At this HGPI Seminar, we hosted Dr. Masaki Sonoda (CEO, CI, Inc.) and Dr. Naoya Hashimoto (CEO, Kids Public). In addition to their activities aiming to solve healthcare issues involving children using the newest technologies at the frontlines of healthcare, both doctors are members of the committee for the Child Rearing Healthcare Committee established at the Ministry of Health, Labour and Welfare according to the Basic Law for Child and Maternal Health and Child Development. Dr. Sonoda and Dr. Hashimoto spoke about the current situation surrounding policy related to children’s healthcare and shared their outlook on the future.

As a countermeasure against the spread of Coronavirus Disease 2019 (COVID-19), this seminar was held online.

 

Key Points of Dr. Naoya Hashimoto’s Lecture

• Although isolation and uncertainty felt by expectant mothers, children, and parents were existing issues in maternal and child health, they became more prominent during the Coronavirus Disease 2019 (COVID-19) pandemic.
• Due to shifts in disease patterns and social issues, we are entering an era in which support for psychological issues and social issues must be provided in addition to support for biological or physical issues among expectant mothers, children, and parents.
• Dr. Hashimoto wants to address uncertainty and isolation that existing initiatives do not reach using online consultation services that function as a social infrastructure for connecting people with support from the Government and from healthcare institutions.

 

■ Issues in maternal and child health became more prominent during the COVID-19 pandemic
Dr. Hashimoto has served clinically as a pediatrician and is currently CEO of Kids Public, an organization that provides online pediatric and obstetrics and gynecology consultation services using ICT. During his lecture, Dr. Hashimoto addressed issues in maternal and child health in Japan during the COVID-19 pandemic from a pediatrician’s point of view.

Stories on the increased number of reports and consultations regarding abuse, unplanned teen pregnancy, and domestic violence have been appearing regularly in the news and are considered to be caused by the COVID-19 pandemic. A similar trend occurred after the Great East Japan Earthquake. Natural disasters and periods of major social change place a significant burden on vulnerable social groups, particularly children. The current circumstances have made it more difficult for people to take important measures in maternal and child health and are hampering systems for protecting children’s health. For example, some parents and guardians have become hesitant to take their children to the doctor for regular vaccinations and medical check-ups.

Although world-class maternal and child health services are provided in Japan, the country is currently facing various issues caused by uncertainty and isolation outside of the reach of current systems. Dr. Hashimoto believes that the ongoing COVID-19 pandemic has highlighted issues in maternal and child health that must be addressed in the future.

Even before the COVID-19 pandemic, a shift was occurring among the issues in maternal and child health that required attention. Japan’s public health initiatives after World War II focused on preventing infectious diseases, but the incidence and severity of infectious diseases are currently declining due to improvements in public sanitation and nutrition and the widespread adoption of vaccination. For example, the infection rate for Haemophilus influenzae type b (Hib) meningitis among infants has decreased dramatically since the Hib and pneumococcal vaccine started receiving public funding support in 2011.

On the other hand, incidence rates for non-communicable diseases (NCDs), abuse, and suicides have increased and are now significant issues. Not only has the number of consultations for child abuse received by child consultation centers tripled in the last decade, it was reported that suicide was the leading cause of death among expectant mothers in 2018.

The constitution of the World Health Organization (WHO) that came into force in 1948 defines health as, “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Due to changes in disease patterns and social issues, the healthcare system in Japan is now transforming to meet the needs of an era in which expectant mothers, children, and parents require forms of support related to the psychological or social aspects of health in addition to the biological or physical aspects of health, as described in the WHO’s definition of health.

It was with this background that Basic Law for Child and Maternal Health and Child Development was enacted in 2019. As a member of the Child Rearing Healthcare Committee, Dr. Hashimoto is also voicing his opinion that it is crucial to implement measures using ICT for maternal and child health.

 

■ Introducing “Pediatrics Online” and “Obstetrics and Gynecology Online” and future developments in those services
People can receive world-class care at healthcare institutions in Japan. However, as mentioned above, there are people whose needs are not being met by existing systems. “Pediatrics Online” and “Obstetrics and Gynecology Online” were established from that perspective to create points of contact for those people through the use of ICT. The content of each service is quite simple. They provide opportunities for people to consult pediatricians or OB/GYNs using the LINE app. Kids Public is currently expanding operations based on the concept of “Improving pre-hospital care in Japan by providing parents and guardians seamless support from before and after childbirth by placing points of contact directly in the palms of their hands.”

“Pediatrics Online” and “Obstetrics and Gynecology Online” began operating in 2015 and 2018, respectively. The greatest strength of these services is that they provide access to high-quality support from specialists such as pediatricians, OB/GYNs, and midwives. Currently, around 160 specialists are registered to provide consultations through these services. They also benefit healthcare providers by providing opportunities to work from home during childcare leave or other leaves of absence.

Kids Public services are also being provided through initiatives at companies or municipal governments that allow users to access them free of charge. This stems from Dr. Hashimoto’s belief that people should be able to receive healthcare services equally, regardless of economic disparities, which is based on his time in graduate school spent researching themes related to healthcare disparities. Kids Public services are currently being offered through more than forty private organizations and local governments. They were also made free to use nationwide from May 1, 2020 to August 21, 2020 as part of the Ministry of Economy, Trade and Industry’s (METI) response to the COVID-19 pandemic. During that period, Kids Public handled several tens of thousands of consultations and found that fewer than 10% of all consultations were about COVID-19 symptoms. Most of the consultations were about hesitation towards medical examinations, the health effects of daily lifestyle changes due to shelter-in-place requests, and child rearing.

When providing services, the aspect of support Kids Public emphasizes most is preventing isolation during pregnancy, childbirth, and child rearing. Kids Public is also undertaking initiatives to respond to increases in child abuse cases and in the number of medical examinations sought for mild symptoms, both of which have become issues in pediatric medicine. Their initiatives are based on the philosophy that “People do not become healthy just by waiting in a hospital.” When looking at examination-seeking behavior, one finds that the number of outpatient medical examinations is higher in Japan compared to other OECD members. Outpatient medical examinations account for over 90% of the examinations given in pediatric medicine, and data shows that 75% of ambulance rides are for mild symptoms.[1] This causes a particularly large portion of the healthcare burden to fall on facilities providing emergency outpatient examinations. Because children are often unable to communicate their symptoms in an effective manner, there are many cases in which parents and guardians grow concerned to the point they seek medical examinations. Allowing those parents and guardians to access online medical consultations at home before they go to the hospital will promote appropriate medical examination-seeking behavior and reduce the burdens placed on both healthcare institutions and parents or guardians without sweeping aside their concerns.

There is a high degree of affinity between the fields of maternal and child health and online medicine. The main target group for initiatives in both domains tends to be the younger generation, and there are many people who speak more openly when texting than when meeting face-to-face. Kids Public surveyed people living in places without pediatricians or OB/GYNs one year after Kids Public services were introduced. The number of people who told them, “I feel like there is a pediatrician nearby I can consult when my child is ill” increased by 20%, demonstrating the impact of online consultations.

“Pediatrics Online” and “Obstetrics and Gynecology Online” aim to relieve uncertainty and isolation that existing child rearing support or healthcare provision systems cannot reach and to function as a form of social infrastructure for connecting people with support from the Government or healthcare institutions. Dr. Hashimoto would like to continue contributing to maternal and child health through such initiatives in the future.

[1] This data comes from the FY2013 report released by the Tokyo Children’s Initial Emergency Medical Care System Study Group.

 

< [Event Report] The 88th HGPI Seminar: Dr. Masaki Sonoda – Considering How to Structure Healthcare in Terms of How It Will Affect Children in the Future (October 9, 2020)

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■ Profile
Dr. Naoya Hashimoto (CEO, Kids Public)
Dr. Hashimoto is a pediatrician and CEO of Kids Public. After graduating from Nihon University School of Medicine in 2009 with a Master’s degree in Public Health and completing his residency at St. Luke’s International Hospital, he began training as a pediatrician at the National Center for Child Health and Development in 2011. He then completed the master’s course at the Department of Public Health Medicine, Graduate School of Medicine, University of Tokyo. In 2015, Dr. Hashimoto established Kids Public to provide healthcare for children online through telemedicine consultation services called “Pediatrics Online” and “Obstetrics and Gynecology Online” and healthcare newsletters called “Online Pediatric Journal,” “Online Obstetrics and Gynecology Journal,” and “Kids Public Journal.”

 

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