of Kyoto University.
In 1961, he became a public prosecutor.
After working at the Embassy of Japan in
U.S.A. and serving as a public prosecutor at
the Japanese Supreme Public Prosecutors
Office, he became director-general of the
Minister’s Secretariat of the Ministry ofJustice in 1990. In 1991, he retired fromthe ministry and assumed his current position. In 2001, he became chairman of theTokyo Council of Social Welfare. His publications include 60 sai kara no “ikiru imi”:
riso no seikatsu wo mitsukeru hinto (The “mean-

Born in 1939, Mr. Konoe graduated from
Gakushuin University’s Faculty of Political
Science and Economics. He studied at the
London School of Economics and Political
Science from 1962 and returned to Japan
in 1964. He joined the Japanese Red Cross
Society (JRC) that same year and was posted to Geneva where he was engaged ininternational aid and relief efforts. Later heserved as head of the social services department of the JRC and vice-president of the
JRC before becoming president in 2005.

ing of life” after 60: hints for finding the ideal life) (co-Hiroshi Miyajima

authored, PHP Institute, 2006).

Professor, Waseda University

Born in 1932, Dr. Deeken earned his Ph.D.
in philosophy from Fordham University in
New York City. He came to Japan in 1959.
As a professor at Sophia University, he wasin charge of classes on the philosophy ofdeath and dying. He has been presented
with the Cross of the Order of Merit of theFederal Republic of Germany, the Kikuchi
Kan Award, and the award of theFoundation of Thanatology (U.S.A.). His
publications include Yoku iki yoku warai,
yoki shi to deau (Live well, laugh well and have agood death) (Shinchosha, 2003) and Shi to do
mukiau ka (How to face death) (Japan Broadcast
Publishing, 1996).

Tadaharu Goto
Director, ILC-Japan; President, Foundation ofSocial Development for Senior Citizens
Born in 1950, Mr. Goto graduated from
Kyushu University’s Faculty of Law. He
joined the Ministry of Health and Welfare(today’s Ministry of Health, Labour and Welfare)in 1973. After serving as Councilor of the
Minister’s Secretariat and Director-Generalof the Equal Employment, Children andFamilies Bureau of the Ministry of Health,Labour and Welfare, he became presidentof the Foundation of Social Development
for Senior Citizens in 2005.

Yoshio Gyoten
Commentator on Medical Issues
Born in 1926, Mr. Gyoten graduated fromthe Chiba University School of Medicine.
He joined NHK and has planned andproduced programs on health as well as
medicine and welfare issues throughout
his career. In recognition of his accomplishments, he was awarded the Dai-ichi
Mutual Life Insurance Company’s Public
Health Award and the Japanese Red Cross
Society’s Emperor Showa Memorial Awardfor the Promotion of Blood Donation. He
has served as member of the Ministry of
Health and Welfare’s Council on Medical
Service Facilities, advisor to the Japan
Hospital Association, and advisor to theInternational Medical Center of Japan.

Yoshihito Karasawa
President, Japan Medical Association
Born in 1942, Dr. Karasawa graduated fromthe Chiba University School of Medicine.
After training at the Fraternity Memorial
Hospital, he opened the Karasawa Clinic.
Later, he served as president of the Sumida
Medical Association and of the Tokyo
Medical Association. He took up his
current position in 2006. His specialties
are internal medicine, pediatrics, gastroenterology, and industrial medicine. He is
certified by the Japanese Society of Internal
Medicine.

Born in 1942, Mr. Miyajima graduatedfrom the Faculty of Economics of the
University of Tokyo and studied in the
doctoral program at that university’s
Graduate School of Economics. He became
lecturer at Shinshu University’s Faculty ofArts in 1972 and later was associate
professor at the Faculty of Economics.
He became associate professor at theFaculty of Economics of the University ofTokyo in 1984 and professor in 1985. Heserved as dean of the Graduate School of
Economics and executive vice-president of
the University of Tokyo. He assumed his
current position in 2003. His publications
include Korei shakai e no messeji (Message to an
aging society) (Maruzen Publishing, 1997).

55

Shigeo Morioka

Atsushi Seike

Takako Sodei

President, ILC-Japan

Professor, Keio University

Professor Emeritus, Ochanomizu University

Born in 1922, Mr. Morioka graduated fromthe Faculty of Agriculture of the Universityof Tokyo. In 1947, he joined Yamanouchi
Pharmaceutical Co., Ltd. (today’s Astellas
Pharma Inc.), where he later served aspresident, chairman, and advisor. During
his time at Yamanouchi Pharmaceutical,
he was president of the Federationof Pharmaceutical Manufacturers’
Associations of Japan and vice-presidentof the International Federation of
Pharmaceutical Manufacturers &Associations. He has been presidentof the ILC-Japan since 1998.

Born in 1954, Mr. Seike graduatedfrom the Faculty of Economics of Keio
University. He earned a Ph.D. (Business andCommerce) from the university’s Graduate
School of Business and Commerce. He
became research assistant at the Facultyof Business and Commerce at the university in 1980 and associate professor in 1985.
He worked as a researcher at the RAND
Corporation (U.S.A.) from 1987 and also
held other positions. He assumed his current post in 1992. His publications include
Eiji-furi shakai wo ikiru (Living in an age-free society) (NTT Publishing, 2006).

Born in 1938, Ms. Sodei graduated fromthe College of Liberal Arts of International
Christian University and received amaster’s degree from the University ofCalifornia and a doctorate from the Tokyo
Metropolitan University Graduate School.
After working at the Tokyo Metropolitan
Institute of Gerontology, she joined thefaculty of Ochanomizu University in 1975,
becoming a professor in 1990. Her publications include Kore de wakaru kaigo hoken
seido Q&A (The long-term care insurance system
made simple: Q&A) (Minerva Publishing, 2005)

and Shoshika shakai no kazoku to fukushi(Family and welfare systems in a society with a declining birthrate) (Minerva Publishing, 2004).

Yoichiro Murakami

Fusako Seki

Professor, International Christian University

Associate Professor, Yokohama National
University

Born in 1936, Dr. Murakami graduatedfrom the College of Arts and Sciences of the
University of Tokyo. He earned his Ph.D.
from the Division of Humanities of the
University of Tokyo’s Graduate School.
He taught at the University of Tokyo andwas director of the university’s ResearchCenter for Advanced Science andTechnology. He assumed his current
position in 2002. He has been awarded theFirst Yamasaki Prize for Philosophy and theThirty -ninth Mainichi Publication CultureAwards. His publications include Bunmei
no shi, bunka no saisei (Death of civilization,
rebirth of culture) (Iwanami Shoten, 2006) andSei to shi e no manazashi (Outlook on life anddeath) (Seidosha, 1993).

Yoshiharu Otsuka
Vice-President, Japanese Red Cross Society
Born in 1947, Mr. Otsuka graduatedfrom the Faculty of Law of the Universityof Tokyo. He joined the Ministry of Healthand Welfare (today’s Ministry of Health,Labour and Welfare) in 1970, where helater served as Director-General of the
Minister’s Secretariat, Director-General of
the Health and Welfare Bureau for the
Elderly, Director-General of the Health
Insurance Bureau, and Vice-Minister for
Policy Coordination before becoming theVice-Minister of the Ministry of Health,Labour and Welfare in 2003. He has been
vice-president of the Japanese Red Cross
Society since 2005.

56

Ms. Seki graduated from the Faculty of
Law of the University of Tokyo andearned a Ph.D. (Social Security Law) fromthe Hokkaido University School of Law(Department of Public Law). From 1998 to2001, she received a Research Fellowshipfor Young Scientists from the Japan Society
for the Promotion of Science. In 2002, she
was a research associate at Hokkaido
University’s School of Law. She assumed
her current position in 2003.

Hiroshi Shibata
Professor, Obirin University Graduate School
Born in 1937, Mr. Shibata graduatedfrom the Hokkaido University School of
Medicine. He was engaged in research on
cardiovascular diseases from 1966 through1972 at the Faculty of Medicineof the University of Tokyo. He joined
the Tokyo Metropolitan Institute ofGerontology in 1982 where he later
became vice-director. He retired fromthe Institute in 2000 and became a professor at the College of Humanities of Obirin
University. He became professor of the
Obirin University Graduate School in
2002. His publications include Shogai geneki “supa rojin” no himitsu (Lifelong service: The
secret of “super seniors”) (Gijutsu-Hyohron, 2006).

Tetsuo Tsuji
Vice-Minister, Ministry of Health,Labour and Welfare
Born in 1947, Mr. Tsuji graduated from theFaculty of Law of the University of Tokyo.
After joining the Ministry of Health andWelfare (today’s Ministry of Health, Labour andWelfare) in 1971, he served as Councilor of
the Minister’s Secretariat, Director-Generalof the Pension Bureau, Director-General of
the Minister’s Secretariat, Director-Generalof the Health Insurance Bureau, and ViceMinister for Policy Coordination. He took
up his current post in 2006.