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Big in Japan – Perspective From 35 Years of Living in an Aging Country

With more than 34 million people over the age of 65, Japan is the oldest country in the world, and it already feels the effects that many countries will experience in the upcoming decades. In this episode, I spoke with Debbie Howard from the Carter JMRN group which specializes in market research in Japan. Tune in to learn about some unique aspects of their aging population and culture, as well as some of the challenges and opportunities that come with an aging society. We’ll also take a look at what it takes for foreign entrepreneurs to bring their agetech solutions to the Japanese market. So if you’re curious about aging and agetech in Japan, stay tuned! 

Debbie Howard is the chairperson of The Carter Group, Japan Market Resource Network. Debbie has lived and worked in Japan for over 35 years and founded Japan Market Resource Network (JMRN) in 1989. This company was merged to form Carter JMRN in 2012.

Debbie translates qualitative research into clear strategic direction for international clients, and over her career has worked with most major brands that have entered Japan. Previously, she served as president and chairperson of the American Chamber of Commerce in Japan and continues to serve as president Emeritis.

She’s also a former caregiver on a mission to change the way the world looks at caregiving so that the impacts are not so devastating.

Her work is focused on providing corporate programs that support working caregivers so that companies can minimize their related risks of absenteeism, employee turnover and escalated healthcare costs. With the launch of AMI and The Caregiving Journey in 2016, Debbie brought her market research acumen to the world of caregiving. Her first book, The Caregiving Journey, targets individuals, and goes far beyond the basics of logistics, wills, and funeral plans.

Her second book, The Caregiving Crisis is due in December, 2021 and targets companies with practical ways forward in terms of supporting their employees who also serve as caregivers. 

You can watch/ listen to the podcast, or scroll down to read a transcript of our conversation, edited for clarity and brevity.

Welcome, Debbie!

Thank you so much, Keren. It’s wonderful to be here. 

You spent most of your career working in Japan. That’s quite a long way from Texas. How did you get started? 

Well, I was actually raised in South Carolina. I was working in Atlanta, Georgia, and I had worked about nine years for a major fortune 500 company in corporate communications, but I was a little bored. And I had a best girlfriend from childhood who was living in Japan, in Tokyo as a travel writer.

And she was sending me these tantalizing letters about the Far East. And I became really charmed and needed to take a gap year at 31. And so I did, and because she was in Tokyo, I started in Japan and I was going to do a one year trip around the world but I never left Japan. It was so exciting to me … and I got a job there right away. I didn’t anticipate that. I was going to just fool around if you want to know the truth.

They kind of say that you can run, but you can’t hide! And I was there for about two months and I started dabbling around, interviewing, and I got a job with McCann Erickson, which was joined at the time with Hakuhodo. So I went to work for the market research agency of a large ad agency in Tokyo. 

So since you’ve been working in Japan for decades and you’ve been helping major companies enter this market; what would you say is the number one misconception foreigners have on Japan as a market?

Well, I think most people who are listening will know that Japan is famously difficult – not just the regulations, but also the consumers are very tough. And I think what surprises me over and over again (and I’ve been working in the market for 30 years) is how surprised foreigners are … at how different Japan is.

So it’s kind of like they come in with their briefcases, especially the Americans. And I can say that because I’m an American … with their briefcases and after one week of appointments, they’ll be going, we couldn’t sell anything. We didn’t get an order. I end up laughing actually, because it is such a difficult market.

And so to, to imagine that Japan is going to be anything like your home market is a big misconception. 

In what ways is it different? Like what do people find so overwhelming? Is it like the culture? Is it the language? Is it the food?  

Well, the language and the food … the language, you can use an interpreter. If you use a good one, you’re going to be okay.

The food is fabulous. If you’re into food … those are both different things, but the culture is what’s so different there. So for example, in Tokyo especially it’s, it’s all form and little substance in the early days of meetings. So you’ll be spending hours in these meetings, talking about things that you never thought you’d have to talk about and having questions (asked) that seem ridiculous to you from your home country’s viewpoint.

I think another real interesting difference that I see very large companies, even large famous companies elsewhere in the world, come to Tokyo or Japan, and nobody really knows or trusts them. And they have that mentality of being, you know, I’m a big company. I’m not going to name any names, but “I’m a big company and we’re famous in the world.”

But actually the Japanese people don’t know them. And I’m talking about end users, whether they are consumers on the street or B2B type consumers.

So what you’re actually saying is that international brands don’t necessarily have the same brand recognition in Japan. So they come in with like their head held high and they basically get a bummed out by the way that no one is perceiving them as like the big shots in the room. 

It can be pretty disappointing, Keren. I mean, imagine, for example, I’m just going to name Facebook, for example, that is huge everywhere else in the world and it’s in Japan, but it is not as well used in Japan as it is in other places in the world. And there’s a homegrown version called line in Japan. L-I-N-E that’s much more prevalent among all age groups than Facebook is.

Coca-Cola is another example. It’s not a Pepsi who is the competitor in Japan. It’s all the plethora of other, not only soft drinks, but tea, drinks, and all kinds of other things that are put out by large Japanese trusted manufacturers who pump products down through the channels and own the distribution.

So, you know, it’s just a different ballgame. And that’s why I say that. Now remember I’m a market researcher, so I I’m prejudiced to tell you to do your homework, but honestly, if you went to another market … if I came to Israel, I would want to do the homework on Israel so that I would understand your market.

I don’t really know anything about Israel. So I would be thinking as a person, as a person who has a lot of experience in a market that’s difficult to understand … my first job for me in going to another market would be learning the landscape. How is it different from my own market? Where are the problems that I might not have thought of?

And that’s often solved by doing a lot of good research and homework. 

You probably don’t know what you don’t know. And if you’re a total novice, like where do you even start? So from your experience, what does it take for foreign companies to actually make it in this market?

Is there one particular theme that all companies, all foreign companies that have made it in the Japanese market, have in common? 

So what we say at Carter JMRN is that building trust … establishing trust and then building that trust … is the most important thing that a foreign company can do. Obviously if people are not aware of your company, you need to build up that credibility and brand awareness. And, and again, the trust, the trust factor is, is very important. We know that one of the reasons Japanese consumers believe in technology and trust technological innovations for example, is that they can … they’ve seen Japanese companies actually deliver products that work. And so there’s an inherent trust in the contract with the consumer there. And so foreign companies need to establish that trust as well. 

As a second side of that, though, I would like to say you don’t do that by being Japanese per se; you have to embrace your foreignness because you will never NOT be foreign in Japan.

You will always be a foreigner, even if you learn how to eat with chopsticks and you look pretty good doing that. Everyone knows that you’re a foreigner. There’s no way to get around that. So you need to embrace that. And use it, use it to your advantage. McDonald’s is an example of a foreign brand that has become almost assumed to be Japanese by little, little children, for example, who have grown up seeing it. They don’t question that McDonald’s is foreign. There are research studies that show that many kids think McDonald’s is a Japanese thing. And, and even (with) the sport baseball, there are some people in Japan that think baseball originated in Japan.

But of course we know it didn’t. But it takes years to get that kind of traction and we would not recommend that. We would recommend (being) who you are and what you are, and use that to your advantage and bring in the credentials and the evidences of how you are successful elsewhere in the world. And the third one is to reset the agenda to, to your strategy.

So understand the landscape. Understand who you are. This is kind of like personal branding actually. And use that being authentic to reset the agenda and create your strategy and your game plan, rather than playing someone else’s game plan. 

You recently published an excellent White Paper about agetech in Japan I will pull a link to it in the show notes. Everyone should definitely read it. So what are some of the unique characteristics of the Japanese agetech ecosystem? 

One of the most important factors is that 30% of Japan’s population of 128 million people is 65 years or older.

That is the highest percentage in the world. The next highest would be Italy, right on Japan’s heels, coming up on 20%. The US has 15% by comparison. And most of the developed countries are somewhere in there. 15, 16, 17%. There’s a little bit of variation. The Asian countries are coming along as well, but Japan, having 30% of its population at 65 or more is, is an amazing opportunity there … just to look at aging and caregiving in a society. I think within that ecosystem, if you will, we have an aging population that is very young at heart. So if we compare Japan’s aged population to let’s say the United States, we will see a better quality of life.

We will see more active, older people, riding bicycles and doing things even working later in life. We have many, many people in Japan who want to work until they’re 75 and 80 even. They’re also exercising three times a week, and doing brain training and things to keep their minds fresh.

So I think the proactiveness of the Japanese people, especially the aging population keeps them very young, giving them a quality of life.

I think another factor is the financial stability. We have less division between rich and poor in Japan. So a much broader middle-class and many more older people with security and no worries about money. as they get older … and that’s very, very different than in many countries in the world. I’m not saying we don’t have problems in Japan. I’m saying that there are many fewer problems than other places in that, in that financial area.

And the third one is open-mindedness about anology because we have 30% of the population over 65. Everyone has seen the impacts of aging and they have felt that in their families. We also have many of the elderly being taken care of at home and in family settings, as opposed to outsourcing the care. And that means that younger people also see their grandparents aging and they understand the impacts of that.

So we have a very high and open-mindedness towards technology because we know we need it. Does that make sense? 

Speaking of technology and being open to adopting technology, I’ve heard it said before that because the Japanese culture is so open to technology, Japanese older adults tend to be more accepting of technology than Westerners who might be slightly squeamish about like humanoid robots.

So what are some of the other cultural differences that need to be taking into account when developing tech enabled products and services for this market? 

Well, one of the most important things that I’m hearing over and over again in focus groups and ethnographic interviews is this idea that if I use something too soon, I may weaken myself. In other words, I don’t want to have a crutch because it’s better for me to suffer and struggle and try. And I’m sorry to say it, but the Japanese are very stoic. I’ll give you a good example of that. I heard a 72-year-old woman the other night in a focus group saying she had given up her walking stick recently because she felt she was becoming too dependent on it.

And she thought that using it … she rationalized that using it would actually weaken her. And so she decided she would tough it out. Now we can all argue about whether that’s true or not. But I’m just saying that’s a reality I hear over and over again .

Let’s say pre-pandemic, when people would be going to the grocery store and they would go to the grocery store in Japan maybe three or four times a week, because it’s more of a small store, fresh food type culture. And we proposed some robotics solutions where they wouldn’t have to go to the store and they can order and have it delivered or they could have the robot actually go to the store and pick things up.

They did not like that. Because for them. Again, I’m talking about 75-, 80-year olds … that was a social thing for them to go to the store and  for them, they got exercise, they got social neighborhood exposure and it was kind of fun. It was like a field trip for them. And so I think when we’re developing technologies for Japan, we need to remember that.

Certainly in positioning and marketing things, we can address this issue of not becoming a crutch and not weakening them, but we need to just keep that in mind that people are very much of the mindset that if I do it myself, I will stay strong and it’ll keep my mind strong and my body strong. Does that make sense?

I totally get why going to the grocery store would be a social experience and why people wouldn’t want to give that up, especially if it’s like this one time of the day when they actually get to go out and talk to another human being. 

Another thing we picked up from the focus groups and ethnographics is that in the West, we don’t want cameras in our homes. We have a resistance to being monitored. The Japanese people … older people … and we’re never saying ALL of anyone … we’re saying they tend to be very open-minded to being monitored because again, the penetration of the aging problem is so great.

They’ve seen news stories about other people who have died alone. And so they see the camera and the monitoring as a way to prevent that. So that’s a second thing that is quite different from the United States or other Western markets. And the third one I wanted to mention is: onboarding users to use anything.

It doesn’t even have to be technology. The Japanese love instructions and a lot of detailed and information. And so anything we can do when we’re developing technology for Japan to help the user in more ways than we helped them in the West will go down well, not only with aging people, but their caregivers.

All the challenges of aging are pretty much universal. That also comes across from your report and from your research. 

You mentioned Japanese older adults being more accepting of monitoring solutions because they realize they might fall in their house and no one will notice. What are some of the more innovative solutions that you’ve seen emerge from Japan and that could apply in international markets? 

This is one of my favorite subjects. I’m going to give you some foundational differences that really are the big things that we need to address systemically in a lot of our other cultures. So Japan has a great national health care system. And of course there are some really interesting things that happen in terms of support for in-home care through that healthcare system.

But because … maybe partly because of the penetration of the aging population. Japan has done a wonderful job educating and building awareness among aging people about staying physically active, staying mentally active, staying socially involved with different generations. And this is something that we see over and over again.

I mean, we see individuals taking responsibility for their physical and cognitive state of being and, and preserving that and maintaining that. And I don’t think we see as much individual accountability at least in the US I’m not going to speak about other countries … but I, we see a lot of lifestyle diseases in the States that we do not see the prevalence of in Japan. Again, we have them, we just do not have them to the same degree. Obesity is not a problem in Japan the way it is in the States … diabetes, heart disease … lots of the things that we see that cause older people, many, many problems over the years to come and impact quality of life … are not as much of a factor in Japan because they’ve done such a great job of education and awareness building.

And there is that individual accountability. I would even go so far as to say that Japan is not as ageist a society as we have in the US for example. In the US everything is young, young, young … and I can tell you, I’ve felt that myself …  but in Japan, old age is revered and respected and older people are taken care of in a different way. They’re not outsourced to an assisted living place or a nursing home. They are taken care of in the home. Some of that has to do with penetration problems of assisted living and that sort of thing, but that cultural underpinning is there. And, and I think that that’s a very good thing because it keeps the older person in a family setting.

Traditionally the oldest son in Japan would be the inheritor of everything. The, the other kids don’t get anything. The older … some of this is  changing … but I’m talking about traditionally, the older son would get everything. And the reason is … that they would take the parents’ home at some point (when they get about 65 or 70), they will raze it and build a new dwelling for that original older family and the nuclear family of the older son. So the older parents live in the house there, and you have an inter-generational living situation.

The penetration of multi-generational households has definitely lowered over the years because of the growth of the nuclear family. And we are seeing more assisted living facilities and that sort of thing in Japan … but culturally speaking keeping the family together (which is the old way we used to do it in the West) has been, I think, a contributing factor to something very good in Japan for the aging population. But we also know that many of the aged population in Japan lived independently. So they may have their own apartment, but they may live, let’s say two blocks or within one hour of a child who will be helping them and visiting them on a regular basis.

These are not strange concepts when we talk about Western countries either. But I think in Japan, it’s, it’s more well penetrated. And so that’s not exactly innovation as you have asked the question, but I think it’s very important to understand that systemically that kind of thinking and that kind of viewpoint is a very positive thing for an aging population.

This is really fascinating. I wonder. If you could talk a little bit about your methodologies that you’ve developed at the Carter group. So if I’m an agetech entrepreneur, and I want to bring my product to the Japanese market, how should I go about it?

How would I go about doing, even the most fundamental market research into figuring out whether my product will work in Japan?

Well, of course each client has a little bit different approach and we don’t have a “one size fits all,” but understanding the landscape of the market for example, is a very important thing. So you may have a product that is sold through government in another country. Thinking you’re going to come to Japan and sell it to the Japanese government right away is probably not realistic.

And, and so we would want to look at the landscape of competitors and near competitors in your space … understand the key points that are better about your product (and not). We would probably recommend not only doing secondary research, which is looking at the existing things and the environment, but also taking the client out on what we call market safaris, where we go and look at different aspects of Japanese society so that you can see how it’s different from perhaps in your home country. And I’ll give you a really good example. This is one that everyone loves. In Japan are the convenience stores. So, you know, when we think of convenience stores in the States … have you been to one in the States?

Yes, absolutely. 

Okay. Well, wait until you see the ones in Japan! Okay. Because they have adapted to consumer needs. First of all, they’re on every corner because Japan is a walking and train society … people have cars, but they don’t use them for commuting to and from work.

So in a non-pandemic world, for example, you’d have a lot of people commuting an average of an hour a day by train and walking an average of 10 to 15 minutes from the train station to their office … and these convenience stores are on literally every corner in the neighborhood where the person came from and in the work neighborhood.

And they have adapted to being like, almost like “lunch-boxes,” … so you can buy fresh food and salads and all kinds of things in convenience stores. And they noticed something about – I’m going to say five or seven years ago – they noticed that, whereas the original target for the convenience stores in Japan were young people … suddenly there were many more older people coming in there. So they literally changed, their offerings to target their customers for that neighborhood. And some of them have put in like lounges, where the older people can come and hang out and socialize in the convenience store.

Yes – I know. I saw your eyes. It’s really interesting and fascinating. And so you know, just to understand and see that concept in practice is a really interesting phenomenon.

It’s also interesting to see how, for example, rehabilitation therapists work with their patients in things like senior daycare centers and hospitals and assisted living facilities. So we can go out for example, and look at the equipment they’ve got … how sophisticated it is, how they’re interacting with the patients. 

We can go into the homes for ethnographic interviews and we can see things like … we can see the floor space is super small and that sometimes there are really narrow, steep stairs to get up and down. We can see the difference in the living spaces when we go into the homes. So these types of things are very important for clients to see for themselves. It’s not just us telling you … we need to take you out there and show you what’s going on. And then you can see. Your robot footprint is not going to fit in there. You can see that you’ll be redesigning the footprint really fast.

So there’s some really interesting things like that. I think mostly for us, it’s about taking the client into the world of Japan and letting them see how different it really is … through not only the home, but the shopping and the experiences, the fitness centers … because everything is more constrained there than you might have in your home country.

Sounds fascinating. I’m sure it has like immense value to your clients that you bring them in and sort of immerse them in the culture and in the physical world their potential users or customers live in … because from what you’re describing (I haven’t yet visited Japan) … it sounds like a really different experience than we’re used to in the United States or in Europe.

We want to show you around! 

Well post-COVID, it’s definitely on the top of my destination list for the post-COVID travel. So on a different but related topic, as the founder of Aging Matters and the author of The Caregiving Journey. Are there any differences between caregiving in the US versus Japan? 

Yes, I think there are some pretty big ones. One is that the aging population of Japan is almost double that of the percentage of the population in the US … so we also have, of course, many more people needed to support those aging people.

So just the magnitude of the problem is a big difference right there. I think another big difference is that the percentage of caregivers in the workforce is likely higher in Japan as well.

And that’s a natural factor of having about 30% of our population in the workforce in the US as caregivers of 50+. In Japan, we think that’s probably about 35 to 40%. We don’t have as good of statistics in Japan as we do in the States about the workforce, but we know what’s happening with the population so we can make an educated guess at that.

I think one of the other things, one of the most dramatic differences … is that the average age of caregivers is older in Japan. The average age of a caregiver in Japan is 65 compared to 49 in the US. And that is also an interesting function of that younger lifestyle and quality of life. So the average Japanese person doesn’t need help as soon as we do in the States. So what we end up with is an older aged average caregiver.

Which has its own challenges. I’m sure. Because as people grow older … when they’re 65 and they need to become physical caregivers for an older parent … that has to be more challenging than it is if you’re 40 or 50. 

Absolutely. And we have in Japan what we call some of the “oldest old” taking care of the old(er).

So we’ll have a 90-year old wife taking care of a 92-year old husband and they will hide their troubles from their kids … because they don’t want to be put in an assisted living or nursing facility. They want to stay in their own space as long as they can. And so, you know, there’s a lot of covering going on there.

If somebody has Alzheimer’s or early dementia, you know, there’s a lot of covering going on. And that’s a huge burden on the caregivers as well, as you can imagine. And, I think on the part of the care receivers, there’s acknowledgement that they need help, but as long as their husband or wife is helping them, they have a false sense of security (actually) about how much help they really need.

I have one other statistic for Japan that’s really interesting in that you know, we have a lot of discussion in Japan about women in the workplace (and why we don’t have more women in the workplace). We know that the lack of childcare support is one of the big problems in Japan. I think there’s a misconception that most women leave the workforce because of childcare responsibilities, but actually statistically, 38% leave due to lack of eldercare support … and only 32% leave due to lack of childcare. So the eldercare responsibilities are really, even more of a reason why women have to leave the workforce. 

That is mind-blowing. 

It is. I was shocked. I was so shocked. I just found that statistic last year and it blew me away as well, Keren. Absolutely. 

Speaking of caregivers in the workforce, your upcoming book, The Caregiving Crisis is about helping companies with practical ways forward in terms of supporting their employees who are also caregivers. Can you tell us a little bit more about your book? 

Sure. Most of the research of the new book is focused – like the old book – in the US … and that is directly because I don’t speak Japanese and I knew it would be easier and cheaper for me to get the research done by myself if I stuck to the English. But everything that I do has a global scope to it because of my experience in Japan. And it’s a natural thing that I’m very, very interested and passionate about.

So we do talk about the global situation, but we use the US as a proxy for that because the numbers in the US are very, very good. We know that 30% of every workforce in the United States are caring for 50+, and if we include those who are caring for kids (so parent caregivers), we’re talking 50% or more of the workforce in the United States … but let’s just stick to those who are caring for elders, if you will. And the cost of that to US businesses is $68 billion annually. And that will more than double over the next 10 years.

So the costs are related to turnover because many caregivers (a third of all caregivers) have to actually leave their jobs at the ends of their caregiving responsibilities, because it becomes so overwhelming. They can’t handle a full-time job AND caregiving at home. We also know that there’s absenteeism and effects on productivity … and there’s also future healthcare costs … because we know that when you’re caregiving, you end up emotionally and physically – and often financially – depleted after caregiving is done. So that costs companies money in the future. Because of, those healthcare issues.

So the book is all about that. It’s all about “You’re losing money; please do something to help your working caregivers.” That’s what the book is about. And I’ll tell you how to do it. (In the book) I’m telling you how to do it – even on your own – and what outsourced services and solutions are available as well should you decide to use those. 

And when is it coming out? 

It’s coming out in December. Fingers are crossed. It may be January, but I’m hoping December … I’m shooting for December. Yes. I’d like to end the year like that. And it it’s really a “how to” book.

I should also say that one of the really interesting things we know about the workforce in America is that the caregiving issue – this again, adult caregiving -is affecting all age groups in companies. Of the 48 million working caregivers in the United States, a quarter of them are millennials … then we also have many Gen-X aged caregivers who are ending up in the “sandwich caregiver” role of taking care of their kids at home and an aging parent.

So when we add all of that up … and of course caregiving doesn’t have any prejudice … it hits everybody the same way … so all ethnicities, all genders, and all age groups are impacted … some more than others, but when companies are looking at their workforces, this is a really important thing to look at for the future.

Absolutely. Debbie; it’s been such a pleasure talking to you today again. Is there anything else you would like to add? 

No … I’m so excited to be on your podcast, Keren. Thank you so much for inviting me and let’s do it again. It’s a continuing story that has really developed so much during this pandemic, this prolonged pandemic … because I think many of us have seen the really negative impacts on aging … people who are living alone and get isolated … and also on their caregivers. 

So it’s both ways. It’s avery interesting and fascinating area. And I know that you’ve dedicated your life to it … and I’m really happy to be talking with you today.

Thank you so much, Debbie


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