In countries far along in the demographic transition, rapidly aging populations are colliding with a severe shortage of health care and elder care workers. Japan may be the most pertinent case study of this and other impacts of demographic disruption. The country’s fertility rate is decreasing faster than projected, and as of 2025, 30% of its population was aged 65 or older. These trends have contributed to a persistent gap between surging demand for elder care and a shrinking care workforce.

To cope with this crisis, the Japanese government has implemented several programs to promote the use of robots in nursing home care. These care robots (or “kaigo robots”) assist care workers and support residents with daily needs. But how does their adoption affect workflows, staff retention, and overall staffing of long-term care facilities? Few studies have empirically examined these questions.

Shedding light on the debate surrounding new automation technologies and their impact on workers, a recent study, published on August 6 in the inaugural issue of the journal Health Affairs Review, finds that care robots help address challenges posed by population aging and care-labor shortages without necessarily displacing workers or lowering care quality.

The study, titled Robots and Labor in the Service Sector: Evidence from Nursing Homes, is part of a collaborative effort driven by the Asia Health Policy Program (AHPP) at the Walter H. Shorenstein Asia-Pacific Research Center. The study’s co-authors are Stanford health economist Karen Eggleston, the director of AHPP; Toshiaki Iizuka of the University of Tokyo’s Graduate School of Economics, a former AHPP visiting scholar; Yong Suk Lee of the University of Notre Dame’s Keough School of Global Affairs, formerly the SK Center Fellow at Stanford’s Freeman Spogli Institute for International Studies; and Ellie Xi, a rising junior at Stanford studying biomedical computation on the pre-med track and a former research assistant to Dr. Eggleston.

“One of the aspects of the paper that I found most interesting is its attempt to move beyond simply documenting where robots are being adopted and instead ask what their adoption may actually do to the long-term care workforce, especially given the sector’s high turnover rates and physically demanding working conditions,” says Xi.

Sign up for APARC's newsletters to receive our scholars’ research updates > 

Lessons from Early Diffusion of Robotics in the Long-Term Care Sector

The researchers grouped the robots prevalent in Japanese nursing homes into three main categories:

• Transfer aids: Wearable and non-wearable devices that assist staff with lifting frail residents from beds to wheelchairs, significantly reducing back strain, a leading cause of caregiver burnout.
• Mobility robots: Assistive systems that help residents move, use the restroom, or bathe more independently.
• Monitoring and communication systems: Sensors that alert staff when a resident has slipped out of bed or fallen, as well as social robots designed to offer companionship and cognitive stimulation.

To examine early diffusion of these robots, the researchers used 2017 survey data on long-term care work across approximately 860 Japanese nursing homes. A second source of data is their compilation of prefecture-level care robot subsidy availability, using regional variation in robot subsidies as an instrumental variable. Think of this as a natural experiment driven by a “geographic nudge.” Starting in 2015, Japan’s central government began providing prefectural governments with funds to subsidize the cost of adopting care robots. Because different prefectures introduced these subsidies at different times and with varying levels of generosity, nursing homes in some regions had a much easier path to acquiring and deploying robots than those in neighboring areas.

By comparing staffing trends between nursing homes that received this external, subsidy-driven "nudge" to adopt robots and those that did not, the researchers could confidently isolate the technology’s causal effects on the caregiving workforce.

The results indicate that nursing homes that adopted robots saw a significant decrease in staffing retention problems. Robot adoption was also associated with a 28% increase in care workers and a 39% increase in nurses, resulting in approximately 26% higher total employment at the facility level. Importantly, this employment growth occurred entirely among non-regular employees – that is, staff members on flexible, often part-time, contracts. The findings also suggest that robot adoption may improve continuity and quality of care while mitigating careworker shortages.

“Using nationally representative data from Japan and an instrumental-variable strategy, the study provides evidence suggesting that robots can complement rather than simply replace care workers, including by alleviating retention difficulties in a sector facing persistent labor shortages and potentially supporting quality of care,” explains Xi. “The paper’s central finding is that robot adoption is associated with reduced retention difficulties and increased employment of care workers and nurses under flexible contracts.”

A Human-Robot Collaborative Future for Elder Care

Caregiving is a physically demanding and high-stress occupation. The study’s findings indicate that, by introducing robots to ease staff burdens and monitor residents, nursing homes were able to promote more flexible work, either by increasing the tasks performed by non-regular employees or potentially encouraging part-time work. This type of work structure is encouraged by the Japan Nursing Association as a means for reducing stress, preventing burnout, and promoting a healthier work-life balance.

“Given recent debates about AI use in healthcare and the future of work, I found it especially interesting that this research highlights the potential for technology to augment caregivers, particularly by supporting physically demanding or indirect tasks, while preserving the human aspects of care that are more difficult to reproduce,” says Xi.

The study's findings are relevant for policymakers seeking evidence on the social value of collaborative robots and their impacts on staffing and care delivery, particularly as aging societies facing demographic pressures similar to Japan consider how to meet growing demand for long-term care.

A Mentorship Story

The study is part of Eggleston’s Innovation for Healthy Aging research track, which investigates how East Asian economies adopt and adapt to emerging technologies, design incentives, and adjust their workforces to support older adults. It builds on an earlier research project focused on the impact of robots on nursing home care in Japan.

For Xi, co-authoring the paper represents an academic milestone. "As someone deeply interested in geriatrics, I first began working with Dr. Karen Eggleston as a research assistant during the summer after my freshman year," Xi recalls. "Last spring, we decided to continue working together through a directed reading."

During that directed reading, Xi was invited to help revise and update a project that had previously circulated as an Asia Health Policy Program working paper. She worked to update the research, framing the original findings within the rapidly shifting landscape of care robotics and artificial intelligence in long-term care.

"I worked on situating the original findings within more recent research and developments in care robotics and considering what Japan’s experience can tell us about the role of these technologies in aging societies today," Xi says. "It was an incredible opportunity to work closely with Dr. Eggleston, Professor Toshiaki Iizuka, and Professor Yong Suk Lee. I was especially grateful to see firsthand how a collaborative project evolves and to contribute to that process as the paper moved from a working paper toward publication.”

This essay first appeared in The Diplomat.

For decades, South Korean strategy rested on a stable hierarchy within the international order. The alliance with the United States provided security; Seoul then managed relations with Japan, Europe, China, and regional institutions around that anchor. The alliance remains indispensable, but Seoul can no longer assume that this foundation will stay stable.

The evidence is visible in the way Washington now deals with allies. In 2025, the United States initially announced sharply differentiated “reciprocal” tariffs on South Korea, Japan, and the European Union. Negotiations later produced a 15 percent baseline framework for all three, but the process mattered as much as the final rate. Trade access, industrial investment, defense procurement, and alliance politics were increasingly handled as one bargaining package. Allies were not exempt from economic pressure because they were allies.

At the same time, Europe and Asia have been building connections that would have seemed highly ambitious a decade ago. The European Union signed security and defense partnerships with Japan and South Korea in November 2024. This year, the EU and Japan launched a defense-industry dialogue, while the EU and South Korea signed a digital trade agreement and began implementing cooperation on maritime security, cyber and hybrid threats, information manipulation, space, and the defense industry. The strategic map is becoming more networked. 

The network, however, remains uneven. Japan already has a mature economic partnership with the EU and rapidly expanding defense-industry ties. EU-South Korea relations are deepening, but they still lack the density and regular strategic consultation found in EU-Japan ties. A trilateral format would therefore do more than add another meeting: it would reduce asymmetry among three partners whose capabilities are increasingly complementary.

Sign up for APARC newsletters to receive our scholars' commentary and analysis >

South Korea, Japan, and the EU now face four converging challenges and pressures.

The first is demographic. South Korea is aging faster than any other OECD society; Japan’s working-age population has been shrinking for decades; and the EU’s fertility rate reached a new low in 2024. Demography is not a social-policy sidebar. It affects defense recruitment, industrial capacity, fiscal room, technological adoption, and the ability to sustain long-term commitments. Each actor is experimenting with immigration, automation, workforce policy, and welfare reform, but the security implications remain largely compartmentalized.

The second is concentrated economic dependence. None of the three can or should decouple from China. Yet South Korea’s experience after the THAAD deployment, Europe’s debates over economic coercion, and China’s export controls on gallium, germanium, and other strategic inputs have shown that interdependence can be converted into leverage. De-risking therefore requires more than national stockpiles. It requires shared risk maps, compatible certification, co-investment in alternative suppliers, and advance consultation before export controls or industrial subsidies create collateral damage among partners.

The third challenge is U.S. volatility. The United States is still the only actor capable of providing extended nuclear deterrence to South Korea and Japan, and NATO remains central to European defense. But dependence on U.S. power now coexists with uncertainty about U.S. policy. The classic alliance dilemmas of abandonment and entrapment are no longer opposite ends of a spectrum. Today, U.S. allies fear both being left out and being drawn into bargains or contingencies they did not shape.

The fourth pressure is the collapse of the old geographic separation between European and Asian security. North Korean munitions, missiles, and troops have supported Russia’s war against Ukraine. Moscow, in turn, has provided Pyongyang with political cover, economic support, and the prospect of military know-how. What happens on a European battlefield is changing the military balance on the Korean Peninsula. A regional response to a cross-regional threat is structurally inadequate.

This is the case for an EU-Japan-South Korea strategic dialogue. This framework should not be described as strategic autonomy, equidistance, or a hedge against the United States. A better term would be institutionalized hedging: risk diversification through standing, rule-based consultation among allies and partners that remain anchored in the broader U.S.-led system.

The proposal is more feasible than ever before. Japan-South Korea relations have improved significantly in recent years. The January 2026 summit in Nara and the reciprocal summit in South Korea in May demonstrated continuity across leadership changes in both countries since June 2025. The EU already has free-trade, digital, green, and security frameworks with both countries. The task is not to invent three new bilateral relationships; it is to connect existing ones.

The dialogue should begin modestly, through a Track 1.5 process involving officials, experts, and industry. Its early agenda must be concrete and specific: a joint critical minerals and supply chain risk assessment; consultation on export controls and investment screening; cooperation on AI, cyber resilience, and digital standards; exchanges on demographic and defense workforce adaptation; and shared monitoring of North Korea-Russia military cooperation. Successful projects could then be elevated to ministerial working groups.

Two design choices are essential. First, the initiative must remain function-driven. It is not NATO, not the Quad, and not an anti-China coalition. Its purpose is to reduce vulnerability without demanding economic separation. Second, it should be complementary to relations with Washington and transparent about that purpose. Horizontal networks strengthen alliances when they help allies absorb shocks, coordinate positions, and arrive at consultations with greater capacity.

For South Korea, the need is particularly acute. Japan already has the G7, a mature economic partnership with the EU, and expanding European defense ties. Seoul’s international weight has grown faster than its institutional depth. An EU-Japan-South Korea dialogue would help close that gap.

Horizontalizing alliances is not a vote of no confidence in the United States. It is insurance for the moments when the United States wavers, overreaches, or changes course. The postwar hierarchy cannot simply be preserved by demanding more reassurance from Washington. Its resilience will depend on whether allies can build connective tissue among themselves before the next crisis forces them to improvise.

In its June 20, 2026, edition, the Nikkei Shimbun's Market Beat financial analysis column, titled US Stocks Attract Japanese Money, examines how the U.S. stock market is becoming a "major league" that is increasingly attracting capital from Japanese individual investors. Several factors drive this phenomenon:

• Massive IPOs: Unprecedentedly large IPOs, as seen by SpaceX, are capturing global attention and investment.
• Structural Advantages: U.S. markets are moving fast to include new, large companies in major stock indices, which forces index-tracking funds to buy shares and creates automatic demand.
• 24-Hour Trading: U.S. exchanges like the NYSE and Nasdaq are moving toward near 24-hour trading to specifically capture Asian daytime investors, making it easier for them to participate.

The column describes how Japanese investors are increasingly bypassing domestic options to capture the immense growth driven by American AI, data infrastructure, and advanced technology IPOs. "Founders and early-stage investors prefer large-scale markets that offer price discovery, liquidity, and visibility. This is likely to accelerate the concentration of innovative companies in the United States," says Curtis Milhaupt, the William F. Baxter-Visa International Professor of Law and APARC faculty affiliate.

The article notes that the speculative nature of advanced tech sectors inevitably fuels market volatility and could pose risks for Japanese investors looking across the Pacific, urging Japanese investors to identify promising domestic companies.

This story first appeared in Japanese in Asahi Shimbun's GLOBE+. The English translation below was machine-generated and lightly edited for accuracy. You can also read a related news article about the Stanford Japan Barometer's experiment discussed here via our website.

The Japanese are currently very cautious about accepting foreign workers, a trend that has intensified especially in recent years. Among foreigners, those from China tend to be less favored, while those more readily accepted are immigrants from Europe, the United States, or Vietnam who work in fields such as medicine, research, or science, speak Japanese, and have high academic qualifications. The Stanford Japan Barometer is an online public opinion survey conducted by Kiyoteru Tsutsui, professor of sociology at Stanford University and director of the Shorenstein Asia-Pacific Research Center, and political scientist Charles Crabtree of Monash University in Australia, covering a variety of themes including Japanese society, economy, and politics. While it boasts one of the largest respondent numbers in Japan, this time the survey focused on the themes of "immigrants" and "foreigners."

The survey was conducted from February 6-8 and 13-16, 2026, with the aim of examining changes in public opinion before and after the House of Representatives election held on February 8, 2026. The number of respondents was slightly over 4,000 in each period. However, the results were almost identical before and after the election.

The survey explored the extent to which Japanese people support or oppose the acceptance of foreign workers. Respondents were asked to answer "agree," "somewhat agree," "somewhat disagree," or "disagree" for 16 policies, including "climate change/global warming," "declining birthrate," "aging population," "social security for the working generation," "national budget cuts," "economic inequality," and "AI strategy."

In the first survey, when asked about "accepting foreign workers," 46.9% answered "agree" (first two groups), and 53.1% answered "disagree" (last two groups), indicating that opposition was the highest percentage. The second survey yielded similar results, with 46.6% agreeing and 53.4% ​​disagreeing.

Regarding policy priorities, including "acceptance of foreign workers," surveys were also conducted in 2022 and 2023. These surveys covered 14 policy items, and while the response categories differed slightly, the content is comparable. In 2022 and 2023, broadly speaking, opposition accounted for 35.5% and 36.6% respectively. This represents an increase of approximately 18 percentage points between 2022 and 2026. This is a significant change compared to other items, where the opposition rate either decreased or remained unchanged, or increased by only a few percentage points. In the following text, the researchers explain the experiment further.

Popular among Westerners and Indians

We also investigated what kind of immigrants are preferred. To do this, we asked people to "make judgments from the perspective of an immigration officer." We asked them about nine attributes: gender, educational background, country of origin, Japanese language ability, reason for immigration application, occupation, length of previous work experience, work plan, and travel history to Japan.

The research method involves randomly combining these nine attributes to create two "candidate profiles," and then asking respondents to choose one of them in a two-option format. The same question is repeated a total of six times with variations in the options, and the responses obtained from all respondents are compiled and analyzed. This method allows for a statistically closer understanding of the respondents' true feelings.

The educational background ranges from "no formal schooling" to "equivalent to a Japanese graduate degree" (7 categories), and the applicants come from eight countries: the United States, India, Turkey, Germany, Brazil, Vietnam, China, and South Korea. Japanese language proficiency is categorized into four levels, from "spoke through an interpreter during the interview" to "spoke fluently in Japanese during the interview." The reasons for applying are categorized into three types: "to live with family already in Japan," "to escape political/religious persecution," and "to seek better employment in Japan." The occupations are categorized into 11 types, including IT engineers, convenience store clerks, caregivers, childcare workers, doctors, research scientists, and financial consultants. Work experience is categorized into four types, from "no experience" to "more than 5 years." Employment plans are categorized into four types: "no plans to look for work at this time," "plans to look for work after arriving in Japan," "no contract with an employer in Japan, but has had job interviews," and "has a contract with an employer in Japan." There are five types of travel history to Japan: "Entered Japan once without legal permission," "Spent six months with family in Japan," "Never visited Japan," "Entered Japan once on a tourist visa," and "Visited Japan multiple times on a tourist visa."

The analysis revealed that the most popular responses for each of the above categories were: "female," "graduate degree," "German," "spoke fluent Japanese during the interview," "to live with family already in Japan," "doctor," "more than 5 years of work experience," "has a contract with an employer in Japan," and "spent 6 months with family in Japan." The countries of origin where they were most likely to be accepted were Germany, followed by the United States, then India, Vietnam, Turkey, Brazil, South Korea, and China.

Furthermore, we investigated whether the ease of accepting immigrants changes depending on the preconditions. Focusing on three areas—the Japanese economy, the culture of Japanese society, and the governance and public safety of Japan—we asked participants to choose from "agree," "somewhat agree," "somewhat disagree," or "disagree" regarding Japan expanding immigration after reading statements such as "increased immigration will benefit the Japanese economy" or "will be a burden," "will enrich the culture of Japanese society" or "will be detrimental," and "will bring stability to the governance and public safety of Japan" or "will cause chaos." The results showed that the most significant increase in support for immigration was when the precondition of economic benefits was read. Conversely, the most significant increase in opposition was when the statement that increased immigration would cause chaos to governance and public safety was read.

"The impact of political public opinion arousal"

Regarding these results, Professor Tsutsui commented, "The acceptance of foreign workers has become a major concern for Japanese people. Previously, it was probably not such a significant issue for the average Japanese person, but interest in accepting foreign workers has rapidly increased following the 2025 House of Councillors election and the subsequent gubernatorial elections. This can be attributed to the influence of political public opinion-raising efforts by parties such as the Sanseito party. Although the proportion of foreigners in Japan is on the rise, it is still low compared to Western countries, and it was surprising to see such a shift in public opinion through a political campaign, even in a country that hasn't received a large influx of immigrants."

Regarding the unfavorable perception of people of Chinese descent, the author states, "The tendency to dislike minority groups that become competitors and threaten one's position is quite widespread. For example, in the United States, after the Civil Rights Movement, when Black people began to enter white residential areas and schools, white people felt their space was threatened and that Black people were becoming competitors, leading to resistance. For Japanese people, even among Asian foreigners, Vietnamese people are seen as people who fill jobs in areas with labor shortages, such as elderly care, and are viewed more as complementary than competitive. This is in stark contrast to the perception of Chinese people."

Furthermore, the survey indicated that foreigners who are easily accepted by Japanese people are "individuals with high levels of education, work experience, and Japanese language proficiency, who possess the ability to contribute to Japanese society and who are prepared to do so. A similar trend has been observed in the United States, where ability is highly valued."

Learn more about the Stanford Japan Barometer's research and insights >