According to a survey conducted in England, men living in the least advantaged area had a healthy life expectancy of 19.3 years longer than men living in the most advantaged area, while their life expectancy was 9.2 years shorter, and women living in the least advantaged areas were found to have 20.1 years of healthy life expectancy and 6.8 years less life expectancy than those living in the most advantaged areas (Steinbach & Eni-Olotu, 2016). Residents living in such areas have limited access to medical care and treatment if their homes are too far from the hospital or if the transport infrastructure is poor. In most cases, their incomes are relatively low compared to those in more affluent areas, and it is difficult to pay for medical and insurance costs.
Are similar health inequalities seen in Japan? How can we eliminate health inequalities caused by geographic factors? I will consider these questions with an example from Japan.
There is a regional bias in medical institutions and doctors also in Japan. Many Japanese doctors try to get a job at a university hospital, such as a private hospital in an urban area where the number of cases is large, and the working conditions are good.
Due to:
・Doctors who work in medical facilities in depopulated areas can not take sufficient time off because there is not enough medical staff.
・Medical facilities in depopulated regions do not have many cases of specialized treatment, and doctors cannot learn advanced medical technology
・living in depopulated areas is inconvenient daily.
(heard from my older brother(he's a doctor))
As a result, doctors with medical skills are all concentrated in urban hospitals, and patients who require advanced treatment spend dozens of hours, sometimes even a day, visiting the hospital. With long-term treatment, some patients may need to move. At present, there is a widening disparity in the number of doctors in 36 of Japan's 47 prefectures. Doctors are concentrated in urban areas, and villages and districts without even a single doctor or nurse in rural areas are increasing.
People living in rural areas, especially the elderly, find it physically difficult to travel to urban areas and often do not have the financial leeway to cover transportation and accommodation expenses. So, they often refuse to go to the hospital even if they feel unwell, or give up on treatment even if they are diagnosed with some disease. Moreover, one study found that patients with acute myocardial infarction (AMI) in rural areas had a much longer time from onset to adequate treatment and higher in-hospital mortality than those in metropolitan areas (Maeda & Arima, 2020). Health disparities between rural and urban areas due to geographic factors certainly exist in Japan.
Many projects are underway to improve this situation. One of them is a system that allows students to be exempted from all medical school tuition on the condition that they work at a local hospital for 10 years after graduation. Currently, not many students use this system, but it is expected that it will become more popular in the future. The other is the use of technology-based telemedicine, which connects hospitals, doctors, and patients with devices such as smartphones and TVs, and attempts to improve access to medical care for patients in rural areas.
In addition, there is a drama that takes up the disparity in medical care in Hokkaido, the largest island in Japan, currently being broadcast. They are attempting to improve access to medical care for patients in rural areas by operating Doctor-Heli (helicopters that allow a doctor to ride and treat the patient during transport to hospitals) and Doctor-Jet (airplanes in which doctors can ride and treat patients during transport to hospitals). It is actually being done in various parts of Japan, not only in drama.
2. What you learned. Any preconceived ideas or notions and how this activity and reading helped to add or dispel those ideas or notions.
I had never experienced inequalities in healthcare before, so I hadn't paid much attention to these issues. Through this assignment, I realized that the national and local governments must take the initiative in developing laws and establishing new support systems to solve these problems fundamentally. At the same time, it is indispensable for the general public to know these current situations and be interested in solving this problem.
References
Maeda, T., & Arima, H. (2020). Rural Health Disparities in Japan―Urgent Need for Big Data Utilization and Health Service Research―. Circulation Journal, CJ-20. Retrieved from https://www.jstage.jst.go.jp/article/circj/84/7/84_CJ-20-0497/_article
Steinbach, R., & Eni-Olotu, M. (2016). Inequalities in health (e.g. by region, ethnicity, soci-economic position or gender) and in access to health care, including their causes. Equality, Equity and Policy. Access at: http://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4c-equality-equity-policy/inequalities-distribution
Vehicle news editorial department. (2017). Japan's first "medical jet'' to be put into practical use in Hokkaido in July - for the move to eliminate regional disparities in medical care [Japanese]. Vehicle news. Retrieved November 25, 2022, from https://trafficnews.jp/post/74668
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