How healthy is ‘healthiest’?

This is no time to be complaining about minor aches and pains. The World Health Organization has just announced that the Japanese are the healthiest people on the planet. This comes as a welcome surprise, since this country is frequently criticized by health-conscious foreign observers for its continuing acceptance of smoking in public places and the extent of the social drinking that lubricates personal and business relationships. At the same time, the usually fatal diseases associated with the stressful lifestyle in developed nations are now common here. Do the WHO experts know something we do not?

The report was a comparative global analysis of national health-care systems. In that ranking, this country did not come out on top. Nevertheless, it is a remarkable achievement for Japan’s health and medical facilities to be placed 10th on a list of 50 nations, well ahead of those in Britain, Canada, the United States and the Northern European countries long considered models for providing maximum health care for their citizens.

Although the WHO study ostensibly was not intended to determine which nations have the healthiest people, that is what its critics say has been the result. Yet attempting to compare systems and conditions in countries as different as San Marino, Singapore, Switzerland and Saudi Arabia, say, must have been a daunting task. Those countries registered as numbers 3, 6, 20 and 26 respectively in the comparison of how well the various governments allocate their health-care budgets and how effective their public-health systems are in keeping people from becoming sick, not just how well illnesses are treated after they are contracted.

Japan may be encouraged that the WHO statisticians rate this country as high as 10th in this regard, but it is no reason for complacency by the public, or by the politicians and bureaucrats who seek ways to cut corners at budget-setting time. One element in making Japan “healthiest” should be the constantly lengthening life expectancies here. Last year the nation counted more than 11,000 men and women aged 100 or above. A private U.S. research firm has predicted that the Japanese will live for an average of 90.91 years by 2050, the longest among the seven leading industrialized nations. The government disagrees. Its estimate for the same year is an average life expectancy of 82.95 years.

As people live longer, however, they naturally become more likely to develop illnesses associated with aging. This is already occurring in Japan, but truly adequate means for dealing with prolonged and often expensive therapies, as well as extended periods of home nursing care, have not been forthcoming, despite all the plans and promises of the government and the Health and Welfare Ministry bureaucracy.

Living longer does not equate with better health if it involves worries over serious and debilitating illness. WHO experts may give high marks to the level of treatment generally available in Japan’s private and public clinics and hospitals. Were they aware of the rapidly rising number of medical mistakes occurring in these facilities, often involving the elderly, that sometimes result in the patient’s death? A recent survey by a medical workers union found that 62.7 percent of nurses in Tokyo have made medical errors on the job. And the health ministry has just announced that, nationwide, only 10 percent of hospital department heads reported medical accidents to the ministry in fiscal 1998, the last year for which official figures are available.

Fears are only partly eased by the proposals for rules and guidelines, designed to reduce the number of malpractice cases, which have been forthcoming from both the Health and Welfare Ministry and a council composed of directors of university-affiliated hospitals operated by the state. Certainly such rules are needed — and must be enforced — since it is sadly clear that too often medical institutions fail to report serious medical errors to the police when the patient dies or to give the victim’s family a full and fair accounting of all that happened.

The WHO specialists who find the Japanese so healthy would be well advised to look more deeply into the situation here. Are they aware, for example, that more than one in three people responding to a ministry survey last year reported suffering from serious chronic fatigue? WHO may have completed its analysis too soon to know that more than 90 percent of respondents in a nationwide government poll fear falling victim to “lifestyle-choice” diseases — high blood pressure, cancer, diabetes — but fewer than 30 percent intend to change their behavior patterns. Does good health lie in the eye of the beholder?

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