Taking the next leap forward in healthy life expectancy

Japan has garnered global attention for several reasons, including its notable achievement in human longevity, as a consequence of effectively implementing practices conducive to longer lifespans. While Switzerland enjoys one of the highest average health statuses among OECD nations, Japan reigns among the G7 nations in terms of population life expectancy. 

Japan's success is not accidental, according to the Swiss Re Institute’s recent report, The future of life expectancy: Forecasting long-term mortality improvement trends for insurance. Through well-planned, decades-long public health initiatives, Japan has adeptly navigated the path of emerging healthcare risks and opportunities. These have enabled advancements in medicine, greater healthcare access, and the adoption of healthier lifestyles – Japan's experience provides an exemplary model for other countries in pursuit of similar healthcare triumphs.

It is vital that policymakers and we as insurers stand vigilant against emerging risks and take the steps necessary to ensure societies remain protected. In this regard, Japan's success serves as an inspiring blueprint. 

Japan’s mortality rates have declined significantly since the 1960s, largely as a result of greatly improved cardiovascular disease (CVD) survival rates. Added to that, the country saw a marked decline in cerebrovascular and stomach cancer-related deaths, both of which had also contributed to lower life expectancies. Between 1980 and 2012, the nation’s population between 35 and 84-years old experienced a 61% decrease in age-adjusted mortality rates from ischaemic heart disease and an 83% decline from stroke. To put this into perspective, these declines represent thousands of lives saved annually and given that these conditions often affect the elderly, contribute to Japan's world-leading longevity. While many of these gains were achieved by an improvement in healthy behaviour, this was led by robust regulations and proactive public health education: such as the launch of a national CVD prevention programme in 1982 and the Health Promotion Act in 2003 to enhance disease prevention and prevent passive smoking. Continued commitment to bettering public health should yield more progress, with chronic heart disease and stroke deaths projected to decrease 16.5% between 2011 and 2030.

Japan is already one of the oldest nations in the world, with 29.1% of people over the age of 65. As we look to the future, Japan is likely to remain the global bellwether of human longevity limits. However, this comes with its own set of challenges. Overall demographic shifts cited in the Swiss Re Institute research – a rapidly ageing society, coupled with a population projected to shrink one-fifth by 2050 – foreshadow challenges that could weigh on the economy and strain social safety nets. The country must extend its targeted and decisive management of the population’s health to prepare for this fundamental shift, which may include additional pressures on the healthcare system to tackle ageing related conditions such as neurodegenerative diseases, as well as addressing the difficult challenges of long-term care. 

Escalating commitment on existing policies may not be the sole answer. Historically, life expectancy improvements rise and wane along with medical innovation and tapering effects over the long term. Advances in life expectancy for both Japan and Switzerland have started to slow down since 2010 as progress in areas like CVD management slows. In addition, an increasingly urban population with a preference for sedentary lifestyles and diets high in ultra-processed foods has resulted in rising obesity and diabetes rates, which may have long term consequences on mortality and morbidity.

Swiss Re’s research outlines some more future-proof and forward-thinking approaches to managing these challenges, while concurrently preserving Japan’s longevity achievements for decades to come. One area of promise could be reducing cancer-related mortality rates due to improvements in diagnostic technologies, and greater availability of targeted cancer therapies over the next 30 years.

Developments in artificial intelligence (AI) are hoped to bring multiple benefits to medical innovations, as has already been observed in the use of machine learning for cancer imaging diagnostics. Other opportunities could be speeding up of drug discovery pipelines by sifting through vast datasets to identify potential compounds, predicting their effectiveness in a fraction of the time traditional methods would take. Deeper integration of AI solutions is expected to aid medical professionals in decision making and the development of personalised treatment plans.

Over the longer term, the focus is expected to shift to the treatment of ageing-related and neurodegenerative diseases such as Alzheimer’s and other causes of dementia. Current therapies are focused on alleviating symptoms, whereas newer therapies are expected to target the underlying origins of these diseases, with the potential to slow or even reverse their progression.

While medical advancements are critical, so too are robust public health policies when managing the underlying risk factors of ill health such as poor diets or habits. Promoting large-scale lifestyle changes will play a critical role in the nation’s quest to maintain life expectancy improvements. Organisations in Japan are already rising to the occasion, with for example the Japanese Society of Hypertension formulating a plan to reduce the country’s salt intake to cut stroke-related deaths.

Improvements in public health can, by extension, increase the country’s resilience to medical challenges. The recent COVID-19 pandemic is a prime example, where impaired metabolic health – marked by the presence of diseases such as diabetes and obesity – was a predictor of lower COVID-19 survival rates. 

While managing chronic diseases is key to the next wave of advances in life expectancy, we believe it is equally important to stay abreast of other emerging risk factors that may detract from these gains. Hazards arising from climate change or antimicrobial resistance could create new threats to human health and increase the vulnerability of the elderly and people with existing comorbidities. 

As we look to Japan to set new benchmarks for life expectancy, its success should be celebrated – and can serve as a model to inspire the many other advanced economies with ageing populations, paving the way for healthier societies and sustainable growth at a global level.