This chapter discusses how island of Okinawa achieved the highest longevity in the world and why it then came to have high premature death rate in Japan. Okinawa returned to Japanese control in 1972 and for 20 years from 1975 to 1995 had the highest life expectancy and the highest number of centenarians per 100,000 population in the country. These days, Okinawa has a higher prevalence of obesity and higher mortality rates among 40-65 years-old than mainland Japan. This chapter seeks to understand the reasons for the health changes, from historical and cultural perspectives as example of social determinants of health.