This week I along with one of my colleagues went to a clinic and got the winter flu vaccine. The winter flu is said to be exceptionally terrible this year and it requires, in some cases, an entire week off work- no thank you.
As part of the visit I had a chat with the doctors and I need further tests. The ironic thing is that one of my awareness topics (diabetes) is something I am now being tested for along with hypertension (high blood pressure).
The vaccine costs ¥3300 (regardless of insurance) and an extremely common side effect is a localised rash and fatigue, both of which I had.
I would recommend getting the vaccine if you haven’t already had it. Additionally, if your at a clinic, spend an extra ¥1000 and get a diabetes test.
Thank you for reading and happy exploring
Quick note, my laptop has broken (thank you window’s update) and is stuck in a boot loop, and my recovery disk broke, so posts may be slower or shorter for a time.
Let’s look at diabetes in Japan in a bit more detail.
Diabetes Millitus is an extremely common non-commutable disease (NCD) that exists in every country- and Japan is no exception. In fact, diabetes has been on the rise in Japan and it is getting the recognition it deserves.
Diabetes in Japanese is 糖尿病 which is read as [too/nyou/byou] and is made up of 3 kanji: 糖- sugar,尿- urine, and 病- sickness so it is a decent translation.
There are a suspected 10 million people who suffer from diabetes in Japan but there are only 78.7% of men who receive treatment and 74.1% of women who receive treatment- but the difficulty is there are an additional 10 million who are at risk of becoming a diabetic. Additionally there are more than 300,000 people who regularly undergo dialysis.
There are 2 main types of diabetes which are simply called:
Type 1 is an immunodeficiency disorder (which means the body attacks its’ self) where the immune system is destroying pancreatic beta-cells that are responsible for producing insulin. People with type 1 diabetes need to inject insulin for survival.
Type 2 can be a few things but it is generally the body’s inability to cope. For example, the body either in unable to cope with the amount of insulin it produces (i.e. too little) or the insulin it does produce cannot properly interact with receptors on the cell membrane and take in sugar.
Other types can include gestational diabetes- diabetes during pregnancy, diabetes which is due to other conditions e.g. endocrine disorders, liver disease, drug or chemically induced etc.
Additionally, there is idiopathic diabetes is diabetes without a known cause. Idiopathic comes from 2 Greek words: ἴδιος (one’s own) and πάθος (suffering).
In Japan, a singular blood test is not enough to be diagnosed as a diabetic. One of the required symptoms of diabetes is chronic hypoglycemia or long-term high blood sugar (慢性低血糖).
After this symptom has been observed and a HbA1c test performed (which gives the average blood sugar level over a 3 month period), further tests are performed which are:
a fasting blood test. Diabetes is suspected if the result is greater than 126mg/ dl (which is greater than 27.0 mmol/l )
An oral glucose tolerance test (a 2h test) and if the result is greater than 200mg/ dl (or greater than 1.11 mmol/l)
The Japanese problem
With the westernization of Japan and the influence of the Japanese diet, in addition to reduced physical activity- Asia and Japan are going to be the epicenter of global diabetes.
Japan has sugar in everything and the Japanese diet is extremely carbohydrate heavy (rice) which encourages poor control and helps the development of type 2 diabetes. Additionally, the estimated cost for diabetic treatment is 400,000 JPY a year and even with the national health insurance discount, this is a whopping 120,000 JPY a year. While this is cheap for Americans in Japan, anyone from a country with a funded health system, this is an extraordinary expense.
Diabetes education and awareness
There are a few diabetes organisations in Japan that are actively working to promote health living and help people who have already been diagnosed with diabetes. However, there is still a lot more to be done. The main source for this information is the Japanese diabetes society (information in English and Japanese). Please check out the “further information” page for further links and reading.
Thank you for reading and happy exploring.
Final note, the following is a list of diabetes vocabulary and the Japanese translation.
As I travel around Japan, especially at this time of year, I seem to almost be assaulted with Christmas, it is inescapable. Just when I thought I would get a break, I’m proven wrong.
The Asunaro is a small train line located in Yokkaichi city, Mie which would be a bus route in any other city. It’s small, cheap and great value for money, it is so much smaller than the Iga tetsudo line but amazingly it has 2 lines.
However Christmas is here as well. Admittedly it was a lovwlth offering but it was so out of place. Yokkaichi is an extreamly Japanese city, even on the train they use ございます(gozaimasu) instead of です(desu) for station names, not even the JR line does that.
Into this mix christmas flows as easily as reading the city’s name: 四日市市 which is easy once you know it (Yokkaichi-shi) but trying to work it out from the Kanji alone is troublesome.
Capital punishment or the death penalty exists in Japan and it is still used. This may come as a shock to people who are excited by the ‘strangeness’ of all things Japanese but it is a reality.
The world seems to be moving away from capital and corporal punishment and there is heavy debate about this- no matter the culture or religious background of the country.
Japan has received criticism, sometimes rightfully so, for many things. The most controversial is political motivation. Executions in 2018 were at a 10 year high at 18 and the reasoning for this simple: it may be hard to carry out executions in 2019 due to the abdication and crowning of the emperor, and a reluctance to carry out an execution when the Olympics are taking place.
Additionally, under Japanese law, commended prisoners are not classified as prisoners so the conditions they are kept in are not reported on. Japan has come under fire from Amnesty International on several occasions because of the way it treats prisoners.
In practice, the death penalty is only given to multiple murders or murders with additional unspeakable actions e.g. murder kidnapping etc. In addition to this, there are a further 9 factors which will affect the sentencing:
Degree of viciousness- was the person ‘put out of their misery’ or was it a messy affair?
Motive- revenge, money, love, just because?
How the crime was committed; especially the manner in which the victim was killed. (also looks into planning and additional factors)
Outcome of the crime; especially the number of victims.
Sentiments of the bereaved family members. (The most important one on the list).
Impact of the crime on Japanese society.
Defendant’s age (in Japan, the age of majority is 20). (18+ can be given a death sentence)
Defendant’s previous criminal record. (first time or long history)
Degree of remorse shown by the defendant. (does depend on the person and the crime)
This was something that I studied in detail during my time a NUFS and it has always stuck with me. In theory there are safeguards and at a sentencing level it does work. Additionally, the death sentence is rarely imposed and the Japanese BAR association want to:
… the JFBA hereby strongly protests the executions conducted today [02/08/2019], and reiterates its stance that the Government should immediately suspend all executions [moratorium], looking towards the total abolition of the death penalty system in Japan by 2020.
Yutaro Kikuchi, President (August 2, 2019) Japan Federation of Bar Associations
The JFBA posts in English, Japanese, and Chinese and it is a brilliant resource which does report on “unpopular” topics- if noting else, please do check out their ‘opinion’ posts.
Alas, the death sentence seems like a convenient option for the Japanese government to be seen to be doing something.
Public opinion is in favor of the death sentence and it is logical that the family of the victim seek the harshest punishment possible- whether this is always the correct choice is another conversation.
Fun fact: trial by jury was only introduced in 2009 in Japan (please re-read that statement. The line in ‘ a trial by your peers’ goes back to 1215 in UK law, to the foundation of the US (it’s the 7th amendment), was used in the ancient world (Greece and Rome) but it is only 10 old in Japan.
Most Japanese are in favor of the death sentence and even though there are campaigns against it, it does not seem likely to change any time soon.
Another fun fact: condemned prisoners sentenced before 2009 have been campaigning for a retrial and to be tried by their peers- most appeals for a retrial has been denied.
The Death chamber
The actual process of execution is carried out by hanging using the ‘long drop’ method to snap the neck.
The death warrant is signed by the minister of justice and once signed the condemned will be executed within 5 days. The problem with this system is that no-one is told. The prisoner is only told the morning of his execution that he as, at best, 15 hours left in this world.
Death chambers are located across Japan, but the 3 that are used the most are in Tokyo, Osaka, and Nagoya (which are the 1st, 3rd and 4th biggest cities ion Japan).
A clash of culture
Japan is an extremely Buddhist country and many laws reflect Buddhist teachings. The death sentence was initially introduced from China (along with a writing system, culture, law, philosophy etc) before being abolished until 1180.
Even though Buddhism teaching the scanty of life and the importance of preserving life, executions until the Meiji period (1873) were cruel and unusual and the meaning for this is said to be Confucianism- where your position in society must be protected and any perceived threat was dealt with. Think of the witch hunts- and you know how they got confessions, treated the accused and just what rights they (did not) have- this was how the condemned were treated in Japan.
In modern Japan, only murder gets a death sentence. But, is this still too much, or is it too little? What do you think?
A difficult topic to talk or write about but: an overview of palliative care in Japan
This is a difficult topic. This is a guide which should able to give you some guidance if you need it. This guide does NOT offer mental or spiritual advice, just an overview on palliative care.
You may be wondering why the warning- simple: dealing with either life shortening illnesses or end of life care is hard to experience. I have seen family members go through this and it is never easy. This guide should be helpful and it will include my opinions, and where to find help in Japan. If you do comment, please remember this is an extremely difficult topic- everyone has their own opinions and needs.
What is palliative care?
Palliative care helps individuals and families that are dealing with life-shortening illness and end of life care. Life shortening illnesses could be ALS, cancer, motor-neuron disease etc. End of life care is usually helping with pain management, emotional, physical, and spiritual support to those whose time is limited.
What you must remember is that everyone has different needs and wishes. Some end of life treatment plans may include hospice care, home care or hospital care. Additionally, palliative care seeks to neither hasten nor post-pone death. It simple seeks to improve the quality of life.
In developing countries at time of diagnosis 80% of cancer is incurable and the only thing left is palliative care- which is still a ‘new’ concept in may countries but millions of people are seeing the benefits of it.
The best resource I have found to show the benefits of this is a YouTube video. Please check out the ‘further resources’ page for the link.
Going to a hospice does not mean a place to die, for many it is a place to live before death. If you are in a position where palliative care is necessary- remember you are still alive and there are still bills to pay, things to do- life does not stop.
Hospice care takes these worries away from a person at a time when they’re usually extremely tired and don’t have much energy. For cancer patients, they can (and usually do) outlive their prognosis and are discharged from hospice care and in extremely rare circumstances return to a normal life (this is from a terminal prognosis).
For others, it is a place to help prepare one’s self and the family for the end.
Japanese hospice care
There are an estimated 300 hospice programs in Japan since the start of the program in the 1970’s.
Hospice care works with one basic principle: quantity rather than quality. For end-of-life treatment, emotional support and pain relief is at the heart of care. However, the hospice movement was a late movement in Japan. Many other countries had programs and support systems in place before Japan and in some respects Japan is catching up.
Therefore, end-of-life treatment in Japan primordially takes place in hospitals, and at home.
The Japanese hospice palliative care foundation looks to improve the image of palliative care in Japan as it is only seen as a place to die not as a place to live.
Home hospice care starts with a care plan with one member becoming the leader of a persons care. Doctors, nurses, people who supply medical equipment etc come together with the patient and family to talk about their goals of care, what they would like and what their family would like.
Home hospice treatment is supported by doctors and nurses trained in palliative care to ensure that (especially in Japan) terminal cancer patients have all the support they need. Home hospice care is becoming even more important in Japan due to 2 factors: an aging population and a short-fall of hospital beds.
Another reason for the rise of home hospice care is cost. For people under 70, a hospice can cost 469,000 JPY a month with a 70% reduction- this could be as little as 93,000 JPY a month- which is still, in my opinion, an unreasonable amount of money. For those over 70, hospice care costs 57,600 JPY a month- which is still expensive. Home care is cheaper- just a consultation fee, medical equipment fees and care support costs are needed.
However, home hospice care is not what most Japanese want. Many Japanese do not wish to be a burden on their families and would prefer to experience hospice care in a hospital setting. This is one of the things that the Japan Home Hospice Association is trying to combat.
There are brilliant resources in Japanese and English- the English resources are more limited. The key focus of this article was awareness and to give you a better understanding of what palliative care in and what your options are if you are researching it.
I have spoken to many people about food in Japan, whether is about breakfast, lunch, special food, shabu shabu (almost a winter broth) or even snacks and everyone I have spoke to said the same thing: watch the salt.
As this is the month of awareness, let’s take a look at the problems salt, along with other causes, may bring. Welcome to cardiac problems in Japan.
Firstly a definition. Cardiac problems will consider heart disease, heart attacks and cardiovascular disease as well. If this were to be published anywhere else I would have to think about each problem separately but not too many people would be interested in that, do let me know if I’m wrong on that front.
Starting off in a happy place, cardiac issues is one of if not the main causes of death in Japan, like many other highly developed nations. There are many causes for this, not just McDonald’s and fast food. The WHO have ranked 3 heart related conditions as the main causes of death in Japan which were: Ischaemic heart disease (aka Coronary Artery Disease), Aortic aneurysm, and other cardiovascular disease.
However, there have been 42,300 fewer CHD deaths because of medical and surgical treatments from 1980- 2012.
Major health trends
To start with let’s take a look at some general health trends which have contribute towards higher levels of heart disease in Japan. Firstly, Japan has become increasingly Westernized and has been since the 1960’s. While this has had many advantages culturally, economically, socially etc, there has been a negative impact on health.
The major trends that have been seen in Japan are a rise in the number of smokers within Japan, a noticeable difference in BMI- levels are much higher (in 1980, the average BMI for men was 22.5 kg/m^2 and by 2000 this has risen to 23.4kg/m^2); a rise in the number of diagnosed diabetics; an increase in blood pressure.
Side note: blood pressure. Blood pressure has 2 values: a systolic value (the top number) and a diastolic value (the bottom number). The WHO recommends that one’s BP should be 120/80 mm Hg- which is the ‘perfect’ value. High blood pressure is any reading that at rest is over 130/80 mm Hg.
Japan’s blood pressure is worrying- the average systolic blood pressure is 135 mm Hg (which is high) and the mean diastolic reading is 85 mm Hg. This average 135/85 mm Hg puts you into the Hypertension stage 1 category or High blood pressure stage 1 group.
Major factor: salt
One resource I used during my research was the Cardiovascular Risk Assessment Chart by Dietary Factors in Japan (which is a brilliant resource- linked in further information) and the major risk assessment was salt.
Salt is essential to life as we cannot naturally product it but we need it in moderation only. In the UK, it is recommended to have no more than 6 grams of salt a day- the recommended daily limit in Japan is 1.5 grams of salt (which explains why Japan has a lower level of CDV (cardiovascular disease). However, daily recommended limits are not always possible.
Average daily salt intake (from a sample size of 9115 people) was 14.0±5.2 g. This means that the lowest average daily intake was 8.2g. The risk assessment categorizes people into 2 groups based on salt intake high (men and women that consumed more than and including 8g and 7g of salt respectively) and low (those who consumed less than this).
This risk assessment showed that after 29 years, there had been 1070 deaths attributed to CVD. From the 2 salt intake groups, there were 57 deaths from the low salt intake group and 1,013 deaths from the high salt intake group (while there were other factors which contributed to their deaths- numbers are telling).
What factors have contributed towards Japan’s low CVD death rate?
Strangely enough, the Japanese diet has helped (and hindered) CVD in Japan. The main things which can reduce risk is consuming omega 3 (eating fish or rarely via supplements), avoiding sugar (hard to do in Japan), avoid trans fats (again difficult to do), ensure adequate vitamin D intake (either dietary, by being in sunlight or supplements) and controlling iron.
Not surprisingly, the Japanese consume a lot of fish- but the amount the Japanese consume has dropped. In 2016, the Japan Times reported that the average fish consumption as a mean 27.3 Kg a year- which is still a massive amount.
Additionally, the Japanese diet of high levels of fish, fruit, vegetables and (ideally) low salt consumption are the perfect heart diet. However with higher salt consumption and what can only be described as a fast food diet (low vegetables, fruit and fish), CVD is extremely likely and possible.
Soy based products (tofu) are also extremely helpful in reducing CVD risk and its’ benefits have been noted in men and women but especially in post-menopausal women.
CVD is regional in Japan and it has mostly been reduced except in major urban areas (Tokyo and Osaka). In major urban areas, there are higher levels of stress, less time to cook (so more processed food), less time for exercise etc so there are higher levels of CVD.
Further reading- The Japanese heart foundation (JHF)
There is certainly more information on this topic- in English (more research papers than advice) and in Japanese. The best resource I have found was the JHF or Japanese heart foundation (BHF or AHF anyone?).
The JHF have information on diet, research, AED and first aid training and so much more. Please do check it out- there are enough info-graphics that if you have a good scientific mind, you should be okay.
Organ donation is a complicated topic in Japan. Here’s a quick guide.
A needed practice but the Japanese usually don’t follow it
One thing I have found during my research on all things Japanese is the need for tradition. Traditions almost govern modern Japanese society and can be observed at every level. However, tradition costs lives.
What I specifically mean by that is traditional practices takes precedence over life in some circumstances. For example, it is culturally expected that a body is to be cremated whole without anything missing. The problem with this is simple, that body is to be disposed via cremation- it is to be burnt and all organic material with it. Why should I be concerned with this- you may wonder. Simple- statistically there are only 0.7 transplants per million or 64 took place in 2016 (for all organs) and in 2019 there have been 102 donors and 372 recipients ( https://www.jotnw.or.jp/ ).
The bright side, the numbers have increased by 38 over a two year period. Alas, the number of people waiting for an organ is 13,948 as of Halloween 2019. This looks especially terrible when you consider that over 1,000,000 Japanese people due annually and many bodies are ‘put on ice’ until there is room at crematoria. I do realize that not all bodies are suitable for transplants- but which ones are?
Under Japanese law, anatomical gifts (organ donations) can be given under 2 conditions: brain death and cardiac death. But the rules governing organ transplantation are possible the strictest in the world. Organ transplantation may only be considered under the following circumstances:
Organ donation or 臓器提供 is based upon explicit permission where people have to opt in. The individual has stated (in writing) that they wish for their organs to be donated.
The family is in agreement
The only causes of death accepted are brain or cardiac death (cases involve suicide to try and help another will NOT be accepted)
In fact, donations from brain-dead donors (脳死）still makes headline news especially donors under 18. In February, the parents of a boy under 6 (his exact age was not given) made the difficult decision to donate the organs of their son- who was always looking to help others. Recipients were almost immediately chosen- highlighting the need further.
There are still problems with this system and again it is cultural. Many doctors still do NOT recgonise brain death as a cause for human death in Japan and if the cause of death is declared as anything else, organ donation is not possible.
Brain death under Japanese law is cited as the following:
Brain death will only be declared if organic injury is observed in the brain with attributable cause and if the following criteria are met:
Dilated and fixed pupils
Loss of brain stem reflex
Flat brain waves
Loss of spontaneous respiration
Two or more doctors with requisite expertise and experience confirm no changes after a second test conducted six or more hours later.
Japanese organ transplantation network
There are ongoing campaigns to either change the law in Japan to allow donations from a wider pool of donors and campaigns to raise awareness. The green ribbon campaign works with one core principle:
Yes is okay. No is okay. It is your intention [choice].
Green ribbon campaign
This campaign shows the difference organ donation has on many lives and has a section on the website to share the stories of recipients so you can see what a difference it has made.
Families that have not been able to receive a new organ have only a few options.
Firstly, do nothing. For patients who need a major organ (heart, liver, lungs etc) they can choose to do nothing. This would result in their death.
Secondly, secondary care options e.g. dialysis for kidney issues. The problem with this option is the expense. Dialysis costs 6 Million yen a year- for the rest of their lives- whereas transplantation costs 6 Million yen and only requires blood tests and doctors appointments instead. This is a cheaper option which takes us to option 3.
Travelling abroad in hopes of paying for a transplant. This method is expensive as in remortgage your house expensive. The problem is that no country has a stockpile of spare organs- but these organs need to be sources from somewhere. This may be the black market or taking organs from others in that country that also need them.
This is an extremely complicated issue in Japan where tradition and human life fight against each other. Japanese law was changed in 2010 and even though may younger Japanese are filling out organ donation forms and, as an outsider, I feel more still needs to be done in order to help more people survive.
Japan and Christmas are a wonderful match, especially when Japanese culture is added to the mix. Partying, even having a dinner party, is an expected part of any festive celebration but why should the adults get the special drinks- won’t anyone think of the children?
Okay this sounds weird but don’t worry children, the soda industry has your back. Firstly, these drinks are not cheap but they are covered in colorful plastic packaging with Doraimon and other characters. There is also Appletiser, which I do like but is still full of sugar.
People usually buy these drinks for either the Christmas party of for New Year’s eve/day celebrations at an extremely cheep 1000 JPY a drink (or 10 USD).
This section is also brilliant for the non-drinkers (me) wanting a social life- just a little one though.
Time for another jolly post but this time about disposition. But why talk about such a topic during awareness month? Simply put, it is a problem that no-one talks about.
Global disposition options
The reason to address this first, it to highlight the differences between Japan and the rest of the world.
When considering disposition, 2 options usually come to mind: burial or cremation.
There are 2 main types of burial: natural burial and traditional burial. Natural burial is the type of burial that has been practiced for generations within the Jewish and Islamic communities and is slowly become more accepted in the western World- even though it has only been about 100 years since it was commonly practiced in the West.
A natural burial is simply burying a body, without any sort of preservation (embalming) in a grave to allow it to decompose and return to nature. In Islamic tradition, a body is washed, shrouded and buried within 24 hours.
Traditional burial (usually but not always) involves emblaming the body to help preserve it, placed into either a coffin or casket (yes there is a difference) and placed into a traditional cemetery with a burial vault (mostly in the US) or into the soil.
Side note: embalming fluid is highly carcinogenic and this fluid enters the water table…how nice.
The other main option is cremation. Cremation is the process in which all organic material (the body) and only non-organic calcium oxide and phosphorous pent-oxide remain. This process takes approximately 1-2 hours and in most countries, the bone fragments are, by law, ground up into the ash that we all know.
While there are different cremation services on offer, the simplist is known as direct cremation and just involves an organisation picking up the body, cremating it and returning the ashes.
The cost does differ on country but you are looking at approximately 1000 USD, 500 GBP plus, or 50,000 JPY (in Yokohama).
Other global options
Alkaline hydrolysis: dissolving the body in an alkaline solution. Any organic material is not released into the air and breathed in by others, but instead go into the water system.
Burial at sea: weighing down the body and allowing it to decompose in the ocean.
Sky burial: breaking up the body and allowing it to be scavenged by animals- another way to “give back to nature”
Human composting: allowing the body to be turned into compost and being reused
Immurement: being placed into a mausoleum or tomb
Mummification: a body is prepared and preserved to make it last a long time
Plasternisation: think of the body works exhibit. It replaces body fats and fluid with plastic and it preserves the body.
Donation: to either help future doctors (medical school use), help scientific research (including body farms and biomedical research, and military use (weapons testing – including biological)
Cryonics: AKA cryogenics the art of freezing the body for possible future revival
*There are cultures that do practice cannibalism- sometimes for positives reasons (to keep them within the community) or negative reasons (because they could).
Disposition in Japan
Even though, legally, there are 2 options that are considered, in practice there is only 1: cremation.
While the UK’s cremation rate is about 70%, France’s at 20%, the cremation rate in Japan is above 99.5%- which is a fantastic number. Burrial is legal but is forbidden in most prefectures or as per local by-laws. Exceptions can be made for religious reasons but new graveyards are forbidden from burying bodies.
Problems with cremation in Japan
Japan has a severe aging population and over 1,000,000 people die each year in Japan. The problem is that even at the largest crematorium, there is still a “waiting list” for corpses.
There are more bodies than crematoria (the plural of crematorium) available and during the traditional Japanese funeral, the family waits in the “lobby” (actually is the funeral hall) while the body is being cremated. Then then pick out the bone fragments from the warm remains and place it in an urn.
Fun fact: this is the only time in Japan when it is acceptable for more than 1 chopstick to move an item at once. 2 people may need to work together to move a large bone fragment into the urn. So, if you do this in public, it may remind someone of this situation and cause flashbacks, so just don’t.
Alternatively, there is a growing trend: 直送 lit. direct delivery or direct cremation- as this is a much cheaper option. It is also the option for those that are from low income backgrounds, live or die alone or the homeless (their funerals are organised by a civil servant).
A traditional Japanese funeral service, not including cremation or the burial plot, ranges from 500,000 JPY to 2,000,000. Cremation usually ranges from 70,000 to 170,000 JPY and if a grave is wanted, prices usually range from 350,000 to 2,000,000 JPY. The final gaijin price range for everything is 920,000 JPY to 4,170,00 JPY (plus tax). This is a massive price: 8,400 USD to 38,000 JPY- considering the average price for a ‘massive’ funeral in Japan in $5,000- Japan is extraordinarily more expensive.
While it is cheaper if you do not require a plot or take the cremation price from Yokohama (12,000 JPY for residents and 50,000 for non-residents), or choose a small family orientated wake, you are sill looking at 3000+ USD.
Please note, I have NOT talked about the annual fees for grave maintenance, the headstone and other fees e.g. food and drink at funerals etc.
Other options for cremains (cremated remains)
Internment in a home shrine (extremely traditional)
Internment in a sky scraper grave
Interment in another mass memorial
Interment is a communal grave (extremely cheap option)
Interment in a company grave
spread on the winds (not really practiced in Japan)
Shot into space (a small part of you only)
up-cycled into jewelry, pictures etc
The Japanese problem
With the amount of dead bodies, and with the limited space available, there is no-where for the dead to go. The tradition of the family plot is unfeasible for those who live in major cities- even those within the industry, do not wish for a traditional Japanese funeral as it would put “too much pressure on their families”.
Cremation is the norm within Japan and will continue to be so- it was the way the Buddha was given back to nature after all. It is just strange that a funeral is so much more expensive than a wedding.
The one positive to Japanese death culture is simple: there is active death awareness. Unlike in the West, death is a taboo topic but with Japan’s death culture and festival (お盆- Obon which takes place in August) is is an active part of life.