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            22 / 06 / 16

            Why joint pain is mistaken for disrespect in Japan

            • The world of medicine and pharmaceuticals is often considered to be the domain of natural science and quantitative research - a field rich in numbers and data, but devoid of emotion and culture. Our experience as researchers, however, reveals just the opposite; consumer research around medical topics often reveals some of the richest and most emotionally laden cultural insights. Especially in patient research, it is impossible to accurately understand patients’ behaviours and attitudes without taking into account the cultural context. The cultural lens is essential if we are to derive the most significant and meaningful consumer insights from medical research.

              Emotional impact

              While the physical symptoms of a given disease may be universal, the cultural context is specific and greatly affects the emotional impact that a disease can have on a patient. In a country like Japan, where there is great pressure put on the individual to meet strictly defined social expectations, the amount of stress caused by highly visible skin symptoms is magnified. With origins in the principles of Zen Buddhism and Shinto, the cultural emphasis put on cleanliness in Japan means that the apparent lack of cleanliness (in the form of skin flaking onto clothing or visible skin issues) can be interpreted as a flaw of character, a lack of discipline and respect, and an anti-social unwillingness to adhere to social norms. The shame and stress that the patient experiences on a daily basis strongly diminishes quality of life.

              In a similar manner, the impact of joint pain can take on a unique form in Japan. Particularly in traditional homes, there are many occasions to sit on the floor with one’s legs folded underneath the thighs (seiza). This style of sitting is considered necessary in formal situations and is required on many public occasions such as funerals and other ceremonies. Not being able to kneel on the floor, due to knee pain, can therefore lead to more embarrassment and frustration in Japan than in other cultures where sitting in chairs is the norm.

              Attitudes to medication

              Cultural factors may also play a role in shaping patient attitudes towards treatment and medication. In contemporary Japan, a form of Eastern medicine called kanpo continues toexist as an institutionalised system, just as established and accepted as Western biomedicine. OTC products made of herbal ingredients can easily be found in drug stores, and acupuncture clinics can be spotted throughout Tokyo. As a medical system, kanpo does not offer specialised drugs for specific pathogens - it ascribes illness to an imbalance in the body as a holistic entity.

              In this context, the reason that many Japanese patients eschew biomedical drugs, even in the face of great pain, becomes clearer -- they believe it is a foreign substance that does not ‘naturally’ belong to the body. We see this amongst many older patients who display unwillingness to take anti-inflammatory drugs to relieve pain.

              An increasingly informed and empowered patient

              Across developed economies, access to medical information is becoming more available to the individual. The Ministry of Health, Labour and Welfare announced earlier this year that all major hospitals in Japan will be required to disclose their performance reviews starting next year, in an attempt to encourage competition among medical institutions and to give people the power to choose what's best for them. And, as populations age at increasing rates, keeping oneself healthy becomes more and more a personal focus. Smartphones come with health-tracking apps, supplements are readily available, and the internet has turned us all into self-diagnosers.

              In this context, where patients have more agency to make their own medical decisions, the need for healthcare companies and medical providers to have a deep understanding of patient needs and behaviours, through culturally informed research, becomes ever more essential.

              This article first appeared in Campaign Asia: Cultural Radar

              Image source: Josie Ryder Flickr

              • Article by Atsuyoshi Ishizumi