The face behind the mask


From the moment you enter the airport concourse at your point of arrival in Japan to the minute you board your flight home, you will be regularly confronted by the sight of people wearing face masks.

The most common explanation for why people “mask up” is that they may be sick and don’t want to infect others or that they don’t want to be infected by sick people around them.

But there are other explanations.

According to one source the wearer could be a member of a bikie gang or simply too embarrassed to show their face on You Tube.  Another suggests that wearing a face mask may be an emerging fashion trend among Japanese youth.  And for anyone who has watched the Sunday morning teen parade on Takeshite-Dori in the Tokyo suburb of Harajuku, the face mask is noticeably present albeit a rather sedate accessory.


Teen parade on Takeshite-Dori

Whatever the reason for wearing face masks, it begs the question: are Japanese people obsessed with their health?  And do they need to be?

More than half a century ago the Japanese government began promoting wellness as a yardstick of good health and with one of the lowest obesity rates – 3.2% – and the longest life-expectancy globally – 81 for men and 87 for women – one would expect the Japanese population to sit back, relax and take a break from thinking about their health.

Not so.

Writing in the New York Times on 16 April, 2013, Kumiko Makihara – an expat living in New York – tells us that about 35% of adult Japanese undergo comprehensive annual physical examinations that take anywhere from a half to several days to complete, depending on the number of areas under scrutiny.

At the end of the examination, the patient is handed a “report card” which grades him or her from A to D across the range of tests carried out.  If you achieve A’s and B’s, you can walk away for another year.  C’s and D’s require retesting and remedial action.

According to a 2011 report, only 8% of the population emerged from the tests with A’s and B’s.  Does this imply that more than 90% of the population is unhealthy?

No doubt Japan’s ageing population – nearly a quarter of the community is older than 65 – is a contributing factor.  But that doesn’t get us to 90% of the population.

In Mr Makihara’s case, his report card showed 21 A’s, three B’s, two C’s and a D.  To anyone outside Japan, this would seem like an outstanding outcome. Apparently not.

A high liver count was potentially attributed to “weight gained too rapidly”.  How much?    2.2 kilograms over a two-year period, after which his weight was still below the average for his height.

If this seems like overkill, then herein lies a clue as to the reason.

A combination of universal health coverage and employer subsidies means that medical tests often leave the patient with low out-of-pocket expenses, while simultaneously supporting an industry that employs strict standards to measure the health of its population.  What may have begun as a symbiotic relationship between consumer and health care professional seems to have evolved into mutual dependency: tests are lucrative for doctors and patients aspire to become “high achievers”.

A few days into our stay, M and I started sneezing.  After a few more days, this gave way to a cold and no doubt to locals we had become a “germ” zone.

We are pretty good at falling into line with local custom, but donning a face mask was a bridge too far.

We hope we didn’t infect anyone.


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