When the Great East Japan Earthquake and subsequent tsunami hit Ishinomaki, a small city in northern Japan in March 2011, more than 3900 people lost their lives – comprising an estimated 20% of the earthquake’s total fatalities. The city’s residents, especially those living along the coast, lost their homes, businesses and social connections, and struggled to access health-care services after the disaster.
Prior to the earthquake, the residents had had strong social connections with their neighbours and could get help accessing medical care when needed. But the disaster changed everything. Without their homes, people were dispersed to live in temporary shelters, which cut off their social connections and negatively impacted their health.
“As the earthquake destroyed communities and reduced social capital, older adults, in particular, became increasingly isolated and distanced themselves from healthy lifestyles,” said Dr Junichi Cho, the late director of the Ishinomaki Care Center. “Both economic and social issues, as well as the loss of community and disintegration of families, led to negative effects on health.”
As a medical doctor who had formerly served in rural clinics and the Saku Central Hospital in Nagano Prefecture, Dr Cho decided to relocate to Ishinomaki in 2011 following the earthquake, dedicating his late career to rebuilding and transforming the health system there.
Prior to his death in June 2022, Dr Cho was a champion for transforming the role of medical professionals to not only care for individuals when they are sick, but to also work hand-in-hand with local communities and other sectors to transform communities in order to protect and promote health.
Dr Junichi Cho decided to relocate to Ishinomaki, Japan in 2011 following the earthquake to dedicate his late career to rebuilding and transforming the city's health system. Photo courtesy of Dr Cho's family.
Building health systems to accompany people throughout their life
The Western Pacific Region has one of the largest and fastest growing older populations in the world. There are more than 245 million people aged 65 years and older in the Western Pacific Region, and this number is expected to double by 2050.
As part of the Regional Action Plan on Healthy Ageing for the Western Pacific, WHO is working with Member States to transform societies, like Ishinomaki, to enable people to age in good health, receive tailored community support and contribute meaningfully to society throughout their lives. Specifically, health system transformation is needed to accompany people throughout their life, with a greater emphasis on preventative health and strengthening communities to provide integrated services and support tailored to the individual needs of older adults.
“The health sector should strive to establish closer proximity to communities and individuals and actively engage with other sectors,” said Dr Hiromasa Okayasu, Director of the Division of Healthy Environments and Populations at the WHO Regional Office for the Western Pacific.
“Dr Cho’s community initiatives in Ishinomaki, which harnessed the power of health care to address not only health problems but also all the life and socioeconomic issues affecting residents, can serve as an inspiration for many other communities in the Region, including those in rural or remote areas. Countries should reorient their health systems from focusing solely on sickness to prioritizing population health and well-being while collaborating closely with communities.”
Rebuilding Ishinomaki’s health system post-earthquake
To rebuild community health in post-earthquake Ishinomaki, Dr Cho and his team started meeting regularly with individuals, including older adults, to discuss their health and social concerns, as well as their care plans. Health and social workers conducted needs assessments, provided geriatric health education and implemented interventions aimed at enhancing the functional ability of older persons.
Initially, the team’s approach focused on addressing the health issues of individual residents; however, they quickly discovered that many of the evacuees living in temporary residences were struggling with alcoholism, depression, post-traumatic stress disorder (PTSD) and social isolation – issues that could not be resolved solely by the health-care system.
To address the various non-medical factors associated with these and other health issues within the community, Dr Cho believed it was an opportunity for the health-care system to engage the local community and work together to rebuild a healthier and more vibrant city. As a result, Dr Cho worked with the community to organize support gatherings where older adults could network, communicate and care for one another, and receive help to navigate complex social welfare systems.
Additionally, interdisciplinary teams − comprising not only health-care professionals, but also those involved in supporting people with disabilities and parents in need of childcare − collaborate to address the needs identified by community members. This includes support to tackle often overlooked social and personal care needs, such as providing companions for people who may be dealing with loneliness.
To continue to meet the needs of the community, Dr Cho believed that ongoing participation was needed by all key stakeholders, including health-care professionals, public servants, local residents and civil society organizations. “I have actively participated in various city-based events and activities, fostering relationships not only within my professional capacity but also beyond, with local residents, government officials, and others,” he said.
The health sector contribution to community empowerment
Recognizing that many residents had volunteered to rebuild their community post-disaster, Dr Cho believed in the importance of empowering local residents to continue to support one another without relying solely on public support, and in the need for the health-care system to collaborate closely with these networks.
“There is value in not only providing health care but also in creating communities through health care,” said Dr Cho.
Today, Dr Cho’s initiatives in Ishinomaki are an example of how the health sector can revitalize communities, even in rural areas, through developing and enhancing health systems and coordinating and integrating community efforts across sectors. Having interprofessional teams with knowledge not only of geriatric issues and the ageing process but also of various socioeconomic factors is particularly valuable for community interventions.
Disclaimer: This story includes the photos and words of Dr Junichi Cho, who passed away on 28 June 2022. The use of his photos and interview has been permitted by his family members.