Japan Press Weekly

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2016 December 21 - 2017 January 3 [SOCIAL ISSUES]

Japan has become a health gap society: health care expert

Chiba University Professor Kondo Katsunori, who specializes in social epidemiology and health policy, in an Akahata interview on December 27 said that Japan is facing health inequalities and social inequalities due to growing poverty. Following is an excerpt of his interview:

Health inequalities can be defined as differences in health status between population groups based on the difference in regional, social and economic situations. Domestic and international research provides various examples of how people’s socio-economic status affects their health conditions.

Among examples, a survey of the elderly aged 65 years and over regarding the relation between their income levels and illnesses shows that the rate of elderly people who have multiple illnesses is higher in low-income groups. The rate of low-income elderly having mental health problems is three times higher than that of high-income elderly.

Another example is a survey regarding the relative risk of suffering from diabetes-related eye disease and other serious health issues. In this survey, people working as temporary workers have a higher risk in this category than those working as full-time workers.

In addition, a four-year follow-up study on the elderly aged 65 years and over shows that the death rate of men in the lowest income threshold is 3.5 times higher than that in the highest threshold, and for women, 2.5 times higher.

These circumstances go against Article 25 of the Constitution guaranteeing the right to live and the Universal Human Rights Declaration promising all people “the right to life, liberty and security of person”.

Those who were born to a poor family and received no tertiary education have difficulty in finding full-time jobs and thus become low-paid, non-regular workers. Unlike full-time employees who can see a doctor during duty hours, non-regular workers have to take a leave even for medical check-ups, which means a decrease in their incomes. This will lead to a situation where temporary workers hesitate to go to a doctor until they develop serious symptoms of diseases. Lower-income people have no choice but to accept the health gaps as a social given.

Many low-income working people are taking on more than one job just to make ends meet. They are too busy to prepare healthy meals at home. In the United States in the last three decades, prices of vegetables increased much more than foods which mainly contain fat and carbohydrates. Under such circumstances, low-income families have to buy cheap but less healthy foods.

Thus, poorer people tend to damage their health condition not only because they cannot afford a healthy lifestyle but also because they fell into poverty due to a vicious cycle they are trapped in from an early age.

Many governments in the world failed to encourage people to adopt desirable life habits because these governments paid little attention to the surrounding social environment. The Japanese government in 2000 launched the “Healthy Japan 21” project, but it was not so successful. Advocates of the “self-responsibility” approach argue that people should blame themselves for their ill health, but it is tantamount to requiring a drowning person to learn how to swim. Instead, the government should take measures to eliminate poverty and other health-damaging factors in order to prevent people from damaging their health.

With successive Japanese governments implementing neo-liberal economic policies, the income disparity is widening. Japan’ relative poverty rate keeps rising and ranks the 6th highest among the 34 OECD nations. The Gini Index rank, which measures a nation’s economic inequality, is the 10th worst. It is also known that a country with a larger economic disparity has a higher fatality rate.

One in six children in Japan lives in a state of poverty. The rise in the child poverty rate is a serious problem. We surveyed 15,000 people who are 65-year-old or older and found that respondents who said they had economic difficulties at the age of 15 tend to have more trouble leading socially-independent lives in their older ages. A growing number of poor children would mean that in the future the government will have to shoulder heavier medical and nursing-care costs and provide more welfare benefits. If such a situation is left unaddressed, government spending on social security programs will increase much more than the current estimate.

The OECD in 2014 released a report on “Inequality and Growth”. Based on an analysis of data for the past 30 years, the report states that “the trend of increases in income inequality has dragged down growth in many OECD countries”.

If the Japanese government wants to boost economic growth, it should sufficiently provide education opportunities for children from low-income families, eliminate the unreasonable wage gap between regular and non-regular workers, and ensure that everyone can have access to medical and nursing-care services. The urgent need now is to tackle the growth in inequality in terms of both income and health conditions.