JAPAN HEALTH
Local mat ters
Local Matters
Local Matters
Health and Wellbeing Our interactions with everyone and everything around us affects how we manage our health, our expectations for treatment, the way we interact with doctors and the way we behave.
4
JAPAN HEALTH NOW . LOCAL MATTERS
The relationship that the Japanese nation
Japan Health Now explores the forces behind
have with its health is evolving thanks to a
the changing healthcare landscape in Japan.
combination of socio-cultural, economic and
It outlines the increasing possibilities that
environmental factors. It is changing the
are opening up for health brands to get in
disease landscape, the health ecosystem, the
sync with Japanese people when it comes to
relationship patients have with their doctor
managing their health.
and how engaged they are in managing their health. This presents new challenges and opportunities for healthcare providers who need to rethink their relationships with patients and healthcare professionals in Japan.
5
What we see 1. Hampered healthcare As people live longer, it is more difficult to keep Japan’s growing elderly population healthy. All eyes are on Japan to see how it responds to this mounting challenge.
2. The fight for fitness The Japanese nation has become increasingly health conscious. People are spending more time and money looking after their physicial and mental wellbeing.
3. Digital dimensions Digital technology has helped fuel a new confidence amongst people to take responsibility for their own health.
6
JAPAN HEALTH NOW . LOCAL MATTERS
4. The disputed divine The traditionally paternalistic relationship between doctors and their patients is changing. Empowered patients want a greater say in how their health is managed.
5. Consultation conversion Mobile has made it possible for healthcare to be practiced virtually anywhere. Healthcare is no longer confined to the doctor’s office or hospital.
6. Courteous customisation Technology has opened up new channels for the pharmaceutical industry to interact with doctors. It has made it possible to adopt a more customised approach to marketing.
7
Hampered healthcare An age old question Japan has the world’s oldest population and
It is also symbolic of the nation’s desire to
people are increasingly living longer. The
continue moving smoothly as it faces the
ageing of the population has been brought
demographic challenge ahead.
about by low fertility and high life expectancies.
emphasis is being placed on individuals
Thanks to a combination of lifestyle, diet,
taking responsibility for their own health. The
genetics and affordable healthcare, Japan has
new paradigm of ‘life-style related diseases’
historically been one of the world’s healthiest
has emerged, reflecting the power people
societies. Unfortunately, as people live longer
have to control their own destiny when it
lives, they are more prone to diseases and
comes to health and wellbeing.
health conditions such as cancer, stroke, Alzheimer’s and dementia. New medical challenges are in the spotlight, such as The Locomotive Syndrome, an umbrella term coined in Japan to describe the physical weakness that comes from ageing joints and muscles.
8
In an attempt to improve the outlook, greater
JAPAN HEALTH NOW . LOCAL MATTERS
All eyes are on Japan as other nations observe how it responds to the challenge of caring for a large and expanding elderly population.
In 2013, a baby was born every 31 seconds in Japan and someone died every 25. This six second difference helped prompt the biggest natural fall on record in Japan’s population.
31 seconds
25 seconds
Source: Ministry of Health, Labour and Welfare
9
An age old question Japan has one of the highest concentrations of centenarians, with the number now increasing at approximately 10% per year:
51,376 25,606 10,000
153
1965
1998
2005
2012
Source: The Guardian, Japan’s centenarian population reaches more than 50,000
Demand for medical care in Japan is expected to triple in the next 25 years
25 YEARS
Source: The Washington Post, Japan’s Health-Care System Has Many Advantages, but May Not Be Sustainable
10
JAPAN HEALTH NOW . LOCAL MATTERS
So what? Getting up close and personal with people reveals how emerging ‘lifestyle diseases’ affect everyday lives of the Japanese nation. Spending time with people as they go about their daily activities helps develop an understanding of the cultural significance of products, services, medical conditions and treatments.
11
Hampered healthcare western reflections Changes in dietary habits are also threatening
As the prevalence of obesity and diabetes
the Japan’s position as the worlds’ healthiest
rises, Japan slowly begins to look a bit more
nation. There is increasing concern about the
like its western peers.
deterioration in diet with the rising popularity of fast food. For example, KFC has become the self proclaimed king of Christmas by aggressively marketing its fried chicken as a Christmas meal. Whilst people may only eat KFC once per year, the odd tradition has led to such high demand for the Colonel’s fare that preorders for Christmas begin in early December.
12
JAPAN HEALTH NOW . LOCAL MATTERS
Since 1976 there has been a 200% increase in the rate of obesity in men, whilst there has been no change in women over the same period. The discrepancy can be explained by women being more responsive to health interventions, as well as their desire to look good.
1976
2014
200%
Source: Ministry of Health, Labour and Welfare, Overview of the National Health and Nutrition survey results
13
Japan has the second largest number of McDonald’s branches after the US
Source: Wikipedia, list of countries with McDonald’s restaurants
14
JAPAN HEALTH NOW . LOCAL MATTERS
kcal The average Japanese person eats about 25% fewer calories per day than the average American
kcal
JAPAN
USA
15
The fight for fitness A shifting focus
But it is not all doom and gloom. The
Increasing health engagement is being
Japanese nation is becoming increasingly
facilitated by government policies to deliver
health-conscious and there is a focus on
education and intervention. Access to
disease prevention. People believe they have
over-the-counter medicines has improved
the power to change their own level of health
and regular check-ups and screening
and are spending more on health
programs are the norm to provide better
and wellness.
early prevention. The popularity of drug
There is a desire to stay healthy by engaging in activities that refresh mind and body: Japan is undergoing a running craze; it makes daily life more enjoyable, gives a sense of purpose and has become akin to something cool. Peo足ple in Japan devour any prod足uct with brain-related claims, reflecting a desire to seek products which improve their lives with a real or perceived function or experience.
16
JAPAN HEALTH NOW . LOCAL MATTERS
stores means that they are one of the fastest growing retail channels.
Waistline limits for citizens aged 40 to 74
33.5
inches
35.4
inches
Source: PolicyMic, Japan Has Cut Obesity to 3.5% in a Controversial Way That Wouldn’t Fly in America
Attempts by the Government to halt the
Contrary to the rise of fast food popularity,
spread of obesity include setting waistline
health-focused restaurants have emerged in
limits for citizens aged 40 to 74. Men
Tokyo called ‘doctor’s restaurants’. These
must maintain a waistline at or below 33.5
restaurants offer doctor certified menus
inches; for women, the limit is 35.4 inches.
which provide a choice of healthy meals
Counselling and support is mandated for
for those following diets, or for specific
anyone straying outside of these limits,
conditions such as diabetes.
although in practice this is rarely enforced.
17
A SHIFTING FOCUS
18
JAPAN HEALTH NOW . LOCAL MATTERS
The Japanese visit a doctor nearly 14 times per year, compared to 5 visits in the US and UK
JAPAN US UK
Source: OECD Publishing, Health at a Glance 2013, page 87
So what? There has never been a better time for brands to shape future wellness in Japan and help people live healthier lives. By understanding what really matters to people, brands can play a vital role in improving quality of life and delivering better health outcomes.
19
Digital Dimensions Challenging a “silent� society In a technologically advanced country like
Due to a rise in smart phone usage, Japan
Japan, it is no surprise that digital channels
became the largest purchaser of apps in
are helping facilitate healthy behaviours.
2013, surpassing the US. There are millions
Digital is empowering people and challenging the stereotype of the passive Japanese patient. It is increasing access to information and giving patients a new confidence to manage their own health.
20
JAPAN HEALTH NOW . LOCAL MATTERS
of downloads in Japan attributed to health and fitness apps alone.
Over 2 million downloads on iTunes
The fitness tracking app, Runtastic, has generated over 2 million downloads from iTunes alone. Runtastic tracks all activities from running to kayaking. Users can connect with one another – and can even cheer one another on via earpieces.
37%
of people in Japan use the internet as the main source for health and medical information
Source: Ministry of Internal Affairs and Communications
21
Challenging a “silent” society
Social media can provide anonymity to talk more openly about conditions such as depression and other mental illnesses, which remain taboo subjects in Japan. Safe online spaces have emerged where people can share stories and seek support whilst “keeping face”. Until recently, depression was only recognised within psychiatry to describe severe mental episodes. It took the pharmaceutical industry to coin the term ‘kokoro no kaze’ (the concept of your soul catching a cold) and to provide a cure through modern antidepressants for depression to be recognised in Japanese society. Most accounts on Japan’s social network sites such as Gree, Mixi and Line are anonymous – it is not who you are friends with, but what you know that matters. This means people can quickly become mini medical experts, using their knowledge to self diagnose, identify the right course of treatment and advise others.
22
JAPAN HEALTH NOW . LOCAL MATTERS
So what? Digital provides possibilities for companies to talk to the Japanese nation more openly about their health. It allows a habitually private nation to share their innermost aspirations and fears, activating invisible or latent consumer needs. Brands can get more in tune with people by understanding what they ‘feel’, ‘think’ and ‘do’ in relation to their health.
23
The disputed divine Transforming the Doctorpatient dynamic The digital revolution is also having an impact on the patient-doctor relationship. Traditionally, Japanese culture has been largely deferential to those in authority. As such, patients once afforded doctors a “god-like� status, following their instructions without question. It was common practice for patients to be unaware what medication they were taking, with medicine prescribed in unmarked bottles.
24
JAPAN HEALTH NOW . LOCAL MATTERS
This once paternalistic relationship is undergoing change as patients want a greater say in how their health is managed. The rise of digital formats relinquishes doctor control, allowing patients to play a more proactive role in decision making about their own health. Patients no longer blindly follow what their doctor says. Whilst they will not complain, they will switch doctors if they are dissatisfied and have freedom to consult any primary care doctor. This has led to long waiting-room times to see a preferred doctor.
The concept of the passive patient was most starkly demonstrated with the death of Emperor Hirohito in 1989 who, in spite of his status, was kept in the dark about his terminal cancer.
25
30% of outpatients and 32% of inpatients have sought a second opinion
Source: MHLW Patient’s Behavior Survey 2011, page 16
26
JAPAN HEALTH NOW . LOCAL MATTERS
71% prefer a collaborative role in the treatment decision between doctor and patient
So what? The Japanese are increasingly finding their voice in decision making about their health. Access to education and knowledge means that people have more choice and will increasingly seek treatments and brands that deliver on their promises.
Source: BMC, Patients’ preferences for involvement in treatment decision making in Japan
27
Consultation conversion Rise of the machines Mobile health is also playing an increasingly
Many doctors use smart devices to
important role for healthcare providers. The
search for medical information, manage
number of smartphones and tablets used by
patient information and facilitate remote
doctors has grown in recent years.
communication. Doctors refer to online sources to help with diagnosis and are frequent users of online medical communities.
28
JAPAN HEALTH NOW . LOCAL MATTERS
% of doctors who access online medical communities
Japan
78
China
55
India
54
Russia
52
Spain
48
USA
47
UK
40
Germany
39
Brazil
29
Italy
15
France
9
Online medical communities give rise to virtual thought leaders who operate in the digital space
Source: PMLiVE, Doctors in BRIC countries more likely to use social media than those in Europe
29
Use of smartphone vs. tablet (%) Searching for medical reports
26
47
Collect information about drugs and treatments
35
42
Read medical news
37
44
For apps useful in clinical situations
24
27
Communication with patients
5
9
Communication with doctors
9
8
Source: CareNet.com, 2013
30
JAPAN HEALTH NOW . LOCAL MATTERS
31
Courteous customisation Merging traditional and modern rep-Doctor interactions Technology is also changing how doctors
Tightening of rules around entertainment and
interact with the pharmaceutical industry.
restrictions on hospital visits has prompted
For many years selling drugs to doctors was
the pharmaceutical industry to turn to digital
based largely on a personal bond with the
interfaces to reach doctors.
medical representative.
Japan is leading the way in “e-detailing� to
Global market forces have prompted the
interact with doctors virtually. Doctors can
need for a new sales model. Declining sales
access company websites or portals to keep
forces and increasingly time pressed doctors
up to date with product information.
restricts rep access.
32
JAPAN HEALTH NOW . LOCAL MATTERS
Average rep visit (minutes)
9
1.5
JAPAN
USA
Focused more on exchanging pleasantries than product information Source: Eye for Pharma
So what? The relationship between the pharmaceutical industry and doctors is in a state of flux. Digital offers new ways of talking to the medical community. It offers the opportunity for greater customisation by getting the right message to the right doctor at the right time.
33
So what matters for Health brands? Adopt a patient-centric approach by exploring what people ‘feel’ ‘think’ and ‘do’. Activate invisible latent consumer expectations by getting up close and personal with people. Seek ‘outsights’ by leveraging knowledge from outside of the sector and beyond the border. Customisation and differentiation will ensure patients ‘opt-in’ to your brand. Use digital to uncover consumer truths about sensitive health and personal issues. Find new ways of maintaining a human-to-human relationship with doctors and other healthcare professionals.
34
JAPAN HEALTH NOW . LOCAL MATTERS
Find out more » To learn more about Japan Health Now, please get in touch:
Office contacts BOSTON » boston@hallandpartners.com Cape Town » capetown@hallandpartners.com Chicago » chicago@hallandpartners.com Johannesburg » johannesburg@hallandpartners.com London » london@hallandpartners.com Los Angeles » losangeles@hallandpartners.com Melbourne » melbourne@hallandpartners.com MUMBAI » mumbai@hallandpartners.com New York » newyork@hallandpartners.com Salt Lake City » saltlakecity@hallandpartners.com Seattle » seattle@hallandpartners.com Shanghai » shanghai@hallandpartners.com Singapore » singapore@hallandpartners.com Sydney » sydney@hallandpartners.com TOKYO » tokyo@hallandpartners.com
www.hallandpartners.com
/hall-&-partners /hallandpartners
/hallandpartners /hallandpartners
/hallandpartners
JAPAN HEALTH
www.hallandpartners.com