How a Sick City Became the Healthiest Place in Japan

Trade shaming for moderation

Kaki Okumura
Published in
5 min readOct 8, 2020


A watercolor of a restaurant
Illustrations: Kaki Okumura

If you type into the Google search bar, “What is the healthiest prefecture in Japan?” one spot comes out on top in big, bold letters: Nagano Prefecture.

Some people might be surprised, expecting Okinawa to be the healthiest prefecture. The Okinawan diet is famous around the world and its people are known for living long, healthy lives. While this is true, especially among traditional Okinawan communities that continue to adhere to old ways of living, Nagano has surpassed it.

In 2015, the people of Nagano had a life expectancy of 84.72 (81.75 for men, 87.68 for women), an average that put it at the top in terms of longevity in the country (Ministry of Health, Labour and Welfare). The prefecture also has the lowest rate of deaths due to illnesses such as heart disease, liver disease, cancer, and pneumonia in the country.

So why don’t we hear about Nagano that often? Until quite recently, Nagano was among the unhealthiest prefectures in the country. They had the highest rates of salt consumption, and, correspondingly, notoriously high rates of deaths due to strokes and heart attacks.

Why Nagano was so salty

Unlike coastal prefectures, Nagano doesn’t have access to the sea and historically had a very difficult time farming enough food to make it through winters. To survive, they relied heavily on pickled foods to conserve whatever they were able to cultivate and added salt to a lot of their foods for preservation.

With a local culture so heavily dependent on salted foods, even with the arrival of modern agriculture and food preservation technology, it was very difficult for the people of Nagano to shift their diet. They had a culture of drinking entire bowls of salty noodle broths and eating large servings of briny nozawana pickles with every meal. But with these daily eating habits, the health of the prefecture’s people was suffering.

An illustration of pickles.

How Nagano saved itself



Kaki Okumura
Writer for

Born in Dallas, raised in New York and Tokyo. I care about helping others learn to live a better, healthier life. My site: 🌱