Introduction If longevity is viewed as a general indicator of health, then Japan, the nation with the world’s highest life expectancy, might be considered the healthiest place on earth. In the interest of maintaining health and longevity, the Japanese have traditionally paid considerable attention to the welfare and soundness of the body. At the same time, sometimes steadily, at other times in dramatic leaps attending broader historical events, there has been considerable change. Of course, the history of health in Japan is not entirely divorced from the history of other countries in the Asia-Pacific region, or in the world for that matter, from the influence of ancient Chinese health practices to the dramatic impact of Western style medicine in the nineteenth century, then on into the era of global­ ization with its own pressing health issues. Nevertheless, the story of health in Japan is substantially different from those of most of its Asian neighbours. Many health advances came earlier and were more quickly integrated into Japanese culture than elsewhere; it does not today have the same double burden of both poverty­ and wealth­ related diseases, or at least to the same extent. However, this is not to say that everything is well. In a sense, Japan’s very success, as marked by its citizens’ renowned longevity, has been and remains the source of some of its potentially most crippling problems. There has been a marked historical inversion, from a traditional regime of high fertility and high mortality to one of low fertility and low mortality and this has brought with it urgent demographically driven issues, most notably those associated with a rapidly ageing population. Meanwhile, as will be discussed later in this chapter, its remarkable economic progress has been bought at the cost of environment­ and lifestyle­ related diseases. In addition, since the country has been in recession for well over a decade, all of the above now exist in the context of considerable economic uncertainty and stress. I cannot hope to provide here an exhaustive history of health and medicine in Japan, but in the pages that follow an attempt will be made to sketch some of the key points of modern cultural change, events that can be said to have played an especially important role in bringing about the health situation of the country today. From there I would like to examine the crucial issues that have emerged

in contemporary Japan around the subjects of health and medical care. It is hoped that marking points at which Japan diverges from its neighbours, as well as those areas in which it shares some common ground with them, will help in a small way towards our creation of a complex, nuanced picture of health issues in the region.