The United States and Japan vary remarkably in terms of two health indicators: life expectancy and infant mortality. America’s Health Rankings (2019) reports that, in the U.S., 5.8 infants die per 1,000 live births and people live an average of 78.6 years. In Japan, infant mortality is1.9 children die per 1,000 live births and life expectancy towers at 84.2 years. Comparted to the U.S., the Japanese live longer, and their children are less likely to die. These differences in population health outcomes are underpinned by four factors: health facilities, health care system, health-related policies, and social programs for the aging.
Japan provides low-cost universal health care with a near 100 percent coverage. Moreover, health facilities are so well equipped that as of 2018, there were 13 hospital beds per 1,000 people (World Bank, n.d.). The government also has extensive care service program for the elderly. Additionally, the Long-term Care Insurance offers institutional and community-based support for everyone aged 65 plus (Nakamura, 2018). These programs allow seniors to choose their service providers as they please, regardless of their income.
The U.S., in contrast, has an outrageously expensive, chaotic health system that is arguably designed to perpetuate health inequalities. With just 2.9 hospital beds per 1,000 Americans, the U.S. lacks a universal health insurance (World Bank, n.d.). Instead, a combination of private insurance and various federal and state programs are in place to provide coverage to most Americans. While health support services are extensive in the U.S., access is inevitably unequal because of high out-of-pocket spending and the lack of flexibility of the programs.
There are many reasons behind the existence of global health disparities for the U.S. and Japan. Weinstein et al. (2017) identify two major determinants of these inequalities. The first one includes systemic and other mechanisms aligning distribution of power and resources along the dimensions of individual and group identity, such as race and class. The other reason is the unequal allocation of power and resources.
In conclusion, the U.S. spends more than Japan on health care, yet access remains unequal. Consequently, Americans generally live shorter lives and their children die more often than in Japan. These differences in community health outcomes suggest that spending more on health care provision does not necessarily guarantee wellbeing for the citizenry.
World Bank. (n.d.). Hospital beds (per 1,000 people) – Japan, United States. World Bank Open Data | Data.
Nakamura, S. (2021). Japan’s welfare for the elderly—Past, present, and future. Asia Health and Wellbeing Initiative.
America’s Health Rankings. (2019). International comparison.
Weinstein, J. N., Geller, A., Negussie, Y., Baciu, A., & National Academies of Sciences, Engineering, and Medicine. (2017). Committee on community-based solutions to promote health equity in the United States. Communities in action: pathways to health equity. Washington, DC: National Academies Press, 57-97.