While medicine has been present throughout Japan’s history, health administration emerged in modern times, specifically from the Meiji era. The initial development of the health system was significantly influenced by the introduction of Western concepts and the impact of pandemics. Evolving policies, shaped by political, social and economic conditions, addressed challenges posed by cholera, tuberculosis and the Epidemic Cold (Spanish influenza), ultimately leading to the achievement of Universal Health Coverage in 1961. The unexpectedly rapid and continuous ageing of the population presented a new challenge, necessitating ongoing health system reforms.