For the past three decades, Japan has had the highest life expectancy in the world. This has been achieved while keeping health expenditures as a fraction of gross domestic product (GDP) under 8.5% in 2008, by contrast with 16.4% in the USA or 10·7% in Germany. Excellent health outcomes in Japan have been attributed to favourable risk factor profi les, health system performance, and universal coverage. Elucidating the underlying reasons for Japan’s health success has important ramifi cations for other nations looking to achieve good outcomes at aff ordable cost. Nayu Ikeda and colleagues provide a careful analysis of the cause of death and risk factor data to investigate potential causes for Japan’s decline in mortality since World War 2.


Murray CJL. Why is Japanese life expectancy so high? The Lancet. 2011; doi:10.1016/S0140-6736(11)61221.