I am fascinated by longevity. Each week I see such an extraordinary difference between ‘older’ patients and their quality of life. At one end, I’ve a patient in her late 80s having had a huge open heart operation, now off to Australia on her own to see her family, and a lady of 96 living independently, picking where in the world to take her next holiday. At the other end, patients my own age (47) with heart failure after heart attacks, awful high blood pressure, morbid obesity or a range of other chronic health conditions. There was even a high profile death this week, as tragically boxing legend Ricky Hatton died at only 46 years old. It remains to be seen what the cause of death was, but given it wasn’t considered suspicious, an unheralded heart attack has to be high on the list.
Living long is one thing, having a good quality of life in the last decade of our life (whenever that may be) is in my view even more important. We call this ‘healthspan’ , as opposed to lifespan, and I often write about strategies to improve it.
Many of these have been practised for centuries in certain parts of the world, so called blue-zones, and no-where on the planet has done this as successfully as Japan, which this week broke its own record for centenarians for 55 straight years. According to it’s health ministry this month, nearly 100,000 people are 100 years or older! Women make up 88% of these which is remarkable. The oldest woman is 114 year old Shigeko Kagawa, and the oldest man 111 year old Kiyotaka Mizuno (I love the name, as have always had Mizuno golf irons!).
Somehow, on a population level, the Japanese have been able to get their citizens to adopt healthy behaviours, and maintain them, at precisely the same time that in the West we have increasing rates of chronic disease, and have seen life expectancy fall for the first time in recent history. They have some of the lowest rates of obesity in the world, diets with minimal ultra-processed food, and exercise is encouraged.
Ask any older person with good mobility what their secret is, and daily movement is sure to feature. Since the 1920s, Japanese have broadcast daily ‘Radio Taiso’ shows, where people are guided through a short gentle calisthenics routine to get their joints moving and muscles stretched. Often, this is performed as a group, adding to the sense of community with exercise. Can you imagine that here?? I can’t, not for a minute, but that doesn’t mean we can’t aspire to a version of that ourselves. Normalising exercise, and having movement as a non-negotiable part of the day, sounds to me a major public health service.
Japan has public health campaigns to reduce salt intake, and I’ve written before about the value of this with respect to cardiovascular disease. Add this to the low processed food consumption (which is notoriously high in salt and sugar), and it’s a recipe for success. This year, over 52,000 people became new centenarians, and received a congratulatory letter and silver cup from the prime minister.
I think regularly about public health, and am becoming increasingly frustrated at seeing patients with heart attacks, strokes, heart failure and so on which could have been prevented with better strategies employed in the years beforehand. We are sleep walking into a chronic disease epidemic, with health inequalities becoming more and more stark. Seeing the Japan example at least gives me optimism that population level strategies can work.