It’s mid-afternoon in Fujisawa. Schoolchildren, rucksacks on their backs, bound into a room where a group of pensioners welcome them boisterously, before sitting them down to help with their homework. This group of older people is looked after by some of the pupils’ parents. Up the road, a cluster of university students live above some over-75s. They get half-price rent in return for checking in on them on their way to and from studies.
This multigenerational community I visited in a small town not far from the port of Yokohama is one of 5,000 in Japan.
Sometimes the solutions to the big social challenges of the day are right in front of us; they don’t necessarily cost much, but they do require forward thinking and a determination to make them work. Across Europe, these challenges are often shirked.
By 2050, the number of centenarians in Japan could reach almost half a million. The proportion of pensioners is expected to rise to nearly 40%. In some ways, Japan is a victim of its own success, with the world’s highest life expectancy for the past four decades. It is now 87 for women and 81 for men.
Japan has also shown that if you can’t avoid a problem, you might as well confront it. Back in 2000, it introduced the long-term care insurance system, one of the first countries to develop such a public scheme. It is transparent and easy to navigate. Everyone knows what they must pay and when (payments begin on your 40th birthday). Its purpose is to “maintain dignity and an independent daily life routine according to each person’s level of abilities”.
The emphasis is on giving people more of a say in where and how they are cared for. Rather than elderly people receiving services that are assigned by the state, they are encouraged to choose and contract the services themselves.
For three years, I scoured the world for best practice in addressing the big present and future challenges. The 10 countries and cities I visited, from Japan to Morocco and India to Austria, had some surprising solutions; some were radical, others were simply the product of better organisation.
Stories about eldercare robots, for example, tend to dominate international coverage of Japan’s ageing society. But I was more impressed by some of the low-tech solutions. In Kawaguchi, a commuter town north of Tokyo, several community general support centres have opened. These are drop-in hubs that provide “lifestyle support” for any older person who wants it. This could be medical advice, help with paying the electricity bill or just company. They are being rolled out in each of Japan’s over 1,700 municipalities.
What the disparate destinations I studied had in common were resilience, imagination and political courage – qualities that mainstream politicians in Europe have long struggled to demonstrate. And they seem allergic to the other precondition for securing lasting change: serious long-term planning.
With ageing populations, many European economies are creaking under the strain of funding pensions, care services and health. Yet the two areas where European governments remain most politically timid are social care and health reform. All suffer from a lack of doctors, nurses and other care professionals. The German government has just announced a series of cuts to healthcare services to balance the books.
Until recently, France was cited as an example of healthcare success, but the highly centralised system disincentivises doctors and nurses from working in disadvantaged regions – so-called health deserts.
By contrast, Sweden, which has a more decentralised approach, continues to overperform. Spain’s success might be seen as more surprising, with one of the highest life expectancies in Europe. It has a universal national system, which, like Britain’s NHS, is free at the point of delivery, but it is run by its 17 autonomous regions, not by a central monolith.
When it comes to building a transparent system for funding care for older people, the UK is the most abject of all. Successive prime ministers have called for change yet have run away from sensible reforms produced by commissions they established, hoping that, by delaying a problem, it would somehow go away.
Japan and Taiwan, as I discovered, started preparing for the demographic challenge decades ago. Taiwan’s national health insurance (NHI), for example, unlike Britain’s NHS, is quick, efficient and highly digitised. Medical literacy and patient autonomy are paramount; everyone learns about diet and exercise from a young age, part of a whole-society approach to “owning” your own health. The system has very few GPs. Patients usually go straight to hospitals or clinics, where they can expect to have a first consultation within 20 minutes. Or they can book on the app, and their doctor can have a look straight away online. Alongside speed of delivery, the other remarkable aspect of this system is the cost. At around 8% of GDP, it is far cheaper than the European average of 10%-12%.
In these examples, and others I looked at – all of which are transferable into a European context – what matters is what works.
Some politicians say all this is impossible. They insist they would be punished for asking voters to endure short-term pain, and that the gains would be enjoyed by successor governments. Yet many examples show the opposite: when a policy is presented transparently, when other political parties are invited to input, and when voters are included in the conversation, they are more likely to accept change.
And leaders are being punished anyway. Friedrich Merz faces the worst opinion poll ratings for a modern German chancellor; Keir Starmer could be out of Downing Street very soon;
in France, centrists face a pincer movement from the far left and the far right in next year’s presidential elections. As they flail around, leaders of many European nations look desperately for instant balm; the more they do so, the more they consign themselves to failure.
Everywhere you look, you see liberal democratic leaders paralysed with fear. They worry about the markets (with reason); they fret about conventional media and social media (with less reason). They wait for bad things to happen, trying to anticipate what their critics might say of them in case they put a foot out of line. It’s a self-fulfilling spiral.
Mainstream parties agonise about tacking to the left or the right. About whether to spend more on public services or slash them; to privatise or nationalise; or to clamp down further on immigration. These are the wrong questions.
Instead, they should do something different – exercise humility, find some curiosity and learn from others. Across all areas of policy, and in all parts of the world, there are examples of good practice: how to build an education system that meets the skills challenge posed by AI; how to provide equitable housing; how to create a sustainable environment and simultaneously boost growth.
Think of it another way. Consider the political developments in London, Paris and Berlin: given that the link between delivery and trust has been undermined, if mainstream politicians don’t think more imaginatively about the future, they won’t have a future.
