Graduates of nursing and paramedical programs have much opportunity, provided they have sufficient Japanese language skills.

Tokyo: Japan’s elderly care sector, $40 billion in size, is much in need of trained personnel with sufficient Japanese language skills to be able to operate effectively. Meanwhile, the unemployment situation in India among the young that is reported anecdotally, is worrying. Japan and India are therefore complementary, with Japan having an urgent need for personnel and India having qualified personnel of various categories available, but lacking in Japanese language capability and proper channels to ensure their placement in the Japanese economy on a permanent basis.
The Japanese language is a particularly difficult one to learn, but Indians have shown great capability to learn any language given time and opportunity. Further, Indians work in a range of positions in multiple countries, notably the US, Europe and the Middle-East. Indian nurses work in large numbers in the health sectors of the US, Germany, UAE, etc. Indian doctors are a mainstay of the US, UK and Gulf health systems.
The lack of political risk vis-a-vis India-Japan, given centuries of cooperation, is very reassuring to the Japanese government and industry and there is a prevalent belief that there will be no tensions as is happening with China. Graduates of nursing and paramedical programs therefore have much opportunity, provided they have sufficient Japanese language skills. India has a surplus of hard-working young people ready and willing to go abroad. The old arguments of brain-drain versus brain-in-the-drain have all become putrid. Today, it is essential for young people to be gainfully employed no matter where they are. Training in Japanese hospital and elderly care institutions’ practices to be able to start working in Japan will require having access to such institutions and facilities. Subject-matter training in order to get certified in the Japanese system, visa, acculturation, language training, accommodation especially for young women, etc. will all need to be arranged. Naturally, the Japanese language skills needed for nurses is high and therefore difficult to accomplish de novo from abroad—an efficient way might be to be able to work as a caregiver or assistant within the Japanese system to acquire sufficient spoken and written Japanese skills as well as scientific terminology, in order to progress smoothly in the value chain. Positions within the Japanese system are broadly on par with the Gulf and Europe in terms of salary scales adjusted for cost of living.
Japan’s ageing problem is severe. Japan has the highest proportion of elderly citizens of any country in the world, therefore is described as a “super-ageing” society. About 40% of Japan’s 126 million population is above the age of 60, with 28% aged 65 or above—a staggering number of around 36 million people, and 12.5% are aged 75 or above. There are 75,000 people aged 100 and above living in Japan today. September 20 is observed as “Respect for the Aged Day”, a national holiday.
Over time, India too will have similar issues related to ageing, and Japan presents a unique, interesting case to create India’s own dynamic structure. Already, there are about 100 million people in India who self-categorize themselves as “aged” although they are merely over age 60, that is not considered old, from a practical point of view, in many countries. Indeed, in certain countries, some who are genuinely elderly can take offence at being categorized that way.
The Japanese government is contemplating extending the retirement age to 70 partly to address a severe labour shortage. In its favour is a recent study showing that working men and women who don’t retire are less likely to suffer from dementia.
Japan is currently the third-largest economy as measured in GDP after the US and China, and having a GDP per capita ($38,000) far in excess of China’s ($9,000). Japan’s demographic dividend, which was in play from 1964, ended in 2004. Japan has a sacred commitment to its World War-generation (including those who were kids in its aftermath and suffered from poverty) and beyond to take care of them in their twilight years—and the national government heavily reimburses elderly care and hospital services. Japan’s rise from the ashes of World War II astonished the world and was a model for countries aspiring to climb out of “underdevelopment”. Today, however, so many jobs are going unfilled as Japan truly becomes an ageing society. Technology can undoubtedly fill some of the gaps, but only up to a point.
Interestingly, while Japan is largely a Buddhist nation (with a small Christian minority that includes former Prime Minister Masayoshi Ohira, and current Deputy Prime Minister and Finance Minister Taro Aso) that always expresses its gratitude for its spirituality that originally came from India via China and Korea, and many deities in Japan are clearly of Indian origin albeit with Japanese terminologies. Even those deities that are less popular today in India, such as Acala/Achala are revered in Japan, in this case as FudŌ MyŌŌ—and were first popularized by Indian Buddhist scholars Vajrabodhi and Amoghavajra in China where Japanese monks were studying as early as the 7th Century. Therefore, it is not a stretch today to have skilled Indians who have learnt the basics of Japan to fit in easily.
And while everyone in Japan remembers Netaji Subhas Chandra Bose as among the very few Asian allies that Japan had during World War II, the reality is that little if any immigration to Japan occurred in the post-War era, for reasons including the Japanese language constraint. Historically, Sindhi traders helped Japan when it faced various kinds of boycotts and embargoes before World War II, by creating alternative pathways for Japan’s export and import, which was under British-led international sanctions at the time.
Common heritage and shared struggle in history are a definite plus for India-Japan, however, still, Indians are slow in taking these massive job opportunities, compared to Vietnamese, Chinese, Bangladeshis, Sri Lankans, Nepalis and Koreans. Despite Japan’s claim that it enables the fastest permanent residency cards in the world for some categories like techies, there is a harsh reality of near-impossible demands for the Indian aspirational class to clear Japanese visa hurdles, even when they overcome the language barrier. Youngsters are being asked for three years of active bank account with lakhs of rupees in deposit (with no recent bulk deposit from a helpful “aunt”). Credit from Indian banks appears to have dried up to the aspirational class for help in emigration, while banks in competitor countries are cooperating to enable credit so that young people can clear the Japanese visa requirement financial obstacle. The Indian government has leverage in negotiations with Japan since India has persistently run a trade deficit with Japan (India imports more from Japan than India exports to Japan) now about $8 billion. Further, India is a trusted partner with Japan on the mission to keep the Indo-Pacific free and open.
Back to our theme of the elderly, government-reimbursed services are even provided at home, including visits by doctors and nurses. Now this sector too is facing crisis and business closure due to shortage of workers, not due to shortage of business. Further, Japan has evolved a plethora of equipment to make life easier for the elderly, differently abled, and care providers. For customer-friendly design, few countries can compete, and it is identified as a key differentiator and basis for the dominance of the Japanese automobile sector in India and indeed much of the world.
Japan has an extensive national licensing system for trained personnel, for senior care providers, welfare service providers, mental health counsellors, auto mechanics, and others, to professionalize the aspirational class. Structured incentives are going to be put in place for digital tool utilization for operational efficiency and transparency due to the recent government reform in national care insurance reimbursement. Bank loans’ interest is in general very low, and it is possible to combine with generous interest subsidy offered by government, and many companies enjoy less than 1% interest rate for a growth industry, i.e. expansion to a large market like India. Therefore, the same processes, technologies, systems, protocols used to take care of Japan’s ageing problem can become an opportunity for a new industry for new growth related to India’s ageing population in the coming years, by relying on India’s vibrant young population of today, but in a professionalized manner. India’s social structures are transforming, and professionalised services will be essential when children and grandchildren are all working with no one available to take care of the elderly within the domestic environment. India will certainly be capable of creating a new economic sector and adding to GDP on elderly care needs and other social services.

Dr Sunil Chacko holds degrees in medicine (Kerala), public health (Harvard) and an MBA (Columbia). He was Assistant Director of Harvard University’s Intl. Commission on Health Research, served in the Executive Office of the World Bank Group, and has been a faculty member in the US, Canada, Japan and India.