Upon visiting Japan this month, I was struck by not just the orderliness of the cities or the pride people take in their work, but the clarity with which the country is confronting one of the biggest demographic challenges in the world.
Japan’s population peaked in 2008 and is set to fall by 45% by 21001. By 2060, 39% of its people will be over 652. This kind of shift could cripple an economy and overwhelm any health system, but instead of shying away, Japan’s people have made a collective commitment to lean hard into digital, AI and robotics in an effort to solve this challenge. And they’re not dipping their toe in; rather, they’re taking what they describe as a “leap of faith”.
The Japanese understand that they don’t have generations to experiment. They have a decade or two to lay down the foundations of a new system before the issues become insurmountable.
A collective resolve
What impressed me most was the sense of national and corporate responsibility. There is an orderly nature to Japanese society, and with it a willingness to do what’s required. People take pride in every kind of work, from service roles through to technology development, and that collective buy-in creates momentum.
It made me reflect on our own situation in Aotearoa, because while the numbers are different, the pressures are very similar.
Aotearoa’s cliff edge
By 2050, Aotearoa will see a doubling of its over-65 population and a six-fold increase in the over-85 population3. On average, our GPs are in their late 50s. Almost half have indicated that they expect to retire or reduce their workload in the next five to seven years4. We’ve increased training places in our medical schools, but only a small proportion of those graduates enter primary care. The University of Waikato’s new medical school – New Zealand Graduate School of Medicine – will help, but its first graduates won’t arrive until the early 2030s.
The gap is real. The maths doesn’t add up. At the same time, hospitals face shortages of beds, capital and workforce. And like Japan, our population is ageing while our birth rate falls below replacement.
We don’t have decades.
What our leap of faith could look like
The question for us is simple: What’s our leap of faith?
New Zealand must become serious about digital and AI to extend our limited capacity. Around the world, this is not a new concept, and it works if it’s set up to succeed. I’ve seen health AI agents that proactively call patients, hold natural conversations, collect blood pressure readings, update records and prompt human intervention when needed. You’d barely know you were speaking to a machine.
This isn’t about replacing care. It’s about creating the space for clinicians to focus on the complex work only they can do. The alternative is fewer and fewer people trying to do more and more, which is exactly what’s driving today’s long wait times in primary and secondary care.
What’s holding us back
The biggest barrier isn’t technology. It’s our collective mindset.
We’ve seen GP networks push back against telehealth, and clinicians who are reluctant to promote patient portals. Too often, the reaction is: “Let’s resist the robots, they’ll make everything worse.” That ignores the reality that human bias, errors and gaps in records already undermine the system. Doing nothing is not safer.
There are risks in doing nothing, and there are risks in doing something different. They’re equally balanced.
Choosing possibility over failure
Japan doesn’t know if its leap of faith will succeed, but it knows that waiting, experimenting cautiously and layering on report after report is a guaranteed path to failure.
We have the same choice in front of us, and it doesn’t seem like a difficult one. Trying new things has possibilities, while the status quo is certain failure.
New Zealand’s health system doesn’t need another working group or another election cycle of debate. It needs urgency and courage. It needs its own leap of faith.