In a Comment with the Series, Professor Christopher Murray, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA, says that Japan enjoyed huge drops in mortality in the 1950s and 60s, and kept pace with other nations for most of the rest of the 20th century. But he highlights the recent, more worrying trend since 1995 whereby Japan's pace of decline for mortality for adult men (aged 15-59 years) has fallen behind Sweden, Italy and Australia, and for adult women has fallen behind Sweden.
Professor Murray says: "If recent trends continue, other nations are likely to achieve lower rates of adult mortality than Japan…Many explanations for this worsening relative performance are offered by [The Lancet's Japan Series], including high tobacco consumption compared with other high-income countries, a modest rise in body-mass index, and high and rising rates of suicide. Unstated is the hypothesis that although Japan has a universal health-care system, the quality of the care delivered might be low."
Professor Murray concludes: "In an era of economic stagnation, political turmoil, ageing populations, and inadequate tobacco control, Japan does not seem to be effective in addressing its new set of health challenges. It will take more than universal access to a low-spending, high-volume health system to tackle these challenges. Without concerted action, Japan, like the USA is likely to continue dropping in the global mortality league tables. Although the relative decline will not be as severe as we are witnessing in the USA, it is a cautionary tale that success in the past does not guarantee top performance in the future."
For Professor Christopher Murray, please contact either William Heisel or Jill Oviatt, IHME Communications. William Heisel T) +1 (206) 897-2886 / + 1 (206) 612-0739 E) wheisel@uw.edu
Journal
The Lancet