“I got all A's on my health check!” I called out to Hai as I opened my letter containing the results of this year's medical examination.

“What's new?” he called back, probably rolling his eyes at the same time. A friendly dig at the fact I did well in school.

Yes, in Japan we get assigned letter grades, A through F, on an annual basis that indicate the state of our health in a variety of areas, and track changes year on year. It's an interesting system that I haven't seen anywhere else, and today I thought I'd tell you a little about it.

So, let's get down to it.

Who has annual health checks in Japan?

Essentially everyone. Employers in Japan have a legal obligation to offer annual health screenings to their employees and most Japanese companies make taking such exams a requirement for entering their ranks and continuing employment.

For those who are not currently in employment, such as stay-at-home parents, or those not in a traditional company setting, like freelancers or small business owners, services are set up via your local city office to ensure you also have access to an annual health check-up. In such cases, whether you decide to take up the offer is entirely up to you. Although most people do, perhaps because annual health checks are such an ingrained part of Japanese society.

Whether you work for a company or not, this service is free to you as the patient. Although this is of course something that is funded through the taxes we pay.

How do you arrange a free health check in Japan?

If you work at a Japanese company, they will give you all the details. Some companies will have medical staff come to their offices or one of their own facilities, and employees will line up one-by-one to go through each of the checks.

Perhaps a more common method, however, is to simply give employees a list of “approved” hospitals and a timeframe, during which time they must arrange and have the health check done.

In our case, we get our free annual health check via the city office system. We get sent a letter every year that announces the health checks for the year. For us, the health checks are usually done in June. It's a popular time for many Japanese companies to have their employees do health checks too, since it gives enough time for things to settle down after the beginning of the new fiscal year in April and it's before August when many people head back to their hometowns for a week or so for Obon holidays. Alternatively, some companies do theirs around September or October, after the summer and before the New Year, another important holiday for the Japanese.

In our city, we can choose one of eight sessions over two weekends. If that doesn't work for your schedule, you can also claim your free health check by arranging a time at one of their participating medical facilities.

So far, we've always been able to make at least one of the time slots so we prefer to just go then, rather than having to make our own arrangements. There's a building adjacent to our city hall that has the necessary space and facilities for health checks to take place.

To confirm our attendance, we just need to select the date and time period (morning or afternoon) from the eight choices on a reply-paid postcard and pop it in the post box. There's no confirmation; we just need to show up with our ‘residence card' and a little slip of paper with our unique health check ID number and personal details (this slip is sent to us with the initial information).

What do you need to do before the health check?

Health checks usually require you to fast for a certain period beforehand. For us it is 3 hours. Those who are having other types of tests (as we'll talk about more below) may need to fast 12 hours, or however long is specified by the medical facility.

As such, you might notice that restaurants and cafes around testing centers and hospitals are more crowded than usual around health check “seasons,” as food is usually the first item on the agenda for most people after the tests.

What happens at an annual health check?

While there may be some variation across the country, generally an annual health check entails:

• a chest x-ray
• a urine test
• girth, height and weight measurements
• blood pressure check
• a blood test (several viles for various tests)

In addition to the physical tests and checks, you fill out a medical questionnaire that asks specific questions about lifestyle, such as how many cups of tea or coffee you drink a day and whether you have it with sugar, or how many hours of overtime you do per month. Here they also ask about any pains, ailments or worries you may have been experiencing.

The questionnaire will be looked over in a private booth by a nurse, who will ask about whether any serious conditions run in your family and whether there is anything you've been worried about in regards to your health, both of which may result in recommending further testing.

At the end of all the standard testing, you will be offered to consult with a doctor, who is waiting on site, should there be anything that you'd like looked at or investigated further.

In certain age brackets, some checks become routine and therefore unavoidable if you work for a Japanese company. For example, Japan has one of the highest rates of stomach cancer in the world so an endoscopy becomes part of your standard annual health check from 40 years of age.

Benefits of the annual health check

There are obvious benefits of having an annual health check-up. I think that simply by having one makes people pay closer attention to their health. And by making it an annual event that almost everyone participates in, and where medical practitioners are there at the ready to address your health concerns, means that people are less likely to put off important medical checks that potentially could save one's life.

I really like the fact that when you receive your health check results, it tracks them against your results for the previous year. This means that changes, both small and major, can be seen clearly. I know of a couple of Japanese people who have had cancer in its early stages detected through these health checks, before they have felt any physical symptoms whatsoever. As such, they were able to get treatment early and are now in full health.

The results also include information on what is considered a normal range for each test, of which BMI is taken into account when relevant. Whether abnormalities have been found is clearly stated, and the letter grades have a clear code as to when seeking further medical examinations is necessary or recommended.

Overall, and especially when many people around the world don't have access to health care and/or simply can't afford it, we must feel appreciative that such a system exists in Japan, and that it is free.

There are some aspects of the annual health check system in Japan, however, that may be considered downsides or at least problematic.

Let's take a look at some of them.

Disadvantages of the annual health check in Japan

Your company gets a copy of the results

Yep, if you work for a Japanese company, they will receive a copy of the results. The main purpose for making them mandatory for employees is to make sure there isn't something that's going to prevent you from doing your job effectively.

From all the Japanese company workers I've spoken to about this, they say the results are usually sent to the HR department. If your results are deemed “normal”, then they'll likely just be placed in your file and not spoken of again. If, however, any abnormalities do come up, or your test results are deemed less than ideal, expect to have a somewhat awkward conversation with HR, or even your boss, about follow-up examinations, what you're doing to address this health concern, and even your role within the company.

While some changes to your role may be indeed beneficial to you and your health, oftentimes the results are used simply for the benefit of the company. Sometimes the results can lead to discrimination and otherwise very fit people being passed up for promotions or other important roles.

The mandatory health check system of most Japanese companies makes it very difficult in many cases to keep your personal medical circumstances private.

The annual health check “cleanse”

Because the annual health check is a mandatory requirement for continued employment at most Japanese companies and due to the issues that may ensue if you perform poorly, many employees go on an active “diet” in preparation for the check. They do such things as eliminating fried foods and alcohol, and pay close attention to getting more sleep, usually for a month or so beforehand.

These lifestyle changes can of course be considered positive, but it really does little to solve the endemic issues that cause them in the first place, such as mandatory company drinking parties where workers are obligated to partake in less than healthy izakaya (Japanese pub) food and excessive drinking. And it's usually company overtime (most of which is not paid), that mean there is little time to rest in between working hours. Even at home or during free time, alcohol is highly consumed as a means to relax and unwind from the stresses of company life.

Until this business culture changes, a temporary, cold turkey lifestyle cleanse will do little to make real, long-term health changes. Oftentimes, once the health check is over, the month's restraint is more than made up for with a night out on the town.

Testing for the unnecessary

While some checks do little to no harm to have annually, it can be argued that some are unnecessary to have on such a regular basis, and can in fact be harmful, however small that risk may be.

The most contentious is the chest x-ray, since you are being exposed to small amounts of radiation each time. And if you haven't had any symptoms warranting one, it may be considered over-the-top to have it done annually.

The same can be said for the endoscopy. It's one thing to pee into a cup, but quite another to have a camera shoved down your throat and moving around some of your internal organs each and every year.

And then sometimes tests are repeated just for the sake of internal paperwork. For example, a friend of mine once started two different university lecturing jobs just a couple of weeks apart. He had to go to the very same hospital and do the very same tests twice within two weeks since both universities required it. The very recent results, at the same hospital no less, weren't enough to satisfy the requirements for the second position. For someone who has difficulty with blood tests, it wasn't a very fun prospect. He told me that the nurses remembered him from the first test though and knowing his squeamishness for blood tests, were very kind and accommodating.

Some people don't have issues with any of the tests and don't mind having them, but I do know a lot of people for whom the annual health check is something that they physically and mentally anguish over for about a good week or so beforehand.

A Japanese test applied to non-Japanese

An increasing issue with more and more non-Japanese living and working in Japan, is that this is a system designed for Japanese people. There is the obvious issue of language, and in our experience, all documentation including the results, and the examination itself is done in Japanese only. Although you may get lucky and encounter staff who can assist, at least somewhat, in English.

Language issues aside though, perhaps what is most pressing, especially for foreigners needing to “pass” to work for Japanese companies, is that the results and acceptable ranges for many of the tests are based on what is considered “normal” for a Japanese person. For those of different ethnicities, what is “normal” could vary significantly, but those differences are not accounted for in the results. This can make it difficult for people of a different ethnicity and even biracial Japanese to get through the bureaucracy of some of this required internal paperwork.

Furthermore, conditions that may be high-risk for your ethnicity or country of origin may not be flagged or checked for at all. For example, stomach cancer is considered of utmost importance to check for in Japan, but something like mole checks for skin cancer, are not. These complexities may need to be addressed further in order to provide health checks that apply better to Japan's growing foreign workforce.

As stated earlier, the Japanese annual health check system, even as it stands, would be considered a luxury in many places around the world, and I am grateful to have access to it. That said, I would love to hear your opinions about it and about the health care situation where you live?

Do you get an annual health check? Is it free or arranged for by the government? Or is health considered an individual concern where you're from? Let us know in the comments!