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The stigma of illness during coronavirus in Japan

Laura Haapio-Kirk17 July 2020

 

A graphic vignette showing two people.

Care workers adapt to the coronavirus in Japan. Names have been changed. Illustration by Laura Haapio-Kirk.

“We often hear the word jishiku repeatedly during this (coronavirus) time. Jishiku means, Ji: self, Shiku: 粛 refrain, or restrain.  In my opinion it’s very much based on Japanese mura (village) culture where everyone looks at what everyone else is doing. It is the big reason why the elderly in rural areas are so nervous to be infected, although the cases are quite low there. You will be mura-hachibu (ostracised) if you get infected in a small mura where everyone knows you well.”

Speaking with Dr Kimura, a social nutrition researcher at Osaka University who conducts fieldwork in Tosa-cho, the same rural Kōchi town where I spent time, she asserts that mura culture is alive and well in rural areas while diminishing in urban areas around the rapid economic growth period of ’80s and ’90s (kodo keizai seichou). The small communities that remain in rural areas who still practice rice-farming tend to be close-knit and everyone knows everyone else’s business. “Here, gossip travels faster than the internet”, says one local woman in the town.

The number of coronavirus cases has remained relatively low across Japan, however now (in July 2020) the numbers are rising in major cities, and Kōchi city, which is a one hour drive away from Tosa-cho, has reported cases again after the prefecture was declared free of coronavirus months ago. This uncertain time has significantly impacted on the lives of older people who are largely remaining at home, with events and social clubs cancelled. But even when things open up again, the social stigma of illness may act as a deterrent to engage freely in social activities. The fear of social ostracisation because of a perceived lack of self-restraint may be greater than the fear of the illness itself.

Yamakubi san, the head of the social welfare office, who usually co-ordinates household visits by social workers, has been motivated by the virus to explore ways for her staff to keep in contact with elderly people remotely. While some are confident with using a smartphone, many others are not. Many older people still use flip-phones and landlines and would find it difficult to engage in video calling. If one of the main issues facing older people during the COVID-19 pandemic is social isolation, this is exacerbated by the inability to use new communication technology. But when older people are interested in developing their digital literacy, such as by joining a smartphone club – as is the case with a number of people in Tosa-cho, they are keen to explore the potential of smartphones for keeping connected during this time. For example, I am part of a LINE (Japanese messaging app) group that that consists of a group of women in their 60s and 70s, which has become a space for sharing virus-related information and photos of home-made facemasks. COVID-19 has shown just how critical digital literacy interventions are when tackling social isolation, which can be compounded by the stigma of catching the virus.

 

Facilitating nutritional health through the smartphone in rural Japan

Laura Haapio-Kirk7 November 2019

Communal eating in Tosa-cho. Photo by Laura Haapio-Kirk (CC BY).

In September I received the good news that a joint application I made for the newly established Osaka-UCL Partnership Funding was successful. Along with Danny Miller on the UCL side, I teamed up with Dr Yumi Kimura from Osaka University who works on nutrition from a public health perspective in Japan, Myanmar, and the Himalayas. The project also involves Lise Sasaki, who previously studied medical anthropology at UCL. Our proposed collaborative project joins my ongoing anthropological research on smartphone usage among older adults in Japan with Dr Kimura’s public research on nutrition, to develop a mobile health intervention which is sensitive to local usage of mobile phones and attitudes towards health.

The project will take place in my rural fieldsite of Tosa-Cho, a town of roughly 4,000 inhabitants, in Kōchi Prefecture, South West Japan. This rural mountainous area is remote, with the nearest city (Kōchi City) being a 1-hour drive away. Rural towns in Japan are most in need of technological innovation to deal with the growing number of elderly people who are living often alone and in need of care. We know from our ethnographic research that mobile health applications are seldom used by older adults in this town, despite smartphone usage being fairly high. This indicates that there is great potential for digital health interventions but these have to adapt to the way local people are already using their smartphones, rather than encouraging them to download new apps.

Sharing food and conversation. Photo by Lise Sasaki (CC BY).

Over the course of our fieldwork, we have seen this trend across several field sites ranging from Brazil to Ireland: although mHealth initiatives may focus on changing behaviours through the use of native apps built specifically for improving health outcomes, we think making use of the ubiquitous platforms already in common use amongst the target populations could offer significant benefits. We plan to examine the creative ways that older adults are already using common smartphone applications for health and wellbeing, and will explore how these everyday applications could be used for purposes of a nutritional intervention, for example meal tracking using the application Line, or the facilitation of social eating in order to reduce isolation among older adults.

We will present our findings to doctors and health researchers at a symposium in 2020 organised by the UNESCO Chair in Global Health and Education, held at Osaka University by Prof Beverley Yamamoto. We also want to share our findings with the local population of Tosa-cho, so we plan to run a community workshop where we will demonstrate ways for people to use their smartphone to benefit their health and wellbeing. We are hoping that this research and accompanying policy report will reach beyond Kōchi prefecture and will be shared more broadly to advise on digital health policy across Japan. As older adults adopt the smartphone at increasing rates, the potential for mHealth to mitigate some of the health challenges that come with ageing is promising, but initiatives must adapt to already existing behaviours if they are going to have a chance to be sustained.