Japan’s death-laden society: Five areas of prospective policy challenges
Today, Japan stands as the world’s leading super-aged society. In the coming decade, preceding the rest of the aging globe, the country will phase into the next demographic stage called a “death-laden” society. Due in part to the aging and prospective mortality of the country’s two major baby boom generations along with a projected decline in the number of the working age population, Japan will be laden with ballooning deaths from old age from 2030 onward for several decades to come. Only in recent years have researchers started paying attention to this demographic prospect, and to date, little study has been done to systematically examine how the coming of a death-laden society may affect the health, well-being, and comfort of those in advanced age in the country. This paper aims to contribute to the newly emerging body of literature on this subject by exploring, based mainly on findings from expert interviews, five key areas of policy challenges with which Japan’s death-laden society will likely contend. These areas include: (1) shortages in basic medical resources for the dying; (2) mounting public burden of disease; (3) potential prevalence of ‘lonely deaths’ among those in advanced age; (4) urgency to facilitate national discussions on end-of-life options; and (5) crematorium shortages and their cultural impact. The future research is called for to help mitigate the impact of a death-laden society not only for Japan but also for other countries that may follow Japan’s demographic path in the conceivable future.
Ahlzen, R. (2020). Suffering, authenticity, and physician assisted suicide. Medicine Health Care and Philosophy, 23(3): 353-359. https://doi.org/10.1007/s11019-019-09929-z
Brink, P. (2008). Determinants of home death in palliative home care: Using the interRAI Palliative Care to assess end-of-life care. American Journal of Hospice and Palliative Medicine, 25(4):263-270. https://doi.org/10.1177/1049909108319261
Cabinet Office, the Ministry of Finance, and the Ministry of Health, Labor and Welfare. (2018). The future of social security: Looking ahead to year 2040 [in Japanese]. United Kingdom: Cabinet Office. Available from: https://www.5.cao.go.jp/keizai-shimon/kaigi/minutes/2018/0521/ shiryo_04-1.pdf
Canetto, S.S., & McIntosh, J.L. (2022). A comparison of physician-assisted/death-with-dignity-act death and suicide patterns in older adult women and men. American Journal of Geriatric Psychiatry, 30(2), 211-220. https://doi.org/10.1016/j.jagp.2021.06.003
Cohen, J., & Gott, C. (2015). Dying in place in old age: Public health challenges. In: Van den Block L, Albers G, Pereira SM, et al, editors. Palliative Care for Older People: A Public Health Perspective. Oxford: Oxford University Press, p.107-119.
Cremation Society. (2022). International Statistics 2019. Available from: https://www.cremation.org.uk/ internationalcremation-statistics-2019 [Last accessed on 2022 Jun 08].
Döringer, S. (2020). The problem-centered expert interview: Combining qualitative interviewing approaches for investigating implicit expert knowledge. International Journal of Social Research Methodology, 24(3):265-278. https://doi.org/10.1080/13645579.2020.1766777
Fuji, K. (2018). What would the coming of a death-laden society bring about to Japan? [in Japanese] Communications of the Japan Association of Real Options and Strategy, 10(2):36-38. https://doi.org/10.12949/cjaros.10.2_36
Gilmour, S., Liao, Y., Bilano, V., & Shibuya, K. (2014). Burden of disease in Japan: Using national and subnational data to inform local health policy. Journal of Preventive Medicine and Public Health, 47(3):136-143. https://doi.org/10.3961/jpmph.2014.47.3.136
Gutiérrez-Sánchez, D., Gómez-García, R., Roselló, M.L., & Cuesta-Vargas, A.I. (2021). The quality of dying and death of advanced cancer patients in palliative care and its association with place of death and quality of care. Journal of Hospice and Palliative Nursing, 23(3):264-270. https://doi.org/10.1097/NJH.0000000000000752
Higo, M. (2022). A “death-laden society”: The next stage of a hyper-aged Japan and health challenges ahead. Aging and Health Research, In press. https://doi.org/10.1016/j.ahr.2022.100110
Higo, M., & Klassen, T.R. (2016). Reforms of retirement policies: Three common paths in aging Japan and Korea. Journal of Aging and Social Policy, 29(1):70-83. https://doi.org/10.1080/08959420.2016.1187035
Hirayama, Y., Otani, T., & Matsushima, M. (2017). Japanese citizens’ attitude toward end-of-life care and advance directives: A qualitative study for members of medical cooperatives. Journal of General and Family Medicine, 18(6):378-385. https://doi.org/10.1002/jgf2.100
Japan Association of Environmental Crematory. (n.d.). Statistics on crematoriums across the country [in Japanese]. Japan Association of Environmental Crematory. Available from: https://www.j-sec.jp/files/f_1546821957.pdf [Last accessed on 2022 May 20].
Japan Society for Dying with Dignity. (n.d.). What is ‘Living will’? [in Japanese]. Japan Society for Dying with Dignity. Available from: https://www.songenshi-kyokai.or.jp/living-will [Last accessed on 2022 Apr 21].
Kamabayashi, R., & Kato, T. (2016). Long-term employment and job security over the past 25 years: A comparative study of Japan and the United States. ILR Review, 70(2):359-394. https://doi.org/10.1177/0019793916653956
Kamm, F.M. (1999). Physician-assisted suicide, the doctrine of double effect, and the ground of value. Ethics, 109(3): 586-605. https://doi.org/10.1086/233923
Kato, T.A., Shinfuku, N., Sartorius, N., & Kanba, S. (2017). Loneliness and single-person households: Issues of kodokushi and hikikomori in Japan. In: N Okkels, CB Kristiansen, & P Munk-Jørgensen, editors. Mental Health and Illness in the City. Berlin: Springer, p.205-219.
Kurahara, M. (2020). Study on the end-of-life care in elderly person facilities in many-death society-through the case of end-of-life care in special elderly nursing home ‘shakunagesou.’ [in Japanese] AIJ Journal of Technology and Design, 26(63):707-712. https://doi.org/10.3130/aijt.26.707
Matsumoto, M., Kashima, S., Owaki, T., Iguchi, S., Inoue K., Tazuma, S., et al. (2019). Geographic distribution of regional quota program graduates of Japanese medical schools: A nationwide cohort study. Academic Medicine, 94(8):1244-1252. https://doi.org/10.1097/ACM.0000000000002688
Ministry of Health, Labor and Welfare. (2021). Annual Whitepaper on Work and Welfare, 2021. Tokyo: Ministry of Health, Labor and Welfare.
Ministry of Health, Labor and Welfare. (2022). Vital Statistics. Tokyo: Ministry of Health, Labor and Welfare. Available from: https://www.mhlw.go.jp/toukei/list/81-1.html [Last accessed on 2022 Mar 16].
Nagaoka, M. (2021). Getting Prepared for the Coming of a Death-laden Society [in Japanese]. Japan: Heibonsha.
National Institute of Population and Social Security Research. (2022). Population Statistics. Japan: National Institute of Population and Social Security Research. Available from: https://www.ipss.go.jp/p-info/e/population%20%20 statistics.asp [Last accessed on 2022 Jul 07].
Nippon Foundation. (2021). National Survey on the End-of-life Decisions. Tokyo: Nippon Foundation Available from: https://www.nippon-foundation.or.jp/app/uploads/2021/03/ new_pr_20210329.pdf [Last accessed on 2022 Jun 26].
Organization for Economic Co-operation and Development. (2022). Life expectancy at birth. Paris: Organization for Economic Co-operation and Development. Available from: https://www.data.oecd.org/healthstat/life-expectancy-atbirth.html [Last accessed on 2022 Jul 19].
Park, E.H. (2020). Ultra-low fertility and policy response in South Korea: Lessons from the case of Japan. Ageing International, 45(2):191-205. https://doi.org/10.1007/s12126-020-09365-y
Research Institute of Economy, Trade and Industry. (2018). The Necessity to Restructure the Healthcare System in Response to Cultural Transformations caused by the Coming of a Death-laden Society-RIETI Policy Discussion Paper Series 18-P-020 [in Japanese]. Tokyo: Research Institute of Economy, Trade and Industry. Available from: https://www.rieti.go.jp/jp/publications/pdp/18p020.pdf [Last accessed on 2022 Jun 20].
Spoden, C. (2020). Deciding one’s own death in advance: Biopower, living wills, and resistance to a legislation of death with dignity in Japan. Contemporary Japan, 32(1):63-82. https://doi.org/10.1080/18692729.2020.1714279
Suzuki, H. (2000). The Price of Death: The Funeral Industry in Contemporary Japan. United States: Stanford University Press.
Suzuki, K., Dolley, B.E., & Kortt, M.A. (2021). Addressing loneliness and social isolation amongst elderly people through local co-production in Japan. Social Policy and Administration, 55(4):674-684. https://doi.org/10.1111/spol.12650
Takata, H., Nagata, H., Nogawa, H., & Tanaka, H. (2011). The current shortage and future surplus of doctors: A projection of the future growth of the Japanese medical workforce. Human Resources for Health, 9(14):1-7. https://doi.org/10.1186/1478-4491-9-14
Tokyo Medical Examiner’s Office. (2022). Statistical Database. Tokyo: Tokyo Medical Examiner’s Office. Available from: https://www.fukushihoken.metro.tokyo.lg.jp/kansatsu/ database/03toukei.html [Last accessed on 2022 Feb 11].
Tsuji, Y. (2006). Mortuary rituals in Japan: The hegemony of tradition and the motivations of individuals. Ethos, 34(3):391-431. https://doi.org/10.1525/eth.2006.34.3.391
United Nations. (2019). World Population Ageing 2019, Highlights. New York: United Nations. Available from: https://www.un.org/en/development/desa/population/ publications/pdf/ageing/WorldPopulationAgeing2019- Highlights.pdf [Last accessed on 2022 May 22].
United Nations. (2022). World population prospects 2022. New York: United Nations. Available from: https://www. population.un.org/wpp [Last accessed on 2022 Aug 27].
World Health Organization. (2008). The Global Burden of Disease, 2004 update. Geneva: World Health Organization. Available from: https://www.apps.who.int/iris/bitstream/ handle/10665/43942/9789241563710_eng.pdf