寿命延长了，但我们能否共同安老？——日本超高龄社会公共卫生治理的定性政策分析

日本拥有全球老龄化程度最高的人口结构之一，其公共卫生体系已成为研究高度发达的福利国家如何应对人口老龄化转型的重要案例。本文旨在探讨2000年至2026年间，日本公共卫生政策如何界定和理解人口老龄化问题，以及这种政策框架的形成与演变产生了哪些政策层面的张力和矛盾。

本文采用定性研究方法，通过对国家法律、政府白皮书、相关政府部门政策规划文件及既有学术文献进行分析与解释，考察日本老龄化公共卫生政策中四个主要框架的发展演变。

首先，在“健康日本21”（Health Japan 21）计划下，政策重心逐渐由单纯延长预期寿命转向延长健康寿命。其次，通过长期护理保险制度（Long-Term Care Insurance），老年照护逐渐被确立为全社会共同承担的责任。再次，在社区综合照护体系（Community-Based Integrated Care System）框架下，地方社区被纳入公共卫生基础设施的重要组成部分。最后，近年来日本老龄化政策出现了规范性转向，更加强调老年人的权利保障与社会包容性参与，这一变化集中体现在《认知症基本法》以及有关孤独与社会孤立问题的法律和政策之中。

研究发现，日本的公共卫生政策逐步将老年健康与照护责任从医院和家庭转向个人与社区，并通过“自主生活”与“相互支持”等理念为这一转型提供政策正当性。尽管这一模式在疾病预防、健康促进和社会参与等方面取得了切实成效，但其运行仍然建立在若干重要假设之上，包括家庭具有足够的照护能力、地方社区具备必要的组织与服务资源，以及照护劳动力能够持续满足社会需求。然而，当前的人口统计数据表明，这些假设正面临越来越明显的现实制约，政策设计与社会实际条件之间的不匹配也日益突出。

本文认为，日本老年照护模式的可持续性，并不主要取决于不断推出新的政策计划，而在于能否恢复并增强照护劳动力的供给与服务能力，同时缓解不同地区和社会群体在健康老龄化机会方面存在的不平等。

Allison, A. (2013). Precarious Japan. Duke University Press.

Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative Research Journal, 9(2), 27–40.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

Cabinet Office, Government of Japan. (2025). Annual report on the ageing society: FY2025 [Summary]. https://www8.cao.go.jp/kourei/english/annualreport/2025/pdf/2025.pdf

Campbell, J. C., & Ikegami, N. (2000). Long-term care insurance comes to Japan. Health Affairs, 19(3), 26–39.

Estévez-Abe, M. (2008). Welfare and capitalism in postwar Japan. Cambridge University Press.

Health and Global Policy Institute. (2024). Dementia policy for an inclusive society 2024: HGPI recommendations on the Basic Plan on Dementia to Promote an Inclusive Society (draft). https://hgpi.org/en/research/dementia-20240813.html

Hikichi, H., Kondo, N., Kondo, K., Aida, J., Takeda, T., & Kawachi, I. (2015). Effect of a community intervention programme promoting social interactions on functional disability prevention for older adults: Propensity score matching and instrumental variable analyses, JAGES Taketoyo study. Journal of Epidemiology and Community Health, 69(9), 905–910.

Ikeda, N., Saito, E., Kondo, N., Inoue, M., Ikeda, S., Satoh, T., Wada, K., Stickley, A., Katanoda, K., Mizoue, T., Noda, M., Iso, H., Fujino, Y., Sobue, T., Tsugane, S., Naghavi, M., Ezzati, M., & Shibuya, K. (2011). What has made the population of Japan healthy? The Lancet, 378(9796), 1094–1105.

Ikegami, N. (2019). Financing long-term care: Lessons from Japan. International Journal of Health Policy and Management, 8(8), 462–466.

Japan News. (2025, April). Nursing care workers in Japan fall to 2.13 million; demand growing higher, but pay remains low. Asia News Network. https://asianews.network/nursing-care-workers-in-japan-fall-to-2-13-million-demand-growing-higher-but-pay-remains-low/

Kondo, K. (2016). Progress in aging epidemiology in Japan: The JAGES project. Journal of Epidemiology, 26(7), 331–336.

Kyodo News. (2026, September 29). Japan elderly population hits fresh high at 29.4 per cent: 2025 census. Bernama. https://bernama.com/en/world/news.php?id=2613292

Lim, D. (2024). The establishment of the Dementia Basic Act in Japan: Key contents and implications. Global Social Security Review, 30, 57–70. https://doi.org/10.23063/2024.09.5

Ministry of Health, Labour and Welfare. (2023). Kenkō Nippon 21 (dai-sanji) suishin no tame no setsumei shiryō [Explanatory material for the promotion of Health Japan 21 (third term)]. https://www.mhlw.go.jp/content/001158870.pdf

Ministry of Health, Labour and Welfare. (2024a). Kenkō jumyō no Reiwa 4-nen-chi ni tsuite [On the 2022 values of healthy life expectancy]. https://www.mhlw.go.jp/content/10904750/001363069.pdf

Ministry of Health, Labour and Welfare. (2024b). Dai 9-ki kaigo hoken jigyō keikaku ni motozuku kaigo shokuin no hitsuyō-sū ni tsuite [Required number of care workers based on the 9th long-term care insurance business plans]. MHLW.

National Police Agency. (2025). Keisatsu no toriatsukatta shitai no uchi, jitaku ni oite shibō shita hitori-gurashi no mono [Persons living alone who died at home among deaths handled by the police, 2024]. NPA.

Nippon.com. (2025). Healthy life expectancy gap remains constant in Japan. https://www.nippon.com/en/japan-data/h02252/

Nomura, S., Sakamoto, H., Ghaznavi, C., & Inoue, M. (2022). Toward a third term of Health Japan 21: Implications from the rise in non-communicable disease burden and highly preventable risk factors. The Lancet Regional Health – Western Pacific, 21, 100377.

Nomura, S., Sakamoto, H., Glenn, S., Tsugawa, Y., Abe, S. K., Rahman, M. M., Brown, J. C., Ezoe, S., Fitzmaurice, C., Inokuchi, T., Kassebaum, N. J., Kawakami, N., Kita, Y., Kondo, N., Lim, S. S., Maruyama, S., Miyata, H., Mooney, M. D., Naghavi, M., … Shibuya, K. (2017). Population health and regional variations of disease burden in Japan, 1990–2015. The Lancet, 390(10101), 1521–1538.

Ochiai, E. (2009). Care diamonds and welfare regimes in East and South-East Asian societies: Bridging family and welfare sociology. International Journal of Japanese Sociology, 18(1), 60–78.

Statistics Bureau of Japan. (2025). Tōkei kara mita waga kuni no kōreisha [Japan’s older population as seen through statistics] (Statistical Topics No. 146). Ministry of Internal Affairs and Communications.

Tsutsui, T. (2014). Implementation process and challenges for the community-based integrated care system in Japan. International Journal of Integrated Care, 14(1), e002.