Living Longer, Ageing Together? A Qualitative Policy Analysis of Public Health Governance in Japan’s Super-Aged Society

Japan has the oldest population in the world, and its public health system has become a laboratory for how mature welfare states respond to demographic ageing. This article asks how Japanese public health policy has defined the problem of ageing between 2000 and 2026, and what tensions those definitions create. Using a qualitative, interpretive document analysis of national legislation, government white papers, ministry planning documents and secondary scholarship, the study traces four policy frames: the shift from longevity to “healthy longevity” in the Health Japan 21 programme; the socialisation of care through Long-Term Care Insurance; the construction of the local community as public health infrastructure under the Community-Based Integrated Care System; and a recent normative turn toward rights and inclusion, visible in the Basic Act on Dementia and the loneliness and isolation legislation. The analysis finds that Japanese policy has steadily moved responsibility for health in later life from hospitals and families toward individuals and neighbourhoods, while relabelling that move in the language of autonomy and mutual support. This approach has produced real gains in prevention and social participation, but it rests on assumptions about family availability, community capacity and care labour that demographic data increasingly contradict. The article concludes that the sustainability of Japan’s model depends less on new programmes than on rebuilding the care workforce and addressing regional and social inequalities in healthy ageing.

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.