In Western English-speaking countries, “how are you?” is part of the standard small-talk repertoire – “Hi, how are you?” “Fine, thanks” (even if you’re not). In England, was even once seen as impolite to actually answer the question – the expected exchange was “How do you do?” “How do you do?”
Basically, it’s become a sort of “I’m making noises with my mouth to let you know I’m still listening” question.
In Japanese, it’s different – you’ll only ask お元気ですか if you know them well, and honestly care about the answer. Small talk instead consists of subjects that you’ll both agree on, such as the weather – it creates harmony, you see. 今日はいい天気ですねぇ et cetera. Instead of inquiring how they’ve been, you might ask what they’ve been doing – 週末、何をしましたか