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The community health check in Japan

Laura Haapio-Kirk4 December 2020

 

One of the biggest challenges facing the healthcare system in Japan today is a rapidly ageing, rapidly shrinking, population. One-quarter of the population of 127 million are over the age of 65 – the world’s highest proportion – and this is predicted to rise to 30% by 2025 (National Institute of Population & Social Security Research [NIPSSR], 2012). According to the World Health Organization, Japan ranks first in the world for the highest age to which a person can expect to enjoy good health: 74.5 years old. Only about 12% of the elderly (those aged 75+) population require long-term care, of which about 4.3% are institutionalised, while the rest live at home and receive care from family and health professionals (Thang, 2011). The healthcare system in Japan is covered by a national health insurance plan focused on preventative medicine through the practice of annual health check-ups. Since the early 2000s, health checks have been delivered for all age groups, and age-appropriate tests are performed for each age category.

In my ethnography of a rural health check in Tosa-cho, Kōchi Prefecture, the patients were generally very positive about their experience of coming to the health check every year, and said that it helped them feel motivated to stay healthy by giving them goals. Each patient brought with them a personal booklet which the doctor would write their notes in, as well as affixing a photograph of the patient with the doctor (which you can see in the video above). These booklets helped the patients to track any differences in their test results year on year, and to help them know which areas they had to work harder to improve such as though dietary modifications. Self-tracking in this case was low-tech, but its motivational power was clear.

The video above is narrated by Dr Kimura Yumi from Osaka University, one of the doctors who co-ordinate this health check for over 75s which has been running for 15 years. The health check was established when the town’s head councillor wanted to improve the health of ageing residents through preventative medicine. He invited doctors and researchers from different universities around Japan with the aim to identify key factors affecting the health of elderly people. This type of community “field medicine” (フィールド医学) is a relatively new practice in Japan, and inviting researchers to the Kochi health check up was the first such attempt among geriatric people both domestically and internationally (Matsubayashi and Okumiya, 2010). The annual community-based health check in Tosa-cho appears to have been successful in terms of reducing medical costs for geriatric care. The medical expenses for the elderly there between 2004 and 2007 were reduced, compared with Motoyama-cho, a neighbouring, similar sized and similar environmental control town, as well as compared with Kochi City and with the average medical expenses of 35 towns in Kochi Prefecture.

After my participation in the health check I returned to this community regularly over the subsequent eight months in order to get a better understanding of people’s lives and wider attitudes to health and wellbeing. My long-term ethnographic research in the community found that people continually emphasised the importance of food and social connection for maintaining health. Indeed many said that they came to the health check each year precisely because of the opportunity to catch up with friends. This finding led to the development of a digital health project in partnership with Dr Kimura and Sasaki Lise which is still ongoing. This project was designed to see if participating in chat groups via the messaging application LINE could improve quality of life among elderly participants.

Because of the coronavirus pandemic, the health check did not run in 2020. However, the crisis prompted innovation: the local town hall were inspired by our digital health project to create their own version in which they connected residents via LINE (the most popular messaging app in Japan). Residents who signed up to the buddy scheme via LINE were then rewarded with a meal at the town hall with their chosen ‘buddy’ – all in a socially distanced and covid-safe manner. Even though digital forms of care are only just emerging among elderly people in this rural town, it is already clear that they are going to be integral to how care is organised in the future, well beyond the pandemic.

 

National Institute of Population and Social Security Research [NIPSSR], (2012). Nihon no shorai suitei jinko [Population projection for Japan] Accessed 01.08.2018 <http://www.ipss.go.jp/site-ad/index_english/esuikei/gh2401e.asp>

Matsubayashi, K., & Okumiya, K. (2012). Field medicine: a new paradigm of geriatric medicine. Geriatrics & gerontology international, 12(1), 5-15.

Thang, L. L. (2011). Aging and social welfare in Japan. Routledge handbook of Japanese culture and society, 172-85.

Creating a free university course during a pandemic

Daniel Miller6 October 2020

While the figures may seem small compared to the one million downloads of our open-access ‘Why We Post’ books, the MOOC created for FutureLearn as part of the Why We Post project was taken by over 40,000 students. A Russian translation of the course was taken by another 9,000 students. Compared to 100 students in a typical lecture class, this certainly seems worthwhile. A MOOC can also reach people in countries and situations that are far more open than traditional university teaching, and it is free. So, we never doubted that we wanted to make another MOOC for the ASSA project. We expect to launch this next April on FutureLearn alongside the first three books. While Laura Haapio-Kirk bore the brunt of the work last time, this time it is Georgiana Murariu, currently working as a public dissemination officer on the project. The FutureLearn platform acts a bit like social media in that the students interact with each other and post loads about their own experiences. This should work well for a topic such as the smartphone, in which most people have personal experiences and observations. By the way, the Why We Post MOOC is still running at: https://www.futurelearn.com/courses/anthropology-social-media.

We are making some changes. MOOCs typically have quite a tail off so we are making a three-week course, rather than five weeks. Currently, the main emphasis is on filmmaking since Ben Collier, our filmmaker, is only employed for a short period. The films are a little shorter than before, but the text is likely to be similar is scope. The first week is mainly devoted to the smartphone itself and our original insights and perspectives on what a smartphone is and will also summarise our comparative book ‘The Global Smartphone’, due to come out next year. The second week considers the smartphone in the context of ageing, which is the main concern of our new monograph series, also due to come out next year. The third week focuses more on an element of ASSA that did not exist for Why We Post – our efforts to make our work of direct benefit to people’s welfare through our radical alternative to conventional mHealth and the general use of smartphones in the field of health.

For the present effort in filmmaking, we are obviously constrained by the circumstances of Covid-19. We don’t have the group and round-table discussions found in the earlier MOOC. Instead, the concentration is more on using material that comes directly from our ethnographic engagements around the world.  Most of our films are pretty serious, but in this instance, it seemed okay to have a bit of fun with the whole issue of filmmaking during a pandemic. I play the role of Mr Grumpy, to Xinyuan Wang’s annoyance.

See the film here: