Life Expectancy and Health Expectancy | Hiroyuki Ishida, Dean, Graduate School of Health Management
September 27, 2022
On September 13, I learned of the death of director Jean-Luc Godard, a leading figure of the "Nouvelle Vague" (New Wave) in French film culture. He was 91 years old. Perhaps because the death of Queen Elizabeth of the United Kingdom had occurred a few days earlier, Godard's passing was not widely reported in our country. However, many cultural figures have offered their condolences, mourning the death of a solitary director who had a profound impact on the world of cinema.
I first learned of Godard during the summer of my first year of high school, when I was in the United Kingdom for a short homestay. I happened to be talking about movies with a Spanish girl I met at a language school. When I asked her, "What kind of movies do you like?" she replied, "Godard's 'À bout de souffle' is wonderful." The Japanese title for "À bout de souffle" is "Katte ni Shiyagare" (not the Kenji Sawada song). This was the feature debut that made Godard's name known to the world. At the time, I prided myself on having already seen many European films, but unfortunately, I was ignorant about Godard. Looking back, if I had been able to reply, "I like 'Pierrot le fou' (Japanese title: 'Kichigai Pierrot')," I might have been able to build a new relationship with that girl. Unfortunately, that was the extent of my abilities at the time. Upon returning to Japan, I promptly went to an art-house cinema to see "Katte ni Shiyagare" and other Godard films. However, I was left with a strong impression only of the dazzling women like Jean Seberg and Anna Karina. The relationships between men and women, lacking a clear beginning, middle, and end, were extremely difficult for a high school student to grasp, and I recall resigning myself to the idea that it was still too early for me to date a European girl. Strangely enough, in the many experiences I have encountered as I have gotten older, there have been not a few moments when I have suddenly recalled images from his films and thought, "This is just like a Godard movie." While I can't shake the frustration of not being able to fully understand them, I suppose that is the nature of a master's works.
Now, I hear that Director Godard chose assisted dying, which is permitted in Switzerland, where he spent his final days. So-called "dignified death," which includes medically assisted suicide, is a subject of global debate, but it can also be interpreted as one option for shortening the gap between life expectancy and health expectancy. Putting aside the pros and cons of assisted dying, how to close this gap is a pressing issue for many developed countries. In recent years, various stakeholders in our country, which has a particularly high elderly population ratio, have been calling for the extension of health expectancy. In the early days of public health and medical technology, an increase in life expectancy was recognized as a sign of the entire nation's health. However, now that these have sufficiently matured, the increase in life expectancy has come to reflect the proportion of the elderly, while the maximum lifespan will not increase significantly due to the Hayflick limit1). So, what happens next when the maximum lifespan remains unchanged and the elderly population increases? The baby boomer and second-generation baby boomer generations, which are prominent (i.e., large in number) in the current population structure, will all face end-of-life care at once (and I am one of them). Unfortunately, in many cases, it will not be a matter of "PPK" (pin pin korori, or dying suddenly after a healthy life). Instead, a considerable period of medical treatment, nursing, and long-term care will be required before death, and the burden, including social security costs, will have to be borne by the smaller younger generations. To avoid leaving behind a negative legacy, I believe that achieving PPK—in other words, closing the gap between health expectancy and biological lifespan—is the final task required of the Showa generation.
Currently, this gap is about 10 years for both men and women. In response to the unprecedented challenge of how to shorten this gap, the Keio University Center for Preventive Medicine has decided to embark on a new endeavor using the latest technology and knowledge. The Center opened in 2012 as part of the university hospital's functions and has achieved results centered on comprehensive health checkups. Next October, it will expand and relocate to Toranomon-Azabudai, with the stated goal of pioneering new preventive medicine, true to its name. After the relocation, in addition to the conventional functions of comprehensive health checkups—namely, early detection and early treatment—the Center will also emphasize intervention from the pre-disease stage and individual assessment to support the realization of each person's well-being. Extending health expectancy and preventing the need for long-term care are closely related. Looking at the causes of needing long-term care, we find that musculoskeletal problems such as fractures, falls, and joint diseases account for about a quarter of cases (according to the 2019 National Health and Nutrition Survey). With the aim of detecting these musculoskeletal problems early while they are still "reversible" and restoring function or delaying the onset of the need for long-term care through exercise and nutritional guidance, our sports medicine group will also participate in the new preventive medicine advocated by the Center. Not limited to the field of sports medicine, the projects of the new Center for Preventive Medicine are highly compatible with the policies of the Graduate School of Health Management. As the only organization within the university's faculties and graduate schools to bear the name "Health," we hope to cooperate in building health for the future.
1) Hayflick limit: The theory that the cells that make up the body repeat cell division during the growth process, but there is a limit to the number of times they can divide. After a certain number of divisions, they stop dividing and eventually undergo cell death (Hayflick is the name of the proponent of this theory). The number of possible cell divisions is predetermined by the species (human, mouse, dog, etc.), which in turn determines the maximum lifespan of the individual (species).