Japan opens eyes to a wider horizon

A little knowledge is a dangerous thing. This is my fifth visit to Japan and my first actively looking for developments in prevention science. I have learned a lot, but the more I think I know, the more I know there is to find out.

The newspapers carry stories familiar to the Western reader. About lengthening queues at job centers, for example, and an anticipated fourfold rise in heat-related deaths in the next decade, put down to the effects of global warning.

There are sensational child welfare cases, too: a 13-year-old left behind by a deported Filipino couple; a psychiatrist handed a suspended prison sentence for leaking information with the intention of protecting a 16-year-old-boy who set fire to his house killing his mother and two siblings.

But dig deeper and significant differences emerge. Inequalities based on wealth are visibly fewer. There are fewer homeless people. There are more elderly people – almost too many for the country to sustain. How the distribution of wealth affects children’s health and development is not known.

Japanese society responds differently to children's development impairments. Children’s services are far less advanced than in the most parts of the United States, Europe or Australasia. This may be good, or bad.

Ingrained restorative justice processes ensure that children getting into trouble apologize to those they have offended, and the procedures result in far lower levels of incarceration. They may also account for the extremely low crime rate.

Observing these differences, one is reminded of the importance of the context of the society in which children live.

Whereas in the West we have become preoccupied with the potential preventative effects of programs and the struggle to get them into mainstream services, Japan reminds us that the promotion of the well-being of children is often bound up in the ordinary lives of families, neighborhoods and schools.

For the British viewer this difference is starkly apparent in the comparison between public transport systems. A year or so into office, the UK Transport Minister has lately embarked on a tour of the privatized railway system to check on its condition. He will soon find out what many of us already know: it’s rotten.

By UK standards, the Japanese transport system borders on the miraculous. It is fast, clean, efficient and supported by an apparently committed labor force.

Whereas in Britain we have argued about the relative merits of a publicly owned versus privately owned railway system - and both have failed miserably - in Japan there is a successful combination of the two, indicating that it is not ownership that matters, but an underlying agreement about what society needs and the best way to make it work.

My Japanese colleague, Shin-ichi Ishikawa at University of Miyazaki, warns me against looking at his country too rosily. “Everybody on morning trains feels uncomfortable,” he tells me. “They are squeezed into overcrowded vehicles like sushi-packs each morning. Some stations even have specialized staffs to cram businessmen on board.”

And, of course, there are downsides to the Japanese solution. Transport is also expensive (although the average trip on the Tokyo Metro costs only $2); people work long hours with little vacation; opportunities for women are limited (with the result that more children spend the early years with their mothers). Schoolchildren work hard and the pressure to succeed is said to be much greater than in the West.

What all this means for the well-being of children is hardly known. The overwhelming impression from my week in Japan and from reading the work of prevention scientists here is of the need for good epidemiology to uncover patterns of health and development, potential influences on well-being and the services children and their families receive.

Here Shin-ichi is on my side ”For the want of better data,” he says, “many people, especially politicians, don't realize, or else they choose to ignore, the importance of preventing childhood mental health problems or enhancing their well-being.”

It is possible that such research would show that the remedy for some of the problems faced by Western children lies not in any “proven program” or in punitive responses to anti-social behavior but in paying closer attention to contextual factors such as the distribution of wealth or the preventative qualities inherent in close-knit societies.

Just as possibly, Japanese society may be badly in need of prevention science and the kind of breakthroughs it has achieved in the West in recent years.

It is striking that this week’s reports from Japan demonstrate how proven approaches such as cognitive behavioral therapy, social skills training and Triple P are producing comparable results in a society so different from the ones where they originated.

Either way, the moral is that Prevention Action must continue to broaden its outlook and to probe beyond the success or otherwise of programs in order to investigate the context in which children are raised.

Have even half an eye to context and it is impossible not to acknowledge that there is no “steady state” in the prevention world. East and West, things change. Shin-Ichi reminds me of recent judicial changes to take account of increases in juvenile delinquency and of uncertainties about the effectiveness of the country’s “citizen” judge system. He is also alert to signs of convergence in Easter and Western prevalence rates for adolescents who suffer from depression.

All speaks for the enormous value of both of us being able to take a rounded – in this case – global view.

See : Sato H, Sakie S and Ishikawa S (2008) “Prevalence rate of depressive disorders in a community sample of adolescents in Japan” Seishin Igaku Clinical Psychiatry 50, pp 439-448.