G7 high-level side event in Niigata

G7 high-level side event in
Niigata: Healthy ageing
and prevention

Welcome
David Sinclair, Chief Executive, ILC-UK
Join the conversation: @ilcuk
#DeliveringPrevention

About ILC
• We are the UK’s specialist
think tank on the impact of
longevity on society, and
what happens next.
• We are one of the founding
members of the ILC Global
Alliance, an international
network on longevity with
members across 16
countries.

Healthy Ageing and
Prevention Index
Arunima Himawan, Senior Health
Research Lead, ILC-UK

Despite repeated commitments to prioritise prevention
action continues to lag
But across the OECD alone, countries only spend
on average 2.8% of their health budgets on
prevention.
If we increase preventative health spend by just 0.1
percentage points it could unlock an additional 9% of
spending every year by people aged 60 or over.

The Healthy Ageing and Prevention Index
• The Healthy Ageing and Prevention Index is a global Index that holds
governments to account on healthy ageing and prevention.
• The Index measures and ranks 121 countries on six healthy ageing and
prevention indicators including life span, health span, work span, income,
environmental performance and happiness.
• For the first time, this Index brings together health, wealth and societal metrics
to give us a comprehensive picture of how sustainable countries are in the
context of longer lives, and the extent to which governments are investing in
efforts to prevent ill-health.
• Aside from ranking individual countries on their performance, the Index also
ranks political and/or economic country blocs, such as G7, EU and OECD.

The six indicators
• Life span and Health span: these are measured at birth using life expectancy and
healthy life expectancy measures (expressed in years) respectively. Data is obtained
from the WHO.
The top five countries for life span in 2019 were Japan (84.3), Switzerland (83.4), South
Korea (83.3), Spain and Singapore (83.2).
The top five countries for health span in 2019 were Japan (74.1 ), Singapore (73.6),
South Korea (73.1), Switzerland (72.5), and Israel (72.4).
• Work span: is defined as the expected number of years spent between being
economically active and retirement (ages 15-65). Work span is expressed in years and
data to calculate this metric is obtained from the World Bank and the International
Labour Organisation.
The top five countries in 2019 were Cambodia (43.7), Ethiopia (40.7), Eritrea (40.6),
Burundi (39.5) and Laos (39.4).

The six indicators
• Income: is measured by GDP/per capita using purchasing power parity ($ 000s) with data obtained
from the World Bank.
The top five countries in 2019 were Luxembourg (120.96), Singapore (101.94), Ireland (89.43),
Switzerland (73.11), Norway (68.35).
• Environmental performance: is measured using the Yale Environmental Performance Index (EPI)
which positions countries on a scale of 0 to 100 (100=best). The global average EPI rating is 48.8.
The top five countries in 2020 were Denmark (82.5), Luxembourg (82.3), Switzerland (81.5), the
UK (81.3), and France (80).
• Happiness: positions countries on a scale of 0-10. 0-4 are interpreted “suffering”, 5-7
“struggling”, 8-10 “thriving”. Data are taken from the annual Gallup World Poll which
asks respondents to think of a ladder and asked to rate their own current lives on
the 0-10 scale. Data is obtained from the UN.
The top five countries in 2019 were Finland (7.8), followed by Switzerland (7.694), Denmark
(7.693), Iceland (7.5), Norway (7.4).

G7 high-level side event in Niigata

The top five countries on the Index
Country Life
span
(years)
Health
span
(years)
Work
span
(years)
Income
GDP/head
ppp ($000s)
Environmental
performance
0-100
Happiness
0-10

The Healthy Ageing and Prevention Index

Only top 1% of world population is best
adapted to longer, healthier lives

There are significant inequalities between
countries at the top and bottom of the Index
• There is a 24-year gap in life span (life expectancy) between
the top 10 and bottom 10 countries.
• There is a 21-year gap in health span (healthy life
expectancy) between the top and bottom 10 countries.
• There is a 23-year gap in work span (working life
expectancy) between the top and bottom countries

Political and economic bloc rankings

The Healthy Ageing and Prevention
programme
• Hold Governments to account by tracking progress on prevention
through the production and launch of the digital Healthy Ageing and
Prevention Index in May alongside the 76th World Health Assembly.
• Engage global health leaders to move from commitment to action
on preventative health.
• Build strong relationships with 20 leading organisations to form a
Healthy Ageing and Prevention Coalition to demand action and hold
governments to account on preventative health.

Dr Haruki Matsumoto
Director-general of the Department of
Health and Social Welfare, Ministry of
Health, Labour and Welfare

HEALTHY AGING AND
PREVENTION IN JAPAN
2023
5.10
NIIGATA PREFECTURE
Harry Haruki Matsumoto
Director General, Health & Welfare
Dep.
Niigata Pref. Gov.

Harry
Haruki
MATSUMOTO
● Director General, Health &
Welfare Dep. Niigata Pref. Gov.
● Exchange from Ministry of
Health, Labour & Welfare,
Japan
(2009-)
● M.D. (3 Y Clinical Exp.)
● M.P.H. (Harvard, Health Policy)
Profile

● World is getting older
● Agenda
Healthier & Longer LIFE
● Japan’s Secret
★ Healthier lifestyle (fish,vege,
etx)
★ More active Life (keep working)
★ Also reducing XXX
Aging World

Healthy life expectancy：63.7Y
Life expectancy：73.3Y
Healthy life expectancy：74.1Y
Life expectancy：84.3Y
Japan has
the Longest life expectancy and
the Longest healthy life expectancy all over the world.
Life Expectancy

• 1 Soup & 3 Dishes（一汁三
菜）
• Ideal Nutritional Balance
• "UMAMI" Helps to Achieve a
Diet Low in Animal Fats
• registered as a UNESCO Intangible Cultural Heritage
in 2013
WASHOKU
Japanese Traditional Cuisine

Labour correlated to health life expectancy in Japan
(R^2=0.180,correlation coefficient=9.567, t-value=3.108, p-value=0.003)
Positive Correlation
Labour force participation rate 65+
to Healthy Life Expectancy.
Within Japan
Analysis

Fish consumption associated w/ health life expectancy in
Japan
(R^2=0.178,correlation coefficient=0.0001, t-value=3.087, p-value=0.003)
Positive Correlation
Seafood intake
to Healthy Life Expectancy.
Within Japan
Analysis

The rank of Niigata in Japan
The lowest BMI of adult male
National average:23.8, Niigata:23.1
High health life expectancy
National average:73.4, Niigata:73.9

The lowest health expenditure per capita
National average: 4360$
Niigata: 3732$

The higher intake of seafoods
average: 5999g/ household
Niigata: 6775g/ household
The higher intake of
vegetables
average: 277g/ day
Niigata: 293g/ day

Question
Living longer & healthier is good.
However,
how much does it cost？

Expenditure per capita of Japan is not so high
Health expenditure per capita of Japan(4691 USD) is
a little higher than the average one of OECD countries(4087USD).
Health expenditure per capita of 2019

Health expenditure as a percentage of GDP 2019-2020
High Health Expenditure %share of GDP
On the other hand,
Japan has the 5th highest health expenditure as a percentage of GDP over the
world.

Health expenditure and Population aging
• Positive correlation Aging
vs Healthcare cost in
general
• Japan: relatively low
Healthcare cost in
G7 when consider the
aging rate.(on the prediction
line)
• = G7

Summary - 1
Japan
❏ High
・ “Healthy” & “Total” Life Expectancy
・Vegetable, Fish, “Washoku”
・Activity
・65＋ keep working
❏ Low
・Fat, Obesity
・Drug abuse
❏ Moderate
・Health Expenditure

Summary - 2
Niigata
❏ High
・Healthy Life Expectancy
・Vegetable & Fish
❏ Low
・Obesity
・Health Expenditure

There is NO royal road to healthy
life.
Nothing is better than Prevention.

Long-standing efforts to decrease the salt
intake
● We have reduced salt intake 6g in 70years (15g→9g)
by efforts such as holding a Low-Salt Food Award, summit, campaign.
● Japan is still working to reduce the intake of salt to less than
6.5~7.5g/day.
-6g in 70years

Health expenditure and Population aging
Population aging and
long-term care
expenditure
• the long term-care expenditure of Japan is twice as
expensive as one of UK
• The number of those who are subject to it and the
whole population of Japan is also twice as large as
one of UK
Japan: 2.75million (120million)
UK: 0.87million (67million)

Jun Saito
Senior Research Fellow, Japan Centre for
Economic Research

On the ILC’s Healthy Ageing and Prevention
Index
10th May 2023 in Niigata
Japan Center for Economic Research
Senior Research Fellow
Jun Saito

Life Expectancy at Birth
43
(Note) * denotes that it is based on a complete life table.
(Data Source) Ministry of Health, Labour and Welfare

Life Expectancy and Gender Gap (2019)
44
(Data Source) WHO

Morbidity of Dementia By Gender
45
(Note) Estimate by Asada (2014)
(Data Source) Komamura (2019)

OECD: Labour Force Participation Rate (55-64)
46
(Data Source) OECD

OECD: Labour Force Participation Rate (65-)
47
(Data Source) OECD

Labour Force Participation and Enrolment in
Education (2019)
48
（Percent of 18-24 year-olds in education and not actively involved in labor market)
(Data Source) OECD

Breakdown of Elderlies Who are
Not in Labour Force (2021)
Breakdown of Not in Labour Force
(Economically Inactive)
Breakdown of Those
Who Want to Work
49
(Data Source) Ministry of Internal Affairs and Communications

Potential GDP Growth Rate (Quarterly)
50
(Data Source) Cabinet Office

Type of Employment by Age (2021)
Male Female
51

Happiness By Age
52
(Note) Estimates based on life satisfaction in International Social Survey Programmes (ISSP) 2017
(Data Source) Blanchflower (2020)
Minimum at 52
Minimum at 44
Minimum at 45
(Age)

Financial Assets and Liabilities by Age of the Head of
Households (2019)
53

OECD: Health Spending
54
(Data Source) OECD

OECD: Family Benefits Public Spending
55
(Data Source) OECD

Thank you for your attention!
Japan Center for Economic Research
Senior Research Fellow
Jun Saito

John Beirne
Vice-Chair of Research and Senior
Research Fellow, Asian Development
Bank Institute

Leaving no one behind
The cost-effectiveness of life course immunisation
Esther McNamara, Senior Health Policy Lead
ilcuk.org.uk
What happens next
International
Longevity Centre UK

About ILC
The International Longevity Centre UK, one of 16 ILC’s across the
world, is the leading think tank on the impact of longevity on society.
ILC UK and the other ILCs comprise the ILC Global Alliance. Each
centre works autonomously and collaboratively to understand how
demographic change affects us all.
Over the past three years, ILC UK has engaged with Governments
and organisations across the world on the need to invest more in
preventative health, as we lead longer, but not necessarily healthier
lives. We know prevention works, but action and investment still lags
behind what is needed.
ilcuk.org.uk
What happens next

Immunisation is safe and effective
Beyond access to clean water and sanitation,
vaccination is the most effective way to prevent
over 20 life-changing diseases.
Programmes of vaccination are already widely
used across different countries and healthcare
systems to prevent serious illness.
ilcuk.org.uk
What happens next

But we’re not where we should be
Globally, only 81% and 71% of
children have received their first
and second measles doses
respectively in 2022.
In 2021, first-dose measles
coverage was at its lowest
level since 2008.
There was a 73% drop in measles infections between
2000-2018 worldwide as a result of high uptake of
vaccination. It is extremely contagious, so monitoring
uptake is vital.

And it’s not just for children – we all need
immunisation across our life course
By 2050, the global population of people aged 60 and over is expected to
double to 2.1 billion. This means we must prepare to meet the
healthcare needs of more people for longer.
We know that older people access healthcare more frequently and
require more of its resource. Some healthcare systems already invest up
to 50% of their resources in people over 60 [UK, NHS]
The “longevity dividend” of life course vaccination programmes could be
enormous.

Adult vaccination is lagging
75%
95
%
World Health Organisation
vaccine uptake targets:
Childhood
Adult

Countries need to invest in and implement
national life course immunisation plans
The World Health Organisation’s
Immunisation Agenda 2030 sets out the
strategy for expanding existing vaccinations
programmes across the world, with a
particular focus on adult vaccines.
Now it is up to governments to take up this
Agenda.

Vaccine-preventable diseases affect
every aspect of our economy
Individual contracts COVID-19:
temporarily absent from
employment; does not spend money
on transport or activities outside the
home; sick pay may be less than
they would have earned had they
worked as normal.
COVID-19 pandemic:
total shutdown of global
economy, costing $12.5
trillion in first two years.
Millions of deaths and major
disruption.
And everything in between.

Immunisation’s value extends far beyond
the health system
1. Reducing healthcare
costs in the short term by
reducing incidence or
severity of vaccine-
preventable diseases.
2. Reducing healthcare costs
down the line by reducing severity
of secondary conditions.
4. Supporting the wider
economy through
greater workforce retention;
fewer pressures on
healthcare system and its
funding; individuals may draw
on their pensions later; more
activity overall if fewer people
are unwell.
3. Keeping people
productive, active and
engaged means fewer
working days missed;
reduced sick pay payments;
continued spending,
volunteering and caring.
Individuals who remain well can work, care, volunteer and
spend as normal.

1. Reducing healthcare costs in
the short term
This generated an
approximate total
cost of £731 million
(US$911 million)
to England’s health
system in 2019.
The cost of each adult
hospitalisation due to
serious pneumococcal
disease in England was
calculated to be £3904
(US$4868) in 2019.
Spanish healthcare
systems spent €134.1
million in 2015 on
treating four vaccine-
preventable diseases
in adults aged over
45.
Campling et al, 2022
de Miguel et al, 2022

$47,479 per
confirmed
case
(n=72)
$2.3 million: public
health response
$1 million:
productivity losses
$76,000: direct
medical costs
Healthcare costs are only a drop in the ocean when we
look at the whole picture
Estimated costs of a measles outbreak in 2018 in
Washington DC, USA, totalled
$3.4 million Source: Pike et al, 2021

2. Reducing long-term costs of
healthcare
• People who have had flu or pneumonia may be six times more
likely to suffer from a heart attack or stroke in the days after
infection [Warren-Gash et al, 2018]
• Since reports of measles were near zero in the United States in
2000, incidents of Subacute sclerosing panencephalitis (SSPE, a
brain disorder) are very rarely reported in the region.
• Around 65 million people worldwide are estimated to be
suffering from Long COVID [Davis et al, 2023]
• Researchers have found a correlation between uptake of one
dose of the flu vaccine and risk of Alzheimer's. Those who have
received a flu vaccine dose could be 40% less likely to develop
Alzheimer's disease [Bukhbinder et al, 2022]

3. Keeping people productive, active,
and engaged
In 2022, influenza was estimated to cost the US economy
$11.2 billion.
$3.2 bn
in direct medical
costs.
$8 bn
in absence from
paid employment.
$? in unpaid care,
volunteering, and
changes in spending.
Flu cost around 159 million working days in 2018 just
for workers aged 50-64 [ILC, 2019].

Health equals wealth
• In countries that spend more on health, older people work,
volunteer, care and spend more.
• People who report being in good rather than poor health are
over four times more likely to be in work between the ages
of 50 and 65, and over 10 times more likely between 65 and
74.
• Increasing preventative health spend by just 0.1 percentage
point can unlock a 9% increase in annual spending by
people aged 60+ and an additional 10 hours of volunteering.

4. Supporting the wider economy
€1 invested in
vaccination
=
€4.02 future revenue

Following the economic shock and disruption of
COVID-19, we need to change course
Source: World Bank, 2022
This graph is an illustration of the deviation in growth from pre-pandemic
estimations; emerging economies will struggle most to recover.

And the consequences will reach far into the future
Enough has not been
done to address
inequalities in access to
healthcare, and between
countries when accessing
resources.
We need to act on the
crucial lessons about
trust in vaccination, and
in governments and
health systems, we
learned through COVID.
Economic losses reached
US$12.5 trillion
globally between 2020-21;
projected to rise to $28
trillion by 2025.

It’s difficult to assess cost effectiveness
A 2016 systematic review of cost-benefit analyses within the EU found 7
of 8 studies identified at least one cost-effective scenario of seasonal
flu vaccine programmes.
Each study used different data sets and measures of cost-effectiveness.
Methods of measuring cost-effectiveness often fail to take into account
the full scope of consequences that are more difficult to measure,
beyond healthcare spending and sick pay.
but we shouldn’t underestimate the
value of immunisation

Investing in life course immunisation will
generate substantial returns
And it’s the right thing to do
This is a call to action to governments and health leaders to
prioritise life course immunisation programmes.
They are not just a “nice to have” – they are an important
investment in our ageing populations and our overstretched health
services.
Focusing on the whole-life impacts of ill health, as well as the
economic consequences, is key to understanding the full value of
prevention through immunisation.

Questions for discussion
• What else do we need to consider when valuing life
course immunisation?
• What are the barriers for national governments to act
on this?
• What examples of good practice are there in
implementing a life course approach to immunisation?

What happens next
Progress on life course immunisation roundtable discussion –
alongside the World Health Assembly
Date: Tuesday 23 May 2023
Time: 1.00pm – 2.30pm (CET), followed by refreshments
Location: Geneva Press Club, Geneva, Switzerland
• Influencing at the G20 in India: there is a broader range of
challenges and opportunities through life course immunisation
• Global launch of findings at hybrid event in London
Esther McNamara, Senior Health Policy Lead
esthermcnamara@ilcuk.org.uk

ILC resources on adult immunisation

Previous ILC reports on immunisation

ILC’s upcoming projects and events
• Upcoming report: Vaccine
Confidence in Central & Eastern
Europe
• Watch our webinar and follow our
activities at this year’s G20 in India
• Healthy Ageing and Prevention
Index
ilcuk.org.uk
What happens next

Discussion

Closing remarks

Upcoming events
G7 high-level side
event: Covid
recovery and
prevention
Hiroshima, Japan
Thursday 18 May
Global launch of the
Healthy Ageing and
Prevention Index - 76th
World Health Assembly
Geneva, Switzerland
Tuesday 23 May
Leaving no one behind:
Progress on life course
immunisation roundtable -
76th World Health Assembly
Geneva, Switzerland
Tuesday 23 May

G7 high-level side event in Niigata

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