Scary Needles and Japanese Health Care

US Vice President Joe Biden once said that health care is a “big f’in’ deal,” and I tend to agree. I don’t just mean in the US, where Biden was referring to Obamacare, but across the world people value their health care systems

Earlier this year, England recognized its National Health Service with a 10 minute celebration in the opening ceremonies of the 2012 London Olympics. Japan is no different; the country has had nationalized health care for over 50 years.

With all of the fuss about Obamacare in the US, health care around the world has been a particularly interesting subject for Americans recently. Unlike American healthcare, the Japanese health care system is largely nationalized, tightly regulated, and relatively cheap.

Photo by James Mutter

It seems to have paid off pretty well, too; life expectancy is pretty high, infant mortality is low, and most of the important stats are right where they should be.

Blah blah blah. I’m sure policy nerds could break down the numbers for you all day. That’s not really what interests me. What’s kind of incredible to me is that many Japanese have physical proof of their participation in the national health care system. A portion of the Japanese have scarring on their arms from — what? Robots? Aliens? Doraemon?!

The scarring comes from a tuberculosis vaccine that nearly every Japanese person gets at around the age of five or so. It scars, unlike other vaccines, because it’s administered with a horrifying syringe — the kind of syringe that children imagine when they refuse to go to the doctor. You know, the kind with nine needles.

Given in recent years, the size of the syringe has gotten increasingly less terrifying, but from an American standpoint it’s interesting that virtually every Japanese man, woman, and child has received this vaccine even though very, very few Americans have.

Why is this? Even though lots of countries around the world administer this vaccine, it’s not seen as necessary in the US. The US government says that the vaccine “should be considered for only very select people who meet specific criteria and in consultation with a [tuberculosis] expert.

Instead of vaccinations, the US deals with TB by blowing away the animals that might cause it. Well, kind of. A certain type of deer carry a strain of TB that’s transmittable to humans, and the US permits people to hunt the deer to keep the disease under control.

But I’m getting off track here. These scars interest me so much because they’re very real, physical proof that the Japanese health care system touches nearly every person (often quite literally) in Japan.

Unfortunately though, it’s not all great. We’ve talked before about how frightening Japanese doctors can be, whether it’s not telling you about your cancer or the sometimes strange diagnoses and excessive prescriptions.

There’s unfortunately more though. As the population gets older and older, there are fewer and fewer young people to pay for the higher health care costs of the elderly. Many people think that the current system is completely unsustainable as it stands.

And even the whole thing isn’t working out too great for Japan. Surprisingly according to the World Bank, Japan actually has a higher rate of TB than the US does, once again proving that there’s no problem Americans can’t solve with guns (or something like that).

But this isn’t anything that the Japanese don’t know about already. The aging of the country is the defining demographic issue of our time or, as Joe Biden might say, a big f’in’ deal.

  • Vongizzle

    I don’t quite understand why the ‘Birth rate (crisis)’ isn’t more of a big deal? With knock-on effects like those mentioned the article I never understood it! (Anyone care to enlighten me)
    With the English system we don’t pay anything (apart from prescriptions and dentists) but anyway ^^
    Interesting article!

  • http://www.myjapanesegreentea.com/ Ricardo Caicedo

    Oh my god, the 9 needle syringe is pretty scary!

  • http://twitter.com/empireofderp nej

    People in the UK get the ‘TB’ jab (as it’s called here) at around the age of 14-15, which is compulsory. It leaves a scar on our upper arm, the 9 needle one is a jab on the lower arm to test to see if you are already immune and don’t need the injection.
    The TB jab is very painful, and leaves a blister on the arm which aches for ages, eventually it scars! D:

  • http://twitter.com/empireofderp nej

    Have to just further this–the 9 needle one goes in almost like a stamp, it’s quick and not really that painful, and I think it’s… if the 9 mark stays you don’t need the injection, if it goes away you do.

  • PianoFish

    The TB jab is no longer given routinely in the UK, it’s now only given to people in high risk groups. I’m 24 and I haven’t had it, I somehow missed it for reasons I’m not entirely sure of but when I checked whether I should get it done now the answer was no.

  • http://www.femgeek.co.uk/ Han

    Its done in schools usually. Its quite sadistic really. Everyone lines up for their injection. I always think its quite odd looking at all the scantily clad girls lining up outside clubs with their matching circular scars branded on their arms.

    (I had mine on my bum when I was a baby, the pros of growing up in a different country!)

  • http://www.facebook.com/people/Jennifer-Eelbeck/1249456412 Jennifer Eelbeck

    It is not compulsory anymore, though, I just missed out on having it, because I was in the first year to not make it compulsory, around 2008/2009, glad to not have it XD

  • Mescale

    The 9 needle test has some dead TB cells on the end of each needle and forms a ring if you’re super human or something.

    TB used to be wiped out in the UK but immigration and internationalisation caused it to return, I had my TB jab when some kids in our school got TB from abroad, so they vaccinated us all.

    It was awesome because you could punch people on the arm, and it would hurt them super mucho, but of course you also had the same weakness.

    Its still fun everytime my sister hits me in the arm to go “OWWW THATS MY TB JAB” regardless of which ever arms she punches :P

  • DAVIDPD

    I proudly wear my TB vaccine scar from when I was born in KOREA!

  • DAVIDPD

    They’re short so it doesn’t hurt as much.

  • Cass

    The 9 needle variety was the least of my worries, quick and painless, the proper TB jab was the problem.
    The nurses had no interest in whether there was a reaction or not, you got the injection! Second and final jab went fine and I have a very small scar, the original jab I had as a baby went badly wrong and according to my mother ‘looked like I had been shot’ and left me with an impressive scar, not a nice circular one…looks more like someone has tried to hack my arm off. It’s a story to tell at least but I certainly wouldn’t worry about the 9 needle one…although I do remember being pushed to the front of the queue by all the boys who were too scared to get it!

  • Rikki-Lee

    I live in NZ and from memory we get a TB shot as babies, then a “booster” one when we turn 13. It’s only one needle though.

  • http://www.facebook.com/Pao.vO.Ov Paulina Gonzalez

    No idea how many needles stabbed my arm, but I also have a freakishly huge scar on my left arm. I got mine in CHILE~! all of us have it too
    When ppl here [NY] see it and ask me about it… they all seem to want some sort of war story, and are visible disappointed when I tell them it’s from a mysterious vaccine…

  • David Gasper

    Sadly thats how the us thinks. Eventually there will be only people left in the whole us and their first thought will be problem solved. God I wih this country didnt exist. The culture is so strange. I mean America

  • http://www.facebook.com/rAnd0mn3ss Paola E. Garcia

    In Mexico (my family except for me) a lot of people have the TB scar (I was too young to receive the shot when we moved to the States).

  • 古戸ヱリカ

    Try… shooting this problem…? With… needles?

  • http://www.facebook.com/eliza.porter.5 Eliza Porter

    I’m curious about why Japan is an aging country? Do they have an increasing elderly population for the same reason as the US? (the baby boom)

  • http://www.tofugu.com/ Hashi

    The aging of Japan is a complicated issue with a lot of effects. It’s not so much that the elderly’s generation is particularly big, it’s more that the current generation, for a bunch of different reasons, just aren’t having kids. Plus, since Japan doesn’t allow much immigration, there’s aren’t new immigrants to help build up and add to the younger generation.

  • http://www.tofugu.com/ Hashi

    I always thought the birth rate crisis WAS kind of a big deal — it seems to come up in a lot of readings I do about Japan, and it was talked about in a lot of my university classes.

    There are a lot of effects, aside from the effect on health care. It also means that the work force is shrinking, and a lot of entitlement programs are going to be massively underfunded. Small towns are shrinking and disappearing too, in part because of the birth rate crisis.

  • milos

    Yep, they even have a catchy term for it: “the birth dearth.”

    Good piece as usual, Hashi.

  • DAVIDPD

    Tis a worldwide problem. Sociologists call it an “inverted triangle”.

  • Triangle Man

    It’s not actually “worldwide” – top-heavy population trees are really only a problem in industrialized countries (with Japan having the most drastic one). The rest of the world maintains the more traditional bottom-heavy or balanced population trees.

  • neu

    I received that particular shot in Jordan when I was in first grade. They administered it with a MASSIVE gun-like device. I was so scared, but surprisingly, it didn’t hurt. At all. Seriously.
    Now I have a scar forever :D

  • Cat

    Whoa, that thing looks terrifyig! My scar just looks like a pinch in the skin; I highly doubt we use more than one needle here in Sweden.

  • http://kennydude.me/ Joe Simpson

    They give it to each year every so often. One year will get it, miss a couple and then the next get it. They say it’s so the antibodies are topped up in-case we loose them or something

  • DeTo-13

    You Americans have got it easy!, in England you get a needle stuck in you 3-4 times through your school life, the last being the arm scaring TB jab in year 10. By the way that 9 needle syringe isnt the bit that scars you, thats just the testing kit which you get a week before in your inner forearm to see if you need the TB vaccine, The actual TB jab is just a standard syringe
    but the area on your arm where you receive the jab gets all pussy over
    the next 2-3 weeks after the injection and swells up then bursts causing
    a round scar. Thats how it works in England anyway.

  • David Gasper

    Eeeeeexacly

  • Amakusa Ichiro

    That needle used by us clinic as well. There was 20 needles, not 9, when I got shot required by US Immigration before leaving Japan. When my son got high school he had smiler shot at our doctor’s office. I was informed by a nurse that I could sue my doctor because I had the scare from the TB shot. I told about my scare on left shoulder to mom. She said she knew about that law, she didn’t want to persuade it because he was our family doctor. This was 35 years ago. My aunt passed away several years ago. She was told by her doctor she got lung cancer and 6 month to live. She didn’t want to get treatment for her cancer. She changed her diet and did what she wanted to do. She died 10 years later, age 82. I was visiting my mom when my son got bit by some insect. I needed to take him to a hospital for his treatment. One hospital told us my waiting time is over one hour so they already called other hospital and set up an appointment for him. 10 minutes later we were at other hospital and got treatment. While a doctor was examining my son I had go through paper work and they asked I have an insurance or not. I told no. They told me it would be expensive without insurance. Total was 35 dollars including doctor’s and medication. I remember that our house had a medicine box and every three months or so a pharmacy visited our house went through the box and re-supplied medicines. The government health care is required some degree. Modern technology is helping us or hearting us. We should be more active physically. Human should be walking more instead of driving, standing instead of sitting. Too much technology is only use finger tip, not whole body. My mother is 93 years old. Her doctor told us her body is 50 years old and my body is older than my age. She used to climb mountain to take care of her farm everyday. She learned how to ride her bicycle when she was 70 years old since my father was in hospital. She cooked breakfast and dinner for him and took to his hospital. She gets Dr. visit every week, of cause it’s free.

  • http://twitter.com/shethatisnau Jessica R-E

    THANK YOU for explaining that scar. I see it ALL the time on people, often fresh on little babies, and it has been one of those things I’ve wondered about without knowing how to ask or what to search for. I stumbled on this post as a fluke and am so relieved to know WTF that scar is now. I’ve actually been tested for TB and received a vaccination against it while in the US (not with a 9-tipped needle, though, thankfully) because I spent some time working in a home for the elderly.

  • http://mistersanity.blogspot.com Jonadab

    > Japan actually has a higher rate of TB than the US does,
    > once
    again proving that there’s no problem Americans
    > can’t solve with guns
    (or something like that).

    Actually, I’m pretty sure the most important method the US uses to keep TB under control is the relentless testing every two years of all workers in certain key fields (particularly doctors, nurses, and teachers). Because TB (typically) has such a long lead time between infection and the onset of symptoms, this policy allows early detection of outbreaks that might otherwise continue undetected for a long time. Why doctors, nurses, and teachers? Because they consistently get exposed to every readily communicable disease that makes the rounds in their community.

    Yeah, it’s weird. But it works.

  • scottwright

    There are several rounds of shots that US children have to go through while in school. These shots are normally called ‘booster shots’, and they start when you are a child. US children also get a TB test (not a vaccine), which is pretty painless. Healthcare workers (and certain other fields) have to get regular TB tests as well.

  • Mathias richter

    Thank you.

  • Saimu-san

    We had a smaller-scale version of that in my high school for our Heaf tests. I got mine done just before they discontinued them in ’05. Don’t remember it being used with a gun, though. It looked more like a little purple stamp you got on your forearm. I can still make mine out from time to time. Can’t imagine what the hell that thing shown above would look like…