Awareness: a quick look into Japan’s changing climate
I have been thinking about the best way to go into detail about Japan’s changing climate. I do realize that this is a global issue, but sometimes an abstract idea like a global environment is a bit too hard to understand. So instead, please look at the picture below: it says more than I ever could.
The headline simply reads “there’s no snow”.
From the Asahi-Shinbun dated 22/01/2020
Japan is an extremely long country starting north of the equator and leading up to the Arctic- it has a vast and varied climate and each prefecture can almost be seen to be its own sub-climate. Hyogo Prefecture is known for snow sports- or should that read was known for snow sports? The long lonely strip of snow is not a ‘freak of nature’, it is an import.
Imported snow- in an effort to keep afloat an economy based on winter sports. Did you also see the ski lift? There’s not much use in that now is there. Imported snow not only moves resources from one place to another, but there are high economical and carbon costs associated with this as well.
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The lack of cold temperatures has also been felt in Hokkaido especially in the run up to the Snow festival or Yuki-matsuri. Snow has been imported as well due to the warmer than usual winter. According to the JMA (Japanese metrological agency), Hokkaido has only received 48% of the expected snow fall a fall of 52% from the previous year.
Climate change is indeed happening and it is happening extremely quickly. This change has been reflected in the forthcoming Olympics as well. Due to exceptionally high temperatures in summer 2019, the marathon has been moved to Sapporo City, Hokkaido. On a more anadoctial front, I recorded temperatures as high as 100.4 degrees Fahrenheit (ca. 38 degree Celsius) in the shade this summer in Iga- and I was not alone with seeing such temperatures.
Across Japan and even the world, record numbers of people were hospitalized due to heat related problems. Currently, one just needs to look at Australia- where they have at times run out of colours to use on heat charts due to the heat. If you need a bit more, conditions have been perfect for the wildfires which have caused complete devastation in places and the true costs of these fires (socially, environmentally, economically, ecologically etc) will possibly never truly be known.
There is a lot one can do but if business do not reflect personal effort i.e. a person becomes incredibly green but the business they work for either doesn’t change or becomes more environmentally damaging, nothing much will change. According to the wolves of Wall Street “Greed is good”, but what will greed do once the planet is uninhabitable?
Last quick note on this, there is an increasing difference on the amount of rice needing to be produced and the amount of rice being eaten. We are already seeing signs of troubles to come. Please do you part- even if it just a small action, it can and it does add up.
There are increasing worries spreading across Japan regarding the new Chinese coronavirus (names nCoV-2019) and its ability to infect both animals and humans. Specifically, the worry is about the virus’s ability to become a pandemic.
To highlight the seriousness of this issue, Japanese prime minister Shinzo Abe has stated that “please take every possible precaution,” which has lead to a public awareness campaign on this issue (it has appeared not just on Japanese news but day-time television as well) and a full traveller screening programme at each Japanese airport.
Current estimates suggest that around 400 people are known to have contracted nCov-2019 and the current death-toll is (at time of writing) at 4 deaths- but why is the global community (and indeed Japan) so concerned about this virus? The answer is simple- uncontrollability.
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Chinese new year is soon to be upon us, which is the time in which most Chinese people travel- both nationally and internationally- which has the potential to ignite a new global pandemic. Global pandemics are most often caused when: a disease can be easily spread across the world with high movement and when the disease has been shown to cross the species barrier.
These prerequisites have already been met in nCov-2019. Initial cases first appeared in Wuhan, China in a market with high frequency animal contact and since this time, the diseases have been spread from person-to-person.
Chinese authorities are already taking action against this outbreak by ordering the use of facial masks in Beijing hospital, and controlling the number of people entering and leaving Wuhan (where the disease was discovered). Currently, this virus doesn’t appear to have mutated and the CDC and WHO are working on the virus but it is still early days.
Symptoms
Current reports suggest that initial symptoms mimic a common cold with some pneumonia-like symptoms. Initial symptoms include fever, cough, tightness of the chest and shortness of breath- the most concerning of which is the tightness of chest- which initially can be easily misdiagnosed.
Current countries with nCov-2019 patients are China, Japan (the person had just returned from Wuhan), Korea, the USA (a traveller had visited Wuhan), Thailand, and more regionally in China from Beijing, to Taiwan.
The international community is highly aware of the potential for this and infection disease control procedures are underway both in China and around the world to deal with the threat of this virus.
Advise
The best advice is to be prepared- use masks in Asia (especially in China) but don’t worry- there is nothing major (currently). Life in Wuhan is ongoing without interruption- life before this virus was discovered. While this virus has the potential to become serious, measures are already underway.
If you have been travelling in China and are experiencing symptoms, please call your doctor- and get their advice. Don’t just turn up in person. While you could just have influenza, they may want to take precautions. There is no data to suggest if some people are more susceptible than others or if it is more damaging to people with compromised immune systems.
Current screening procedures at airports just involve walking in front of a thermal camera. If there is anything wrong- you may be taken to an isolation area until tests are performed. From there, a treatment plan may be started or general health advice given.
Thank you for reading and happy and safe exploring.
An awareness and resolution post, looking into global vaccinations including proving Karens of the world wrong! Also, vaccinaion programs in Japan
While scrolling through social media, there have been several posts suggesting that a pandemic is to occur this decade. There have been major epidemics and thus pandemics in the 1720s, 1820s, 1920s with the 2020s to possibly follow. But what disease if any would be the probable cause?
Firstly: terminology. An epidemic is when a disease affects a great number of people in an area or country. A pandemic is a global epidemic- simple. Previous examples of pandemic diseases are SARS, avian influenza, Ebola, small pox, yellow fever, TB, leprosy, Spanish flu etc.- there are an awful lot of examples.
While many countries are doing a lot to combat this, there is certainly more that can be done. However, not every country is able to prepare to a similar level- which is part of the problem.
In some LMICs (lower to middle income countries), are more prone to starting a pandemic due to very high contact with animals along with poor access to medical facilities. In addition to this, these countries are usually unable to invest large amounts into epidemic preparedness.
There are many challenges facing the global community with regard to pandemics and one of the more worrying examples is increased antibiotic resistance which a disease can develop if, for example, a person does not complete a dose of antibiotics correctly, if antibiotics are over prescribed and if the disease mutates.
I do have to note that antibiotics will NOT work for viruses at all- if you have influenza antibiotics are as useful as tick tacks- but at least tic tacks will freshen your breath.
Immunization 101
One thing that increases the risk of an ID (infectious disease) mutating is lack of immunization. Immunization helps protect a population from a disease by introducing them to either a dead or ‘live’ disease via an injection. The body’s immune system then works to counter act the disease and produces antibodies which are then ‘saved’ in the body. Some time later, if a person comes into contact with the actual disease, their body is already ready and prepared to fight off this disease.
Many people suffer or die from preventable diseases because they are not immunized. A 2015 case in Japan featured a 10-month-old boy who caught Japanese encephalitis and although he did live, his arms and legs have been severely paralysed. There are many cases of people catching and dying from measles.
The elephant in the room
Some people (we’ll call the Karens) are against immunization because of several reasons including: possible side effects including the adverse medical reactions, the introduction of harmful chemicals (including aluminium and mercury), and there being “no point” in being immunized because the diseases that people are immunized from are ‘no longer a risk’.
I know that I have set up a straw-man argument against the Karens of the world but I shall enjoy using this argument flaw method regardless.
Number 1: immunizations cause adverse medical effects
Most people will cite the study that “showed” a link between the MMR vaccine and autism. Simply put there is NO link between the two- in any way. The review into this study was produced by the WHO (World Health Organization) who’s only bias is the promotion of global health.
Other people may look at the “link” between the DTP vaccine and SIDS (sudden infant death syndrome) and while it seems to be directly related to one another, this is again false. If there were a true link between the 2 factors, the number of SIDS deaths would be astronomically higher. The SIDS deaths were by chance but people have a need point to a cause of death and the vaccine was chosen.
In fact, several studies have shown that the DTP vaccine actually reduces the chance of SIDS deaths.
Number 2: the introduction of harmful chemicals
Many Karens will also say that “vaccines contain harmful chemicals that will harm me/ my child, so I’m not going to vaccinate. It’s my choice.”
The first question for the Karens of the world is: do you drink from soda cans, or live near a road, or smoke? Yes, you already take in 4 times the aluminium that is allowed in a vaccine.
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Other harmful chemicals that may exist within a vaccine usually only exist in trace amounts which help with the bodies autoimmune response and only in certain vaccinations. However, using mercury and formaldehyde as examples- mercury acting as a preservative- in tiny amounts and in a safe compound- and formaldehyde used to render certain viruses such as polio inactive for use in vaccines, more harmful chemicals are ingested in everyday life than via vaccines.
If we look at mercury, and ignoring the fact it has been eliminated from most vaccines since 2001, 69 mcg of mercury is ingested in 1 can of tuna while 25 mcg of mercury is taken in with one influenza injection.
Regarding formaldehyde (the highly carcinogenic, environmentally toxic chemical used in embalming), is extremely common in the environment. Most apples contain more formaldehyde than in the “Hepatitis B, DTaP and polio vaccines together”- a little FYI, this includes organic apples as formaldehyde is a naturally occurring chemical and the human body produces it as part of metabolism which is then converted into carbon dioxide and exhaled.
Pont 3: there is no point in vaccinations as the diseases that are being vaccinated against are no longer a threat
This one is the easiest to disprove to the Karens of the world and can be done with just one world: measles.
Need a bit more? The WHO reports on disease prevalence and outbreaks globally and has reported such trends as the highest measles’ prevalence are in countries with low vaccination rates and there are ongoing out breaks (Angola, Cameroon, Chad, Kazakhstan, Nigeria, Philippines, South Sudan, Sudan and Thailand). While the data from 2019 is still provisional (to be finalized by July 2020), there were some serious trends that appeared when comparing the first 6 months of 2018 and 2019.
The US reported over 90,000 cases of measles at the start of 2019- the highest in 25 years
From 2018 to 2019 measles prevalence has increased:
900% in the WHO Africa region
120% in the European region
50% in the Eastern Mediterranean region
230% in the western Pacific region
Additionally, the WHO reports that fewer than 10% of measles cases are actually reported.
The final jolly bit will be just one number- the number of people that died from measles in 2018. Please remember the measles is mostly a preventable disease- so most of these deaths if not all were preventable.
So Karens of the world, there is no reason not to be vaccinated- not even ignorance will save you!
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Vaccination in Japan
There are 2 types of vaccines in Japan: voluntary and routine vaccinations. Routine vaccinations are free if you take your child to a clinic within the time frame. Some voluntary vaccines may be routine vaccines in some prefectures.
Voluntary vaccinations are paid for out-of-pocket- and there is quite the list (see below). It is also important to note that out of the 15 vaccinations, 5 are ‘live’ vaccines which depending on pre-existing medical conditions, you may not be able to take.
The ministry of health has a vaccination programme in place for children under 1 to be inoculated free of charge, and they’ll receive 19 shots in total (including boosters) but not every family is able to go to a clinic regally and if an appointment is missed, the remaining shots must be paid for by the parent.
An additional problem regarding vaccinations in Japan is the lack of combined vaccinations. In the UK, most children receive the MMR vaccine but in Japan the Mumps vaccine is routine while the MR vaccine (measles and Rubella) is voluntary. One way to increase total vaccination rates would be to have a greater availability to combination vaccines but Japan wants to protect domestic vaccination production rather than import vaccines which are seen by many to be better.
A full vaccination schedule (in English) is available on the further information page.
A guide to Parkinson’s disease and the costs in Japan
Parkinson’s disease is quite a common NCD in Japan with over 150,000 people who suffer from the disease in Japan. But what exactly is it?
Parkinson’s disease is a progressive nervous system disorder is caused by the loss of dopamine production in the part of the brain called the substantia nigra- part of the midbrain.
Parkinson’s disease is not a life shortening disease alone but many sufferes also develop dementia separately which can be life-shortening.
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Early symptoms
Parkinson’s is comprised of 5 stages and early symptoms of the disease include:
A tremor in a hand, leg, finger
stooped posture
stiffness
difficulty walking
small handwriting
Bradykinesia: sudden stiffness with often a ‘mask-like’ expression
Later symptoms
Loss of balance
sleep problems
problem with swallowing
memory issues including dementia
Basic treatments for Parkinson include medications which when taken convert to dopamine and help the body cope with loss of production, a healthy and balanced diet. However, as the disease progresses, patients will often decline physically.
Loss of independence
Late stage Parkinson’s patients will likely require around the clock care as they become unable to complete simple household tasks such as cooking, cleaning or washing.
About 40% of stage 5 patents will have a form of dementia as well as more common symptoms such as loss of bladder control, frequent mood changes, respiratory problems, less responsiveness to dopaminergic medications (dopamine replacement medications), dysphasia (inability to understand language), dysarthria (the inability to speak) etc.
Some late stage patients have described it as being a “drooling vegetable” but each person with the disease is different- and each treatment plan is different.
In Japan
Many universities in Japan are studying Parkinson’s disease and are running clinical trials including Kyoto University (who have transplanted iPS cells [induced Pluripotent Stem aka non-specific stem cells] to supplement dopamine-emitting neurons), and Tokyo Metropolitan University of medical science (looking at the effects of adiponectin [a protein produced by fat cells with many effects] on neurodegeneration).
The costs of PD in Japan is high. Curative care (treatment which looks towards a cure- even if not possible) is around 500 USD a month. Palliative PD care or PD care requiring a care home is significantly higher and estimates are hard to find in Japan.
With a monthly cost of around 500 USD and an annual cost of around 6000 USD, it is estimated that 90% of this cost is from PD medication- but this is mainly for earlier stages. For patients in later stages and for patients who have had PD for more than 10 years, the costs are between 550 and 600 USD a month. Costs do change with symptoms. If a patient requires pain medication, the costs are higher; if the medication is “wearing off”, the costs are higher.
One problem with PD costs in Japan is that there is very little research. One article I used (see further links page) doesn’t consider long term care home costs. But the costs are comparable to the cost of PD in the US, UK, or Germany.
Basic care home costs in Japan are around 40,000 JPY a month for basic care needs which is 446,000 JPY a year. This would be in addition to direct PD care costs. Please note, the care home cost is for a basic level of care only- PD would require a lot more care and thus expense.
In order to combat this costs, it is estimated but the JT that around 470,000 people left their jobs between 2007 and 2012 to help care for elderly relatives which does reduce costs but by how much is yet to be determined.
Although this is not applicable to me, for many people coming to another country can cause anxiety because they have allergies. Sometimes allergy some minor things like hay fever for example however some people can have major anaphylactic reactions to certain products.
This post is to fold the first post this post will be a guide on how to navigate Japanese food labels and restaurants. The second part of this post will be an awareness post on allergies in Japan.
Food labels
Under Japanese law there are 7 foods or ingredients that must be labelled on food packaging and these are: shrimp (えび), crab (かに), wheat (小麦), buckwheat (そば or 蕎麦), eggs(卵), milk (乳), and peanuts (落花生).
There are more foods that may cause a deathly reaction and an epipen to be used and that is the first problem: what are you allergic to? Because there are so many other allergens, you must look up in Japanese, ideally before you travel, what you are allergic to. A handy phrase would be:
______アレルギーがあります。I’m allergic to_____.
A person I know who moved to Japan is allergic to bananas and must be careful with any confectionery product because it’s an ingredient that is used everywhere.
In restaurants, the 7 allergens will be listed in Japanese on the menu if not apparent e.g. “egg salad” contains egg. If you are allergic to anything else, research before you arrive. Most menus are available online and even if you only have the ingredient that you are allergic to, you can usually see if they have it.
Additionally you can ask! If you don’t speak Japanese, use the phrase above and the waiter/waitress will help you out.
Voluntary ingredients
In addition to the 7, there are an additional 20 ingredients that can voluntary be put on packaging. These 20 can roughly be separated into 4 groups: nuts (walnuts, cashews etc), fruits (oranges, bananas etc.), meat (pork, fish roe etc.), and other (gelatine). This is down to the manufacturer of each product and you need to be aware of this fact when buying food.
Furthermore, there is always a risk of cross-contamination because even though there are extremely high standards of food manufacturing in Japan, allergies seem to be the exception rather than the rule.
The reaction to allegies
Japan is becoming more aware of allergens and allergies as the number of sufferers increases globally. One brilliant example of this is Mos Burger. This fast food chain has released a range of low allergen products in an effort to allow people with severe allergies to still enjoy their food.
According to the ministry for health, it is estimated that around half of the Japanese population have some sort of reaction to some foods.
Medication
Japan is known for having a hey fever problem and there are many medications for this and others. There are 5 types of medicines for allergies in Japan:
• General allergy medicines (the best I would say is Claritin EX [loratadine 10mg] which is a pharmacy only product, or contac Z [cetirizine HCl 10mg]- if you can take these. There are many other ones but the list of contras(contra indications e.g. Don’t take if you have X or not for people who are Y) does get quite long. • Eye drops. Many people use medicated eye drops to stop an inflammatory reaction occurring. • Eye washes. None medicated option to clean the eye of irritants • Nadal sprays. To stop the airways reacting to allergens or to prevent this reaction • Epi pen.
I hope this guide is helpful if your travelling to Japan.
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.
Background
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.
Scientific background
There are 2 main types of diabetes which are simply called:
type 1
type 2
other
Type 1
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
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
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).
Diagnosis
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.
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.
Hospice care
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.
Fish
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:
Deep coma
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.
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.
Burial
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.
Cremation
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
cannibalism*
*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).
Price
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.
The world of languages 