Trends in health and health inequality during the Japanese economic stagnation: Implications for a healthy planet

Ayako Hiyoshi; Kaori Honjo; Loretta G Platts; Yuka Suzuki; Martin J Shipley; Hiroyasu Iso; Naoki Kondo; Eric J Brunner

doi:10.1016/j.ssmph.2023.101356

Trends in health and health inequality during the Japanese economic stagnation: Implications for a healthy planet

SSM Popul Health. 2023 Feb 6:22:101356. doi: 10.1016/j.ssmph.2023.101356. eCollection 2023 Jun.

Authors

Ayako Hiyoshi^{1

2

3}, Kaori Honjo⁴, Loretta G Platts⁵, Yuka Suzuki⁴, Martin J Shipley², Hiroyasu Iso^{6

7}, Naoki Kondo⁸, Eric J Brunner²

Affiliations

¹ Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
² Department of Epidemiology and Public Health, University College London, London, UK.
³ Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
⁴ Department of Social and Behavioural Sciences, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.
⁵ Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden.
⁶ Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
⁷ Institute for Global Health and Medicine, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
⁸ Department of Social Epidemiology, Kyoto University, Kyoto, Japan.

Abstract

Introduction: Human health and wellbeing may depend on economic growth, the implication being that policymakers need to choose between population health and the health of ecosystems. Over two decades of low economic growth, Japan's life expectancy grew. Here we assess the temporal changes of subjective health and health inequality during the long-term low economic growth period.

Methods: Eight triennial cross-sectional nationally representative surveys in Japan over the period of economic stagnation from 1992 to 2013 were used (n = 625,262). Health is defined positively as wellbeing, and negatively as poor health, based on self-rated health. We used Slope and Relative Indices of Inequality to model inequalities in self-rated health based on household income. Temporal changes in health and health inequalities over time were examined separately for children/adolescents, working-age adults, young-old and old-old.

Results: At the end of the period of economic stagnation (2013), compared to the beginning (1992), the overall prevalence of wellbeing declined slightly in all age groups. However, poor health was stable or declined in the young-old and old-old, respectively, and increased only in working-age adults (Prevalence ratio: 1.14, 95% CI 1.08, 1.20, <0.001). Over time, inequality in wellbeing and poor self-rated health were observed in adults but less consistently for children, but the inequalities did not widen in any age group between the start and end of the stagnation period.

Conclusions: Although this study was a case study of one country, Japan, and inference to other countries cannot be made with certainty, the findings provide evidence that low economic growth over two decades did not inevitably translate to unfavourable population health. Japanese health inequalities according to income were stable during the study period. Therefore, this study highlighted the possibility that for high-income countries, low economic growth may be compatible with good population health.

Keywords: De-growth; Economic stagnation; Epidemiology; GDP; GDP, Sustainable Development Goal; Health inequalities; Planetary health; Self-rated health; Sustainable development goals; UK, The United Kingdom; US, The United States; Wellbeing.

Grants and funding

MR/R024227/1/MRC_/Medical Research Council/United Kingdom