An Introduction to Japanese Society’s Attitudes Toward Race and Skin Color

Reviewed by: Hate Speech in Japan: The Possibility of a Non-Regulatory Approach ed. by Shinji Higaki and Yuji Nasu Celeste L. Arrington (bio) Hate Speech in Japan: The Possibility of a Non-Regulatory Approach. Edited by Shinji Higaki and Yuji Nasu. Cambridge University Press, 2021. xviii, 506 pages. $125.00, cloth; $100.00, E-book. Hate Speech in Japan is an information-packed new book about a significant recent development in Japanese society: hate speech. Public demonstrations [End Page 435] and online comments against ethnic Korean residents of Japan (zainichi Koreans) attracted media attention within Japan and worldwide a decade ago and spurred international criticism. Particularly shocking was the targeting of a Korean primary school in Kyoto by the Zaitokukai (Zainichi Tokken o Yurusanai Shimin no Kai, or Citizens Association against Special Privileges for Resident Koreans). This book analyzes such hate speech and its relationship to older forms of discrimination against Japan's Korean and outcaste (burakumin) communities. It also details and assesses the diverse recent efforts to address the problem of hate speech, including via new national legislation, subnational government ordinances and guidelines, administrative measures, and court rulings. Through both formal legal analysis and nuanced examinations of policy implementation, this book's 20 chapters significantly advance scholarship about regulatory styles, law and social change, and the balance between freedom of expression and the right to human dignity in Japan. The term "hate speech" (heito supiichi) gained currency in Japan in the early 2010s, and new legislation to address the problem was enacted within just a few years. The 2016 Hate Speech Elimination Act (HSEA) defines hate speech as "unfair discriminatory speech and behavior against persons originating from outside Japan" or "their descendants who are lawfully residing in Japan." This narrow definition reflects what Erin Chung has called "rights hierarchies" in the South Korean context; noncitizens have different human rights protections depending on their visa category.1 And it excludes Japanese minorities like burakumin, Ainu, and Okinawans (for political debates about the definition, see pp. 233–36). Many of this book's contributors document discrimination against burakumin and zainichi Koreans long before the term "hate speech" began circulating and grapple with why zainichi Koreans were targeted most recently (chapter 16). This volume is empirically rich, drawing on formal legal analyses, comparisons of legal scholars' arguments, media and online content analyses, and interviews. For example, chapter 12 uses interview quotes to expose the traumatic impacts of hate speech on members of Kyoto's Korean community. And the social psychological discussion of discrimination, prejudice, and stereotypes illuminates phenomena adjacent to hate speech and the hateful Internet content analyzed in chapter 17. Despite such evidence, the Japanese government reported to the UN Committee on the Elimination of Racial Discrimination as recently as 2013 that it "does not believe that, in present-day Japan, racist thoughts are disseminated and racial discrimination is incited to the extent that … legislation to impose punishment … [End Page 436] should be considered even at the risk of unduly stifling legitimate speech" (p. 66, note 30). Indeed, Japan long resisted regulating discriminatory speech, which led some of this book's contributors to worry that Japanese people were unaware of hate speech until the Zaitokukai demonstrations (pp. 222, 239–40). This volume persuasively documents, in a great service to scholars without Japanese-language abilities, one reason for the lack of hate speech regulations: Japanese legal scholars tended to privilege freedom of expression, usually citing the U.S. model rather than the German approach, which emphasizes human dignity (chapters 1 and 15, pp. 242–43, 415–21). Part 2 of the volume (chapters 7–9) details how few legal tools existed for addressing hate speech and racial discrimination in Japan. Criminal and civil claims can be made regarding defamation or insult, but such speech must be targeted against specific individuals or organizations. Since hate speech generally targets broader categories of people, it falls outside existing criminal and tort frameworks in Japan. The book's contributors conclude that it is unlikely that Japanese courts will recognize racist speech and discrimination as a new type of tort anytime soon (p. 204). Ryangok Ku summarizes the weaknesses of Japan's legal and institutional frameworks...

Dear Dr. Dermatoethics: Why is diversity in clinical trials important?

Influence of environmental stress on skin tone, color and melanogenesis in Japanese skin

Past evidence has documented that attitudes toward marriage and cohabitation are related to sexual behavior in adolescence and young adulthood. This study extends prior research by longitudinally testing these associations across racial/ethnic groups and investigating whether culturally relevant variations within racial/ethnic minority groups, such as skin tone (i.e., lightness/darkness of skin color), are linked to attitudes toward marriage and cohabitation and sex. Drawing on family and public health literatures and theories, as well as burgeoning skin tone literature, it was hypothesized that more positive attitudes toward marriage and negative attitudes toward cohabitation would be associated with less risky sex, and that links differed for lighter and darker skin individuals. The sample included 6872 respondents (49.6% female; 70.0% White; 15.8% African American; 3.3% Asian; 10.9% Hispanic) from the National Longitudinal Study of Adolescent to Adult Health. The results revealed that marital attitudes had a significantly stronger dampening effect on risky sexual behavior of lighter skin African Americans and Asians compared with their darker skin counterparts. Skin tone also directly predicted number of partners and concurrent partners among African American males and Asian females. We discuss theoretical and practical implications of these findings for adolescence and young adulthood.

I sat bemused watching ‘This Morning’ in December 2011. There were two Black British women — one Asian, one African Caribbean — talking about why they ‘bleached’ their skins and why they would continue. Both women placed skin-bleaching within the preference for lighter skin and contempt for darker skin within British society in general and within the employment market in particular. Although they spoke openly about anti-Black racism’s preference for whiteness and discrimination based on skin colour — colourism — the discussion was contained by the show’s presenters within the taken for granted discourse of ‘individual preference for whiteness’ and ‘self-hatred if darker-skinned’. Encouraging the audience to think through individual Black pathology and Black communal and global hatred of darker skin denied the need to talk about the racism of colonialism and enslavement which cemented the value of lighter skin within the Global North West; the existence of racism and colourism as part of structural inequality; that what we should note is that skin lightening is practised by women and men around the globe; and skin lightening is a big money earner for many multinational beauty companies based in the USA and Europe. Skin lightening is so normalized that you can buy these products in the world’s marketplace, Amazon, including creams for lightening armpits, inner thighs, elbows, knees, face, anus and vagina as well as lightening pills.

Antiracist Knowledge Production: Bridging Subdisciplines and Regions

Cathepsin L2 Levels Inversely Correlate with Skin Color

Racism has historically been a primary source of discrimination against African Americans, but there has been little research on the role that skin tone plays in explaining experiences with racism. Similarly, colorism within African American families and the ways in which skin tone influences family processes is an understudied area of research. Using data from a longitudinal sample of African American families (n = 767), we assessed whether skin tone impacted experiences with discrimination or was related to differences in quality of parenting and racial socialization within families. Findings indicated no link between skin tone and racial discrimination, which suggests that lightness or darkness of skin does not either protect African Americans from or exacerbate the experiences of discrimination. On the other hand, families displayed preferential treatment toward offspring based on skin tone, and these differences varied by gender of child. Specifically, darker skin sons received higher quality parenting and more racial socialization promoting mistrust compared to their counterparts with lighter skin. Lighter skin daughters received higher quality parenting compared with those with darker skin. In addition, gender of child moderated the association between primary caregiver skin tone and racial socialization promoting mistrust. These results suggest that colorism remains a salient issue within African American families. Implications for future research, prevention, and intervention are discussed.

Background: Inequities in dermatologic health outcomes translate to worsened clinical outcomes for minority groups. For example, despite a lower incidence of skin cancer overall, African Americans are diagnosed at later stages with greater degrees of lymph node involvement. This has been shown to lead to disproportionate mortality when compared to lighter skinned individuals. Medical education materials contain a significantly lower percentage of skin of color (SOC) images than of lighter skin and research has indicated lower diagnostic accuracy of dermatologic conditions in darker skin by U.S. medical students. The objective of this study was to explore U.S. resident dermatologists’ ability to accurately identify skin pathology among SOC patients verus lighter skin to potentially identify gaps in training that may contribute to this disproportionate morbidity and mortality. Methods: A cross-sectional electronic REDCap survey open to all U.S. dermatology residents asked participants their basic demographics (e.g., level of training, racial and ethnic identity) and program characteristics (e.g., geographical location, proportion of patients by Fitzpatrick type, presence of a dedicated SOC clinic). This data was correlated with participant visual diagnostic accuracy on a 22-item multiple choice quiz (images selected by a senior academic dermatologist) of characteristic nonmalignant and malignant conditions in lighter skin and SOC. Results: Residents preferentially misdiagnosed malignant lesions in SOC over lighter skin (p <.0001) and preferentially misdiagnosed malignant lesions in SOC over nonmalignant lesions in SOC (p <.001). None of the residents’ basic demographic or program characteristic variables had significant relationships with any assessment of performance. Conclusion: Dermatologists should maintain a high clinical suspicion for malignant conditions in patients with darker skin types, given that these lesions are the most preferentially misdiagnosed and the fact that these lesions carry higher risks for morbidity and mortality. Dermatology residency programs should instill efforts to emphasize correct detection of malignant lesions amongst those with skin of color.

Relationship between skin color and skin response to ultraviolet light

A lack of representation of skin of color (SoC) in dermatology curricula is well-documented across North American medical schools and may present a barrier to equitable and comprehensive undergraduate medical education. This study aims to examine representation in dermatologic educational materials and appreciate a link between bias in dermatologic education and student diagnostic ability and self-rated confidence. The University of Toronto Dermatology Undergraduate Medical Education curriculum was examined for the percentage photographic representation of SoC. A survey of 10 multiple-choice questions was administered to first- and third-year medical students at the University of Toronto to assess diagnostic accuracy and self-rated confidence in diagnosis of 5 common skin lesions in Fitzpatrick skin phototypes (SPT) I-III (white skin) and VI-VI (SoC). The curriculum audit showed that <7% of all images of skin disease were in SoC. Diagnostic accuracy was fair for both first- (77.8% and 85.9%) and third-year (71.3% and 72.4%) cohorts in white skin and SoC, respectively. Students' overall self-rated confidence was significantly greater in white skin when compared to SoC, in both first- (18.75/25 and 17.78/25, respectively) and third-year students (17.75/25 and 15.79/25, respectively) (P = .0002). This preliminary assessment identified a lack of confidence in diagnosing dermatologic conditions in SoC, a finding which may impact health outcomes of patients with SoC. This project is an important first step in diversifying curricular materials to provide comprehensive medical education.

Various studies have revealed that there is a disproportionately low representation of skin of colour (SOC) in medical school dermatologic curriculum and board study resources. First-year and second-year medical students were emailed an 18-question survey regarding (1) identifying correct diagnoses of dermatologic conditions on either White skin or SOC and (2) their confidence in identifying dermatologic conditions on SOC. 15% of the images of dermatologic conditions included in the institutional preclinical curriculum show images of patients with SOC. Regarding overall scores for diagnosing dermatologic diseases, students performed similarly on both the White image survey (61.73%) and SOC image survey (66.20%) with no statistically significant differences between surveys (p=0.14). Second-year medical students performed better than first-year medical students overall (p=0.01) and on White skin image survey scores (p=0.02) but not on people of colour image survey scores (p=0.09). Students largely agreed that they were more comfortable identifying dermatologic diagnoses on White skin and that their school could benefit from increased SOC dermatological resources. The overall low scores for the diagnosis of common skin conditions on both the White image and SOC image survey by first- and second-year students are not surprising given the results of a prior study and support the need for re-exposure to dermatology presentations in all skin types during the preclinical curriculum. The low scores support the need for changes in the pre-clinical dermatology curriculum to improve diagnostic ability. Second-year students performed better at diagnosing dermatologic conditions overall and on White skin compared to SOC at the end of their didactic years, possibly due to an underrepresentation of SOC images in institutional and outside educational resources. Attitudes towards school-specific dermatologic SOC education demonstrated a clear desire amongst students for more exposure to dermatologic conditions in various skin colours throughout the curriculum.

BackgroundPatients with skin of color are at risk for skin cancer, pigmentary disorders, and photo-exacerbated conditions but find it challenging to use sunscreens on the market that leave an obvious residue on their skin.ObjectiveThe objective of this study was to examine sunscreen recommendations from the popular press and from practicing dermatologists for patients with skin of color.MethodsWe queried the Google search engine with the following search terms: “Sunscreen” with “skin of color,” “dark skin,” “black skin.” For comparison, we also searched for “sunscreen” with “white skin,” “pale skin,” and “fair skin.” We conducted an anonymous survey regarding sunscreen recommendations among dermatology trainees and board-certified dermatologists.ResultsWebsites with recommendations on sunscreens for patients with skin of color compared with sunscreens for white or fair skin were more likely to recommend chemical sunscreens (70% vs. 36%) and more expensive products (median: $14 vs. $11.3 per ounce), despite the lower sun protection factor level (median: 32.5 vs. 50). In our survey study, dermatologists were overall cost-conscious and felt that sun protection factor level, broad spectrum (ultraviolet A/B protection), and price were the most important features of sunscreens for their patients. Cosmetic elegance was deemed least important. Dermatologists overall counseled patients with skin of color less on sunscreen use, and 42.9% reported that they either never, rarely, or only sometimes take patients’ skin type into account when making sunscreen recommendations.ConclusionThese data represent an area for growth within dermatology to improve culturally competent care by gaining familiarity with sunscreen types and formulations that are geared toward patients with skin of color.

Hate speech, or intentional derogatory expressions about people based on assigned group characteristics, has been studied primarily in online contexts. Less is known about the occurrence of this phenomenon in schools. As it has negative consequences for victims, perpetrators, and those who witness it, it is crucial to characterize the occurrence of offline (i.e., in the school) and online hate speech to describe similarities and differences between these two socialization contexts. The present study aimed to investigate the prevalence of hate speech witnessing, victimization, and perpetration, in a sample of 3,620 7–9th graders (51% self-identified as female) from 42 schools in Germany and Switzerland. We found that 67% of the students witnessed hate speech in their school, and 65% witnessed online hate speech at least once in the past 12 months. Approximately 21% of the students self-identified as offline perpetrators and 33% as offline victims, whereas these percentages were lower for online hate speech (13 and 20%, respectively). In both settings, skin color and origin were the most common group references for hate speech (50% offline and 63% online). Offline hate speech mainly came from classmates (88%), unknown sources (e.g., graffiti; 19%), or teachers (12%), whereas online hate speech mostly came from unknown persons (77%). The most frequent forms of offline hate speech were offensive jokes (94%) and the spread of lies and rumors about the members of a specific social group (84%). Significant differences by country, gender, and migration background were observed. Girls reported more offline victimization experiences, less perpetration, and a greater frequency of witnessing hate speech. This difference was larger in magnitude in the online setting. Students in Switzerland reported being exposed to hate speech more often than students in Germany. Students with a migration background reported higher hate speech victimization based on skin color and origin than students without a migration background. The high prevalence of hate speech highlights the need for school-based prevention programs. Our findings are discussed in terms of the practical implications.

Ultraviolet-based dermoscopy may support the recognition of scabies, yet neither accuracy analyses nor data on skin of colour are available. The aim of this multicentric observational retrospective was to investigate the diagnostic accuracy of polarised and ultraviolet-induced fluorescence (UVF) dermoscopic examination in both fair and dark skin, also assessing possible differences according to the skin tone. Consecutive patients with a diagnosis of scabies were eligible. All the images were randomly evaluated by two independent experienced investigators to identify scabietic findings reported in the literature. Interobserver agreement was evaluated for both polarised and UVF dermoscopic pictures through Cohen's kappa coefficient, while Fisher's exact test with p-value set at 0.05 was used for comparative analyses between the two settings. A total of 97 lesions from 43 patients (21 with fair skin and 22 with dark skin) were included. The comparative analysis highlighted a superiority of UVF dermoscopy to detect the burrow (p = 0.003) and scabietic eggs (p = 0.012) in skin of colour, while polarised dermoscopy was more accurate to show the mite in fair skin (p = 0.042). Additionally, a general higher accuracy of both settings in light phototypes was also found, with a higher prevalence (p < 0.05) of typical scabietic findings (i.e., serpiginous white tract, 'triangle' sign and grey-brown outlines of the burrow for polarised dermoscopy and green dot for UVF dermoscopy) compared to dark skin. Kappa values were 0.87 and 0.83 for polarised and UVF-dermoscopy, respectively. UVF dermoscopy improves the recognition of scabies, though it should be considered complimentary to polarised light dermoscopic examination to increase diagnostic performance.