Research into the Foundations of Health in Japan, Southeast Asia and Surrounding Countries

Research into the Foundations of Health in Japan, Southeast Asia and Surrounding Countries

Center for Southeast Asian Studies (CSEAS), Kyoto University
SAKAMOTO, Ryota Medical Group


This research program explores the local foundations of people’s health in Japan, Southeast Asia and surrounding countries in order to maintain and strengthen them in partnership with the people in local communities.

This academic year’s activities

– Field medicine project in Tosa Town, Kochi Prefecture

We are carrying out a field medicine project in cooperation with the Tosa Town Hall (Kochi Prefecture) and the Tosa Town Council of Social Welfare. Every month, we visit the Tosa Town in Kochi Prefecture. We have been contributing to community healthcare as we provide medical exams and treatments and participate in individual care conferences, community care conferences, events at the Kochi Prefecture Attakafureai Center, and local community hall meetings. From August 8 to 12, 2017, we carried out “longevity medical examinations,” which drew the participation of 267 elderly members of the community aged 75 years or older. We were also involved in the health promotion of residents in their 40s and above by holding sessions explaining the results of Special Health Check-ups (specific medical exams established by the Ministry of Health, Labour and Welfare for citizens aged 40 to 74). In relation to this project, I wrote an article as the lead author comparing elderly residents’ health results and sense of happiness in Tosa Town with those living in a region of high attitude, as described in greater detail below. This article will be published in Geriatrics & Gerontology International (in press). In addition, I was a co-author of articles about sarcopenia and oral functions and periodontitis in elderly residents, which were published in the Journal of the American Geriatrics Society, Journal of Periodontal Research, and Journal of Oral Rehabilitation [1-4].

– Community-based medical care for the elderly in Bhutan

In cooperation with Bhutan’s Ministry of Health, we are implementing a project to establish an elderly care system, with an emphasis on preventive care. This project was built upon the results of previous programs and policies. Since 2009, we have been carrying out elderly care activities in the Khaling region of eastern Bhutan, which have been well-received. Also, based on recommendations of efforts that should be tackled for Bhutan’s Eleventh Five Year Plan, which was established by the country’s Medical and Health Council in 2011 and commenced in 2013, about 30 Health Assistants were selected from districts in the country every year to undergo training of trainers (ToT). In 2015, a performance agreement that included the spread of the five year plan in phases to the entirety of Bhutan was formulated and signed on July 10 of the same year by Prime Minister Tshering Tobgay and Minister of Health Tandin Wangchuk. In September 2017, about 30 health staff workers from Chukha District, Haa District, Paro District, Samtse District, Thimphu, Trashigang District, and Trongsa District participated in ToT in Gedu, Chukha District. In December 2017, four health workers from Bhutan were invited to learn about current elderly care in Japan. In March 2018, there is a plan to invite the chief planning officer of the Ministry of Health.

– Research on Legionella bacteria

It is now known that the occurrence of legionellosis is closely tied to rainfall. Legionellosis prefers relatively warm temperatures of 25 – 42ºC. This phenomenon has become an important issue because of global warming. However, at the present time diagnosis of this disease requires a special diagnostic kit, and is conducted only in countries and regions such as Europe, the U.S., and Japan. The current status of this disease is still not well-known on a global scale. We believe that Southeast Asia is an especially critical region for diagnosing this disease due to the effects of monsoons and other weather phenomena. We took samples from asphalt roads in Bhutan. Using a new colorimetric method called PALSAR (probe alternation link self-assembly reaction), we detected the 16S rRNA component in Legionella bacteria. An English article of the results, of which I am the lead author, was accepted by the journal Himalayan Study Monographs [5]. As far as we know, this was the first detection of Legionella bacteria in Bhutan. Legionella bacteria are a critical cause of severe community-acquired pneumonia, so its detection is an invaluable step for the epidemiology of legionellosis. This is an international transdisciplinary research effort in which researchers and government officials from different countries and fields of expertise collaborate.

– Effects of high-altitude environment on the health of residents

In high-altitude areas, a variety of special environmental conditions exist, such as low oxygen concentration, low temperatures, and intense ultraviolet radiation. We thus conducted research on physiological and cultural adaptations by residents who have been living in the high-altitude areas for generations. This academic year, an article, of which I am the lead author, on the quality of elderly people’s sleep in the Rahdalke region of India was accepted by the international journal Psychiatry Research [6]. The findings revealed that high altitude is a cause of sleep disorders even for residents born and raised in such areas. It is widely known that when low-altitude residents move to high-altitude areas, sleep disorders occur. However, research on the sleep quality of high-altitude residents has been limited. The new findings are thus valuable. The study examined the relationship between the altitude of residential areas and residents’ sleep quality along a distribution of elevation from 2,800 meters to 4,200 meters. The study was made possible by international interdisciplinary research. In addition, as noted above, an article on villagers’ sense of happiness is slated for publication in the journal Geriatrics & Gerontology International [1].

– Others

Eleven guests from the Royal University of Bhutan, including President Nidup Dorji, were invited an international symposium entitled “Emerging Sciences for Wildlife and Culture in Bhutan,” held at the Kyoto University Clock Tower Centennial Hall on July 11, 2016. From August to September, we participated in a JICA survey by providing technical advice for plans to improve medical equipment in Bhutan’s National Referral Hospital and regional core hospitals. We contributed to the outfitting of medical equipment in Bhutan by acting as intermediaries between JICA and Bhutan’s Ministry of Health and target hospitals.

Also, on August 1, 2016, and January 31, 2017, we held community care conferences at the Goou-jinja Shrine in Kyoto in cooperation with the Ogawa Community Comprehensive Support Center of the Kyoto City Kamigyo-ku Council of Social Welfare. These conferences drew about 80 participants who provide day-to-day care of the elderly in the community, such as volunteers and workers from preventive care promotion centers, day service centers, in-home care support providers, and the police department. We shared with each other community challenges and activities, and discussed future directions for elderly care.

Four physicians and physical therapists from Gia Dinh People’s Hospital in Ho Chi Minh City, Vietnam, were invited in February 2017 to observe the infection control departments of Kyoto University Hospital and Osaka University Hospital. In addition, they participated in discussions about the future direction of cooperative relationships between the Kyoto Min-iren Chuo Hospital rehabilitation department and a non-profit organization in Tây Ninh Province, Vietnam, concerning community rehabilitation. During the same month, two doctors were invited from the University of Medical Sciences of Bhutan. They observed the activities of the Kyoto City Minami-ku Community Comprehensive Support Center, NPO Higashikujo Community Development Support Center, Sanda City Keyakidai Elementary School, Sanda City School Lunch Center, Sanda City Public Health and Welfare Center, Disaster Reduction and Human Renovation Institution in Kobe City, One Medicine One Health Center within the Kobe Biomedical Innovation Cluster, and Kyoto University Hospital. Their visit was reported in the February 8th morning edition of the Asahi Shimbun and Kobe Shimbun [7, 8]. A workshop entitled “Current Health Care Situations in Bhutan and Vietnam” was held on February 8, drawing 27 participants (including eight non-Japanese participants).

Furthermore, in February 2017 we traveled to Yangon, Myanmar, and met with the president and other officials of The University of Medicine 2 Yangon. In addition, we visited the JICA Myanmar Office, where we shared challenges related to lifestyle diseases in Myanmar and explored possibilities for cooperation going forward.

In the remaining academic year, we plan to hold an international exchange course entitled “An Alternative Development by Learning from Rural Bhutan” from February 27 to March 16, 2017, bringing seven students of this university to stay in eastern Bhutan. We also plan to hold a workshop at Sherubtse College, Royal University of Bhutan during the same period.


  • Sakamoto R, et al. Health and happiness among community-dwelling older adults in Domkhar valley, Ladakh, India. Geriatrics & Gerontology International 2017 (in press).
  • Iwasaki M, et al. The association between dentition status and sarcopenia in Japanese adults aged ≥75 years. Journal of Oral Rehabilitation 2017; 44: 51-58.
  • Chang NY, et al. Relationship between oral dysfunction, physical disability, and depressive mood in community-dwelling elderly adults in Japan. Journal of the American Geriatrics Society 2016; 64: 1734-1735.
  • Iwasaki M, et al. Longitudinal relationship of severe periodontitis with cognitive decline in older Japanese. Journal of Periodontal Research 2016; 51: 681-688.
  • Sakamoto R, et al. Detection of Legionella spp from rainwater on roads in Bhutan. Himalayan Study Monographs 2017 (in press).
  • Sakamoto R, et al. Sleep quality among elderly high-altitude dwellers. Psychiatry Research 2017; 249: 51-57.
  • “Bhutanese Medical School Professors Observe School Lunch at Elementary School in Sanda,” (Takeshi Ito) (in Japanese), Asahi Shimbun Digital, February 8, 2017, 3:00 a.m.
  • “To Spread School Lunch System — Bhutanese Medical School Professors Observe Elementary School in Sanda” (in Japanese), Kobe Shimbun NEXT, February 8, 2017, 5:30 a.m.