Rural Japan Research Articles

Willingness to pay for municipality hospital services in rural Japan: a contingent valuation study

BackgroundThe Japanese healthcare system has undergone reforms to address the struggles that municipality hospitals face. Reform guidelines clearly define criteria for administrative improvement. However, criteria to evaluate the demand for healthcare provisions in rural Japan, including the needs of rural residents for municipality hospitals in particular have not been specified. The purpose of this paper is to measure residents' willingness to pay (WTP) for municipality hospital services using the contingent valuation method, and to evaluate municipality hospital valuation on the basis of WTP. K town, located in the Hokkaido prefecture of Japan, was selected as the location for this study. Participants were recruited by a town hall healthcare administrator, hospital and clinic staff, and a local dentist. Participants were asked what amount they would be willing to pay as taxes to continue accessing the services of the municipality hospital for one year by using open-ended questions in face-to-face interviews.FindingsForty-eight residents were initially recruited, and 40 participants were selected for the study (response rate 83%). As compared to K town's population, this data slanted toward the elderly, although there was no significant difference in frequency among the characteristics. The median WTP was estimated at 39,484 yen ($438.71), with a 95% confidence interval 27,806-55,437 yen ($308.95-615.96). Logistic regression revealed no significant factors affecting WTP.ConclusionsIf the total amount of residents' WTP for the municipality hospital were to be estimated by this result, it would calculate with 129,586,000 yen ($1,439,844). This is approximately equal to the amount of money to be transferred from the general account of the government of K town, more than one-half of the town tax of K town, and about two-fold in comparison to Japan as a whole. This showed that K town's residents placed a high valuation on the municipality hospital, which nearly equalled the amount that the K town government provided to the municipality hospital to cover its annual deficit. K town residents had come to expect not only general clinical practice, but also emergency medical services and night practice provided by their own town's municipality hospital. WTP can be used as a measure of hospital evaluation because it reflects the importance of the hospital to the residents in its region.

Fractured landscapes: detection, location and history in Uchida Tomu's Kiga kaikyo/A Fugitive from the Past

The narrative of Uchida Tomu's hugely successful, but critically neglected, detective film, Kiga kaikyo/A Fugitive From the Past (1964), traverses time (from the late 1940s to the late 1950s) and space (from rural Northern Japan to the urban streetscapes and communities of Tokyo and the coastal port of Maizuru on the Japan Sea). Ostensibly a work of crime fiction, the film can also be read as both a consideration of the cost of postwar social transformation and the hidden legacies of the trauma of World War II. This essay examines how the film's various topographies specifically help locate a sense of the social changes undergone by Japan in that distinctive phase between its demilitarization and renewed corporate growth. In particular, it redefines Martin Lefebvre's influential work on the ambiguities of the relationship between landscape and film by turning to a more historicized conception of the treatment of space, time and the moving image in one specific instance of Japanese genre cinema from the mid 1960s.

Earthquake, tsunami, radiation leak, and crisis in rural health in Japan

On 11 March 2011, the Tohoku-Kanto earthquake struck rural Japan. The magnitude of the earthquake was 9.0, which made it the largest earthquake in recorded history in Japan, and the fourth-largest earthquake in the world since 1900. Subsequent tsunamis devastated the Pacific coast of the Tohoku region. Six days after the disaster, the number of confirmed deaths has already exceeded 5000 and is expected to exceed 10 000. Approximately 9000 people are missing and 400 000 people are being housed in evacuation shelters 1 . Hydrogen explosions at nuclear power reactors following the disaster are dispersing radiation.

Divorce in Early Modern Rural Japan: Household and Individual Life Course in Northeastern Villages, 1716-1870

Drawing data from the local population registers in two northeastern agricultural villages, this study examines the patterns and factors associated with divorce in preindustrial Japan. Divorce was easy and common during this period. More than two thirds of first marriages dissolved in divorce before individuals reached age fifty. Discrete-time event history analysis is applied to demonstrate how economic condition and household context influenced the likelihood of divorce for females. Risk of divorce was extremely high in the first three years and among uxorilocal marriages. Propensity of divorce increased upon economic stress in the community and among households of lower social status. Presence of parents, siblings, and children had strong bearings on marriage to continue.

The forgotten Japanese: encounters with rural life and folklore

Tsuneichi Miyamoto (1907-1981), a leading Japanese folklore scholar and rural advocate, walked 160,000 kilometers to conduct interviews and capture a dying way of life. This collection of photos, vignettes, and life stories from pre- and postwar rural Japan is the first English translation of his modern Japanese classic. From blowfish to landslides, Miyamoto's stories come to life in Jeffrey Irish's fluid translation.

Feasibility and Problems on Remote Monitoring System under Management of a Rural Hospital

Background: Our hospital is situated in rural Japan. Remote monitoring systems for cardiac-implanted devices, such as implantable pacer-generators (IPG) or implantable cardioverter-defibrillators (ICD), are usable in areas hardly accessible by means of public transportation. However, the systems are not readily operable by elderly patients.Objective: Clarification on the feasibility of using the system, and problems on the remote monitoring system.Method: Form April 2010 to May 2011, we introduced remote monitoring systems for 26 patients (mean age: 71.3±10.6; %male 84%). We retrospectively studied the patients, background, the frequency of transmission, and the data transmitted. And we compared the frequency of transmission by the elderly group (age >=75) with the younger group.Results: The implanted devices were ICD for 20 cases (16 cases, with Optivol system) and IPG for 6 cases (3 cases, with ATP system). Frequency of transmission: 95 (total), 3.8±3.2 (mean and SD), 89 (planned), 11 (unplanned), respectively. In the elderly group, the frequency of transmission: 2.1±1.7, which was smaller than in the younger group (4.9±3.5, p<0.05). Transmitted data (planned): No event 50, AT/AF 26, SVT/NST 6, VT/VF (no Tx) 6, Optivol 11, (unplanned): VT/VF (with Tx) 5, SVT 1, Optivol+AT 4.Conclusion: For elderly patients, the use of remote monitoring systems is feasible to promptly detect the device status but the difficulty of data transmission remains intact.

Edited by Masae Tsutsumi『A Turning Point of Women, Families and Agriculture in Rural Japan』

Edited by Masae Tsutsumi『A Turning Point of Women, Families and Agriculture in Rural Japan』

Tsuge Yoshiharu and Postwar Japan: Travel, Memory, and Nostalgia

Tsuge Yoshiharu and Postwar Japan:Travel, Memory, and Nostalgia Yoshikuni Igarashi (bio) In 1968, the manga monthly Garo published a highly successful special issue featuring the work of Tsuge Yoshiharu (b. 1937).1 Far from reveling in his growing popularity, however, the artist quite literally tried to run away from it. Faced with his own commercial success, this painfully shy man felt tremendous angst, eventually deciding in September of that year to drop everything and flee to Kyushu. There he intended to lead a new, anonymous life with a female fan whom he knew only through the letters they had exchanged.2 Perhaps predictably, this plan fell apart after a mere two weeks, and Tsuge returned to Tokyo, where he spent much of 1969 on hiatus, working only as an assistant to another manga artist. Nonetheless, Tsuge's escape attempt reveals the degree to which this artist struggled—both in his life and his work—to secure a place for himself in a radically transforming society. The early death of his biological father and his mother's remarriage to an abusive man contributed to the conditions of extreme poverty in which he grew up during the years of the Asia-Pacific War and the immediate postwar.3 In fact, to support his family, he began working odd jobs in his early teens, eventually missing his entire middle school education. By his late teens, Tsuge had found his calling: drawing manga allowed him to use his artistic talent [End Page 271] and to work alone, a boon for a man who found all contact with others painful. In 1955, Tsuge made his debut as a freelance artist for rental manga books. Although he published numerous works over the following decade, he continued to struggle financially, occasionally even selling his blood at a blood bank just to survive.4 Meanwhile the medium of manga was undergoing a drastic transition. In the early 1960s, the market for rental manga books began to collapse as weekly publications rapidly expanded their readership. As a result the manga art form, once deemed marginal and insignificant, gained a new legitimacy. Some authors adjusted to the changing market and made considerable commercial gains. Tsuge, however, took a different path. In 1965, after giving up his own career as a rental manga author, Tsuge began working as an assistant to manga artist Mizuki Shigeru, publishing his own short pieces in his spare time.5 Rejecting the larger and hence more lucrative market of the weeklies, he chose Garo, a monthly magazine more open to experimental works, as the main medium for his art. There he found a niche, albeit temporarily, and, with a score of highly acclaimed short pieces that appeared from 1965 to 1968, Tsuge finally attained financial stability even as he expanded the boundaries of manga expression. However, Tsuge did not feel completely comfortable with his own success, for it forced him to climb out of the social class to which he was accustomed. While benefiting from financial stability, he tried hard to adhere to his working-class identity, rejecting the pretense of being what he felt he was not. In the second half of the 1960s, his search for his lost identity in the midst of financial success led him to various locations in Japan: he sought an environment where he could capture the shadows of the disappearing past. By deliberately staying at shabby inns, he indulged in the fantasy that he was a castaway in postwar society. The comfort that he found in these experiences, he later claimed, satisfied his desire for self-denial.6 Tsuge's works that are based on his trips strongly suggest that he sought a piece of the past that he had lost. The shabby inns were attractive precisely because they offered him a life for which he felt a strong affinity. Echoing this experience, his stories from the second half of the 1960s are often set in rustic locales that have been left behind by the economic growth of contemporary Japan and feature protagonists who arrive at an unspecified location in the country as if to reconfirm their affinity with the fast-disappearing world of rural Japan. Yet, just...

Listening to Kamagasaki

Keywords: commentary, Japan, soundscape, urban, music, labor, homeless

The Association Between Socioeconomic Status and Prevalence of Diabetes Mellitus in Rural Japan

ABSTRACT The objective of this study is to investigate the association between socioeconomic status and diabetes prevalence. A population-based cross-sectional survey was conducted in Japan. The association between household income tertile, duration of education (<12, 12, >12 years), or occupation (blue collar, white collar) and diabetes prevalence were assessed in 6,197 participants using multivariable-adjusted logistic regression models. Blue collar occupation and middle household income were found to be associated with high prevalence of diabetes mellitus.

Aging in Rural Japan—Limitations in the Current Social Care Policy

Owing to equal and increased opportunities for education and employment, today's trend in Japanese marriages is characterized by late and less frequent marriage. This paper discusses unavoidable diversity in rural families to point out the anticipated consequences of aging in rural areas and to discuss limitations in current public social care policies. Specifically, the averaged proportion of never-married and single persons at ages 45 to 49 and 50 to 54 in legally recognized depopulated cities, towns, and villages in Japan is calculated to illustrate the expected diversity in families in rural depopulated areas. It also illustrates the need for future studies to develop better social care policies for increasing numbers of single caregivers and single elders.

8-1-2 学融合の試み「地域の森農業・農山村再建による地域活性化」の検討結果(8-1 学融合,Session 8 エネルギー評価・経済(エネルギー学含む),研究発表)

8-1-2 学融合の試み「地域の森農業・農山村再建による地域活性化」の検討結果(8-1 学融合,Session 8 エネルギー評価・経済(エネルギー学含む),研究発表)

Retention of physicians in rural Japan: concerted efforts of the government, prefectures, municipalities and medical schools

In post-war Japan, a number of factors lead to a general shortage of physicians by the 1950s, which became acute in rural areas and has continued until recent times. Teamwork among national, prefectural, municipal governments and public medical schools has addressed this shortage of physicians. The national government doubled the number of medical schools in the 1960s and 1970s; each of the country's 47 prefectures, whether rural or not, has at least one medical school. In rural areas where private hospitals are not profitable, municipal governments have funded public hospitals and physician recruitment from their own budgets. A cooperative project among Japan's 47 prefectural governments and the national government established Jichi Medical University (JMU), which conducts a bound medical education program followed by obligatory rural service. As a result, the number of 'non-physician communities' (muichiku) nationwide has decreased by 73%; however, the gap between physician concentrations in urban and rural areas has not changed. Therefore, the government has recently implemented a JMU-like contractual program as a form of 'rural quota' at other medical schools in all 47 prefectures. If all the replicated programs work as successfully as JMU, the impact on the geographic distribution of physicians will be substantial. The Japanese public-sector-led rural physician securing system could also be effective in countries where rural healthcare provision is the responsibility of the public sector and close cooperation among levels of government is possible.

A Utopia of Self-Help: Imagining Rural Japan in the Meiji-Era Novels of Ambition

Timothy Van Compernolle examines the bestselling "novels of ambition" ( risshi shōsetsu ) that appeared at the end of the Meiji era-just when the school system had become so rigid as to narrow opportunities in the metropolis for social advancement. Focusing on the works of the now forgotten author Horiuchi Shensen (1873-?), who was a staff writer for the magazine Seikō (Success), Van Compernolle argues that these novels created an imaginative literary space in which a rural society under siege from both capitalism and urbanization was symbolically rejuvenated and then made the only authentic and meaningful place for rising in the world and achieving success. He further demonstrates how this subgenre of the modern novel, in mapping out a particular social topography, engaged with early-twentieth-century debates over the relationship between the country, city, and nation in a rapidly modernizing Japan.

Intergenerational Ambivalence, Power, and Perceptions of Elder Suicide in Rural Japan

This article explores perceptions of elder suicide by older Japanese and contextualizes these perceptions within the theoretical framework of intergenerational ambivalence theory. The examples discussed show how people can use perceptions related to intergenerational relationships and changing social structures and values to create explanatory models for suicidal behavior. In the cases discussed here, high elder suicide rates are seen as a product of conflicting family values and conflicting expectations about how power should be allocated within families. Suicide is one means by which actors negotiate contradictions in the surrounding social environment, contradictions that for many Japanese appear to be consistently evident in the context of multigenerational families where communication and interaction between younger and older generations is perceived as being difficult.

Truth or fallacy? Three hour wait for three minutes with the doctor: Findings from a private clinic in rural Japan

IntroductionWhile previous reports examine various aspects of Family Medicine in Japan, there is sparse research on consultation lengths. A common phrase permeates throughout Japan, sanjikan machi, sanpun shinsatsu that means, "Three hour wait, three minute visit." The purpose of this study is to examine consultation length in Japan, and how it is affected by patient variables.Case DescriptionWe conducted a case study of consultation length and how it varies in relation to the demographics, presenting illness, and diagnoses at a rural clinic in central Japan. Data were coded according to the standards of the International Classification of Primary Care. Descriptive statistics were obtained to identify features of the data. Further, regression analysis was performed to characterize and to quantify the association between length of consultation and various subject level characteristics.Discussion and EvaluationA total of 263 patients aged 0 - 93 years old had consultations during the 8-day study period. The mean consultation duration was 6.12 minutes. Of all consultations, 11.8% lasted 3 minutes or less. The mean (median) consultation time among males was 6.29 (5.2) minutes and among females was 6.03 (5.4) minutes. The duration of visits increased with age. Among different International Classification of Primary Care categories, psychological issues required the most time (mean = 10.75 min, median = 10.9 min) while urological issues required the least (mean = 5.08 min, median = 4.9 min). The majority of cases seen in the clinic were stable, chronic conditions and required shorter consultation times.ConclusionsWhile the mean and median consultation length in this study extends beyond the anecdotal three minutes, the average length of consultation is still remarkably short. Trends affecting consultation length were similar to other international studies. These data present only one aspect of primary care delivery in Japan. To better understand the significance of consultation length relative to the delivery of primary care, future research should examine issues such as continuity, frequency of consultations over time and comprehensiveness of care.

Perspective of "Green Tourism" for Foreign Tourists in Rural Japan:From the Viewpoint of Marketing Research

日本国内におけるグリーン・ツーリズムの展開が始まってから15年以上が経過したが，その主たる顧客対象は国内都市住民に限定されてきた．その結果，「ありのままの地域資源」を活かしたグリーン・ツーリズムでは地域間の差別化が十分に図れず，都市住民という共通の市場を奪い合う「グリーン・ツーリズムのジレンマ」と称される事態に陥っている．一方，2003年からの「ビジット・ジャパン・キャンペーン」の展開によって国際的な観光立国に向けた動きが始まり，外国人観光客を対象としたグリーン・ツーリズムの萌芽もみられ始めている．本報告ではマーケティング分析の視点から，グリーン・ツーリズムにおいてどのような外国人市場が考えられるのかを分析するとともに，先発事例である富山県立山町と青森県十和田市の事例分析からその背景と課題を明らかにする．

The Oddness of Things: Morality Games and Interpretations of Social Change Among Elders in Rural Japan

This article explores perceptions about social change as they relate to ideas about the family as a moral unit in rural Japan. I draw upon the work of Pierre Bourdieu and Ludwig Wittgenstein to develop a means for understanding discontinuities that arise amidst rapid social change. The article focuses on emotions of discomfort and surprise at the way rural Japan turned out for older people in the late twentieth and early twenty-first centuries and discusses the gendered nature of a moral discourse on social change that has arisen in the post-war era. Using Wittgenstein's ideas of language games, I argue that the older generation is largely displaced from the prevalent language (morality) games that surround them among other generations; as a result, they find that the world is odd and experience feelings of being out of place in modern Japanese society.

Globalization and Language Learning in Rural Japan: The Role of English in the Local Linguistic Ecology

Drawing on a study of current language use in a rural community in Japan, we question to what extent English actually does serve today as a lingua franca in multilingual, internationally diverse communities. Specifically, we report on a critical ethnography of a small Japanese community with a growing number of non—English‐speaking immigrants, largely from Brazil but also from China, Peru, Korea, and Thailand. We investigate how people in the community view and engage in local linguistic diversity and how this is related to their subjectivities and to their experiences in learning and using English. We analyzed the public report of a community survey on diversity conducted by the city and interviewed three Japanese volunteer leaders who are teachers and learners of English and two Japanese who study Portuguese in order to support the local Brazilian migrant workers. Based on our findings, we highlight four emergent themes that provide insights into the significance of learning English in a linguistically diverse context. We also discuss the pedagogical implications of the local linguistic ecology for the teaching and learning of English.

The Relationship Between Time Spent Outdoors, Falls, and Fall-Risk Among the Community-Dwelling Elderly in Rural Japan

Falls are a major health concern among the older adults, and physical activity has been linked to fall-risk. This cross-sectional study aimed to identify the relationship between time spent outdoors and the frequency of falls and fall-risk among the older adults in two rural Japanese communities. In Okikamuro, there was a positive correlation between fall-risk and age (r = 0.40, p < 0.001), as well as a slight negative correlation between the time spent outdoors and fall-risk (r = -0.20, p < 0.05). In Iwasaki, there was no correlation between fall-risk and age nor between fall-risk and the time spent outdoors; however, fall-risk was significantly higher in Iwasaki (p < 0.05) than Okikamuro and the time spent outdoors during winter was significantly less (p < .001).