KYOTO – In a country famous for the longevity of its inhabitants — this year Japan’s population of people age 100 or over topped 70,000 for the first time — Aomori Prefecture is an outlier.
That’s because Aomori consistently ranks bottom for average life expectancy for both men and women.
According to the government’s most recent statistics, the average life expectancy for men in the prefecture is 78.67 years, and 85.93 for women. In contrast, men in Shiga Prefecture live the longest in Japan on average — just over three years longer than their northern counterparts. Women in Nagano Prefecture live the longest, at 87.68 years.
Aomori is broadly in line with average life spans in countries belonging to the Organisation of Economic Cooperation and Development, of which Japan is a member. But as professor Shigeyuki Nakaji of Hirosaki University in the prefecture points out, just focusing on the headline figures — in this case the average age of death — doesn’t give a full picture of the true health of the prefecture, across all age groups.
“When you take a deeper look into the statistics, you will find that the mortality rate of each age group is quite high in Aomori,” Nakaji said.
“This is why it’s meaningless to focus solely on the elderly,” he added.
For at least the last three decades, Aomori has been trying to play catch-up with the rest of Japan, and several studies as well as public health promotions are ongoing.
In particular, health officials have been trying to wean the people of Aomori off their extreme fondness for salt — and soy sauce and miso and butter — and to re-engineer their lifestyles toward one that includes more exercise, more vegetables and more medical consultations.
The tip of the iceberg
Professor Nakaji probably knows the most of anyone in Aomori about the health of the prefecture. In 2005, Nakaji helped found the Iwaki Health Promotion Project, which uses data drawn from a wide range of sources to track health variables.
“What we know so far is only the tip of the iceberg; we only understand 10 percent of the whole problem,” Nakaji said.
According to Nakaji, what the studies show so far is that — as you might expect — lifestyle has a correlation with longevity.
“What we’ve found so far is that an unhealthy lifestyle, including smoking and or drinking, lack of exercise, excessive intake of salt, all impact on health.”
“The other 90 percent is problems related to weather, culture, education, income … and lifestyle habits exist on top of these other issues,” Nakaji added.
Through the Iwaki Health Promotion Project, Nakaji has been trying to better understand that 90 percent.
According to Yukako Tateda, from the Department of Cancer and Lifestyle-related Diseases Prevention in Aomori, the prefecture has the nation’s second-highest rate of smoking among men — at 36.5 percent — as well as the highest rate of habitual alcohol use among men. It also comes in 46th in the nation for steps walked per day by men, an indicator of how active a person is.
In order to lift Aomori off the bottom of the pile, it’s not as simple as telling people to quit smoking, Nakaji said. “The situation would hardly change, and it would be irresponsible for us to say such a thing.”
Cutting back on salt
One issue that politicians and health officials have been united on is in getting people across Aomori to consider how much salt they use, and how much they actually need.
Hisao Nishimura, 69, originally from Aomori city and now living in Kyoto, recalls that when he moved to the Kanto region for university, he became the object of attention during lunch times in the college canteen. “I used to pour soy sauce on nearly every dish. Eventually my friends spoke up and warned me that I was using too much.”
As Nishimura explained, growing up in Aomori, the two main seasonings his family would use were salt and soy sauce.
“We’d pour soy sauce on everything — even on salty food like pickles.”
The long harsh winters in Aomori might also explain why the prefecture outranks the rest of Japan when it comes to consuming instant noodles, another product with a high salt content.
Aomori has, however, made progress when it comes to convincing residents to consume less salt. Between 2006 and 2010, the average daily intake of salt by men was 13 grams, the second-highest in the nation, while for women it was 10.9 grams, the fifth-highest in the country.
In 2016, salt consumption had dropped to 11.3 grams per day for men and 9.7 grams for women, according to that year’s National Health and Nutrition Survey. While that was still above national targets laid out in 2015, at less than 8 grams a day for men and 7 grams a day for women, Aomori is headed in the right direction.
By reducing salt consumption, health officials in Aomori hope to decrease deaths and illnesses caused by heart attacks, strokes and cancer.
Professor Nakaji and his team at the Center of Healthy Aging Innovation at Hirosaki University have turned to data, in a big way, to get a fuller picture of the overall health of residents in Aomori and as a way of improving health conditions.
Through the Iwaki Health Promotion Project, they have been tracking thousands of people in Aomori across hundreds of variables that include sleep, diet and working habits, as well as hobbies, time spent conversing with others, intestinal bacteria and even genome analysis.
Nakaji said that there’s still a considerable amount of sifting through the data that needs to be done, but ultimately he believes it will help them better understand health issues and even assist with detecting diseases such as dementia and lifestyles diseases early on.
Nakaji explained that schools and workplaces across Aomori are frontiers where issues about health awareness can be tackled.
So far, about 100 elementary and secondary schools have signed on for health education classes that give students a basic health literacy and vocabulary.
“It sounds basic, but in order to achieve a longer life expectancy, children need to know and understand about health matters,” Nakaji said.
If intent is a yardstick to measure what Aomori plans on doing, then the outlook is rosy. There are health initiatives drawing in business and companies throughout the prefecture, and by June all 40 municipalities in Aomori had signed on for a prefecture-wide “health declaration” to improve health conditions and health awareness.
“I’m very serious about changing society through cooperation,” said Nakaji. “Otherwise, people cannot become healthy. We cannot break the stigma of Aomori’s shorter life expectancy.”