Learning from Asia to Curb World's Leading Cause of Death

The leading causes of deaths worldwide are diseases that are not acquired through infection from other people but through a combination of individual physiology and lifestyle, the so-called "noncommunicable diseases" (NCDs). Diabetes, most cancers and most heart diseases are examples, and they disproportionally affect low- and middle-income countries, where they are on a dramatic rise because of unhealthy lifestyles and insufficient health care. A health expert specializing on NCDs, Kobe University Associate Professor YAMAGUCHI Yuko compares issues and solutions across Asia such as in Japan, Taiwan, and the Philippines. We ask her what they can learn from each other and what impacts COVID-19 and Artificial intelligence (AI) have on her work.

Noncommunicable diseases (NCDs) are the leading cause of deaths. What are the benefits of comparing the situations in Japan, Taiwan and the Philippines?

I am interested in noncommunicable diseases (NCDs) in Asia, because these diseases are spreading especially rapidly there. One reason for that is physiology. For example, compared to Africans, Europeans and Americans, the insulin secretion capacity is lower in Asians and they also have a lower body-mass index so that they simply get diabetes more easily. And the second part to the answer is that NCDs are influenced by lifestyle and culture, and so I want to know the cultural situation in developed and developing countries in Asia, which might be more comparable to each other.

Kobe University has a Memorandum of Understanding with Taipei Medical University, which made it easy to connect, too. But with the Philippines, the university had only established connections with health centers, not with researchers. So, I tried to find papers relating to my research from Filipino researchers and approached them, and that worked well.

In your work, you emphasize the importance of support from the community for the prevention of NCDs. What have you learned from studying the situation in these countries and regions, compared to Japan?

Generally, to prevent NCDs, an individual approach is important. This means that health professionals instruct patients to check and manage themselves wherever possible. But this is very difficult in Japan because especially older people are affected by social isolation and have little access to preventive activities or insufficient information about them. In my previous studies, we could show a relationship between social isolation, that is, loneliness and living alone, and difficulties in implementing NCD-preventing behaviors in Japan.

Therefore, it is important to promote community-based care systems. In particular, the Japanese government is trying to promote a transition from hospital-based care to home-based care in a program called "community-based integrated care system". They want people to live in their community as long as possible, not in the hospital. We also know through studies that elderly people are often willing to connect, they just lack the chances or have inadequate information.

In the Philippines, however, community life is quite well established and they usually have strong relationships within the community through what we call commons, shared activities and spaces. Therefore, by learning from the way community life is organized in the Philippines, it should be possible to promote effective community-based care systems in Japan, too.

Your work relates to SDG targets 3.4 (reduce mortality from NDC through prevention, treatment, and promotion of mental health and well-being), 3.8 (achieve universal health coverage) and 3.c/d (develop health workforce in developing countries / reduce health risks). How do you develop your work focus?

I align my research with the SDG 3. While I am not a member of any UN working group, my research projects try to follow the WHO recommendations. As in the Philippines, middle income countries have a high burden of undiagnosed, poorly controlled NCDs. That's why the WHO recommends NCD prevention especially for low-income countries. Based on the WHO recommendations, the Filipino government created the PhiliPEN, a universal health coverage project with NCD screening tests and consultations. But they still face many challenges to prevent NCDs because of limited resources. In particular, limited human resources are one of the biggest issues for NCD prevention. That's why in my research project I focus on the role of community health workers in the adoption of NCD-preventing behaviors.

I used to work as a nurse in a hospital, in the cancer ward, so I took care of many terminally ill patients. I found this work very rewarding, but I felt a dilemma because they take medicine and medical treatments but sometimes without much effect. That's why I started to get interested in public health prevention rather than treatment and medication and started to study public health in my master's and PhD courses. And because I want to connect research and implementation and focus on current global issues, especially in Asian countries, I focused on the NCDs issue.

Why did you choose to work at Kobe University?

Kobe University is strong on internationality. I got a bachelor's degree from another university, but I wanted to study for my master's program here, because the university has many relationships with other countries and universities, especially many exchange programs. That's why it's easy to connect with other countries in research settings and education. For example, in my master's program I could study in Thailand. And under the diversity program, Kobe University gave me the chance and funds to study abroad at John Hopkins for a year, mostly to study statistical analysis. I still continue my research projects there.

Recently, I became a member of the Graduate School for Advanced Studies and Research. The main purpose of this project is to help researchers to improve their research skills. This means I can focus on research rather than on teaching. Also, the members of this program are not only from my field but also from many other fields. That's why I can develop my network and my understanding of developments with knowledge and information from other fields. I only joined this program this April, but I can already see the possibilities to connect with the others when I want to ask for help in my future work.