Commentary / Japan

Is Japan’s low COVID-19 death rate due to a 'higher cultural level'?

by Rochelle Kopp

Contributing writer

I was sent scrambling for my dictionary on June 4 when Finance Minister Taro Aso declared that the different “mindo” between Japan and other countries was the reason behind Japan’s low COVID-19 death rate.

A quintessentially nebulous Japanese word, mindo denotes the standard of living and cultural level of a people, and can variously be used to refer to a population’s degree of maturity in terms of intellectual, educational, and cultural levels, or behaviors.

The word “mindo” was created during the Meiji Ea (1868-1912), a time when Japan became interested in comparing itself with other countries. Inherent in it is a sense of judgement about which populations’ “level” or “standards” are higher or lower. Scholar Michael Kim notes that during the colonization of Korea, “The Japanese deployed the mindo concept frequently to justify their unequal colonial policies and explain their rationale for excluding Koreans from the welfare and educational policies instituted in Japan proper.” Last week, television personality Dave Spector said that he had been told never to use the term on air.

Assailed over the use of this loaded term, Aso later explained that he didn’t mean to put down “other countries,” but rather to point out that, unlike Japan, they were unable to keep their death rates down despite using coercion, and that the Japanese should be proud of how they cooperated with social distancing requests that were more gentle.

For many Japanese, Japan’s low death per capita rate from COVID-19 in comparison to many other industrialized countries has indeed become a point of pride — one that is not necessarily misplaced. Initially, many observers were worried that Japan would have a much higher death toll than it currently has. With its high proportion of elderly residents and densely packed cities — combined with little polymerase chain reaction (PCR) testing and a reluctance to impose harsh lockdowns — it seemed that Japan might end up looking like hard-hit areas such as northern Italy or New York. Fortunately, though, that grim scenario did not materialize.

The resulting relief and pride have fostered a sense of exceptionalism. Nobel laureate Shinya Yamanaka has hypothesized an as-yet-unknown “Factor X” that accounts for Japan’s low death rate. Explanations of Japan’s success have been various, with Prime Minister Shinzo Abe lauding an undefined “Japan model,” the vice chairman of Japan’s coronavirus expert panel Shigeru Omi citing hygiene practices such as wearing masks and washing hands, and commentator Yoshiko Sakurai, in echoes of Aso’s use of mindo, praising “the Japanese people’s higher public health consciousness, moral values, and sense of solidarity to overcome adversity.” One Japanese blogger listed 43 different theories that have been circulating.

It is important to keep in mind, however, which “other countries” Japan’s low death rate is being compared to. As of Tuesday, according to data website Worldometer, Japan has had 7 deaths per 1 million population from COVID-19. That number indeed looks excellent in comparison to some of the hardest hit countries, such as Belgium with 829, the United Kingdom with 598, Spain with 580 and Italy with 562.

On the other hand, there are quite a few countries with lower death rates than Japan’s. They include South Korea with 5 per 1 million; Singapore, Malaysia, New Zealand and Australia with 4; Thailand with 0.8; Taiwan with 0.3 and both Vietnam and Mongolia with zero. I wonder, would Aso say that that all those countries have higher mindo than Japan?

Data-based analysis

Recently, I have been attempting to do my own analysis of this issue. Like many others, I have been fascinated by the question of Japan’s low death rates and, at the same time, deeply aggravated at the lack of data-based analysis circulating currently. I also started to wonder, does an X factor really exist, or is Japan’s low death rate explainable by the same factors — whether they be cultural, social, demographic, geographic or genetic — that explain the other differences between countries?

I discovered a paper that Adam Acar, intercultural researcher and proprietor of Maikoya in Kyoto, had published in April. It includes a striking finding that COVID-19 death rates were correlated with one of the key indices used to compare cultures: Geert Hofstede’s individualism-collectivism scale. I invited Acar to team up to broaden the set of variables being examined to include other emerging hypotheses and we ended up screening more than 200 variables, using a set of 46 countries.

In the process, I have learned quite a bit about what data is out there for comparing countries in various ways. One piece of data that I spent hours searching for in vain was something that might quantify differences in hygiene or cleanliness between countries, one aspect of what Aso calls mindo.

However, although data on environmental pollution is plentiful, I was able to find little international comparative data on how neat and clean people keep their homes or bodies. The only data I was able to find looked at handwashing with soap after using the toilet, and in that study, Japan was in the bottom five of all countries surveyed.

We ended up screening the variables for correlation with each country’s number of COVID-19 deaths per million. We realize, of course, that correlation does not equal causation, but felt that identifying correlations could be an important step in beginning to sort through the many theories.

We looked at variables relating to geography and climate, health status, attributes of the health care system, demographic factors, measures related to governance and wealth, cultural values and cultural practices that include styles of greeting, the wearing of face masks and whether shoes are removed at home. We also threw in data on a few unique theories, such as whether a country has a female leader, whether it has adopted 5G wireless and how often people have sex (spoiler: we couldn’t find a correlation on any of those ones).

The strongest statistically significant correlation we found was that countries in the Asia-Pacific region are more likely to have lower COVID-19 death levels. This supports a theory that has been proposed by Tatsuhiko Kodama, a professor at the University of Tokyo, that states people in Asia-Pacific countries (including Asian countries as well as Russia, Australia and New Zealand) have some existing background immunity due to more exposure to other coronaviruses that circulate more here.

Another strong correlation we found was that countries with higher percentages of blood type B tend to have lower levels of COVID-19 deaths. This is consistent with a recent finding by scientists studying blood type and COVID-19. We also found a correlation between a higher percentage of those with East Asian genes in the population and lower deaths, echoing studies that are currently looking into whether East Asians are genetically less susceptible.

Other factors we found that correlated with lower levels of COVID-19 deaths were a higher average household size and higher percentage of households that are in extended families, the custom of removing shoes in the home, and the percent of those under age of 39 who have had the BCG vaccine. Correlating with higher death levels were higher total cholesterol, higher latitude and the percentage of the male population who were over 80 years old. Culture was also a factor — countries with a higher degree of individualism, a larger share of extroverted personalities, and greetings that involved hugging and kissing were more likely to have higher death rates.

We next attempted to combine some of these variables to create a comprehensive model but were not able to find a combination that yielded a statistically satisfactory result. However, other researchers have recently created good models that explain a statistically significant amount of the variation between countries. Professor Tsuyoshi Miyakawa at Fujita Health University and others recently showed that a combination of BCG vaccination policy and prior incidence of tuberculosis in the population is associated with a reduction in COVID-19 deaths.

Michele Gelfand, author of “Rule Makers, Rule Breakers: How Tight and Loose Cultures Wire Our World,” and her colleagues at the University of Maryland, College Park, have found that death rates were lower in countries like Japan that have a combination of high government efficiency and high cultural “tightness” — strong norms and a pressure for conformance.

Based on these findings, one can say that, in a sense, Aso was both right and wrong. If one defines mindo as high adherence to group norms (such as requests to stay home not backed up by legal force), plus habits such as wearing masks, bowing when greeting and taking off shoes at home, then Japan can be said to have high mindo. However it is not the only country where that is the case, and Japan also seems to have had some advantages both genetically, and from its BCG vaccination policy and its location in Asia, that may have helped it against COVID-19 regardless of its mindo.

The backlash against Aso’s comments have been strong enough that it’s unlikely we will hear others in prominent positions using the word mindo. I am concerned, though, that the exceptionalist attitude that there is something unique about Japan’s response to the pandemic has taken firm root.

Rochelle Kopp teaches at Kitakyushu University and consults with both Japanese firms operating globally and foreign firms operating in Japan. You can find her on Twitter at @JapanIntercult.

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