Gender inequality in Japan: a case report of women doctors

Kyoko Nomura, MD, MPH, PhD

keynote talk presented at the Ludwig Boltzmann Forum on women’s development and leadership, Tokyo, Monday 16 May 2016

[Japanese version 日本語版　野村恭子、医師・医学博士、日本の男女共同参画：女性医師を事例に]

by Kyoko Nomura, MD, MPH, PhD: Director, Support Center for women physicians and researchers, Associate professor, Department of Hygiene and Public Health, Teikyo University, School of Medicine, and Associate professor, Teikyo School of Public Health

In 2016, Japan’s elderly population, aged 65 years or older, comprises 26%, which is one-fourth of total population. By contrast, the younger generation, aged 0-14 years, comprises only 14%. Why so low?

Nowadays, the birth rate in Japan is estimated at 10.3 per 1,000 population, meaning that one woman bears only one child over her lifetime on average. The Japanese Health Ministry estimates that the nation’s total population will fall to 95.2 million by 2050. The aging of Japan is brought about by a combination of low birthrate and longevity.

Now we understand that Japan faces an aging society. Who is going to take care of this quickly growing aging population? Of course, younger people and women! This is the fundamental reason why women are encouraged to work as much as men to support the aging society.

However in Japan, our traditional gender roles that men should work outside and women be good house wives is strongly embedded in our mindset and hard to get rid of.

According to the Gender Gap Index by the World Economic Forum, Japan ranks at 105th near the bottom among 135 countries in terms of gender equality, mainly due to the underrepresentation of women in economic and political leadership.

In the medical area, Japan faces a physician shortage because the number of physicians per 1000 population is 2.2 which is lower than the average of OECD countries, 3.2 per 1000 population. This means, if you reside in a remote area and suppose you have a cancer, it is less likely to find a medical doctor who can treat your cancer in your neighborhood. Hence, Japan needs higher numbers of medical doctors to meet patients’ needs and definitely women medical doctors are expected to work more to take care of patients.

Actually the number of women entering into medicine is increasing and now constitutes 20% of total number of medical doctors. But this value is still low among OECD countries (actually it is lowest) and thus, we need to set up an urgent strategy to improve working conditions for women to work as much as male counterparts and pursue their potentials as well.

Dr. Nomura conducted a surveys of alumnae from 14 medical schools and found that 98% of men worked in full-time positions, but only 70% of women worked in full time positions, and that men work longer hours per week compared to women. In her another survey with colleagues, they also found that many women quit working at the time of life events like marriage and child birth or rearing; the retirement rate from full-time labour was 44％ in 5 yrs and rose up to 85％ in 10 yrs. To make matters worse, once they switched from full-time to part-time positions, only one third of these people will return to full-time work.

As a consequence, women are underrepresented in medicine. We have 80 medical schools in Japan and each has one dean but there are only 2 women and women constitute only 2.6% of full professors in medicine in Japan, which is far behind of USA (19%) and UK (16%).

Dr. Nomura and her colleagues have recently published an article to the international scientific journal “Surgery” in February 2016 and this epidemiological study based on 8,000 surgeons who are members of the Japan Surgical Society demonstrated that married men earn more than unmarried women after adjusting for covariates including working hours; as the number of children increases, annual income increases only for men but decreases for women. 

In another study, she also demonstrated that the length of weekly domestic working hours is much longer for unmarried women than for married men and men do not work at home even if they have children (the average household working hours for men is only 3 hours per week).

These findings suggest that Japan’s stereotypical gender role, where men should work outside and women should be housewives still prevails even among highly qualified professionals like medical doctors.

One of the top scientific journal “Nature” recently published a special issue called “women in science”. This article states that Science remains institutionally sexist. Despite some progress, women scientists are still paid less, promoted less frequently, win fewer grants and are more likely to leave research than similarly qualified men.

Dr. Nomura has launched a women support center at her University in 2014 and provides various kinds of support to women researchers and physicians including

• to provide a nursery for children including sick children
• to provide social support like mentorship
• to provide various seminars and workshops on research skills
• to promote gender equality campaigns

With these efforts, Teikyo University has successfully increased the numbers and percentages of women faculty members. Dr. Nomura concluded by saying “in order to support women, environmental support at the workplace is not enough, but a combination of workplace support with educational intervention and career development works very well.”

Kyoko Nomura, Teikyo University, Profile

Education:

MD, Teikyo University School of Medicine, Tokyo, Japan, April 1987-March 1993

Master of Public Health: Quantitative Methods, Harvard School of Public Health, MA02115, USA, June 2001-June 2002

PhD: Dep. of Hygiene and Public Health, Teikyo University School of Medicine , April 1999-March 2003

Current position:

• Associate professor of Dep. of Hygiene and Public Health and Teikyo University School of Medicine, and Teikyo School of Public Health
• Director of Teikyo Support Center for women physicians and researchers

Kyoko Nomura, Teikyo University, publications

Kyoko Nomura, List of publications (partly in Japanese language)

Copyright 2016 Eurotechnology Japan KK All Rights Reserved

Michinari Hamaguchi

keynote talk given at the 8th Ludwig Boltzmann Forum at the Embassy of Austria, Thursday 18 February 2016

by Michinari Hamaguchi, President Japan Science and Technology Agency (STA), President emeritus of Nagoya University

summary written by Gerhard Fasol

About Nagoya (Professor Hamaguchi is emeritus President of Nagoya University)

Nagoya is an industrial powerhouse with more than 100 international enterprises based with their headquarters in Nagoya.

If Nagoya was a country, Nagoya would be ranked 20th globally in terms of GDP

Ranking countries by GDP (source World Economic Outlook Database April 2011):

1. USA: US$ 14,685 billion
2. China: US$ 5,878 billion
3. Japan: US$ 5,459 billion
4. Germany: US$ 3,316 billion
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19. Switzerland: US$ 524 billion
20. Greater Nagoya region: US$ 491 billion
21. Poland: US$ 469 billion

Nagoya hosts Toyota, and is also a center of Japan’s aerospace industry with Mitsubishi and Kawasaki. 35% of the Boeing 787 body are made in the Nagoya region.

Toyota’s hybrid technology was developed by Nagoya University alumni Mr Uchiyamada, who is currently Chairman of Toyota Motor Corporation.

Nagoya University

Nagoya University researchers and alumni are beginning to achieve a number of Nobel Prizes in recent years:

• 2001: Ryoji Noyori (Chemistry)
• 2008: Toshihide Maskawa (Physics)
• 2008: Makoto Kobayashi (Physics)
• 2008: Osamu Shimomura (Chemistry)
• 2014: Isamu Akasaki (Physics)
• 2014: Hiroshi Amano (Physics)

Nagoya University has a very interesting Academic Charter (名古屋大学学術憲章), which lays out the fundamental objectives and policies.

Nagoya University’s Academic Charter (名古屋大学学術憲章) emphasizes a free and vibrant academic culture (自由闊達な学風), the cultivation of courageous intellectuals endowed with powers of rational thought and creativity (論理的思考力と想像力に富んだ勇気ある知識人).

Interestingly the fundamental objectives emphasize international cooperation – with emphasis on Asian nations (とりわけアジア諸国と).

Nagoya University guarantees freedom of academic research (学問の自由) and aspires to be an accessible University ((開かれた大学).

Question 1: Can we foster a “brave heart” by education? (勇気は教育で生み出すことができるものか？)

Inspired by Nelson Mandela: courage is not the absence of fear, but the triumph over fear, conquering fear. Education is the most powerful weapon to change the world. （私は学んだ。勇気とは恐怖を知らない事ではなく、それに打ち勝つところにあるのだと。勇者とは怖れを知らない人間ではなく、怖れを克服する人間の事なのだと。）

We want to educate courageous individuals endowed with powers of rational thought and creativity. (論理的思考力と創造力に富んだ勇気ある知識人）

Question 2: Can we foster “innovative talent” by education? (イノベーティブな才能は教育で生み出すことができるものか？)

M. Reznikoff et al (Reznikoff, M., Domino, G., Bridges, C., & Honeyman, M. (1973). Creative abilities in identical and fraternal twins. Behavioral Genetics, 3, 365–377.) studied 117 pairs of twins and failed to identify a genetic component in creativity. It appears that we inherit general intelligence genetically, but not creativity.

Entrepreneurship on the other hand is not “natural”, not creative – it is work. Both entrepreneurship and innovation are hard work, can be learned and require effort.

see: Christensen “The Innovator’s DNA”, and Drucker “Innovation and Entrepreneurship”.

Intelligence and age: Fluid intelligence and crystallized intelligence

Psychologist Raymond Cattle (see also: “A Memorial to Raymond Bernard Cattle, 1905 – 1998“), later with his student John Horn, developed the theory of fluid and crystallized intelligence:

• Fluid intelligence (閃きの知性): is the ability to think an reason abstractly and to solve problems. Fluid intelligence is thought to be independent of learning, experience and education.
• Crystallized intelligence (結晶化する知性): comes from prior learning and past experience. Crystallized experience typically grows with age.

When we look at the age at which Nobel Prize winners have done their prize winning work, we see a broad distribution, with a peak around 35-39 years age, with outliers in the 20-24 years age group, and above 60 as well.

Mentors are important: at Nagoya University Nobel Prize Winner Osamu Akasaki has educated and influenced five more Nobel Prize Winners.

Question 3: Is there any culture (soil) that makes innovative talent to blossom out? (イノベーティブな才能を開花させる文化（土壌）は存在すか？)

Frans Johansson examined the “Medici Effect”, the explosion of creativity during the Italian Renaissance period: innovative ideas flourished at the intersection of diverse experiences.

Frans Johansson: The Medici Effect: What Elephants and Epidemics Can Teach Us About Innovation

The Medici Effect at Nagoya University:

We have equal partnerships to support innovative ideas and mentorships to encourage young talent’s independence.

Question 4: What is required for youth to be an innovator? (イノベーターになるには、何が必要か？)

Clayton Christensen identified 5 skills as the innovator’s DNA:
“The Innovator’s DNA: Mastering the Five Skills of Disruptive Innovators” by Clayton M. Christensen, Jeff Dyer, Hal Gregersen

Two common themes motivate innovators:

• Actively desire to change the status quo
• Regularly take smart risks to make that change happen

Question 5: How can we teach to take smart risks? (スマート・リスクをとる勇気はどうやったら教えることができるか？)

The answer I found is: “let them go abroad and experience diversity”.

The “Hamaguchi Plan” for Nagoya University: accelerating Nagoya University’s internationalization “名古屋大学からNagoya Universityへ”

The “Hamaguchi Plan” covers five areas:

1. Cultivation of global leaders:
   • Enrichment of liberal arts education
   • Strengthening of global competitiveness through the Global 30 Program
   • Re-Inventing Japan Project, and
   • Programs for Leading Graduate Schools

2. Promotion of world class research:
   • Cultivation of internationally recognized young researchers
   • Exploration of new frontiers through the utilization of cutting-edge facilities

3. Organizational innovation:
   • Development and expansion of the Graduate School of Pharmaceutical Sciences
   • Reorganization of educational and research functions
   • Collaboration with other universities

4. Collaboration with and further contribution to local and regional communities:
   • Collaboration with the “Knowledge Hub” Project and
   • Promotion of community health systems

5. Raising of Nagoya University Fund:
   • 5 Billion yen (US$ 50 million) within 5 years for use toward scholarship and student support

You can download the Hamaguchi Plan for Nagoya University here in English.

Simple facts I found by the internationalization of Nagoya University:

• Surprisingly, most outbound students are women!
• Women are courageous intellectuals endowed with powers of rational thought and creativity
• Why?

UN HeForShe and 10x10x10 programs

Nagoya University initiates and takes part in many programs for and with women. Here two examples:

• HeForShe, see also: https://en.wikipedia.org/wiki/HeForShe
• IMPACT 10x10x10: 10 Governments x 10 companies x 10 Universities: Nagoya University is one of 10 “University Impact Champions”

Today’s conclusion

Ladies will rescue “the world at risk” and give us hope!

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