International Grant Program Project ReportsLetʼs Talk about Empathy
Conversations Between the Grantees

ReportMarch 2023

Introduction

Under the theme of “Cultivating Empathy Through Learning from Our Neighbors: Practitioners’
Exchange on Common Issues in Asia,” the international grant program has been based on the methodof direct mutual visits between practitioners as the foundation of the program. However, as the coronavirus pandemic from the beginning of 2020 has reduced the number of opportunities to meet others
face-to-face and much communication is now done online. There is a need to reconsider the significance of mutual exchange, which is the foundation of the program, as well as the empathy expectedfrom it.
Against this backdrop, under the theme of "Let’s Talk about Empathy - Conversations Between the
Grantees," series of dialogues featured discussions on how to understand empathy through projects
and how to use it to solve social issues, etc. as well as reports on the outline of grant projects in the
categories of Education, the Power of Design, and Health and Care. The sessions can be viewed on
YouTube.
This report provides an overview of the projects undertaken by the speakers and a summary of the
discussion points.

https://www.youtube.com/c/TheToyotaFoundation

C ontents[J a p a n e s e Ed i t i on ] 02-17
I n t rod u c t i on 20
Progra m 21
S e ss i on 1 : Ed u c a t i on
S p e a k e r s & Proj e c t I n t rod u c t i on 22
H i g h l i g h t s f rom t h e Di a l ogu e 24
S e s s i o n 2 : Th e Powe r of De s i gn
S p e a k e r s & Proj e c t I n t rod u c t i on 26
H i g h l i g h t s f rom t h e Di a l ogu e 28
S e s s i on 3 : H e a l t h a n d C a re
S p e a k e r s & Proj e c t I n t rod u c t i on 30
H i g h l i g h t s f rom t h e Di a l ogu e 32
A b o u t th e Toy ot a Fou n d a t i on 34
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Program

Session 1

Education
Speakers

Kanako Kusanagi
Assistant Professor, The Center for Advanced School Education and Evidence-Based Research (CASEER),
Graduate School of Education, University of Tokyo

Sayaka Hashimoto
Visitor & Sales Team Ofﬁcer, SALASUSU

Session 2

The Power of Design
Speakers

Ryota Kamio
Senior Director, Re:public Inc.

Masataka Mori
Director, issue+design

Session 3

Health and Care
Speakers

Jun Sasaki
CEO, Yushoukai Medical Corporation

Hirotake Mori
Associate Professor, Department of General Medicine, Juntendo University Faculty of Medicine;
Visiting Professor, Faculty of Tropical Medicine, Mahidol University*Afﬁliations and titles are those at the time of speaking.

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Session 1 Education

Speakers & Project Introduction

Assistant Professor,

Kanako Kusanagi The Center for Advanced School Education and Evidence-Based Research (CASEER),
Graduate School of Education, University of Tokyo

Her research interest is in supporting the professional learning of teachers to ensure the well-being of bothteachers and students. After working as an educational consultant in Indonesia, she has been interested in
facilitating teachers’ local initiatives for professional learning and building a learning community. She supports
schools in implementing Japanese education models such as “lesson study” and “tokkatsu”(holistic education)
based on their local educational needs and interests. She also leads an international program that aims to nurture empathic, responsible, and engaged global citizens through exchanges of educational practices and multicultural dialogues among students, teachers, and communities in Indonesia, Malaysia, and Japan.

Toward Building Multicultural and Resilient Societies- Nurturing Empathic,
Responsible and Engaged Global Citizens in Indonesia, Malaysia, and Japanin the Post-COVID-19 Pandemic（FY2020）
The COVID-19 pandemic has disrupted the way we live, learn, work, and communicate. The social crisis highlighted the problemsof social exclusion and discrimination around the world. Building an inclusive, multicultural, and resilient society where every
member feels respected and valued is a common challenge among Indonesia, Malaysia, and Japan. There is a gap between what
the current education provides and what our children need in building such societies. In the reopening of schools after the
pandemic, a new approach for learning is required to prepare its citizens to deal with new challenges in our societies.
This Global Empathic Multicultural (the GEM Project) was carried out to fill such a gap through its implementation of the program
under the theme of learning together based on empathy for two years (2020-2022). Throughout the project period, schools experienced many restrictions on their educational activities due to the COVID-19 pandemic. This project aims to nurture empathic,
responsible, and engaged “global citizens” by providing children with opportunities for dialogue and collaboration. Through aparticipatory approach, we recruit parents and community members to join a dialogue and collaboration with children to solve
local issues. Also, we provide an international exchange place to share such experiences, where we learn and collaborate withpeople of different backgrounds and values. The theme of international exchange were social and emotional learning, online
education, and the collaboration between parents/community and schools. The GEM project's ultimate goal was to support
children and teachers in this challenging time through the following five activities: 1. Online workshops (Japan, Malaysia, andIndonesia), 2. Face-to-face workshops (Indonesia and Malaysia), 3. Global Citizenship Education Activity Study Group (Tokkatsu
Lesson Study), 4. Face-to-face teacher international exchange, 5. Online International exchange for children.
The project built a support community for teachers and children and initiated bottom-up educational reform. Whereas theconventional teacher training focuses on acquiring new teaching methods and improving students' academic achievement, theGEM project created a safe learning space and encouraged teachers' creative educational practice to support students in copingwith challenges in the pandemic.

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Sayaka Hashimoto Visitor & Sales Team Ofﬁcer, SALASUSU
Hashimoto became a public elementary school teacher in Tokyo after graduating university. She moved to Siem
Reap, Cambodia in 2016 and has worked in an organization which supports village schools and manages handcraft factories. She has also been in charge of product sales. She joined SALASUSU in 2017. Having the mottothat "being one of those who support the growth of young people by realizing each of their values through thelearnings with SALASUSU together", she has been developing and delivering fieldwork programs and online
studying programs targeting students of Japanese high schools and universities. She is also engaged in interntrainings, and projects with teachers.

Educational leader development program between Japan and Cambodia
by designing soft skills training through tackling global social issues（FY2020）
To accelerate the soft skills education of young people in uncertain times, it is important to exude deep and strong leadershipbased on the original experiences of individual teachers. Therefore, in this project, educators from Japan and Cambodia, twocountries in different phases of development, traveled to each other’s countries to engage in dialogue with others, shake theirsense of self-worth, promote deep self-awareness, so as to grow as a true leader in accelerating soft skills education throughaddressing social issues.
Eleven Japanese high school teachers and 10 Cambodian educators (primary school teachers, English teachers, vocational
school staff and NGO staff) have been involved. This project is coordinated by NPO SALASUSU for educators in Japan andCambodia to connect with each other and use each other as a mirror, taking time to reflect on their own roots as educators. They
have also been challenged to give concrete form to the lessons, training, events and teaching materials they want to share with
their own students, getting clues from their own views and intentions on education, the values they hold most important, and thedifferences between the two countries, such as culture, language, values as their inspiration. The two years were divided into
three phases: 1) encounter with other participants and self-reflection, 2) planning and development of small group activities(lessons, workshops, teaching materials), and 3) practice and reflection of the activities.
The first outcome is the growth of participants as educational leaders. Secondly, the participants themselves experienced the'reality' through the online community and field visits and reflected this in their group works, which led to increase the awarenessof the students of the social issues in front of them and gave them the opportunity to broaden their career choices. Lastly, theexposure of each other’s educational issues and their own struggles as educators, transcending schools, regions and countries,
as fellow educators, has resulted in an irreplaceable connection with people who can ask each other important questions andthink and explore together in their future educational activities.
It is hoped that the spread of connections with a common understanding of issues and common struggles will continue to be a
driving force against a rigid education system and lead to changes in education in their respective countries.

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Highlights from the Dialogue
Session 1 Education Recorded:July 2022

This dialogue between the two projects shared the vision of learning together with teachers and children. In the field of
education, where correct answers are often demanded, the two speakers spoke about their efforts to create a place of
empathy that transcends nationality and position, by learning with teachers.

Encouraging teachers as people
Kusanagi

When I talked to Indonesian students, they shared their struggle of coming from poor communities.
Their families pushed them to be teachers for economic security; however, they told me, “I don’t know

if I really want to be a teacher.” They expressed the struggle between pursing their own life interest and having to live up
to expectations of their families. In Indonesia, it is difficult to pursue the passion for education because teachers feel prioritizing the interest of the government rather than the children is important in their teaching careers. But of course, there arealso teachers who put children first, and I wanted to support them. This situation is similar in Japan, too. Hardworking
teachers may not always be rewarded and some leave teaching due to overwork.

HashimotoI was an elementary school teacher in my past job, but up until that point in my life, I had been able toget to college and then become a teacher without having to think too hard. So my first experience ofbeing frustrated was my first year as a teacher. I suddenly found 38 children in front of me, and I was left to manage their
daily school life as their homeroom teacher. In the midst of all this, many unexpected things happened, and I was at a loss
as to what to do back then. I gradually started wondering if I was really doing right or not. I was trapped between suchthoughts. I was caught in the gap between myself as a teacher and my own self, and I was unsure of what and how to teachthe students in front of me.
I was involved in activities in Cambodia in my current position. The experience reminded once again how I knew nothing
and could not do much. I was horrified to think that I who knew so little was teaching as a teacher. What a small world I
was living in. This experience became my turning point. I thought of the wide gap in Japan where people graduate university and from day one entering society as a teacher you are required to think your own, demonstrate more unique perception
and thought, and nurture more diverse thinking without any experiences in real society. So in this project, I wanted soften
this gap with teachers in the front line and research how teachers can bring a more positive impact on children if they can
do what they themselves wanted to do.

Signiﬁcance of learning from stumbles and applying them to activities
HashimotoA teacher in Cambodia shared his school day memory of his teacher
beating him with a bamboo stick or something when he forgot to do

his homework. This caused him to really disliked studying. However, he told me hehappened to meet with NGOs in his teens, who opened his eyes to the importance of
education. He discovered what hope education could bring and how important it was forhis country. When this topic was brought up, a Japanese teacher also shared his memory.
Because acting as a group is absolutely required in Japan, he was left out of the loop
when he took slightly different action from the others and that was painful. He went on to
say that the pain he experienced at that time was the starting point for his involvement ineducation. This spurred a discussion that teachers should lead children’s experiences in
education to more positive directions, and I very much resonated with his conversation.
I heard many teachers in Indonesia and Malaysia say that COVID triggered them to lookback on their lives, their own values, and why they became educators.

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SayakaHashimotoKusanagi

In the dialogue between Indonesian principals and a Japanesekindergarten principal, there was a moment for the Indonesian princi-

pals to recall what is the most important as educators. Online education triggered by the
pandemic had brought many challenges that the Indonesian principals did not know how
to respond to parents complained that their children were not receiving adequate education. The Japanese principal said “Parents and teachers share a common goal: providing
a happy and good learning environment for the children. If you could explain that clearly,
parents will definitely support you. To gain such support you must first share yourthoughts behind education and your hope for your children. Parents will be happy tosupport you.” When the Indonesian principals heard these words, they remembered what
KanakoKusanagi

is most important is supporting children.
As long as teachers and parents share the same goal and make opportunities for
dialogue, they can learn from each other. Then teachers can get a sense of fulfillment andjoy as educators.

Communication that transcends the position of “teacher” or “expert”
Kusanagi

Collaborative and active learning is not as easy as it might seem, especially in emerging countries
where academic achievement is most prioritized in schools. There is a norm that teachers must be

always right and teach correct knowledge. In the program, teachers often asked “What is the right way to implement global
citizenship education?” It was difficult in the beginning to convey that there is no right answer. Some have come to understand that different schools have different practices and that they created them through trial and error. But to be honest, I
think there are still many others who did not understand of what I was talking about.
People will not realize what they want to do or what skills the lack until they actually try out. So it was

Hashimoto very difficult to bring the teachers into that kind of situation naturally. In hindsight, I really struggledwith the question of how to create a place where teachers could do what they really wanted to do as their true selves topeople around them, and how to draw out such feelings from the teachers on the online platform.

Kusanagi

The pandemic has made it almost impossible to do things the “conventional way,” and in a sense,teachers could no longer be perfect teachers. At such time, it was interesting teachers were asked

what kind of persons they are as individuals and what they want to do in their lives. In this sense, the project was interesting and dynamic. Until now, teachers felt constrained by their roles. However, in the future, we do not need to beconstrained by our roles but transform the rules and framework of society in order for everyone to be happy.
Through the project I put focus on how to break the shell of the teachers. But at the same time, I often

Hashimoto I realize that I myself was looking at the person in front of me as a “teacher.” I was conflicted about
whether I was seeing the person in front of me as an individual person or not. Going forward, it will be very important forme to have dialogue and secure time for talks. I think I learned some important lessons for my life from this project.

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Session 2 The Power of Design

Speakers & Project Introduction

Ryota Kamio Senior Director, Re:public, Inc.
Ryota is a Yokohama native, an urbanist, and a designer. He earned a master’s degree in Design for Emergent
Futures from the Institute for Advanced Architecture of Catalonia (IAAC) / ELISAVA School of Design and Engineering. He also holds a master’s degree from the University of Barcelona in Spatial Planning & Environmental
Management. Since 2016, Ryota has been a freelance researcher working around urban issues that deal withhousing, gentrification, and public spaces. He also designs lifestyles and living environments that complement
emerging technologies.

Design for People-Centered Circular Systems: Examining food packaging,
services and hygiene concerns from post COVID-19 lifestyle changes（FY2021, Ongoing）
Globally, there is a paradigm shift towards a more circular economy that steers away from mass production, mass consumption,and mass disposal. Coupled with the abrupt lifestyle changes caused by the COVID-19 pandemic, our society’s behavior andmindset towards hygiene continues to alter. In particular, this shift in mindset towards hygiene has influenced the ways in whichfood is packaged, which has challenged the environmental mission of waste reduction. In the past, the ban or limitation of
single-use plastic for food packaging seems to have been the dominant solution to waste reduction. Instead, there is a need fornovel food packaging solutions that take into account the environment along with the new perceptions and needs that surroundhygiene. The purpose of this project is to design a circular system around food packaging in Taiwan and Japan, countries thathave successfully implemented circular economies and are expected to develop exponentially. By having a “people-centered”
approach that addresses new societal values and perceptions towards hygiene, this project aims to foster sustainable development across Asia.
The project is planned in three phases: 1) research, 2) design (prototyping), and 3) documentation. In the first year, we establisheda research methodology to identify consumer behavior patterns and conducted user research in both Japan and Taiwan. Future
work will include prototyping a design around food based on the research results and documenting and publishing the entire
process.

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Masataka Mori Director, issue+design
Born in 1995 in Shiga Prefecture, Japan, Masataka Mori graduated from the Department of International Development, University of Sussex (UK). As a student, he engaged in fieldwork and qualitative research on small
businesses in Africa and open innovations in Europe. After working for a nonprofit think tank, he has been in his
current position since 2021. He has been involved in the Decarbonising Cities project since its inception and is
now the project leader.

Co-creation of civic education and community building methods using Taiwanese ICT
and Japanese entertainment for the purpose of realizing zero emissions in East Asia（FY2021）
Climate change is causing increased wind and flood damage, deaths from heat waves, food crises, and the emergence of new
infectious diseases. Slowly and surely, a crisis is approaching humanity. East Asia accounts for 33.4% of the world's greenhousegas emissions, and the solution to the common problem of Asia is the solution to the global problem. Governments have begun
to take action to address this issue, but top-down measures such as emission regulations are not enough, and citizens mustchange their lifestyles to achieve significant reductions. In this project, in order to encourage ordinary citizens to make climatechange their own issue and change their lifestyles, we focused on two methods that have a strong power to change consumption
and lifestyles, especially among the younger generation: entertainment such as games and animation (a strength in Japan) andICT (a strength in Taiwan). Researchers, businesspeople, university faculty, and designers worked together to create educational
methods and supportive community building methods to confront climate change in a fun and interesting way.
In implementing this project, we conducted interviews and discussions with practitioners and researchers in Taiwan, which is aleader in citizen participation and city planning and collected case studies. The program was conducted while leveraging thepower of entertainment.
After the completion of the demo program, we are continuing to brush up the program by conducting demonstration tests invarious locations throughout Japan with people who are interested in climate change and decarbonisation initiatives.
For more information on the project, please visit: https://issueplusdesign.jp/climatechange/college/27

Highlights from the Dialogue
Session 2 Power of Design Recorded:September 2022

With their shared backgrounds in European education, the two exchanged opinions on bottom-up social transformation
originating in Asia, with design as the key word. The discussion covered the difficulty of communicating with people toget them engaged and the importance of having fun while building on realistic initiatives, even while setting big goals
that will move society.

What kind of design encourages behavior change?
Mori
Kamio

Why did you become interested in Asia while you were originally researching so-called Western urban
planning in Spain?
I feel that the scope of what is called design is changing now.
In the environmental field, when it comes to approaching behavior change from the resource circulation we

have been looking at, what we have been doing in our design practices no longer passes muster. And when I take a fresh look at
Japanese crafts for example, I realize that they may actually be cutting edge, and I am at the phase of just beginning to realize this.

Mori

For example, do you mean that the context of Japanese crafts and manufacturing might actually have value

Kamio

Yes, that’s right. When we consider the environmental impact of organic food transported from overseas forthat could contribute significantly to areas like the circular economy?

consumption, I think that the circular economy as understood by environmental engineering to date has unex-

pectedly underestimated indigenous lifestyles and lifestyle technologies. It’s still a hazy idea that we should consider including thatonce more in our efforts to address climate change and other issues.
I think our common word is design. I think that the kind of design that we are considering is design in the broad sense of the word,
which encompasses not only graphics and products, but also behavioral changes in people, and things that evoke empathy.
It seems to me that the main actions for environmental issues were things that we would avoid doing if we could, such as enduringor doing our best to be very meticulous about sorting our trash. Yet, I think it is difficult for people to sustain activities that theyfind difficult, so I think the role of designers is to create a framework that allows people to undertake initiatives while being excitedand having fun in the process.

Approaching social issues through entertainmentMori

We developed the card game because people can think about how
they should act as a player while enjoying the game first. I think insome ways the game format makes it easier for us to grasp the issues by providing a role
and a worldview that is separate from reality. If you play the role of government, for example, you may have budget but not know who to support or what kind of support to give.
At the beginning of the game, players tend to look only at what is in front of them and act
accordingly, but this does not help them achieve their own goals or those of the community, so they gradually interact with other players, who have a variety of roles. Then there isan exchange that says, you should do this, we can do this together. The atmosphere of the community changes completely before
and after the game. I think it is very important for the participants to share the experience.
If something can be comprehended by reducing language dependence, it can be understood regardless of country, region, or
language. Basically, we try to make our products understandable only by looking at illustrations, and we try to avoid using technicaljargon.

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KamioI believe that there are actually design elements in Japanese subcultures. In Europe, there seems something rather like a cause at theoutset of the design process. It is wonderful that people are aware of the cause as a sharedsocial issue, but to move people, it is not enough to just raise a cause, and I havewitnessed the difficulties in Europe. In this light, I think the sense of games and entertainment is actually very important.
On the other hand, I thought that although there are many cases of very advanced activities in Asia, they are often not put into words. I feel it is important to reinterpret or re-edit
the fact that something we have not been so aware of is actually essentially an activity thatis involved in design and environmental issues. Information on how to communicate this is
Ryota
Kamio

still spreading.
I have a vague feeling through this project, that the role of myself, Mr. Mori and otherdesigners of our generation will be to properly interpret existing things and re-edit them ina way that is easy to understand.

Changing peopleʼs behavior and society through the power of design originating in Asia
Mori

In this project, I realized that it is important to communicate as simply as possible and to ask those who
understand to take on a role to spread the message next time. I believe that “leave for the next genera-tion” is the key phrase this time.
If I have the chance, I would like to expand this to Asia and further to Europe and the United States. In fact, I think there
has never been a method or program originating in Japan that has spread to the West to solve social issues and other problems. Therefore, I think there is still potential for programs using gamification to expand, and I would like to attempt it.

Kamio

I believe that Asia still has relatively indispensable manufacturing and supply functions, and I thinkthat’s an advantage. Europe has very few manufacturing bases left now, so there is a hypothesis thatnew designs should be considered in the Asian region.

Mori

I too have seen and heard about so-called advanced regions and initiatives overseas. To turn ideas into
reality, it is very important to have a base of operations and to build from the ground up. If not for thisopportunity, I would have focused on developing the project in Japan. But when I thought about expanding the project, I
came to view what is needed to solve this global issue from the Asian perspective.

Kamio

In any case, I think it is important to build up examples. As an urban design, it is difficult to suddenly
enter a market on a large scale, and the number of stakeholders involved quickly increases. However,I think it is possible to produce results in one year, for example, the way garbage is disposed of in the district or the designof a container for a garbage disposal site. I think it is important to make many such small steps and steadily build them up
one by one. I would like to continue to be conscious of not only communicating a vision, but also incorporating it into asmall reality.

Mori

There is a limit to what I can do on my own, so it is important for me
to be able to pass it on to others and work with them. Put differently,

it is the opposite approach to international development. Here the mainstream is fromthe bottom up, rather than the top down. That is where I feel hopeful and what I want tochallenge with this program.
I think there are many things that can be done because the challenges are great, and I
think it is no use chasing after just ideals all the time. I would therefore like to do mybest in the way I can and where I can win.
MasatakaMori

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Session 3 Health and Care

Speakers & Project Introduction

Jun Sasaki CEO, Yushoukai Medical Corporation
Dr. Sasaki is CEO at Yushoukai Medical Corp., the largest group of home care clinics in the Tokyo metropolitan
area. He has won multiple awards including Global Ageing Influencer in 2018 and 4th & 5th Asia Pacific Eldercare Innovation Awards in both 2016 and 2017 as best home care provider, and Forbes Wellness Award in 2016.
Before starting Yushoukai, he served as general practitioner and gastroenterologist in Mitsui Memorial Hospital
after graduating from Tsukuba University. He is an expert member of Regulatory Reform Promotion Council of
the Cabinet Office and Board Member of Ageing Asia Innovation Forum.

Redeﬁning "community symbiotic society" focusing on dementia（FY2018）
As the world population ages, the number of people living with dementia is increasing rapidly. Rather than an increase in thenumber of dementia cases, it might be better to think of this as an increase in the number of people who can live long enoughto develop dementia. The prevalence of dementia increases with age. In Japan, one out of every two people between the agesof 85 and 94 has dementia, and more than 80% of people over the age of 95 have dementia. It is estimated that 20% of theremaining people also have mild cognitive impairment (MCI). It may be said that dementia is a part of life for those of us living
in a long-lived society. While efforts to prevent and treat these diseases that cause it are of course important, dementia as aphysiological aging phenomenon is difficult to prevent and treat. In addition, dementia is not the name of a disease, but a condition that causes irreversible loss of intellectual function and interferes with daily life. We need to hasten the creation of a society
and community where people with dementia can live well until the end of their lives without giving up.
In this project, we collected case studies of community development in Japan and Taiwan, where people with dementia are notjust "people who need care" or "people who can be supported," but people who can continue to have a place and role in thecommunity as residents. In selecting the case studies, we assumed that the projects were not based on the provider's idea of"good care," but on the premise that the people with dementia would feel that they were living a better life. In addition, the casestudies were carefully selected by researchers from both Japan and Taiwan, with an emphasis on not only embodying a social
inclusion, but also containing hints that can be generalized and adopted by anyone. In collecting information, we did not only
focus on the concept of the business operation, but also on the challenges and innovations in the actual business operation(securing funds, securing and training human resources, maintaining good relationships with local residents, coordinating withthe mutual government, etc.). The information collected is intended to provide guidance for individuals, corporations, and local
governments who wish to start and operate similar businesses.

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Associate Professor, Department of General Medicine, Juntendo University Faculty of Medicine;

Hirotake Mori Visiting Professor, Faculty of Tropical Medicine, Mahidol University
Dr. Mori is a medical doctor specializing in general medicine, community health and tropical medicine.

After graduating from Kagoshima University in 2002, he started his career as a resident physician at Okinawa
Chubu Hospital and has engaged in community health in various places. He undertook a Diploma in Tropical
Medicine and Hygiene at Mahidol University in 2010and completed a doctoral program in 2014. In addition toteaching at Juntendo University, he is currently serving as a visiting professor and involved in teaching andresearch in Mahidol University as well as organizing training programs of tropical medicines and medical education projects utilizing IT. Also, he is leading nonprofit initiatives called Glocal Medical Support and Tochinoki
Network to connect community-based healthcare network internationally.

Building an educational model for improving community health through collaborative learning:
The Japan-Thailand Multidisciplinary International Consortium（FY2021, Ongoing）
Problems associated with the declining birthrate and aging population, including the response towards the novel coronavirus,
are urgent issues faced by both Japan and Thailand. Through a multidisciplinary collaborative governance approach, thepresent project aims to resolve the five essential social issues in community healthcare that are common in both Japan and
Thailand. We intend to summarize the epidemiological data, analyze the current situation in communities in both countries, andidentify the problems. Study tours of medical educational institutions and community healthcare facilities are conducted in both
Japan and Thailand, and based on discussions among stakeholders in both countries, a multidisciplinary project team was set
up to explore solutions. We intend to establish an educational system built on a foundation rooted in the following pillars: building a community-based integrated care system that reflects the needs of the community; strengthening social capital; training
general practitioners who oversee the entire community; preventing lifestyle-related diseases; and providing education about
infectious diseases.

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Highlights from the Dialogue
Session 3 Health and Care Recorded:September 2022

This dialogue reexamined the role of doctors and care and considered what it means to live happily until the end of one’s
life, and how society can realize such a life. They also talked from their experiences about the significance of looking
broadly overseas for exchange.

Community connectedness and the happiness of those receiving care
Mori

Related to community connectedness is the well-being of those who are receiving care, which I believe isdifficult to quantify. I have the impression, for example, that the level of happiness shown internationally is notalways objective, as it includes various indicators.

Sasaki

I think what makes us feel happy depends highly on the individual. To deal with this, flexibility is important, notin systems, but in connections, and having someone nearby who somehow understands one’s values, outlook

on life, priorities, and criteria for decision-making can provide a sense of comfort. Even if a person is no longer able to articulate hisor her own intentions well, I think it is a very key prerequisite for living a happy life to have a connection nearby that enables someone
else to judge the situation according to the person’s thoughts and feelings.
According to the World Happiness Report, Japan’s index of social connectedness is exceedingly low. Japan is by far the number one
in the world when surveying people who are alone, with 14% of the population living without talking to someone at least once a week.
In terms of household composition, about 16% of the elderly live alone, followed by about 15% of the working generation who live
alone, with about 30% living alone, followed by elderly households. It is quite common for elderly households to be isolated from thecommunity and for couples to have little or no conversation with each other. In fact, I think that the lack of connection and the resulting narrowing of options is one of the factors that keeps people in Japan from feeling happy.

Mori

In my case, one of the things I have learned is that in the community medical care field in Thailand, one canstrongly feel the situation where health is maintained through community connections. For example, living in alarge family and being taken care of, or having neighbors who take you to the hospital, deliver food, etc., even if you don't have family
nearby. I believe this used to be the case in Japan as well, but now, especially in urban areas, it is fading away. I think it is difficult tocreate an urban model for building community connections, but what kind of efforts should be made in the future as a solution?

SasakiI have been engaged home care in the Tokyo Metropolitan area for a long time. and I don’t think it’s possible to“create” a community. It’s not something you can create, but something that forms naturally, so I think thatdrive is very limited and rare in the central Tokyo.

Yet there are communities even in big cities in places like Taipei, Taiwan, or Singapore. On the ground floor of housing complexes,
for instance, there are places to eat and discuss problems. Residents feel a sense of connection with each other, as if “somehow,
when I go there at this time, that person will be there.” There are no obligations or rules, but a place where you can spend the day
cheaply even if you have nothing to do. And there is a loose connection that allows you to stay athome if you don’t want to feel like engaging that day, which I find very comfortable.
I think “place”, food, and shelter would be key words. I have seen some examples in Japan, but
again, everyone has a feeling somewhere that they would rather be with someone than at homealone. People can be a bit anxious about going to a new place, so in some cases they gather again
at what used to be a school. I think familiar places may be the key word.
When we go to Asian countries, we are told that Japan is an advanced aging society so pleaseshare some case studies. But when we visit such countries, we do a full circle sometimes feel thatwhat they are doing now is more leading-edge. When I go to Asia, I often feel as if Japan is runningahead of the curve in creating various systems, such as long-term care insurance, but in fact it isbehind the times when it comes to communities.

32

Jun
Sasaki

The role of healthcare professionals in solving social issues
Mori

Do you have any thoughts on what should be promoted in the future when developing healthcare

SasakiI have always thought that Japanese doctors do only half the work. Article 1 of Japan’s Medical Practi-

professionals, especially doctors, in solving social issues?

tioners Act states that “Medical practitioners are to contribute to the improvement and promotion of

public health,” yet all they do is wait for the people to get sick and then name the disease and treat those who are sick. If
it is a traffic accident or an infectious disease, I think we protect the health of the people by saving the lives of healthypeople. However, the disease structure has now changed, and various abnormalities have appeared in the body as a resultof lifestyle changes, such as hypertension, diabetes, and dementia. These are diseases that are named after certain thresholds are exceeded, but shouldn’t we really try not to exceed these thresholds, or help people live better lives longer without
getting sick as much as possible? I don’t think we can do this within the current framework of insurance-covered treatment.
There is a saying, "Don't treat the disease, treat the sick person," but it is not enough to just look at the sick person. We
must also look at the person’s living environment, including who he or she is living with and in what kind of community, andbe involved in a holistic manner, which I believe is the primary health care we should be providing.

Japan and Asia learning from each otherMori

In Japan, I think there is an aspect of medical care and healthcare
being separated in the field of education. For example, the experi-ence of seeing both in the front lines of community medical care in Thailand is somethingthat those who receive medical care education in Japan can learn from. I think you arecreating role models while interacting with society, but I thought it was necessary tocome up with a framework or program to study what is important in the experience, otherthan the disease and its diagnosis.
I think it is important for us to be connected with overseas medical and nursing carefacilities. When they are faced with a problem, I may come up with some ideas fromJapanese facilities or myself, and conversely, they may have some ideas when we are ata loss. Even if we don’t get an answer right away, as we worry and discuss together,

HirotakeMorimutual connections will arise to introduce people to each other. I believe that having
various connections is a vital aspect, both domestically and internationally.

Sasaki

I think we can only comprehend the value of the overseas medical and nursing care facilities’ efforts
when we look at each other as equals, humbly learning from each other for the issues that we ourselves

are currently unable to solve. The aging of the population and the increase in dementia are not problems that are confined
to a single country but are global issues. I believe we can reach a better future faster when various people share theirsuccess and failure stories through trial and error in their own positions and environments.
The medical care and nursing care fields are very domestic, and many people don’t feel the necessity to go outside. But
before it’s too late, I think it is very important to look at the outside world instead of only staying inside.

33

The Toyota Foundation
The Toyota Foundation is a grant-making foundation established in 1974 by the Toyota Motor
Corporation. It views events from a global perspective as it works to support activities that bringbroad, long-term benefits to society. The Toyota Foundation identifies issues in a wide range ofareas in line with current needs, including human and natural environments, social welfare, andeducation and culture, and provides grants for research and projects that address these issues.

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intended goals.

34International Grant Program
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