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hospital's long-term-care ward

Japanese leaders have made radical changes to the way health care is delivered in recent decades, most notably with the introduction of long-term-care insurance in 2000. The system is far from perfect, but Japan has been unafraid to improve the system as they learned its faults, and as an economic boom gave way to zero growth.

ut Japan's government, businesses and society are facing these challenges earlier than others, allowing the world to learn and benefit from their stumbles, innovations and experiments.

5 per cent of Japan's population is currently over the age of 65,

where the hospital says there are no trainee nurses.

this demographic is forecast to make up a full 40 per cent of the country's population by 2060

2010 and 2060, the percentage of Japanese citizens over the age of 75 will more than double from 11 per cent to 27 per cent

he absolute number of old people will soon level off in Japan, but the proportion of the population who are young is declining rapidly: The percentage of Japanese younger than 19 years old, who constituted 40 per cent of the population in 1960, will decline to just 13 per cent in 2060.

apan's total population peaked in 2010 at around 127 million people and has already begun to decline. In 2014, the country lost a record 268,000 people, as deaths continued to outstrip births.

ging society is a reality, as well as a business opportunity.

Lawson Inc.,

"seniors' salon" with a blood pressure monitor, pamphlets on municipal health care services and nursing homes, and on-staff social workers.

he store also has a special section featuring adult diapers, special wipes for bathing the elderly, straw cups, a gargling basin and detergent that is tough on urine and perfect for bed mats and wheelchair coverings. Staff will also deliver heavier items, such as bags of rice or water, to local residents.

Prime Minister Shinzo Abe's administration is concerned about how Japan's aging and shrinking work force will slow down the national economy. One piece of Mr. Abe's so-called Abenomics revival program – which also includes getting more women in the workplace – is an emphasis on new medical technologies, including experimental regenerative medicine and cell therapy. The hope is that with two new acts governing regenerative medicine to help commercialize technologies more quickly, the Japanese government can save money on future health care costs while spurring the creation of a valuable new industry – particularly in bio-medical hubs such as the one in Kobe, which features a gleaming new mini-city of medical buildings, research centres and hospitals on a man-made island near the port city's airport.

macro level, Japan's predicament is prosperity, which is always followed by lower fertility rates and higher life expectancy. At 83.4 years, Japan has the longest life expectancy at birth in the world, according to the Organisation for Economic Co-operation and Development (OECD). Many Japanese people are also fearful of the type of immigration that has sustained slow population growth in the industrialized West.

The elderly in Japan, similar to seniors across Asia, are less likely to live with their children

women, after decades of opting out of a career after giving birth, are also being encouraged by the government to re-enter the work force, something that may eventually help boost Japan's declining labour numbers, as the government hopes, but also prevents women from acting as caregivers.

small baby boom "echo" took place between 1971 and 1974

Liberal Democratic Party to expand the country's health care system as Japan aged, but by the 1990s, the enormous price tag raised the spectre of tax hikes.

Japan chose to supplement its national pension plan with long-term-care insurance (LTCI), which was implemented in 2000.

one of the most generous long-term-care systems in the world in terms of coverage and benefits."

People pay into the system starting in their 40s and are eligible to receive benefits starting at 65, or earlier in the case of illness.

assigns the person a care level.

allowing the patient to choose between competing institutions and service providers offering everything from home visits, bathing and help getting groceries to paying for short stays in hospitals or long-term residence in nursing homes and specialized group homes for dementia patients.

The LTCI system covers up to $2,900 a month in services, as opposed to cash payment, and does require "co-payments" from patients. LTCI co-payments are capped or waived for low-income individuals, and the system saves money by providing options other than full-on institutionalization.

has demonstrated to other governments around the world that it pays to adjust programs before problems become systemic.

The LTCI system was originally designed to alleviate the strain on family caregivers, but that hasn't entirely happened. Research shows that LTCI, in terms of freeing up family carers to work and have more free time for themselves, has only marginally benefited caregivers, and only then from wealthier families.

Xingu,

itself a major tributary of the Amazon.

shorts

kids wearing only

ears of the youngest among them were pierced with conical wooden plugs

Kayapo pierce their infants’ earlobes

ifts for our hosts: fishhooks, tobacco, 22 pounds of high-quality beads made in the Czech Republic.

Barbara Zimmerman, the director of the Kayapo Project for the International Conservation Fund of Canada and the United States–based Environmental Defense Fund,

chief, Pukatire,

wearing glasses, shorts, and flip-flops.

English he’d picked up on a trip to North America

dispute about logging.

Fissioning,” as anthropologists call it, is often the way Kayapo resolve disagreements or relieve the strain on resources in a particular area.

a generator in a government-built nurses’ station; a solar panel array enclosed in a barbed wire fence; satellite dishes mounted on truncated palm trees. A few families have TVs in their thatch houses and enjoy watching videos of their own ceremonies, along with Brazilian soap operas. Pukatire showed us to a two-room schoolhouse built a few years ago by the Brazilian government—a pistachio-colored concrete structure with a tile roof and shutters and the luxe marvel of a flush toilet fed by well water.

ngobe, or men’s house

shelling nuts and cooking fish wrapped in leaves and buried in coals.

crops of manioc, bananas, and sweet potatoes. A tortoise hunter

loudly singing in the Kayapo custom to announce his successful quest for the land turtles that are a vital part of the village diet.

soccer ball

swallows; o

kingbird

evening baths,

caimans

persecution and disease that have ravaged nearly every indigenous tribe in North and South America.

In 1900, 11 years after the founding of the Brazilian Republic, the Kayapo population was about 4,000. As miners, loggers, rubber tappers, and ranchers poured into the Brazilian frontier, missionary organizations and government agencies launched efforts to “pacify” aboriginal tribes, wooing them with trade goods such as cloth, metal pots, machetes, and axes. Contact often had the unintended effect of introducing measles and other diseases to people who had no natural immunity. By the late 1970s, following the construction of the Trans-Amazon Highway, the population had dwindled to about 1,300.

1980s and ’90s the Kayapo rallied, led by a legendary generation of chiefs

Ropni and Mekaron-Ti

organized protests with military precision, began to apply pressure

even kill people caught trespassing on their land.

ar parties evicted illegal ranchers and gold miners, sometimes offering them the choice of leaving Indian land in two hours or being killed on the spot. Warriors took control of strategic river crossings and patrolled borders; they seized hostages; they sent captured trespassers back to town without their clothes.

the chiefs of that era learned Portuguese

enlist the help of conservation organizations and celebrities such as the rock star Sting,

1988 the Kayapo helped get indigenous rights written into the new Brazilian Constitution, and eventually they secured legal recognition of their territory.

Kararaô Dam

Xingu River, which would have flooded parts of their land.

the Altamira Gathering.

Kayapo leaders made a brilliant translation of the Kayapo warrior tradition to the tradition of the 20th-century media spectacle,”

e Kayapo population is now rapidly growing.

shotguns and motorized aluminum boats to Facebook pages, they have shown a canny ability to adopt technologies and practices of the cash-based society at their borders without compromising the essence of their culture.

hey have embraced video cameras to record their ceremonies and dances and to log interactions with government officials.

based on the logo of the Bank of Brazil.

1980s and in the 1990s sold mahogany logging concessions—alliances they came to regret and now have largely ended.

Kayapo learned to organize and to put aside their sometimes fractious relations to cultivate unity of purpose among themselves

the richest and most powerful of around 240 indigenous tribes remaining in Brazil. Their ceremonies, their kinship systems, their Gê language, and their knowledge of the forest and conception of the continuum between humans and the natural world are intact. What may be the most crucial of all, they have their land. “The Kayapo aren’t entering the 21st century as a defeated people. They aren’t degrading themselves,” Zimmerman told me. “They haven’t lost a sense of who they are.”

400 Kayapo chiefs avowed their opposition to a raft of decrees, ordinances, and proposed laws and constitutional amendments that would gut their ability to control their land and prevent them, and any other indigenous group, from adding to their territory.

a campaign to enable mining, logging, and agricultural interests to circumvent indigenous rights, now inconveniently guaranteed by the Brazilian Constitution. A

. The Kararaô project is back under a new name: the Belo Monte hydroelectric complex.

n Kayapo villages the division of labor falls along traditional lines. The men hunt and fish; the women cook, garden, and gather fruits and nuts.)

two aluminum skiffs powered by Rabeta motors

a bow and arrows over his shoulder

Okêt a shotgun.

It was as obvious to Meikâre as the meat department of a Stop & Shop would be to me. He and Okêt darted ahead. Fifteen minutes later a shot rang out, then two more.

plugged the escape holes of a mole cricket nest in a sandbank and then had dug up and captured a batch of mole crickets, which they used to bait fishhooks and catch piranha.

peacock bass and piabanha.

Bic lighters a

freshly whittled skewers.

flashlight.

he only things we need from the white culture are flip-flops, flashlights, and glasses,”

his children had died of malaria not long after the founding of Kendjam.

Portuguese from missionaries

the program of pacification by the Indian Protection Service, a forerunner of the National Indian Foundation, or FUNAI,

“Before contact we were clubbing each other to death, and everybody lived in fear,” he said. “Without a doubt things are much better today because people aren’t hitting each other over the head with war clubs.”

construction finally began in 2011 on the $14 billion Belo Monte.

he complex of canals, reservoirs, dikes, and two dams is located some 300 miles north of Kendjam

on the Xingu

Its supporters defend it as a way of delivering needed electricity, while environmentalists have condemned it as a social, environmental, and financial disaster.

the region’s indigenous people were not adequately consulted, Brazil’s federal Public Prosecutor’s Office filed a series of lawsuits to stop the complex, essentially pitting one branch of the government against another. The cases went to the country’s Supreme Court, but judgments have been deferred, and construction of Belo Monte has been allowed to proceed.

nflux of an estimated 100,000 workers and migrants. The dams will flood an area the size of Chicago. Official estimates project that 20,000 people will be displaced; independent estimates suggest the number may be twice as high. The dams will generate methane from inundated vegetation in quantities that rival the greenhouse gas emissions of coal-fired power plants. The diversion of some 80 percent of the water along a 62-mile stretch of the Xingu will dry up areas that depend on seasonal floodwaters and are home to endangered species.

ho still wear the lip disk

carried a wooden war club,

woman approached, held his hand, and began to sob. In a different culture bodyguards might have hustled her away, but Ropni seemed unfazed and in fact began sobbing as well. The anguished weeping was not the result of some fresh catastrophe but a form of ritual Kayapo mourning for departed mutual friends.

“I don’t like Kayapo imitating white culture. I don’t like gold miners. I don’t like loggers. I don’t like the dam!”

the chiefs of the eastern part of the territory had been accepting money from Eletrobras. Boxes of brand-new 25-horsepower boat motors were stacked on the porch of the Protected Forest Association headquarters.

money that activists said was an attempt to dampen indigenous opposition to Belo Monte.

he consortium building the dam was investing in wells, clinics, and roads in the area and was paying a dozen villages nearby an allowance of 30,000 reais a month (roughly $15,000) for food and supplies, which Schwartzman describes as “hush money.”

specially in villages close to towns on the Brazilian frontier.

pollution from clear-cutting and cattle ranching had wrecked the fishing grounds, and it was not uncommon to see Kayapo shopping in supermarkets for soap and frozen chicken.

In the old days men were men,” Ropni said. “They were raised to be warriors; they weren’t afraid to die. They weren’t afraid to back up their words with action. They met guns with bows and arrows. A lot of Indians died, but a lot of whites died too. That’s what formed me: the warrior tradition. I have never been afraid to say what I believed. I have never felt humiliated in front of the whites. They need to respect us, but we need to respect them too. I still think that warrior tradition survives. The Kayapo will fight again if threatened, but I have counseled my people not to go looking for fights.”

FUNAI paperwork authorizing various matters they had discussed. Mekaron-Ti, who was fluent in the Western world as well as the forest world, signed his name quickly like someone who had written a thousand letters. But Ropni held the pen awkwardly. It was striking to see him struggle with the letters of his name, knowing what esoteric expertise was otherwise in his hands, how deftly he could fasten a palm nut belt, or insert a lip plate, or whittle a stingray tail into an arrowhead, or underscore the oratory that had helped secure a future for his people. In the Xingu Valley there had hardly ever been a more able pair of hands. But in the realm that required penmanship, the great chief was like a child.

painted faces carrying water in old soda bottles,

chopped off seedpods of the wild inga fruit.

In the past some anthropologists have fetishized cultural purity, fretting over the introduction of modern technology. But cultures evolve opportunistically like species—the Plains Indians of North America picked up their iconic horses from the Spanish—and strong traditional cultures will privilege themselves, making the accommodations they think will ensure their futures. We can question whether a man dressed in a parrot feather headdress and penis sheath is more valuable than one in a Batman T-shirt and gym shorts. But who can be blind to their knowledge of forest plants and animals or to the preeminent values of clean water, untainted air, and the genetic and cultural treasure of diversity itself?

now turning to those first inhabitants to save ecosystems recognized as critical to the health of the planet—to defend essential tracts of undeveloped land from the developed world’s insatiable appetites.

ertanistas to contact the Indians who lay in the way of the road.

aim of “pacifying” isolated tribes. I

measles

annihilation of their people. And I witnessed Indians losing their identity, their languages and their land.

contact with the outside world is not in the interest of uncontacted Indians

‘come and share a world which is technologically more advanced!’ But all of it is a lie.

The Indian loses the grace of a man who is so integrated into his environment that he’s beautiful and carries himself with pride.

I began to fight to change long-held policies to those of non contact; I began to persuade those in power that the state has a duty to protect people – dying remnants of societies that once numbered thousands – who are unable to defend themselves against a much more powerful society.

They very often make it clear that they seek their isolation, so the first right of isolated peoples is to allow them to remain isolated.

the right to happiness.

we have to rethink the rights of Indians to health, peace, freedom – in short

The local official in charge of family planning promised a $380 reward, presented anonymously, to anyone who informed on an unauthorized baby. Someone reported on Victory,

The one-child policy, unlike many Chinese missteps, was not a product of Chairman Mao’s zeal or ideology; in fact, China was extricating itself from Maoism when it adopted the one-child policy.

“One child isn’t too few, two are just fine, three are too many.” And within about a decade it managed without coercion to reduce the average number of births per woman from six to three, a remarkable achievement. It’s rarely acknowledged that the biggest drop in Chinese fertility came not from the one-child policy, but earlier during this voluntary birth control campaign.

If it had continued, China’s birth rates would have continued to drop, as they have for the rest of the region (Malaysia today averages just under two births per woman; Bangladesh averages 2.2).

In retrospect, Western sympathizers were right about the need to curb population growth in China—and blind to the brutality of China’s policy. Partly that’s because China covered up the abuses and pretended that the policy was essentially voluntary, backed by fines but not by force.

Internationally, the most visible legacy of the one-child policy is the large number of Chinese-born children who have been adopted in the West

because an unauthorized birth would lead her husband to be fired from his job as well as to a large fine and her forced sterilization.