Non-communicable diseases (NCDs) such as hypertension, diabetes, strokes, cancer and depression disproportionately affect people in low-income contexts, particularly as they get older. They can be some of the most resource-intensive conditions to manage, requiring changes in working routines, regular visits for hospital care and long-term medication. Chronic, long-term illness in old age can be particularly demanding for family caregivers as they navigate hospitals and home life. Yet they are also often overlooked in terms of research, policy and funding. In Uganda, for example, it was only in 2005 that NCDs were given an explicit place in the national health strategy, and there remains limited research and resources, particularly for long-term funding to support NCD information, prevention and care^[i]. The relatively recent rise of NCDs as widespread health problems in Uganda is often attributed to contemporary lifestyles, the pollution and stressors of city life and personal problems imposed by global processes[ii]. As much as biological factors, NCDs can be inextricably linked to inequities around employment, education, nutrition and housing. Wide-reaching economic factors influence both experiences of chronic illnesses and access to treatment, determining who is responsible for long-term care; often families, navigating overstretched health systems and existing obligations.

Anthropology has a lot to offer in understanding how people manage uncertainty related to long-term illness. As argued in my previous blog post, it is often through dialogue and conversation with each other, that people seek to establish control in an ambiguous world[iii]. By detailing conversations around chronic illness and care, we can gain an insight into how people also understand and manage the wider world, particularly in terms of how health inequities impact on their everyday lives. The pertinence of this anthropological project, to take pre-existing conditions, their conceptualisation and management, into account, has been highlighted by the current COVID-19 pandemic, which has shown that the epidemiological boundaries between communicable and non-communicable diseases are evidently blurred, with both determined by social networks and inequities[iv]. Intensified pressures on households, health workers and hospital administrators who have to improvise and make do have shown the need for preparedness through prior and ongoing understanding of the “complex social drivers of our wellbeing”[v]. And clearly, ways of navigating stratified access to health provisions are of primary importance not just to those obstructed, but to us all.

Pharmacy service inside a regional government hospital near the Kampala fieldsite

Notice for visiting hours and Doctor’s round at the hospital

[i]  Susan Reynolds Whyte, ‘Knowing Hypertension and Diabetes: Conditions of Treatability in Uganda’, Health & Place 39 (May 2016): 219–25, https://doi.org/10.1016/j.healthplace.2015.07.002.

[ii] David Reubi, Clare Herrick, and Tim Brown, ‘The Politics of Non-Communicable Diseases in the Global South’, Health & Place 39 (May 2016): 179–87, https://doi.org/10.1016/j.healthplace.2015.09.001.

[iii] Susan Reynolds Whyte, Questioning Misfortune: The Pragmatics of Uncertainty in Eastern Uganda, Cambridge Studies in Medical Anthropology 4 (Cambridge ; New York: Cambridge University Press, 1997).

[iv] Lenore Manderson and Ayo Wahlberg, ‘Chronic Living in a Communicable World’, Medical Anthropology 39, no. 5 (3 July 2020): 428–39, https://doi.org/10.1080/01459740.2020.1761352.

[v] Napier, D. (2020) The Culture of Health and Sickness: how Uganda leads on Covid-19. In Le Monde Diplomatique p.6-7

“I am ashamed of our government” messaged Inoue san*, a 65 year old woman from Osaka. She is retired and has been staying at home as much as possible during the coronavirus outbreak. “In Japan, regretfully it seems that people don’t think it’s so serious. I can’t believe it!” For the past month my friends in Japan have been telling me that they are concerned by the slow response to the coronavirus from the Japanese government. 

For many people I got to know, it is customary to go to the clinic or even hospital as soon as you suspect you may have the flu. According to my doctor contacts in Kyoto, hospitals are starting to become overwhelmed by the numbers of people seeking help and advice. As the story of Sato san shows, illustrated above, even the official corona virus hotline recommends for people to go to hospital. There is a feeling that unless drastic measures are taken, such as a lockdown, the number of infections will soon explode and hospitals will not be able to cope.

While here in the U.K. the numbers of cases and fatalities rose dramatically during March and early April, in Japan the number of confirmed cases remained low and is only just reported to be rising. While some of my contacts believe that the government’s response has therefore been appropriate, in general trust in the government’s crisis response is low among the 60 or so individuals I got to know well during my fieldwork. This negativity is primarily due to their concern over how the government handled the aftermath of the 2011 earthquake, tsunami, and nuclear meltdown. Japanese media is largely state-controlled and many people question the transparency of reporting. During the coronavirus pandemic people are turning to their smartphones to seek out the latest information about the virus, such as through the messaging app LINE which collates news from various sources. 

The smartphone is not only a key source of news, but it is also where people can express their frustration with the government’s response. What many people want is for employers to be forced to close businesses, and for there to be financial aid given to workers. For example on 16 April there was an organised Twitter protest targeting government policy, with the hashtag #休業補償と一律給付で命を守って, meaning ‘save lives with leave compensation and uniform benefits”. While Japan’s working poor continue with their daily commutes to work, the government have promised to send face masks to every household. This gesture has been widely regarded as out of touch with reality, and has prompted ridicule online, such as the memes below and the trending hashtag #Abenomask which plays on Prime Minister Abe’s eponymous ‘Abenomics’ economic policies.

On 16 April the government issued a nation-wide state of emergency, giving them greater power to request the closure of businesses. The Japanese constitution makes it difficult for the government to issue the sort of lockdowns that we have seen in Europe, so they have relied on issuing requests for people to work from home if possible and avoid mass gatherings. Yet these guidelines have not been binding by law, meaning that many employers have largely been carrying on as normal, while individuals feel increasingly conflicted.

See Laura’s Instagram for more illustrated ethnography.

*Names have been changed for anonymity in this blog post.