Understanding the SDGs from a Health Perspective

Japan’s SDGs: Widely Known, Sparsely Acted Upon

We often see terms like “SDGs” and “sustainable” in our daily lives. According to various surveys, nearly 90% of Japanese people are aware of the SDGs. However, few actively seek information about the SDGs, and there is low interest in companies actively working on SDGs and related products. How about you?

Common actions that align with the SDGs include using eco-bags and reusable bottles, going paperless, sharing household chores, childcare, and caregiving responsibilities between partners. Additionally, purchasing electric vehicles and conserving electricity and water are also popular SDG-aligned activities. Some people may engage in these actions without consciously thinking about the SDGs, while others may intentionally act with the SDGs in mind. There are also practices that have been carried out since before the SDGs were established. Everyone’s approach varies.

One survey found that the SDG goal that interests Japanese people the most is “Goal 3: Good Health and Well-being.” This might be because health is a familiar and relatable issue. However, achieving “Good Health and Well-being for All” requires progress on all the SDG goals. In this blog, we will explore the SDGs from the perspective of health.

What are the SDGs?

The Sustainable Development Goals (SDGs) are international goals adopted unanimously by UN member states at the September 2015 UN Summit, as part of the “2030 Agenda for Sustainable Development.” These goals aim to create a sustainable and better world by 2030. They were born out of a growing sense of crisis over issues that cannot be resolved without global cooperation, such as environmental destruction and widening inequality.

The SDGs consist of 17 goals and 169 targets, and pledge to “leave no one behind.” These goals address a wide range of critical issues facing the world with the aim of achieving a sustainable and inclusive society.

Achieving the SDGs requires the cooperation of all stakeholders, including governments, businesses, and civil society. The SDGs represent a common vision for a sustainable future, and it is believed that by involving everyone, we can move closer to achieving these goals.

What are the SDG Goals?

Here is a concise list of the SDG goals:

Goal 1: No Poverty – End poverty in all its forms everywhere.
Goal 2: Zero Hunger – End hunger, achieve food security and improved nutrition and promote sustainable agriculture.
Goal 3: Good Health and Well-being – Ensure healthy lives and promote well-being for all at all ages.
Goal 4: Quality Education – Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.
Goal 5: Gender Equality – Achieve gender equality and empower all women and girls.
Goal 6: Clean Water and Sanitation – Ensure availability and sustainable management of water and sanitation for all.
Goal 7: Affordable and Clean Energy – Ensure access to affordable, reliable, sustainable and modern energy for all.
Goal 8: Decent Work and Economic Growth – Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all.
Goal 9: Industry, Innovation and Infrastructure – Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation.
Goal 10: Reduced Inequality – Reduce inequality within and among countries.
Goal 11: Sustainable Cities and Communities – Make cities and human settlements inclusive, safe, resilient and sustainable.
Goal 12: Responsible Consumption and Production – Ensure sustainable consumption and production patterns.
Goal 13: Climate Action – Take urgent action to combat climate change and its impacts.
Goal 14: Life Below Water – Conserve and sustainably use the oceans, seas and marine resources for sustainable development.
Goal 15: Life on Land – Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss.
Goal 16: Peace, Justice and Strong Institutions – Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.
Goal 17: Partnerships for the Goals – Strengthen the means of implementation and revitalize the global partnership for sustainable development.

SDGs Through the Lens of Health

Can you name all the SDGs? With 17 goals, many people can recall a few key ones, but few can name them all. The broad scope of these goals, aiming to solve various global issues sustainably, makes them difficult to remember. However, when viewed through the lens of health, it becomes clear that all 17 goals are deeply interconnected. Let’s examine each goal with a focus on the Japanese perspective.

Goal 1: No Poverty – End poverty in all its forms everywhere.

The most important factor for health is a balanced diet. When poverty exists, both the quantity and quality of food can become insufficient, leading to health problems. This is especially true for children, whose healthy physical and mental growth can be hindered. To support a balanced diet, adequate income must be secured for everyone. However, in recent years, income inequality has widened in Japan, and the number of people in poverty has increased. As of August 22, 2023, Japan’s relative poverty rate was 15.7%. Among the G7 countries, Japan has the highest poverty rate, and among 30 advanced countries, it has the 4th highest poverty rate. According to the United Nations “Sustainable Development Report 2023,” the achievement level of Goal 1 is rated as “Challenges remain,” the second highest of four levels.

Particularly noteworthy is the issue of child poverty, which gained social attention around 2008. In 2013, the Law for the Promotion of Measures to Address Child Poverty was enacted. Various initiatives to combat child poverty began, including the rapid increase of “children’s cafeterias” across Japan, which numbered over 9,132 as of January 2024. These cafeterias provide free or low-cost nutritious meals and warm community interaction for children, their guardians, and local residents. Addressing the increasing poverty in Japan is fundamental to ensuring that “no one is left behind” in achieving health.

Here’s the bar graph comparing the poverty rates of different countries in 2024. The data indicates that Japan has a poverty rate of 15.7%, which is high compared to other developed countries like the United States (11.8%) and Germany (10.6%), but lower than Italy (20.1%) and South Africa (25.2%). This graph was created by wellhomewellout.com, referencing data from the OECD and the World Bank.

Here’s the line graph showing the annual poverty rate trends in Japan from 1985 to 2023. In 2023, the poverty rate stands at 15.7%. This graph was created by wellhomewellout.com, referencing data from the Ministry of Health, Labour and Welfare and the OECD.

Goal 2: Zero Hunger – End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.

It is clear that hunger and malnutrition are detrimental to health. This is especially true for children, whose physical and mental growth can be stunted. Many people may not believe there is hunger in Japan, but it is said that there is hunger among the relatively poor. In fact, the “Sustainable Development Report 2023” rates Japan’s achievement level for Goal 2 as “Significant challenges remain,” the third highest of four levels.

In Japan, the relative poverty line is set at an annual income of 1.27 million yen or less, and the relative poverty rate was 15.7% in 2021, meaning about 20 million people live below the poverty line. The relative poverty rate for children was 11.5% in 2022. In Japan, to maintain a job and social connections, one needs minimum clothing, housing, and appliances, as well as communication devices like smartphones and computers. In some areas, a car is also necessary. With an income below 1.27 million yen, prioritizing expenses for clothing, communication, and maintaining a car or home often means food expenses are pushed to the back, leading to difficulties in securing daily meals.

Japan’s food self-sufficiency rate in agriculture and fisheries was 38% on a calorie basis in 2023, the lowest among developed countries, which is a major concern. Additionally, recent yen depreciation has led to rising food prices, increasing the burden on people’s diets.

Here’s a bar graph comparing the food self-sufficiency rates of different countries in 2021. The data indicates that Japan has a food self-sufficiency rate of 38%, which is significantly lower compared to other developed countries like Canada (233%) and Australia (169%). This graph was created by wellhomewellout.com, referencing data from the Food and Agriculture Organization (FAO) and respective national statistics agencies.

Here’s the line graph showing the annual trends in Japan’s calorie-based food self-sufficiency rate from 1980 to 2023. The data indicates a gradual decline over the years, starting from 53% in 1980 and stabilizing around 38% in recent years. This graph was created by wellhomewellout.com, referencing data from the Ministry of Agriculture, Forestry and Fisheries of Japan.

In Japan, Goals 1 and 2 overlap significantly, suggesting that poverty reduction strategies can serve as common solutions. Promoting sustainable agriculture to increase food self-sufficiency and ensuring economic and political mechanisms to adequately distribute food to the entire population are essential foundations for the health of every citizen.

Goal 3: Good Health and Well-being – Ensure healthy lives and promote well-being for all at all ages.

Reading through this blog, you will realize that achieving Goal 3 requires addressing all 17 SDGs.

What is the current situation in Japan? In the 2023 world life expectancy rankings by WHO, Japan ranked first with an average life expectancy of 84.3 years. Additionally, Japan also ranked first for healthy life expectancy (the period during which one can live without being limited in daily activities due to health problems) at 74.1 years. This is attributed to the Japanese lifestyle, such as a diet known for its health benefits like traditional Japanese cuisine, and a highly accessible public health insurance system that allows people to receive advanced medical care at low costs. This might make it seem as though Japan has fully achieved Goal 3. However, according to the “Sustainable Development Report 2023,” Japan’s achievement level for Goal 3 is rated as “Challenges remain,” the second highest of four levels. What challenges remain or have emerged?

This bar graph ranks the top 10 countries by life expectancy in 2023. Japan leads with a life expectancy of 84.3 years, followed by Switzerland at 83.6 years, and Spain at 83.4 years. This ranking is based on data from the World Health Organization (WHO) and was compiled by wellhomewellout.com.

This graph ranks the top 10 countries by healthy life expectancy (HALE) in 2023, based on data from the WHO. Japan tops the list with a healthy life expectancy of 74.1 years, followed by Switzerland at 73.3 years and Singapore at 73.2 years. This ranking is based on data from the World Health Organization (WHO) and was compiled by wellhomewellout.com.

One major challenge is the sustainability of the current public health insurance system amidst a rapidly aging population, which leads to increasing medical needs. With an aging population, the prevalence of chronic diseases such as cardiovascular diseases, cancer, and diabetes is rising. The demand for long-term care is also increasing. This growing demand for medical and caregiving services directly leads to rising medical and caregiving costs, risking the collapse of the financial resources needed to sustain the public health insurance system. Reforming the medical system to withstand these cost pressures and ensure sustainability is crucial.

Additionally, the increase in medical needs due to the aging population exacerbates the shortage of medical and caregiving personnel. Japan is known for having a relatively low number of doctors among developed countries. According to a survey by the Japan Medical Association Research Institute, Japan has 2.4 doctors per 1,000 people, compared to the OECD average of 3.5. Not only is the absolute number of doctors low, but there is also a problem of geographical imbalance, which worsens the shortage of doctors in rural areas. The reform of work styles for doctors started this year, reducing the reliance on overtime work to cover manpower. Increasing the number of doctors and medical/caregiving personnel and ensuring their proper distribution is urgent. Japan is at a crucial point where it needs to reform its medical system, including the roles of medical professionals.

Another issue is the imbalance in medical access within Japan. While the public health insurance system theoretically allows free access to any medical institution at any time, the uneven distribution of medical institutions and doctors creates disparities in medical access between urban and rural areas. In particular, remote islands and mountainous regions often lack adequate medical services. Solutions include the spread of telemedicine and the strengthening of regional healthcare systems. The underlying cause of medical disparities and imbalances is the “freedom” of doctors and medical institutions. In Japan, doctors are free to choose their workplace, and private clinics, which make up a large part of the medical system, can open wherever they choose. As depopulation progresses in rural areas, it is expected that medical disparities will widen, making it a critical issue to address in medical reforms.

Another concern is Japan’s high suicide rate. Japan has the highest suicide rate among G7 countries and ranks 9th globally. The increasing prevalence of mental health issues underlies this problem. The suicide rate is particularly high among young people, with depression and anxiety disorders emerging as significant social issues. Strengthening preventive measures and support systems is crucial. This includes transforming psychiatric care, implementing mental health care systems in educational and workplace settings, and addressing harassment and bullying issues.

Shifting focus to a global perspective, many countries are unable to achieve a healthy living standard due to various challenges highlighted by the SDGs. Understanding Japan’s issues and recognizing global challenges is essential for driving worldwide healthcare transformation.

Goal 4: Quality Education – Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.

To maintain a healthy lifestyle, it is essential to promote health education, spreading knowledge about the body and mind, nutrition, and preventive healthcare. This enables individuals to manage their health through healthy lifestyle choices.

Education is one of the two goals for which Japan has received the highest rating, “SDG achieved,” in the “Sustainable Development Report 2023.” The high enrollment rate in primary education and the high percentage of people receiving higher education are recognized. However, Japan is lagging in health education. Several surveys have revealed the low health literacy among Japanese people. For example, a 2018 survey using the European Health Literacy Survey Questionnaire (HLS-EU-Q47) showed that the average health literacy score (out of 50) was 37.1 for the Netherlands, the highest, and 34.4 for Taiwan, the highest in Asia, while Japan scored the lowest at 25.3. More recent data from the WHO Action Network M-POHL, collected between 2019 and 2021 using the Health Literacy Survey Questionnaire (HLS19-Q), reveals that Slovenia had the highest score at 86%, followed by Portugal and Austria at 85%, while Japan scored lower at 70%. These comparisons underscore Japan’s relatively low health literacy levels compared to other developed countries. To address this, Japan needs to fundamentally reform health education in compulsory and post-secondary education. Incorporating comprehensive sex education and lifestyle disease prevention education into the curriculum is crucial for enhancing students’ self-management skills and promoting healthy lifestyle habits.

Health Literacy Scores in Europe and Japan. This graph was created by wellhomewellout.com, referencing data from the WHO Action Network M-POHL, highlighting the health literacy scores across various European countries and Japan.

Goal 5: Gender Equality – Achieve gender equality and empower all women and girls.

In the “Sustainable Development Report 2023,” Japan is rated as having “Major challenges remain,” the lowest of four levels. According to the “Global Gender Gap Report 2023” by the World Economic Forum (WEF), Japan ranked 125th out of 146 countries, dropping from 116th the previous year. Japan received the lowest rankings in the fields of politics (138th) and economics (123rd), with the low ratio of women in parliamentary and managerial positions highlighted. Let’s examine how gender inequality impacts women’s health.

High relative poverty rate among women: The low participation of women in political and economic spheres reflects a societal structure that disadvantages women. As a result, women tend to earn less than men and are more likely to fall into poverty, which in turn hinders their right to lead a healthy life. Recent data from the Ministry of Health, Labour and Welfare, and OECD indicates that Japan’s relative poverty rate shows significant gender disparities, especially among the elderly. According to the 2021 National Survey, for example, the relative poverty rate for single individuals aged 20-64 is 22% for men and 24% for women, showing a slight difference. However, for those aged 65 and over, the disparity widens dramatically: the poverty rate for men is 30%, while for women, it rises to 44%. In addition, the poverty rate for single-mother households is particularly high, with more than 50% of single mothers living below the poverty line. Transforming the societal structure to achieve gender equality is necessary to eliminate poverty that prevents women from leading healthy lives.
Sexual and domestic violence: In Japan, sexual and domestic violence against women remains a serious issue. These forms of violence have long-term negative effects on the victims’ mental and physical health. According to UN reports, many women in Japan have experienced partner violence, and the risk increased during the COVID-19 pandemic. Strengthening support systems for victims, enhancing hotlines and shelters, and implementing education and awareness programs to prevent violence are essential.
Mental health issues: Gender discrimination and unequal treatment adversely affect women’s mental health. Workplace harassment and bias, in particular, contribute to women’s stress and mental health problems. Promoting gender equality in the workplace, enhancing mental health care, and improving workplace environments are necessary.
Reproductive health and rights: In Japan, information and services related to women’s reproductive health are sometimes inadequate. Issues include insufficient sexual health education and limited access to contraception. Strengthening sex education, improving access to contraceptives and reproductive health services, and enhancing counseling services on reproductive health are necessary.
Unpaid care work: In Japan, women disproportionately bear the burden of unpaid care work, such as household chores and caregiving, which affects their health. The impact of COVID-19 has further increased this burden. Reviewing the division of household chores and caregiving, providing government-supported care services, and improving childcare leave systems are necessary.

This graph illustrates the age group and gender-specific relative poverty rates in Japan for the year 2018. The data highlights that women experience higher poverty rates compared to men, especially in the older age brackets. This graph was created by wellhomewellout.com, referencing data from the Gender Equality Bureau Cabinet Office, Japan.

Goal 6: Clean Water and Sanitation – Ensure availability and sustainable management of water and sanitation for all.

Water and sanitation are directly linked to human health. Both the quantity and quality of water must be managed sustainably. According to the “Sustainable Development Report 2023,” Japan is rated as “Challenges remain.” Let’s examine what challenges remain from a health perspective.

First, let’s consider water quantity. In Japan, tap water is always available, so people rarely feel a water shortage. However, water scarcity does occur, and Japan is known as a country with high water stress. From 1992 to 2021, Japan’s average annual water resources were about 430 billion cubic meters, and the per capita water resource availability was about 3,400 cubic meters per year. Compared to the world average of about 7,100 cubic meters per capita per year, Japan’s availability is less than half. In the Tokyo metropolitan area, it is comparable to regions like North Africa and the Middle East. Due to the steep gradient of many rivers, water quickly flows into the sea, making water retention difficult. While Japan relies heavily on imported food and industrial products, it is estimated that the freshwater resources needed for domestic production are insufficient.

This graph was created by wellhomewellout.com, comparing the total renewable water resources and per capita water resource availability for Japan and other selected countries in 2023. The data highlights the disparities in water resources, with Japan having 430 billion cubic meters of renewable water resources annually and 3,400 cubic meters per capita. In contrast, Canada boasts the highest per capita availability at 73,469 cubic meters, reflecting its vast natural water resources. Sources: List of countries by total renewable water resources – Wikipedia, Knoema – Renewable water resources per capita by country, 2023.

Next, let’s consider water and toilet sanitation. Contaminated water can harbor pathogenic microorganisms such as bacteria (shigella, cholera, typhoid fever, enterohemorrhagic E. coli (O157)), viruses (infectious diarrhea viruses, hepatitis A virus), and protozoa (Cryptosporidium, Giardia, amoebic dysentery). Drinking contaminated water can lead to infectious diseases. Additionally, fecal-oral transmitted diseases such as cholera, dysentery, typhoid fever, hepatitis A, norovirus infection, and rotavirus infection can spread without sanitary toilets. Japanese people, who have long been accustomed to safe water and sanitary toilets, may not fully appreciate their importance for health. Data shows that Japan’s water supply coverage rate is about 98%, and the toilet coverage rate (sewerage coverage rate) is about 80%. Besides sewerage, there are septic tanks and pit latrines, with the latter posing significant hygiene issues. About 7.4% of the population still uses pit latrines. From the perspective of “leaving no one behind,” these issues also need to be addressed.

Finally, there is the issue of water pollution. During Japan’s period of rapid economic growth, industrial wastewater pollution became a major problem, leading to diseases caused by toxic substances like Minamata disease (caused by methylmercury) and Itai-itai disease (caused by cadmium). Strict wastewater regulations and sewage treatment improvements were implemented as a lesson learned. Today, the main cause of water pollution is domestic wastewater, which includes kitchen waste, bathwater, laundry water, and toilet flushes. Over 70% of water pollution in rivers and seas is attributed to domestic wastewater. Although current water pollution does not directly harm human health as in the case of Minamata disease or Itai-itai disease, it causes “eutrophication,” lowering oxygen levels in water and leading to mass deaths of aquatic life, resulting in environmental destruction.

Goal 7: Affordable and Clean Energy – Ensure access to affordable, reliable, sustainable, and modern energy for all.

In the “Sustainable Development Report 2023,” Japan is rated as having “Significant challenges remain,” the third highest of four levels. Japanese people rarely experience difficulties with electricity. The “for all” aspect seems to be achieved. However, there are several challenges regarding the “clean” and “sustainable” aspects.

Low penetration rate of renewable energy: As of 2023, the proportion of renewable energy in Japan’s total energy supply is about 20.3%.
Low energy self-sufficiency rate: Japan’s energy self-sufficiency rate is only 12.1% as of 2023. This is due to continued reliance on energy imports, which poses challenges in terms of supply stability and cost.
Room for improvement in energy efficiency: Although improvements in energy efficiency are being made, further enhancement is necessary. As of 2023, Japan’s energy consumption per unit of Gross Domestic Product (GDP) is about 3.5 GJ per 10,000 yen, indicating room for improvement in the energy efficiency of the industrial and building sectors.

From a health perspective, many household appliances, infrastructure, and medical services essential for a healthy lifestyle require sufficient energy. To ensure people live healthily, an affordable and stable energy supply is necessary. A decrease in energy imports due to external factors like war can destabilize the foundation supporting Japanese health.

Considering that fossil fuels will eventually be depleted, it is clear that developing renewable energy and its technologies is essential for humanity to maintain a healthy lifestyle in the future. Furthermore, this energy must be clean, because energy sources that cause environmental destruction can have long-term adverse effects on health due to climate change and air pollution.

This bar graph compares the share of renewable energy in total energy consumption among various countries in 2021. This graph was created by wellhomewellout.com According to the IEA “Market Report Series – Renewables 2022”

Goal 8: Decent Work and Economic Growth – Promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all.

In the “Sustainable Development Report 2023,” Goal 8 is also rated as having “Significant challenges remain,” the third highest of four levels. Let’s look at the challenges identified by the United Nations regarding Japan, focusing on those related to health.

Increase in non-regular employment: In Japan, the proportion of non-regular employees is high, with about 38% of the workforce being non-regular employees (2023). Non-regular employees earn lower wages and have less job stability and fewer benefits compared to regular employees.
Existence of wage gaps: Wage gaps between genders and between regular and non-regular employees still exist, with women’s wages being particularly lower than men’s. As of 2023, the gender wage gap is about 25%, highlighting the urgent need to address this disparity.
Long working hours: The normalization of long working hours is another concern raised by the United Nations. To reduce the risk of overwork-related deaths and health issues, it is essential to shorten working hours and improve working conditions.

Trend of the Ratio of Non-Regular Employment in Japan (1985-2023). This table illustrates the changes in the percentage of non-regular employment over the years, highlighting a significant increase from 15.3% in 1985 to 36.9% in 2023. This graph was created by wellhomewellout.com based on data from the Ministry of Internal Affairs and Communications.

These issues highlight the strong connections between Goal 1 (No Poverty) and Goal 5 (Gender Equality). As discussed in Goal 1, poverty is a major threat to health. Even if they are not living in poverty, non-regular employees and women may be at a disadvantage from a health perspective due to their inability to afford a healthy diet and sufficient exercise.

Additionally, long working hours impose significant mental and physical stress, which can harm health. In the medical field, Japan has begun implementing “work style reforms for doctors” in 2024 due to concerns about suicides caused by overwork. The cap on overtime and holiday working hours has been set at 960 hours, similar to other workers. Given the shortage of doctors in Japan, these reforms will reduce the manpower of doctors, necessitating policies to increase the number of doctors simultaneously.

Goal 9: Industry, Innovation, and Infrastructure – Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation.

Goal 9, along with Goal 4 (Quality Education), is one of the two goals for which Japan has received the highest rating, “SDG achieved,” in the “Sustainable Development Report 2023.” Let’s look at the medical device industry, pharmaceutical industry, and other healthcare industries. In the medical device industry, many devices have a market share of over 50% in Japan, the US, or Europe, indicating that Japanese companies are performing well globally. However, compared to Europe and the US, Japan has fewer products with more than 50% market share, with only endoscopes, medical light sources, and fundus cameras holding such a significant share. Overall, the industry appears less competitive. The data on the global market share of Japanese pharmaceutical companies shows a notable decline over the years. According to sources, Japan’s global market share in the pharmaceutical sector decreased from 12% in 2003 to 7% in 2019. Various challenges in the public, private, and academic sectors are pointed out as the reasons. In other words, Japan has a foundation for technological innovation in the medical device and pharmaceutical industries, and it is both possible and necessary to address these challenges and advance sustainable industrialization.

This graph shows the global market share (%) of Japanese pharmaceutical companies from 2002 to 2018. This graph was created by wellhomewellout.com based on data sourced from the Japan Pharmaceutical Manufacturers Association (JPMA) reports.

On the other hand, Japan is lagging in the adoption of new healthcare approaches represented by telemedicine and digital health, as highlighted in the “New Global Initiative to Advance Digital and AI-Driven Transformation of Healthcare Systems” by the World Economic Forum in 2024. Japan began adopting electronic medical records relatively early, indicating a foundation for digital technology. However, there are still issues with many electronic medical records lacking interoperability, preventing unified data management. Additionally, Japan’s early establishment of a healthcare system and infrastructure that provides affordable and accessible medical care has become a legacy that may hinder the transformation towards patient-centered care using digital, AI, and data technologies, which are expected to become the global standard. Moving forward, Japan needs to develop its digital healthcare industry to create a world where everyone can protect their health without being left behind, leveraging its technological strengths.

Goal 10: Reduced Inequality – Reduce inequality within and among countries.

In the “Sustainable Development Report 2023,” Goal 10 has been downgraded to “Significant challenges remain,” the third highest of four levels. Let’s look at the issues related to inequality within Japan, as identified by the United Nations.

Widening income inequality: This issue is closely related to Goal 1 (No Poverty) and Goal 8 (Decent Work and Economic Growth).
Unresolved gender inequality: This is an issue related to Goal 5 (Gender Equality).
Expanding regional disparities: As discussed in Goal 3 (Good Health and Well-being), regional disparities in healthcare are also widening.
Unresolved social exclusion: Support and inclusion for socially vulnerable groups such as the elderly, disabled, and foreign workers are insufficient.
Widening educational disparities: Disparities in access to and quality of education are arising from differences in household economic conditions.

Even within Japan, there are more inequalities to address than are often perceived. As repeatedly mentioned, income inequality, gender inequality, and regional disparities lead to health disparities. Being healthy is a fundamental human right, and inequality in this regard should not exist. To create a world where everyone can be healthy without being left behind, addressing the inequalities targeted by the SDGs is an unavoidable task.

Goal 11: Sustainable Cities and Communities – Make cities and human settlements inclusive, safe, resilient, and sustainable.

Housing and city planning are essential for a healthy life, much like a balanced diet. When a home is lost due to an earthquake or other disaster, health risks increase. Particularly for the elderly and disabled, safe, barrier-free housing protects health. In the “Sustainable Development Report 2023,” Japan is rated as having “Challenges remain,” the second highest of four levels. Let’s examine the challenges Japan faces in terms of housing and city planning necessary for health.

Quality and accessibility of housing: In Japan, the provision of affordable and safe housing is insufficient. The supply of safe, barrier-free housing is particularly lacking as the population ages.
Securing green spaces and public areas: Urban areas lack sufficient green spaces and public areas, adversely affecting residents’ stress levels and mental and physical health. The development of green spaces and parks and the provision of accessible public areas are necessary.
Transportation network challenges: Overcrowding in subways and commuter trains is a serious issue, especially in major metropolitan areas. Overcrowding causes commuting stress, overwork, and physical health problems. To alleviate rush hour congestion, measures such as dispersing commuting times, promoting telework, and further developing public transportation infrastructure are needed.
Disaster risk management: Japan is highly susceptible to natural disasters such as earthquakes, typhoons, and tsunamis. Every major earthquake highlights the health risks faced by survivors. Strengthening urban planning and building standards, establishing evacuation shelters, and improving disaster risk reduction infrastructure are inadequate in many areas.

Year	Earthquake Name	Epicenter	Magnitude (Mw)	Impact
1995	Great Hanshin Earthquake	Southern Hyogo	7.3	6,434 deaths, 43,792 injured, 104,906 buildings damaged
2004	Niigata Chuetsu Earthquake Chuetsu	Niigata	6.6	68 deaths, 4,805 injured, 16,887 buildings damaged
2011	Great East Japan Earthquake	Offshore Tohoku	9.0	15,897 deaths, 2,533 missing, 6,157 injured, over 400,000 buildings damaged
2016	Kumamoto Earthquake	Kumamoto	7.0	273 deaths, 2,809 injured, 169,000 buildings damaged
2018	Northern Osaka Earthquake	Northern Osaka	6.1	6 deaths, 462 injured, 1,800 buildings damaged
2018	Hokkaido Eastern Iburi Earthquake	Eastern Iburi , Hokkaido	6.7	41 deaths, 770 injured, 2,769 buildings damaged
2019	Yamagata Offshore Earthquake	Offshore Yamagata	6.4	26 injured, 1,080 buildings damaged
2021	Fukushima Offshore Earthquake	Offshore Fukushima	7.1	3 deaths, 241 injured, many buildings damaged
2023	Noto Peninsula Earthquake	Noto Peninsula , Ishikawa	6.5	245 deaths, 1,299 injured, 81,717 buildings damaged

This table was created by wellhomewellout.com based on data from various sources.

Additionally, Japanese housing has a shorter lifespan compared to other developed countries. According to data from the Ministry of Land, Infrastructure, Transport, and Tourism, the average lifespan of wooden houses in Japan is about 30 to 40 years, and non-wooden houses (such as reinforced concrete) last about 50 to 60 years. This means there is a continuous demand for housing construction and renovation due to aging. This demand should be leveraged to pursue and provide housing that not only ensures safety but also supports health. The same applies to city planning. Future housing and cities should aim for smart houses and smart towns that monitor health information to prevent sudden deaths and protect health.

For more details, visit COMBATING THE SHADOW OF SUDDEN DEATH AT HOME: TRANSFORMING THE FUTURE WITH SENSOR AND AI TECHNOLOGY AND COMMUNITY POWER

Goal 12: Responsible Consumption and Production – Ensure sustainable consumption and production patterns.

In the “Sustainable Development Report 2023,” Japan is rated as having “Major challenges remain,” the lowest of four levels, for five goals, including Goal 12.

This goal may be somewhat unclear, but it means that both producers and consumers should act responsibly to protect the Earth’s environment and human health. The following issues in Japan help clarify the meaning of Goal 12.

Plastic waste management: Japan has the second-highest per capita plastic consumption in the world, making plastic waste management a significant challenge. Much plastic ends up in the oceans, causing environmental pollution. Improving the recycling rate of plastics and reducing the use of disposable plastics are necessary. Details will be further explained in Goal 14.
Electronic waste: Japan generates a large amount of electronic waste, and adequate disposal and recycling are insufficient. Electronic waste contains harmful chemicals that can negatively impact the environment and human health.
Food waste: According to the Consumer Affairs Agency, “food loss” refers to food that is still edible but discarded. In Japan, food loss amounts to 5.23 million tons. This is equivalent to 1.2 times the annual global food aid (about 4.4 million tons in 2021) to people suffering from hunger. On a per capita basis, this means about one bowl of food (approximately 114g) is wasted every day. Reducing and recycling food waste and improving the efficiency of the entire food system are necessary.
Management of chemicals and hazardous waste: The management of chemicals and hazardous waste is inadequate, increasing risks to the environment and health. Proper management and disposal of these substances are necessary.
Resource efficiency and sustainable production: Efficient use of resources and sustainable production are not progressing sufficiently. In particular, the manufacturing industry needs to reduce resource use and promote the use of renewable energy.

This graph illustrates the annual plastic waste emissions in Japan from 2010 to 2020, measured in million tons. The data highlights a steady increase in plastic waste emissions over the years, emphasizing the growing need for effective waste management and recycling measures. This graph was created by wellhomewellout.com, referencing data from the Ministry of the Environment, Japan.

We have lived our lives without much awareness of these issues, but living an ordinary life in Japan still generates various harmful chemicals and hazardous wastes from plastics and electronic waste, leading to environmental pollution and potentially harmful effects on the human body through the food chain.

Additionally, the scale of food loss is surprising. While I noticed unsold food items left in supermarkets late at night, I did not realize that the amount of food loss exceeds the global food aid. According to a report by the Food and Agriculture Organization (FAO) of the United Nations, carbon dioxide emissions related to food loss amount to approximately 3.7 billion tons annually, accounting for about 8% of global greenhouse gas emissions.

These issues ultimately harm our bodies and undermine sustainability in terms of health. To address them, it is necessary to further promote measures already being implemented in Japan, such as using paper straws, charging for plastic shopping bags, reducing plastic use through recycling, properly disposing of and recycling electronic waste, promoting the recycling of food waste, and strengthening the management of chemicals.

Goal 13: Climate Action – Take urgent action to combat climate change and its impacts.

This goal is closely related to “carbon neutrality” and “renewable energy,” which are frequently mentioned alongside the SDGs. Unfortunately, in the “Sustainable Development Report 2023,” Japan is rated as having “Major challenges remain,” the lowest of four levels. Climate change causes weather disasters, heatwaves, and the spread of diseases, posing external threats to health. Achieving this goal is crucial for maintaining a healthy lifestyle sustainably. However, addressing such external factors requires global cooperation, not just actions by Japan. Let’s summarize Japan’s current situation.

Reduction of greenhouse gas emissions: In 2021, Japan’s greenhouse gas emissions were approximately 1.17 billion tons of CO2 equivalent, a reduction of about 16.5% from the baseline year of 2013 (1.4 billion tons). However, emissions remain at a high level. The energy sector, especially fossil-fuel-based power plants, accounts for about 45% of total emissions. Since the Great East Japan Earthquake, the dependency on thermal power plants has increased due to the halt of many nuclear power plants. Japan aims to reduce greenhouse gas emissions by 46% from 2013 levels by 2030, but current efforts are deemed insufficient to achieve this target. A concrete roadmap for achieving carbon neutrality by 2050 is necessary.
Introduction of renewable energy: As of 2022, the share of renewable energy in Japan’s total power generation has increased to about 22.7%. However, this level is still low compared to other developed countries.
Strengthening climate change adaptation measures: Japan spends approximately 3 trillion yen (about 27 billion dollars) annually on disaster measures, but further adaptation measures are needed to strengthen infrastructure susceptible to climate change impacts.

This graph was created by wellhomewellout.com based on data from the Ministry of Economy, Trade and Industry (METI) and the Agency for Natural Resources and Energy (ANRE), illustrating Japan’s energy mix over the years, highlighting the share of renewable energy and other sources in the total energy supply.

Goal 14: Life Below Water – Conserve and sustainably use the oceans, seas, and marine resources for sustainable development.

Seafood is known to be rich in excellent nutrients that help maintain health and prevent diseases. Surrounded by the ocean, Japan has long relied on a variety of marine products to support the health of its people. A wide range of fish species, shellfish, crustaceans such as shrimp and crabs, mollusks such as octopus and squid, and seaweeds such as nori and wakame regularly appear on Japanese tables. These foods are rich in high-quality protein, minerals, omega-3 fatty acids, vitamins, dietary fiber, and antioxidants, all of which are beneficial to health.

However, overfishing and marine pollution are threatening the sustainability of marine resources. Unfortunately, in the “Sustainable Development Report 2023,” Japan is also rated as having “Major challenges remain” for Goal 14. The following issues are of concern:

Overfishing: Overfishing in the seas around Japan is causing many fish stocks to decline, with a risk of becoming irrecoverable. Sustainable fisheries management and appropriate catch levels are necessary.. Sustainable fisheries management and appropriate catch levels are necessary.
Marine plastic pollution: Plastics break down into microplastics in the ocean. Microplastics absorb harmful chemicals in the water and spread, being ingested by plankton, fish, and birds. This poses serious threats to marine ecosystems and raises concerns about the impact on human health through the food chain. Japan, the second-highest consumer of plastics in the world, has reduced plastic waste by exporting it to Asian countries. However, microplastic pollution in the seas around Japan is now 27 times higher than the global average. Reducing plastic use and promoting plastic recycling are essential.
Coastal eutrophication: Eutrophication of coastal areas is increasing, leading to the frequent occurrence of harmful red and blue tides. The primary cause of eutrophication is domestic wastewater, especially the discharge of nitrogen and phosphorus, which negatively impact marine ecosystems.
Expansion of marine protected areas: Marine protected areas in Japan account for less than 10% of its waters, far short of the international goal of establishing 30% of marine protected areas by 2030. Expanding marine protected areas is necessary to promote the protection and recovery of marine ecosystems.

Goal 15: Life on Land – Protect, restore, and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, halt and reverse land degradation, and halt biodiversity loss.

The destruction of terrestrial ecosystems threatens the safety of clean water, air, and food, negatively impacting health. Uncontrolled development without management and protection diminishes the richness of the land necessary for people to live healthy lives.

In the “Sustainable Development Report 2023,” Japan is rated as having “Major challenges remain” for Goal 15. Both Goal 14 (Life Below Water) and Goal 15 (Life on Land) present significant unresolved issues for Japan. Let’s summarize the challenges on land from a health perspective.

Deforestation and degradation: Japan’s forest area is on the decline. From 2015 to 2020, the forest area percentage decreased from 24.1% to 23.7%. Forests play a crucial role in purifying air and water and protecting ecosystems. The quality of air and water forms the basis of health.
Loss of biodiversity: Biodiversity loss is progressing in Japan. According to the Ministry of the Environment’s Red List, the number of endangered species is increasing, particularly due to habitat destruction from deforestation and agricultural expansion. Loss of biodiversity can lead to reduced food diversity and nutritional value. For example, a decline in pollinating insects significantly affects food production.
Invasion of alien species: Invasive species disrupt ecosystems and increase the risk of new diseases. For example, invasive mosquitoes can carry emerging infectious diseases such as dengue fever and Zika virus. Additionally, invasive species negatively impact agriculture, potentially reducing food production and increasing the risk of malnutrition.
Soil degradation: Excessive agricultural use and urban development cause soil degradation. At the same time, abandoned farmland is increasing. Soil degradation raises the risk of lower crop nutritional value and decreased food production. Sustainable soil management is essential for providing healthy food and ensuring safe water resources.

Goal 16: Peace, Justice, and Strong Institutions – Promote peaceful and inclusive societies for sustainable development, provide access to justice for all, and build effective, accountable, and inclusive institutions at all levels.

It is easy to imagine that violence and injustice can severely impact both mental and physical health. In societies or countries where violence and injustice occur, there is a risk of suddenly losing the ability to live healthily.

In the “Sustainable Development Report,” Japan received the highest rating of “SDG achieved” from 2020 to 2022. However, in 2023, the rating dropped to the second highest level of “Challenges remain.” This is attributed to the inability to address emerging issues such as:

Challenges in the judicial system: Prolonged pre-trial detention and unequal access to legal assistance are significant concerns. Enhancing legal support for low-income individuals and minorities is particularly needed. Those not legally protected are at increased risk of mental health issues, such as stress, depression, and anxiety disorders, which can lead to long-term health problems.
Violence and abuse against vulnerable groups (child abuse and domestic violence): Insufficient measures to prevent increasing violence and abuse against children, women, and the elderly have been noted. Victims suffer severe physical and mental health impacts, including injuries, chronic diseases, psychological trauma, and developmental disorders. In the case of children, abuse can lead to long-term health and social adaptation issues.
Maintaining low crime rates and the rise of internet crime: Japan continues to maintain a low crime rate, which is a positive aspect. However, the recent increase in internet crimes and fraud has emerged as a new challenge. Victims experience anxiety, fear, and loss of trust, impacting their mental health.

This graph illustrates the annual trends in domestic violence and child abuse cases in Japan. The data, sourced from the Ministry of Health, Labour and Welfare, highlights the increasing prevalence of both issues over recent years. This graph was created by wellhomewellout.com using data from the Ministry of Health, Labour and Welfare.

Goal 17: Partnerships for the Goals – Strengthen the means of implementation and revitalize the global partnership for sustainable development.

Japan has expanded its Official Development Assistance (ODA) since 1954. ODA involves the provision of funds and technical cooperation by the government or its implementing agencies to assist the economic and social development of developing countries and improve the welfare and stability of their citizens. The ODA-to-GNI ratio has risen to 0.44%, but it is still far from the target of 0.7%. On the other hand, cooperation with private companies has been strengthened in promoting sustainable business models and technology transfer. Examples include:

Cooperation with the Asian Development Bank: The Japanese government and private companies cooperate with the Asian Development Bank (ADB) to support sustainable infrastructure projects in the Asia region, including environmentally friendly transportation systems and clean energy projects.
Collaboration with JICA: The Japan International Cooperation Agency (JICA) works with private companies to implement technical support and economic development projects, such as the dissemination of agricultural technology in Africa and water resource management projects.

These efforts have been recognized, and Japan’s rating in the “Sustainable Development Report” improved from “Major challenges remain” in 2022 to “Significant challenges remain” in 2023.

To create a world where everyone can maintain their health without anyone being left behind, let’s summarize the global partnerships Japan can engage in:

Strengthening international health cooperation: Japan has played a certain role in international health cooperation, but further strengthening in terms of funding and technical support is necessary, particularly in supporting infectious disease control and the spread of vaccinations.
Dissemination of sustainable medical technology: Partnerships are lacking to disseminate Japan’s advanced medical technology to developing countries.
Development of medical infrastructure: Japan provides support for developing medical infrastructure, mainly in the Asia region, but further financial investment and technical support are needed to achieve sustainable development. There is a particular need for the development of medical facilities in rural and peri-urban areas.
Public health and preventive medicine: Support in the fields of public health and preventive medicine is insufficient, and preventive measures against infectious and non-communicable diseases are inadequate. Strengthening health promotion activities in developing countries by leveraging Japan’s public health knowledge and technology is necessary.
Emergency medical support: Strengthening medical support systems for emergencies caused by natural disasters and conflicts is required. Japan has experience in disaster medicine, but building partnerships to utilize this internationally is necessary.

This graph was created by wellhomewellout.com, using data sourced from the Ministry of Internal Affairs and Communications and various JICA annual reports, showcasing the trends in JICA’s Public-Private Partnership (PPP) investments from 2010 to 2023.

Creating a World Where No One Is Left Behind in Health: The Necessity of a Multifaceted Perspective on the SDGs

We have reviewed the SDGs with the goal of creating a world where no one is left behind in maintaining their health. This requires a multifaceted approach, much like the compound eyes of a dragonfly. The seeds of health risks are everywhere, and while some can be addressed within Japan, others require global cooperation. These health risks are often not easily noticeable in everyday life, making it crucial to pay attention to the research findings and recommendations of specialized agencies and researchers worldwide, such as the WHO, to develop an eye for identifying these unnoticeable but present health risks.

We are now entering an era where healthcare is being transformed through new technologies, such as digital health and AI. However, it is not enough to merely apply technology to existing healthcare systems. We must build a revolutionary digital healthcare system that can pursue sustainable health by integrating information about all potential health risks.

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