By Georgiana Murariu and Laura Haapio-Kirk

In this blog post, we present the fourth comic in our ASSA comics series, this time set in Kyoto, one of Laura Haapio-Kirk’s fieldsites. Laura undertook fieldwork here for 16 months on the intersection of ageing and smartphone use and a significant part of her research focused on the rise of visual digital communication among older adults.

One of the findings in our project is related to the rise of social media and smartphones: we found that visual digital media such as emoji and stickers have become an integral element of conversation. Increasingly conversations do not necessarily need either voice or text. It is among older women in particular that Laura found these visual elements to be perceived mostly positively, as a quick and easy way of expressing care. Stickers also mean one is less likely to make mistakes such as typos, and they also help maintain the right atmosphere in a conversation, which is very important in Japan. On the dominant messaging app called LINE, billions of emojis and stickers are sent back and forth every day. However, it is not just stickers that help uphold social norms and etiquette – one’s ‘digital public façade’ can also be upheld through their style of digital communication.

In the comic below based on one of Laura’s participants, we meet Hiro-san, a man in his early 50s who finds the smartphone convenient, but also finds that his style of communication does not fit with what is expected of him when using the smartphone. Hiro-san prefers to write long messages, just as if he was writing an email as he is used to doing in his working life. However, increasingly this style of communication does not fit with the rapid and constant exchanges he is part of in groups on LINE. He also thinks the fact that people can see when one has read a message puts more social pressure on the individual to respond quickly. In response to this sense of pressure, he develops a ‘tortoise’ persona who replies slowly, writing long messages without the use of stickers. ‘Becoming a tortoise’ online frees him from the pressure to fit in with the popular style of messaging which he feels is far too fast-flowing for him.

When this particular participant explained his ‘tortoise’ persona to Laura, she immediately could see the potential of developing the story in a comics format. Laura sent some ideas to John Cei Douglas, the artist we are collaborating with, exploring the possibility of showing the character physically changing into a tortoise costume. John responded with panels that build suspense by showing elements of the costume sequentially, only revealing the full effect in the final panel. One challenging aspect of illustrating this story was how best to show Hiro san’s long messages. Instead of presenting these long text messages visually, John has instead shown the abundance of short and quick reactive messages that Hiro-san was concerned about. We hope that the comic conveys in a playful way how smartphones can both facilitate connection and also be sites for disconnection for those who feel that they do not fit in.

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.