Advertisement

Ageing and the Case of Democratic Medicine in Japan

  • Aaron HamesEmail author
ORIGINAL ARTICLE

Abstract

Aging populations present serious challenges to societies for the provision of care and support for their eldest members. These include increased demands on families for care at home, shortages of professional care workers and facilities, and financial strains on governmental budgets. However, these conditions also provide space for the elderly to adapt institutions to secure care and support. This essay examines the ways the elderly work through Min-Iren, a federation of medical institutions in Japan, to meet their needs. Premised on a “democratic” model of solidarity, Min-Iren institutional structure provides participating elderly substantial power to modify ostensibly medical institutions. Drawing from 18 months of fieldwork, this essay ethnographically explores how the elderly refashion Min-Iren clinics and hospitals to offer venues for socializing, community building, and political action as well as conventional medical care. On the medical side, Min-Iren institutions enact a form of coproduction of health. However, interpreted from the perspective of social capital, Min-Iren institutions’ forays into local social milieus resemble activities of civic organizations and foster social engagement, collective action, and social support. In the hands of the elderly, Min-Iren medical institutions, thus, endeavor to improve individual and neighborhood wellbeing in ways beyond medical care. Min-Iren’s model that centers participation and local ownership is general and can be applied to other contexts.

Keywords

Ageing Cooperatives Medical institutions Japan Social capital Coproduction 

Notes

Acknowledgements

I am indebted to all the individuals I met during the course of research. This essay has benefited from comments by Geoff Childs, Anne Allison, and Bradley Stoner. I would also like to express my gratitude to Margaret Perkinson, anonymous reviewers, and the editorial staff at the Journal of Cross-Cultural Gerontology.

Funding Information

This project was funded by a Doctoral Fellowship from the Japan Foundation.

Compliance with Ethical Standards

IRB: I received ethics approval from the Institutional Review Board of Washington University in St. Louis and the Ethics Board at Kakinomoto Hospital.

Conflict of Interest

1) Over the span of a year (4/2017–3/2018), I wrote a twice monthly column on discrimination and anti-Semitism for Min-Iren’s newsletter for very modest compensation. 2) I have given five talks about my research findings at Min-Iren institutions. For each talk, I received very modest honoraria and travel expenses. I have no further potential conflicts of interest to report.

References

  1. Adams, V. (2013). Markets of sorrow, labors of faith: New Orleans in the wake of Katrina. Durham and London: Duke University Press.CrossRefGoogle Scholar
  2. Aida, J., Kuriyama, S., Ohmori-Matsuda, K., Hozawa, A., Osaka, K., & Tsuji, I. (2011a). The association between neighborhood social capital and self-reported dentate status in elderly Japanese – The Ohsaki cohort 2006 study. Community Dentistry and Oral Epidemiology, 39(3), 239–249.CrossRefGoogle Scholar
  3. Aida, J., Kondo, K., Hirai, H., Subramanian, S. V., Murata, C., Kondo, N., Ichida, Y., Shirai, K., & Osaka, K. (2011b). Assessing the association between all-cause mortality and multiple aspects of individual social capital among the older Japanese. BMC Public Health, 11, 499.CrossRefGoogle Scholar
  4. Alakeson, V., Bunnin, A., & Miller, C. (2013). Coproduction of health and wellbeing outcomes: The new paradigm for effective health and social care. Retrieved from: http://www.healthissuescentre.org.au/images/uploads/resources/Coproduction-health-wellbeing-outcomes.pdf. Accessed 7 June 2019.
  5. Allison, A. (2013). Precarious Japan. Durham: Duke University Press.CrossRefGoogle Scholar
  6. Allison, A. (2018). Not-waiting to die badly: Facing the Precarity of dying alone in Japan. In M. K. Janeja & A. Bandak (Eds.), Ethnographies of waiting: Doubt, Hope and uncertainty (pp. 181–202).Google Scholar
  7. Baum, F. E., & Ziersch, A. M. (2003). Social capital. Journal of Epidemiology & Community Health, 57(5), 320–323.CrossRefGoogle Scholar
  8. Berkman, L. F., Glass, T., Brissette, I., & Seeman, T. E. (2000). From social integration to health: Durkheim in the new millennium. Social Science & Medicine, 51(6), 843–857.CrossRefGoogle Scholar
  9. Berman, M. (2018). Religion overcoming religions: Suffering, secularism, and the training of interfaith chaplains in Japan. American Ethnologist, 45(2), 228–240.CrossRefGoogle Scholar
  10. Bestor, T. C. (1989). Neighborhood Tokyo. Stanford, California: Stanford University Press.Google Scholar
  11. Bourdieu, P. (2002). The forms of capital. In N. W. Biggart (Ed.), R. Nice (Trans.), Readings in economic sociology (pp. 280–291). Malden: Blackwell.Google Scholar
  12. Brown, J. M. (2003). Under one roof: The evolving story of three generation housing in Japan. In J. W. Traphagan & J. Knight (Eds.), Demographic change and the family in Japan’s aging society (pp. 53–72). Albany: State University of New York Press.Google Scholar
  13. Cabinet Office, Government of Japan. (2018). Annual report on the ageing society. Retrieved from https://www8.cao.go.jp/kourei/whitepaper/w-2018/html/zenbun/index.html. Accessed 14 Jul 2019.
  14. Caldwell, J. C. (1982). Theory of fertility decline. London; New York: Academic Press.Google Scholar
  15. Campbell, J. C. (2000). Changing meanings of frail old people and the Japanese welfare state. In S. O. Long (Ed.), Caring for the elderly in Japan and the US: Practices and policies (pp. 82–97). London; New York: Routledge.Google Scholar
  16. Childs, G., Goldstein, M. C., & Wangdui, P. (2011). Externally-resident daughters, social capital, and support for the elderly in rural Tibet. Journal of Cross-Cultural Gerontology, 26(1), 1–22.CrossRefGoogle Scholar
  17. Coleman, J. S. (1990). Foundations of social theory. Cambridge, Mass; London: Belknap Press of Harvard University Press.Google Scholar
  18. Cowgill, D. O. (1974). Aging and modernization: A revision of the theory. In J. F. Gubrium (Ed.), Late life: Communities and environmental policy (pp. 123–146). Springfield, Ill: Charles Thomas.Google Scholar
  19. Cowgill, D. O., & Holmes, L. D. (1972). Aging and modernization. New York: Appleton-Century-Crofts.Google Scholar
  20. Coyle, C. E., & Dugan, E. (2012). Social isolation, loneliness and health among older adults. Journal of Aging and Health, 24(8), 1346–1363.CrossRefGoogle Scholar
  21. Croll, E. J. (2006). The intergenerational contract in the changing Asian family. Oxford Development Studies, 34(4), 473–491.CrossRefGoogle Scholar
  22. Dahl, N. (2018). Social inclusion of senior citizens in Japan: An investigation into the ‘Community-based Integrated Care System. Contemporary Japan, 30(1), 43–59.CrossRefGoogle Scholar
  23. Danely, J. (2014). Aging and loss: Mourning and maturity in contemporary Japan. New Brunswick: Rutgers University Press.Google Scholar
  24. de Silva, A., & Welgama, W. M. J. (2014). Modernization, aging and Coresidence of older persons: The Sri Lankan experience. Anthropology & Aging, 35(1), 1–26.CrossRefGoogle Scholar
  25. Dore, R. P. (1958). City life in Japan: A study of a Tokyo Ward. University of California Press.Google Scholar
  26. Douglass, M. (2006). Global householding in Pacific Asia. International Development Planning Review, 28(4), 421–445.CrossRefGoogle Scholar
  27. Ferry, E. E. (2005). Geologies of power: Value transformations of mineral specimens from Guanajuato, Mexico. American Ethnologist, 32(3), 420–436.CrossRefGoogle Scholar
  28. Fotaki, M. (2011). Towards developing new partnerships in public services: Users as consumers, citizens and/or co-producers in health and social Care in England and Sweden. Public Administration, 89(3), 933–955.CrossRefGoogle Scholar
  29. Foucault, M. (1978). The history of sexuality (1st American ed; R. Hurley, Trans.). New York: Pantheon Books.Google Scholar
  30. Goldstein, M. C., & Beall, C. M. (1982). Indirect modernization and the status of the elderly in a rural third world setting. Journal of Gerontology, 37(6), 743–748.CrossRefGoogle Scholar
  31. Hayashi, Y. (2019). Kaigo Hoken wo Meguru Jōsei to Seifu no “Kaigo Jinzai Seisaku” ni Tsuite. [The Present State of Long-term Care Insurance and the Government’s “Policy for Human Resources for Long-term Care.”] Retrieved from https://www.min-iren.gr.jp/kaigo_wave/data/2019/190221_02.pdf. Accessed 1 June 2019.
  32. Ikels, C. (2006). Economic reform and intergenerational relationships in China. Oxford Development Studies, 34(4), 387–400.CrossRefGoogle Scholar
  33. Kaskie, B., Imhof, S., Cavanaugh, J., & Culp, K. (2008). Civic engagement as a retirement role for aging Americans. The Gerontologist, 48(3), 368–377.CrossRefGoogle Scholar
  34. Kasmir, S. (1996). The myth of Mondragón: Cooperatives, politics, and working-class life in a Basque town.Google Scholar
  35. Kato, A. (2013). The Japanese family system: Change, continuity, and regionality over the twentieth century (No. WP-2013-004). Max Planck Institute for Demographic Research, Rostock, Germany. Retrieved from https://ideas.repec.org/p/dem/wpaper/wp-2013-004.html. Accessed 17 Jul 2019.
  36. Kavedžija, I. (2016). The age of decline? Anxieties about ageing in Japan. Ethnos, 81(2), 214–237.CrossRefGoogle Scholar
  37. Kavedžija, I. (2019). Making meaningful lives: Tales from an aging Japan. University of Pennsylvania Press.Google Scholar
  38. Kawachi, I. (1999). Social capital and community effects on population and individual health. Annals of the New York Academy of Sciences, 896(1), 120–130.CrossRefGoogle Scholar
  39. Kawachi, I., Subramanian, S. V., & Kim, D. (Eds.). (2008a). Social capital and health. Springer New York.Google Scholar
  40. Kawachi, I., Subramanian, S. V., & Kim, D. (2008b). Social capital and health. In I. Kawachi, S. V. Subramanian, & D. Kim (Eds.), Social Capital and Health (pp. 1–26). Springer New York.Google Scholar
  41. Kawano, S. (2010). Nature’s embrace: Japan’s aging urbanites and new death rites. Honolulu: University of Hawaii Press.CrossRefGoogle Scholar
  42. Kishimoto, Y., Suzuki, E., Iwase, T., Doi, H., & Takao, S. (2013). Group involvement and self-rated health among the Japanese elderly: An examination of bonding and bridging social capital. BMC Public Health, 13(1), 1189.CrossRefGoogle Scholar
  43. Knodel, J. (2014). Is intergenerational solidarity really on the decline? Cautionary evidence from Thailand. Asian Population Studies, 10(2), 176–194.CrossRefGoogle Scholar
  44. Kurimoto, A., & Kumakura, Y. (2016). Emergence and evolution of co-operatives for elderly care in Japan. International Review of Sociology, 26(1), 48–68.CrossRefGoogle Scholar
  45. Lin, N. (1999). Building a network theory of social capital. Connections, 22(1), 28–51.Google Scholar
  46. Liu, J. (2014). Ageing, migration and familial support in rural China. Geoforum, 51, 305–312.CrossRefGoogle Scholar
  47. Lochner, K., Kawachi, I., & Kennedy, B. P. (1999). Social capital: a guide to its measurement. Health & Place, 5(4), 259–270.CrossRefGoogle Scholar
  48. Long, S. O. (2003). Becoming a cucumber: Culture, nature, and the good death in Japan and the United States. Journal of Japanese Studies, 29(1), 33–68.Google Scholar
  49. Long, S. O. (2005). Final days: Japanese culture and choice at the end of life. University of Hawaii Press.Google Scholar
  50. Love, B. (2013). Treasure hunts in rural Japan: Place making at the limits of sustainability. American Anthropologist, 115(1), 112–124.CrossRefGoogle Scholar
  51. MacKay, L. (2007). Health cooperatives in BC: The unmet potential. BC Medical Journal, 49(3), 139–142.Google Scholar
  52. Marmot, M. (2015). The health gap: The challenge of an unequal world. Bloomsbury Publishing.Google Scholar
  53. Martinson, M., & Minkler, M. (2006). Civic engagement and older adults: A critical perspective. The Gerontologist, 46(3), 318–324.CrossRefGoogle Scholar
  54. McCurry, J. (2016). Japan’s dementia crisis hits record levels as thousands go missing. The Guardian. Retrieved from https://www.theguardian.com/world/2016/jun/16/record-12208-people-with-dementia-reported-missing-in-japan. Accessed 14 June 2017.
  55. Min-Iren. (2013). Min-Iren charter. Retrieved from https://www.min-iren.gr.jp/?p=20933. Accessed 19 Mar 2018.
  56. Min-Iren. (2017). Min-Iren by the data. Retrieved from https://www.min-iren.gr.jp/?p=20889. Accessed 24 June 2017.
  57. Ministry of Health, Labour and Welfare. (2017). 平成28年人口動態統計月報年計(概数)の概況 Annual Vital Statistics Report 2016. Retrieved from http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/geppo/nengai16/dl/gaikyou28.pdf. Accessed 12 Dec 2017.
  58. Ministry of Health, Labour and Welfare. (2018). Heisei 30 Nendo Kaigo Hōshū Kaitei ni Tsuite. 2018 Revision of Long-term Care Benefits. Retrieved from https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/kaigo_koureisha/housyu/kaitei30.html. Accessed 1 June 2019.
  59. Minkler, M. (1985). Building supportive ties and sense of community among the Inner-City elderly: The tenderloin senior outreach project. Health Education & Behavior, 12(3), 303–314.Google Scholar
  60. Nash, J. C., Dandler, J., & Hopkins, N. S. (Eds.). (1976). Popular participation in social change: Cooperatives, collectives, and nationalized industry.Google Scholar
  61. National Institute of Population and Social Security Research. (2017). Population Projections for Japan: 2016-2065. Retrieved from http://www.ipss.go.jp/pp-zenkoku/j/zenkoku2017/pp29_ReportALL.pdf. Accessed 19 Mar 2018.
  62. National Police Agency. (2017). Report on Missing Persons 2016. Retrieved from http://www.npa.go.jp/safetylife/seianki/fumei/H28yukuehumeisya.pdf. Accessed 27 Feb 2018.
  63. Nozawa, S. (2015). Phatic traces: Sociality in contemporary Japan. Anthropological Quarterly, 88(2), 373–400.CrossRefGoogle Scholar
  64. Ochiai, E. (2009). Care diamonds and welfare regimes in east and south-east Asian societies: Bridging family and welfare sociology. International Journal of Japanese Sociology, 18(1), 60–78.CrossRefGoogle Scholar
  65. Oda, S. (2016). Cheaper sake cup gifts from Abe show surge in Japan centenarians. Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2016-09-15/cheaper-sake-cup-gifts-from-abe-show-surge-in-japan-centenarians. Accessed 25 Apr 2017.
  66. Ostrom, E. (1996). Crossing the great divide: Coproduction, synergy, and development. World Development, 24(6), 1073–1087.CrossRefGoogle Scholar
  67. Ozawa-de Silva, C. (2008). Too lonely to die alone: Internet suicide pacts and existential suffering in Japan. Culture, Medicine, and Psychiatry, 32(4), 516–551.CrossRefGoogle Scholar
  68. Ozawa-de Silva, C. (2010). Shared death: Self, sociality and internet group suicide in Japan. Transcultural Psychiatry, 47(3), 392–418.CrossRefGoogle Scholar
  69. Palmore, E. (1975). The status and integration of the aged in Japanese society. Journal of Gerontology, 30(2), 199–208.CrossRefGoogle Scholar
  70. Pantell, M., Rehkopf, D., Jutte, D., Syme, S. L., Balmes, J., & Adler, N. (2013). Social isolation: A predictor of mortality comparable to traditional clinical risk factors. American Journal of Public Health, 103(11), 2056–2062.CrossRefGoogle Scholar
  71. Pestoff, V., Brandsen, T., & Verschuere, B. (2012). New public governance, the third sector and co-production. Routledge critical studies in public management, 7. New York: Routledge.Google Scholar
  72. Pestoff, V., Vamstad, J., & Saito, Y. (2015). Co-production of health and elder care – Cooperative models in Japan. EMES conferences selected papers series, 1–21. Retrieved from https://emes.net/publications/conference-papers/5th-emes-conference-selected-papers/co-production-of-health-and-elder-care-cooperative-models-in-japan/. Accessed 14 May 2019.
  73. Peterson, N. D. (2014). “We are daughters of the sea”: Strategies, gender, and empowerment in a Mexican Women’s cooperative. The Journal of Latin American and Caribbean Anthropology, 1(19), 148–167.CrossRefGoogle Scholar
  74. Pfeiffer, J. (2004). Condom social marketing, Pentecostalism, and structural adjustment in Mozambique: A clash of AIDS prevention messages. Medical Anthropology Quarterly, 18(1), 77–103.CrossRefGoogle Scholar
  75. Pigg, S. L. (1997). Authority in Translation: Finding, knowing, naming, and training “traditional birth attendants” in Nepal. In R. Davis-Floyd & C. F. Sargent (Eds.), Childbirth and authoritative knowledge: Cross-cultural perspectives (pp. 233–262). Berkeley: University of California Press.Google Scholar
  76. Putnam, R. D. (1995). Bowling alone: America’s declining social capital. Journal of Democracy, 6(1), 65–78.CrossRefGoogle Scholar
  77. Rakopoulos, T. (2015). Which community for cooperatives? Peasant mobilizations, the mafia, and the problem of community participation in Sicilian co-ops. Focaal, 2015(71), 57–70.CrossRefGoogle Scholar
  78. Rakopoulos, T. (2017). Antimafia families: Cooperative work and flexible kinship in Sicily. Critique of Anthropology, 37(2), 115–131.CrossRefGoogle Scholar
  79. Reynolds, I. (2009). Ageing Japan cuts cost of 100th birthday gifts. Reuters. Retrieved from http://www.reuters.com/article/us-japan-birthday-idUSTRE5220ZP20090303. Accessed 25 Apr 2017.
  80. Salomon, J. A., Wang, H., Freeman, M. K., Vos, T., Flaxman, A. D., Lopez, A. D., & Murray, C. J. (2012). Healthy life expectancy for 187 countries, 1990–2010: A systematic analysis for the global burden disease study 2010. The Lancet, 380(9859), 2144–2162.CrossRefGoogle Scholar
  81. Sampson, R. J., Raudenbush, S. W., & Earls, F. (1997). Neighborhoods and violent crime: A multilevel study of collective efficacy. Science, 277(5328), 918–924.CrossRefGoogle Scholar
  82. Schneider, S. D. (2010). Mexican community health and the politics of health reform. Albuquerque: University of New Mexico Press.Google Scholar
  83. Schreck, H. (1994). The Church at Work in creating community: Strengthening support networks for the homebound elderly. City & Society, 7(1), 163–173.CrossRefGoogle Scholar
  84. Shikimoto, R., Sado, M., & Mimura, M. (2016). The social costs of dementia in Japan: Focusing on the informal care cost. Brain and Nerve, 68(8), 939–944.Google Scholar
  85. Shimizutani, S. (2014). The future of Long-term Care in Japan. Asia-Pacific Review, 21(1), 88–119.CrossRefGoogle Scholar
  86. Skrabski, Á., Kopp, M., & Kawachi, I. (2004). Social capital and collective efficacy in Hungary: Cross sectional associations with middle aged female and male mortality rates. Journal of Epidemiology & Community Health, 58(4), 340–345.CrossRefGoogle Scholar
  87. Statistics Bureau, Ministry of Internal Affairs and Communications. (2018). Population Estimates, Monthly Report. Retrieved from https://www.e-stat.go.jp/en/stat-search/files?page=1&layout=datalist&lid=000001202623. Accessed 19 Mar 2018.
  88. Sugiyama, T. (2015). Sengo Nihon ni Okeru Iryōfukushijigyō no Rekishiteki Hensen kara no Ichikōsatsu: Kokumin Kaihoken Taisei no Moto de no Muryō Teigaku Shinrō Jigyōsho Ichizuke wo Megutte. Journal of the Faculty of Social Welfare, 11, 47–60.Google Scholar
  89. Terebi Kanazawa. (2015). Waratte Shineru Byōin: “Saigo no Onegai” wo Kanaeru Kibō no Iryō. Tokyo: Wanibukkusu.Google Scholar
  90. Traphagan, J. W. (2004). Interpretations of elder suicide, stress, and dependency among rural Japanese. Ethnology, 43(4), 315–329.CrossRefGoogle Scholar
  91. Traphagan, J. W. (2007). Disability in local and global worlds. In B. Ingstad & S. R. Whyte (Eds.), Disability in local and global worlds (pp. 259–287). Berkeley: University of California Press.Google Scholar
  92. Tsukamoto, I. (2012). The potential of nonprofit-government partnerships for promoting citizen involvement. In V. Pestoff, T. Brandsen, & B. Verschuere (Eds.), New public governance, the third sector, and co-production (pp. 281–294). Routledge critical studies in public management, 7. New York: Routledge.Google Scholar
  93. Uslaner, E. M. (2006). Political parties and social capital, political parties or social capital. In R. S. Katz & W. J. Crotty (Eds.), Handbook of Party Politics (pp. 376–386). SAGE.Google Scholar
  94. Vargas-Cetina, G. (2005). Anthropology and cooperatives: From the community paradigm to the ephemeral Association in Chiapas, Mexico. Critique of Anthropology, 25(3), 229–251.CrossRefGoogle Scholar
  95. Vargas-Cetina, G. (2011). Corporations, cooperatives, and the state: Examples from Italy: With CA comment by Michael Woodard and Emilie Bess. Current Anthropology, 52(S3), S127–S136.CrossRefGoogle Scholar
  96. Varshney, A. (2002). Ethnic conflict and civic life : Hindus and Muslims in India. New Haven: Yale University Press.Google Scholar
  97. Weiss, H. (2011). Gift and value in Jerusalem’s third sector. American Anthropologist, 113(4), 594–605.CrossRefGoogle Scholar
  98. White, M. I. (2002). Perfectly Japanese: Making families in an era of upheaval. University of California Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of AnthropologyWashington UniversitySt. LouisUSA

Personalised recommendations