The New Deal's Unsung Victory

Seventy-five years ago this March, major media outlets have reminded us over recent weeks, Franklin D. Roosevelt's New Deal had its American debut. But when exactly did the New Deal end? The American Journal of Public Health has just published a fascinating article that suggests a surprising answer.

FDR's New Dealers, the evidence in this piece helps establish, may have actually scored their biggest victory over inequality after Roosevelt died in 1945. And this landmark victory didn't even take place inside the United States. America's New Dealers had their last -- and most lasting -- egalitarian hurrah in Japan.

Japan's "New Deal" era began in 1945, right after the surrender that ended World War II. The public policy veterans of the Roosevelt administration who streamed into Japan that year, as staffers for the Allied Occupation run by General Douglas MacArthur, found not just a war-weary nation, but a deeply unequal one.

By 1952, the year the occupation ended, that gross inequality was fast disappearing. Japan would soon become one of the world's most equal -- and prosperous -- nations. By the late 1980s, World Bank statistics document, Japan would sport the world's smallest internal gaps in income distribution.

Stephen Bezruchka and Tsukasa Namekata of the University of Washington School of Public Health and the Oregon Health & Science University's Maria Gilson Sistrom tell the tale of this remarkable transformation in the current issue of the American Journal of Public Health.

What's an article about an economic story over half a century old doing in a professional health journal? The simple answer: Japan didn't just become more equal after World War II. Japan became incredibly more healthy.

In the half-century before World War II, a time when huge business conglomerates had come to concentrate Japan's growing industrial wealth within a narrow privileged class, average Japanese men lived just 42.8 years. By 1960, male life expectancy had registered a remarkable rise to 60.8 years, and Japanese women had seen their lifespans increase, on average, from 51.1 years to 64.8.

The top U.S. health official during the Allied occupation of Japan, note Bezruchka and his colleagues, would later call this "astounding jump" in life expectancy "unequaled in any country in the world in medical history in a comparable period of time."

Japan's lifespan gains would continue. By 1979, no people in the entire world lived any longer than the Japanese. The world's most equal and most healthy nations, in effect, had become one and the same.

A coincidence? Health analysts like Bezruchka, Namekata, and Sistrom don't think so -- and they strengthen their case for a link between inequality and health by exploring other possible explanations for Japan's post-World War II gains in life expectancy.

The Japanese, the three authors show, didn't become healthier because the Japanese health care system suddenly became world-class. It didn't. And Japan didn't jump to the top of the world lifespan rankings because Japanese families eat a wholesome Asian cuisine. Japanese eating habits have actually become more Westernized -- and less healthy -- since World War II.

Nor do individuals in Japan avoid unhealthy personal habits. Men in Japan smoke, for instance, at among the highest rates in the developed world.

So what's behind Japan's fabulously good health outcomes?

Japan's phenomenal health success reflects the importance of what analysts now call the "social determinants of health."

"Policies that produce more egalitarian societies," as the Bezruchka team puts it, "may explain profound health improvements."

These improvements most likely work their medical magic by reducing debilitating chronic stress. And this stress reduction owes far more to "political changes" than to "specific public health programs."