Dr. Rie Ogasawara, Assistant Professor, Graduate School of Human Sciences

"Ensuring no one gets left behind – Lessons in health equity learned from cultural and linguistic minority populations"

Japan enjoys one of the world’s highest life expectancies. It is widely known that excellent health outcomes in Japan have been largely attributed to its healthcare system performance based on universal health coverage. Ethnic and cultural diversity in Japan is low compared to other member countries of the Organization for Economic Co-operation and Development (OECD), and disparities in health have been said to be fairly small. Since the 1990s, however, the number of foreign residents (including temporary migration) has been steadily on the rise. According to Japan’s Ministry of Justice, as of the end of 2019, there were over 2.9 million foreign nationals residing in Japan.

Separate from foreign residents are culturally and linguistically diverse populations of Japanese nationals. One these groups is Japanese returnees from China, or JRC. The first generation of JRC are Japanese nationals who had been left behind in China during WWII and could not return to Japan until the diplomatic ties between Japan and China were restored in 1972 (subsequent generations are usually considered JRC regardless of their nationality). Having spent many years in China, they adopted Chinese as their first language as well as a Chinese way of life, which made it difficult for them to overcome the language barrier in Japan.

In particular, many JRC had been isolated from Japanese society during the 1980s and 90s when the assimilation policy was dominant. Interviews conducted in 2015 focusing on their life stories revealed many in-depth problems for JRC in receiving medical care [1]. In many cases, they received care without any language support, relying on their smattering of Japanese and writing Chinese characters ( kanji ). They were very reluctant to ask questions even when they could not understand what was said, which sometimes kept them from receiving the care they required. Regardless of such difficulties, they showed their satisfaction with healthcare service in Japan, saying, “My doctor knows me well.” Such passive attitudes make me anxious as I hardly see them exhibit any patient autonomy. It was at this point that I made a hypothesis: this attitude may be rooted in assimilation policy, in that those who could not assimilate into Japanese society as expected may have taken the strategy of “being obedient” instead of assimilating. And if my hypothesis is correct, we should look back on how Japanese society has treated those minority populations so that we can learn lessons from it.

Japan has established good health outcomes on average, but little effort has been made to promote health equity for cultural and linguistic minority populations. There is no national policy to guarantee appropriate communication between patients and medical providers where language is a barrier to receiving quality care and a risk factor in producing health inequity. JRC are so vulnerable and invisible that many university students do not even know who they are. Health and human rights need to be emphasized for those minorities as an issue in our society in terms of public health, not just majority health.

[1] Rie Ogasawara (2019). “Sociology of Minority Health in Japan: The Illness Narratives of Japanese Returnees from China”. Osaka University Press. Osaka.

Edit: Kim Mawer, Christopher Bubb