Renegotiating the Social Contract Challenges to Health and Social Policy in Japan Chan Chee Khoon

Japan, which has been well known for its high health indicators in spite of relatively low health expenditure, is now witnessing a significant change in this pattern. The health indicators of the younger generations, most evident in high smoking and suicide rates, are much worse than the older generations. Health care expenditure, the author argues, is weakly related to health indicators while other factors such as these play a much more significant role in its determination. The earlier pattern was generally attributable to diet, physical activity, lesser social disparity, and a relatively homogeneous and inclusive society but modern Japan, along with changes in diet and lifestyles, is increasingly facing an erosion of egalitarianism. There is considerable casualization of the workforce and associated downward pressure on wages. These phenomena, coupled with a loss of employment security and mounting social inequalities, pose a significant threat to the positive health indicators in the country.

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