Week 4: たばこ (Smoking)


One of the major public health risks in Japan that has been treated differently, culturally speaking, than in the US is smoking. Until 1985, the Japanese government owned the largest tobacco company in the country, Japan Tobacco, and they still own two-thirds of it. Lawsuits calling for tighter regulation and even health warnings have been scrapped. How could a country known for being so healthy embrace a decidedly unhealthy habit? This article from This Japanese Life offers some insights on the matter.
As it turns out, there’s an interesting paradox when it comes to smoking in the Japanese population: they smoke more, but have lower rates of lung cancer (although smoking is the major cause of it by a large margin). There are several reasons as to why: Although the Japanese smoke more cigarettes, they usually do not finish them, leaving quite a bit behind. They start later, with about 60% starting after the age of 20 (the age of majority, and the age required to purchase cigarettes). And, perhaps most surprisingly, they drink lots of tea, which has been shown to be an excellent cancer preventative. Finally, Japan’s view of smoking as a moral choice rather than a disgusting habit, even now, is certainly an interesting one. And the smoker’s paradox is quite unlike anything in other powers of its size.

This week’s vocabulary:

肺 (はい): the lungs
Are you traveling to Beijing? Please check the air pollution levels. I’ve heard the air there can be bad for your lungs.

肝臓 (かんぞう): the liver
The liver is the largest of the internal organs.

胃 (い): the stomach
I ate a lot recently, and my stomach hurts. Do you have any antacid with you?

脳 (のう): the brain
I think doing math is a good idea. It’s important for your brain!

腎臓 (じんぞう): the kidneys
A: 腎臓が気になります。
B: もっと水を飲めばいいでしょう。
A: I’m concerned about my kidneys.
B: Then drinking more water would be a good idea.

Japanese attitudes towards smoking not as a health problem, but as a social/moral problem, would never fly in the US, Canada, or even other countries within Asia. Compared to stern warnings on packages and commercials that show, say, graphic images of diseased lungs, Japan gets a relative slap on the wrist. And the fact that their rate of lung cancer is low compared to other countries, which also shocked me. And yet, the rate of smokers keeps falling every year, which may suggest a shifting trend towards the other end of the scale. Then again, maybe this shouldn’t be all that surprising because of the very healthy Japanese lifestyle, but every country has their unhealthy habits. Next week, I think I’m going to take a look at how the Japanese look at another lifestyle-oriented disease common in Westernized societies: obesity.

Other sources on the subject:


Week 3: 病院 (Hospitals)


Hospitals are an important part of the Japanese healthcare system, and this article from Japan Health Info, a site dedicated to explaining the Japanese health system to expatriates, is fully detailed in its description of how hospitals are usually run in the country. As found in the NPR article from Week 1, hospital stays can be long, but, occasionally, going to the hospital might be even more convenient than going to a clinic to get treatment. First consultations are usually made in the morning, and appointments are not required, while afternoon appointments are usually only for returning patients. Unless a person has an emergency, they cannot use the hospital on the weekends or public holidays, and even then, there is a chance that the hospital might not accept the patient. Japan’s health insurance usually pays 70% of bills, while 30% is left to the patient. On top of that, patients without doctors’ referrals are often charged fees (usually ¥2,000-5,000). Wait times are generally long enough to require number cards for both the consultation itself and for payment, the latter of which is cash-only much of the time.

This week’s vocabulary:

救急車 (きゅうきゅうしゃ): ambulance
Ahh! I have bad diarrhea, and I saw blood! Call an ambulance!

内科医 (ないかい): physician (internal medicine)
いつもフラフラですか? 心臓の大切なことですから、内科医に行けばいいの?
Are you always feeling tired/groggy? For the sake of your heart, you should probably see a physician about that.

医療費 (いりょうひ): medical bill/expenses
I think Mr. Tanaka’s high blood pressure treatment is expensive. How come he is able to pay his medical bills so quickly?

待合室 (まちあいしつ): waiting room
1時間後: お待たせしました。待ち合わせのために、待合室をお出し下さい。
One hour later: I am sorry to have kept you waiting. Please leave the waiting room for your appointment.

患者 (かんじゃ): patient
I met an interesting patient. He was an old man, and would always forget about healthy things, but has not died even now.

In spite of Japan’s high standard of care and a healthcare system that (in theory) provides good care for all citizens, its hospitals are another matter. They do not seem to compare favorably to those in a Western countries. The hours might seem archaic, fees are high, payment must be in cash only most of the time, and there are certainly long stays. Although these and other areas might be particularly unfavorable, there is, actually, also much to like about the system. The fact that Japan’s health insurance pays for the bulk of the cost would also be unthinkable in the US, and in Japan, specialists can usually be seen directly, rather than, say, after a wellness check. The inconveniences do seem to factor highly into public perception of the system, however, with a major recent story of a man dying after being rejected 36 times from 25 different hospitals gaining particular notoriety. Indeed, thousands of hospital patients have been rejected at least three times from hospital treatment. That is certainly a concerning low point in an otherwise cheap and decent healthcare system, at least thus far.

Other sources on the subject:

Week 2: 漢方薬 (Chinese Herbal Medicine)


Although Japan uses Westernized medicine like most world powers of its size, one particular method of treatment distinguishes them from the rest: Chinese herbal medicine, or 漢方 (かんぽう)。This website from the Japanese conglomerate Kracie, one of the leaders in the Japanese kampō industry, discusses many of the basic aspects of how it works. The word 漢方 is a portmanteau of 漢, or the Han Chinese, who introduced the Japanese to this kind of medicine in the fifth/sixth centuries, and 方, used as “method” in this case, because Western medicine was called 蘭方 (らんぽう), literally “Dutch medicine” thanks to Japan’s colonial history with that country.
Kampō medicines are usually made with natural herbs that are infused in boiling water. Pharmaceutical companies such as Kracie do this in laboratories and compound the extracts into usable forms. Japan is the only country where doctors can legally prescribe kampō alongside, or as an alternative to, Western medicine, and Japan’s health insurance covers both types. The approach to kampō is more holistic in nature, focusing on the whole body and mind while alleviating symptoms.

This week’s vocabulary:
薬局 (やっきょく) pharmacy
I’ve got a bad cold. How about I go to the pharmacy and get some cold medicine?
生薬 (しょうやく) herbal medicine
That kampō medicine is one kind of herbal medicine.
医大 (いだい) medical school
He wants to go to a good medical school, but his grades have gotten worse. But he’s a student at Tokyo U…
がん cancer
The incidence of cancer in Fukushima’s population has increased, hasn’t it?
QOL – キューオーエル quality of life
People who want to increase their quality of life must do healthy things every day.

Perhaps the strong focus on both Western medicine and Eastern medicine in Japan might be one reason why the Japanese live so long. Even in diseases as complex as cancer and HIV, the use of kampō medicines, either alone or, more commonly, in tandem with drugs developed under the Western tradition, is fairly common in Japan. Contrast this with the US, which certainly has people who use supplements and alternative medicine. The FDA, however, does not regulate what they call “supplements” (that is, herbal medicines and vitamins) on the same level as other drugs, and most insurance companies do not cover them, either. It’s certainly an interesting dichotomy, to say the least, and I wonder what would happen if Western societies considered to use Eastern medicines, like kampō, in their own health regimes. Maybe they might be effective with a low risk of side effects, or maybe they don’t do much of anything. Either way, kampō still has its place in Japan not just as medical treatment, but as another Chinese cultural product adapted and ingrained into Japanese culture.

Other sources on the subject:


Week 1: 健康のシステム (The Health System)


This article/piece from NPR discusses several major key points of the Japanese healthcare system, giving some reasons why it is such a successful one as far as world powers are concerned. Health insurance is mandatory, and the government pays it for you if you are poor, but most hospitals and almost all doctor’s offices are privately owned and operated. The Japanese Health Ministry, on the other hand, regulates fixed prices on procedures and medications in a way similar to that of the National Health Service in Britain. Insurers cannot deny claims. In spite of this, doctors are not paid well in Japan compared to other countries, hospital stays are long, and, surprisingly, hospitals are in a financial crisis.

This week’s vocabulary:

健康保険 (けんこうほけん): health insurance
If you have health insurance, you’ll be fine in any sort of accident.

保険金 (ほけんきん): insurance money
He wants to claim insurance money, but he didn’t suffer any serious injuries in that accident, right?

退院 (たいいん): discharged from the hospital
My grandfather was recently discharged from the hospital, and seems to have become even stronger than before.

検査 (けんさ): examination/scan (such as an MRI or PET scan)
The liver cancer test came back negative. That’s a relief!

手術 (しゅじゅつ): operation/procedure
To prepare for the surgery, you absolutely mustn’t drink anything for the next 24 hours.

I was surprised to see that the Japanese healthcare system serves as a sort of opposite to American healthcare. The Japanese system seems to place most of its expenditures toward affordable healthcare for all instead of only some, and the insurance companies do not serve as enforcers, unlike in the American system, but rather as beneficiaries in addition to the government. For the record, $10-a-night hospital stays would be unthinkable in the US, but then again, so would two-week ones unless someone is severely ill. This sort of dichotomy is especially interesting coming from a country known for hard-line stances on work and school attendance. Although the Japanese, as in other societies, know that healthcare is not a universal good (even with the Health Ministry’s fixed pricing schemes, some drugs are still extremely expensive), they do manage to keep it at least somewhat free and beneficial. Although imperfect, and possibly not sustainable in the near future because of an aging population, it still serves as a good example of an effective universal healthcare system.

Other sources on the subject:


My name is Will, and I’m a sophomore at Austin College currently living in the Japanese House. As someone who has always had a passion for health, medicine and the like, as well as one for East Asian languages and cultures, I have always wondered why Japan has had such a high life expectancy. In particular, I want to see how the Japanese as a society use healthcare in their everyday lives. What I do know is that the healthcare system is universal (in other words, mandatory insurance), there is much reliance on self-medication, and certain diseases, such as obesity and mental illness, have a stigma attached to it that impacts their treatment in this society.

Thus, I have decided to use this blog as a portfolio dedicated to this extended research project. I hope you enjoy my look at Japan’s healthcare system, as well as how the Japanese live healthily.