Thomas Jefferson famously said, “The man who reads nothing at all is better educated than the man who reads nothing but newspapers.” As cliche as it’s become, the quote still rings very true to me as an avid newspaper and online news consumer.

Even today, it is very easy for those following the news to get caught up in the story of the day and completely miss the big picture. Part of the reason for this is that a news story is quite often the end result of months and months of researching, campaigning, planning, cost-benefit analyzing, focus grouping, intra-group wrangling, or any combination of the above. Therefore, when the average reader sees an announcement, whether it’s for a new hamburger at Wendy’s or the Barack Obama Speech About Race, we are forced to accept the basic premise and set of facts presented, and prevented by our own ignorance as outsiders, and the immediacy of reading information on the Internet, from seeing different parts of the story. The only possible response from the consumer is a sort of tit-for-tat reaction to the new information.

With that in mind, I want to talk about “Metabolic syndrome,” a set of symptoms, including overweight and high blood pressure, that puts one at risk of “lifestyle diseases” such as diabetes. In many cases it is indistinguishable from obesity (and in modern Japanese the terms are used somewhat interchangeably), but it is apparently useful as a medical definition.

The term became especially popular in Japan in 2007, as popular TV shows, infomercials, newspapers, and even the government played up the disease as a growing danger for Japanese people as they live increasingly sedentary lifestyles and consume ever-greater quantities of greasy Western snacks.

The English-language news media has noticed this phenomenon. The Japan Times, a local Japanese English-language newspaper aimed at the expat population, notes:

These days, not a single day goes by, it seems, without there being a fitness-club flier, a beverage ad or a new recipe that contains some mention of metabo, short for “metabolic syndrome.”

In contrast to the massive hype over the increasing problem of metabolic syndrome, the introduction of “specified medical examinations” at the beginning of this month has received much less fanfare. Under this system, all insured persons aged 40-74 will be required to undergo a yearly health check up, followed up by mandatory “guidance” if they are diagnosed with certain conditions. Metabolic syndrome is perhaps the most controversial, as people diagnosed with the condition may have to go through “active guidance” if they are particularly fat.

Coinciding with the introduction of this program is a series of article in the Nikkei Shimbun by a major corporate research group (I think Nomura) titled “the Emerging Metabolic Syndrome Market.” The series is ongoing, but some of its main points can be summed up as follows:

1) The specified examination system will result in thousands, if not millions, of people being officially diagnosed with “metabolic” syndrome.
2) The current medical establishment does not have the capacity to handle all these new “patients” so the mandatory follow-up care will be left in the hands of outsourcers.
3) The program, part of a Koizumi-era medical reform plan (also featuring increased premiums and patient contributions), is intended to make people healthier, which will reduce Japan’s total medical bill. However, actual cost savings will probably take at least 25 years to emerge, and in the short term the government will be dishing out massive largess to whoever can fill this current legally-mandated demand.

The Japan Development Bank has estimated that this metabolic syndrome market will grow to 280 billion yen, a “chance for medical institutions facing harsh business conditions [due to a drop in government payments in the national insurance scheme] to improve their revenue.” 45% of the 9.45 million targets of the system are expected to be judged as metabolic cases or in danger of becoming so, resulting in extra medical expenditures of 73-141 billion yen per year.

This specified exam system has been in the planning stages for years. In the meantime, the media has fanned popular worry over an obesity epidemic, couched in the convenient, one-word slogan “metabo.” And now doctors, or their counterparts in third-party examination centers, have the correct mindset and the legal authority to start diagnosing the problem and mandating treatment. The media, over the past two years or so, has featured the problem of metabolic syndrome in perhaps dozens of creative segments, ranging from features on anti-metabolic syndrome products, to informative explanations of the waist size/internal organ fat conditions for the diagnosis, to wackier efforts by Health Ministry officials to document their efforts to lose weight.

While the term metabolic syndrome is not new and is not a Japanese invention, the intense media campaign has injected the word “metabo” as synonymous with obesity in the Japanese language, with the added twist of hipness (new, trendy words are always a topic of small talk in Japan) and the specificity that comes with “metabolic syndrome” being the name of an actual disease rather than a mere physical attribute.

Without this propaganda campaign and the re-definition of the word obesity, it is unlikely that a vibrant market for anti-metabolic syndrome products would develop as effectively. But taken together, public awareness of the issue is so high that a diagnosis of metabolic syndrome will make much more sense to people and may make them more receptive to attempts to influence their behavior in a healthier direction.

I see two ways to view this major awareness campaign to alert everyday Japanese to the dangers of obesity – either Japan’s medical establishment has come up with an ingenious method for preventive care that will ensure that the life expectancy for Japanese people extends well into the 90s, or government, industry, and the media are conspiring once again to manufacture demand to solve a non-existent problem.

True, it seems like there is a real obesity problem here and a comprehensive plan focused on preventive care (i.e., fighting unhealthy habits will help prevent more serious ailments such as diabetes and heart disease) is a great idea. On the other hand, a massive, mandatory treatment program might be overdoing it, especially if it is taxpayer funded. The system does sound like it might be effective in addressing a real problem, to the extent that it encourages healthy behavior, and could lead to better quality of life for a lot of people. And as with the intention of many Koizumi-era reforms, the creation of new markets through smart regulation may be just what Japan needs to enliven its economy and, through the health benefits, help keep its working population on the job for the extra years that will be required in an aging society.

But my more cynical side tells me that the medical industry may not have Japan’s best interests at heart. If in fact, the expenses are not justified (and hundreds of millions of dollars in extra health burden with no promised overall benefits for a generation seems a little fishy to me) then the government could merely be entrapping its people into a handout scheme for the medical and health product industries.

Only 3% of Japan’s population is considered obese by body mass index standards, compared to ten times that ratio in the US. The figure has risen significantly for Japan over the past few decades, no doubt a result of the often mentioned higher living standards and Westernized diets. But as any prolonged contact with Japanese people will tell you, the demand for health supplements, beauty products, spa treatments, exercise machines, and all manner of health-related products is enormous. I wouldn’t be surprised if the market scale rivaled the US.

However, metabolic syndrome is a substantial redefinition of obesity (not that that is necessarily a bad thing—it seems to correspond much more closely to health problems than BMI, at least from a comparison of Wikipedia articles). Even if people are not fat in the traditional sense, they are much more likely to have the required body measurements for metabolic syndrome. And sure enough, media fanfare over this syndrome dovetails nicely with the ever-growing numbers of products offered to help fight it. And as any quick look at the Japanese mass media will tell you, there is no shortage of such products (today on NHK I saw a full-on infomercial for boxer briefs that force men to take larger strides when they walk, which will help them burn more calories during the day).

From my own observation of the Japanese user-generated media (which consists of a few favored blogs, a 2ch news aggregator, and the diary posting of my mixi friends), the reaction to the metabolic syndrome hype has been quite shallow, with perhaps zero discussion of this upcoming mandatory treatment system (until now, since it came into effect). Indeed, according to a survey translated at What Japan Thinks, almost two thirds of people are unaware that the specified examination system even exists. That, I think, is understandable since the coverage of this issue has tended to be in the form of corporate press releases quoted verbatim, statistics from medical establishment publications on the growing problem.

Honestly, I am no medical expert, and I do not intend to attempt a comprehensive assessment of the relative benefits of mandatory health exams for the middle aged, or of the real dangers of metabolic syndrome. But personally, I have been disappointed in myself for not giving this issue much thought until I ran across that series of articles in the Nikkei. Like many people, probably 75% of the reading I do in a given day consists of news articles, the paper newspaper, and blog posts. They are all quite entertaining to read and keep me informed of what’s going on in the world on a day to day basis, but the net effect of reading superficial day to day coverage is that I end up being completely in the dark about what sort of plans are being hatched behind the scenes.

The Japanese press has asked some of the right questions, and for someone more engaged the information is out there. A Yomiuri Shimbun report from last year cites experts who wonder why the waist size requirements are slimmer than those of other countries (a detail that can have massive implications on how many are singled out for mandatory “guidance” and whether that will affect people who are actually healthy), but in the end the hype has drowned out skepticism and a “metabolic syndrome market” is already fast being built without the knowledge of the vast majority of people. Residents of Japan may be getting fleeced in the deal in terms of increased insurance costs and dubious products intended to solve a problem that for many won’t really exist.

While reading about Asia’s newest self-proclaimed democracy I did a double-take at the following factoid:

Bhutan’s first democratically elected prime minister will be Jigmi Thinlay, a charismatic politician who has portrayed the DPT as the party of ordinary Bhutanese. His rival, Sangay Ngedup, leader of the rival People’s Democratic Party (PDP), is the brother of the previous king’s four wives, all sisters.

(Note to readers: I know my last couple of posts have been frivolous. Many apologies. This stuff is just too amusing not to blog.)

One of my best friends in college was a Taiwanese guy firmly in the “green” (pro-independence) camp. We had many conversations about the symbolism of green in the independence movements of both Ireland and Taiwan. We were also both into vexillology, the study of flags, and we often compared the evolution of Irish flags to the evolution of flags in Taiwan.

Fast forward a few years. Today was the St Patrick’s Day parade down Omotesando in Tokyo. Much to my curiosity, there were a couple of elderly Taiwan independence protesters out with their green Taiwan independence flags, which made for an interesting comparison with the Irish tricolors hung from flagpoles farther down the avenue. It was also an interesting contrast with the typical crowd of subculture groupies and bemused foreigners that hang out by the entrance to Yoyogi Park.

Despite being color-coordinated for the occasion, they seemed rather lonely at their posts. Apparently getting Taiwan admitted to the UN is not high on the political priority list of most Tokyo residents.

For whatever reason, green is an underused national flag color once you go east of the Indian subcontinent and the extensive Islamic influence in that half of Asia. Macau has a nice green flag (as does Tokyo), but the nations of East and Southeast Asia have generally adopted red, white and blue in varying proportions, with yellow stars sprinkled here and there.

The consensus among books I’ve read and people I’ve spoken to is that green became associated with Ireland (and its native Catholics) simply because Ireland is a very green country—they don’t call it the “Emerald Isle” for nothing. (Although green is prominent in the flags of other Catholic countries—Italy, Portugal, Mexico and Brazil for instance—it doesn’t have religious significance in the stories behind any of these flags.)

Wikipedia’s explanation for the Taiwanese independence movement’s use of green is that the Democratic Progressive Party adopted green because environmentalism was a major part of its agenda, and the color eventually became associated with everything else the DPP advocated.

In both cases, it seems that green took on another meaning: it drew a sharp contrast to powerful adversaries who flew red and blue flags, namely the British in Ireland and the communists and Kuomintang in China and Taiwan. Then you have the United States, where the Green Party is the most popular (if you can call it that) alternative to the “red” and “blue” parties.

I’m not sure if there is really a point to these parallels, besides that people will find ways to divide themselves by color even when they’re all the same color to begin with. The Irish flag acknowledges this in its own way—it stands for peace (the white mid-section) between two opposing sides (the green Catholics and orange Protestants). Ireland eventually got this peace after a few decades of faking it. Who knows where Taiwan is headed—all I know is that I will support a green flag in Asia, because this part of the world is crying out for vexillological diversity.

Do any of our well-informed regular readers have pointers to some more reliable and details information (in either language) on the Diet’s proposed Internet censorship legislation that everyone’s been talking about?

The following came out of the mouth of one of my parents’ neighbors:

I just don’t trust that Hillary. She’s soft on terrorists. She’s never gonna find Aladdin.

For those who are curious, the old voting machines in my area looked very much like this one, color and all

The actual controls were a bit different, and significantly the big lever was vertical along the right side, but you certainly get the idea.

Unfortunately, I couldn’t find a photo of the new machines I could embed, but you can see a hilariously 1980s educational film style demonstration of them, courtesy of the Essex County Clerk’s office here on their web site.

I just came back from voting in my first presidential primary election. I did vote in both the 2000 and 2004 general elections, but I was living at college an hour away and voted through absentee ballot since I did not want to skip class to come back to my hometown, the only district in which I have ever been registered to vote. But absentee ballots are not available for the primary, and I didn’t even consider skipping class for that (I believe I was also in Japan during the 2004 New Jersey primary).

I have however voted in person before, during a couple of the less significant election years between the presidential race, and I also spent several election days in the polling location at Edgemont Elementary School around the corner from my house when my father held a Democratic party position involved with supervising the polling station during my childhood.

Voting today was nearly the same experience as before. I told the man sitting at the A-K half of the desk my name, signed the blank signature line next to the photocopy of my signature from my voter registration card, and was given a pink voting slip, which I also signed. I had brought my passport along to use as ID, since I did not remember if any documentation is required, but in fact the only verification is a signature check, and knowing your own name and address. I then proceeded to the curtain-encircled voting machine and handed the pink slip to the woman sitting next to it. Her job is to collect each slip, make sure it is properly filled-out, and then pierce it on one of those spiked receipt collector things one often sees next to cash registers and the like. She then presses the button on the rear of the voting machine to prime it for the next voter.

Next, I stepped inside the curtain. This is the point at which there was a slight variation from the old days. I had grown up with the awesome yet clunky great blue mechanical voting machine, which had now been supplanted by electronic ones. There was something viscerally satisfying about actually flipping each little mechanical switch into the correct position before locking and then through the pull of the oversized lever on the right of everything else, transmitting your choices through a series of gears into the hole-puncher in the rear of the machine, encoding your vote onto the long and wide paper feed spooling one line at a time through the apparatus.

Now it is electronic, but thankfully not one of the overcomplicated and eminently hackable touchscreen monstrosities used in many areas. The New Jersey machine, at least the one I used here in Montclair, Essex County, simply has a plastic insert printed with the exact same material as the sample ballot I received in the mail a week or two ago, laid over a series of light-up buttons. When the machine is activated by the attendant, a backlight comes on behind the applicable ballot portion: Republican, Democrat or both depending upon your registered affiliation (both is for people like me who register as unaffiliated). Today is only a primary vote and not a real election, so the sole choice was for choice of presidential nominee. I clicked the Barack Obama button, the names of his four convention delegates to the right, the little red light behind his name came on, and I pressed the finalize button on the bottom right. It took only a couple of seconds, and I was out of there.

But in my heart, voting will never truly feel like democracy to me if you don’t get to pull a big, blue, metal lever at the end.

Update: How did my vote  do? Well, Obama and Clinton are currently looking like they’re tied neck and neck nationwide, Clinton won New Jersey by about 9%, but Obama won my Essex County by around 15%. I believe this means that, since delegates are more or less apportioned  at the county level, the candidate I voted for technically won in the election which my vote directly counted towards.

At least, that is how it is described in the words of Carol Lloyd, blogger on women’s issues at Salon.com. Due to the centuries as a Spanish colony, The Philippines is a firmly Catholic country-one in which the Church holds a level of influence rarely seen in the western world. Although the Catholic Church has oddly never managed to have any appreciable effect on the Philippines endemic Southeast Asian liberalism towards homosexuality and gender identity, they have managed to keep abortion illegal in all circumstances but to save the life of the mother. (More information on abortion in SE Asia here.) Although pre-conception birth control remains legal throughout The Philippines, in 2000 conservative Catholic Mayor Jose “Lito” Atienza of Manila issued an executive order removing all contraception from free clinics within the city. Many women in the desperately poor slums of Manila find it impossible to fit contraception in with food and other basic needs into their family budget, which has the eventual effect of a larger and even harder to feed family. This is what has women living in three urban slums to file a lawsuit demanding revocation of the order. From Reuters:

Emma Monzaga, one of the petitioners, said she was getting injections once every three months to prevent her from becoming pregnant, but was told on her third visit to a public clinic that the treatment was no longer available. “I was asked to go somewhere else to get the shots because the city hall has stopped funding the family planning program,” Monzaga said, adding her family could not afford to spend extra for contraceptives. “We used to get it for free. It’s becoming a burden because we have to eat and send our six children to school.” She said she has given up the idea of saving some money from her husband’s 300 pesos ($7) daily wage as a construction worker to pay for the vaccines because of rising cost of basic needs.

Amazingly, it took almost eight years before a local NGO managed to file the lawsuit “because the women feared political reprisals.” Unsurprisingly, there is now a different mayor in charge, and many hope that he will revoke the previous order without the need for the lawsuit to proceed. The Center for Reproductive Rights has a 50 page report, full of testimony, on the issue entitled “Imposing Misery: The Impact of Manila’s Contraception Ban on Women and Families,” which may be downloaded in PDF from their website at the above link. The report claims that the executive order violates the Republic’s 1987 constitution, stating:

The 1987 Philippine Constitution guarantees the
rights to liberty, health, equality, information and education for all citizens,
as well as the right of spouses to found a family in accordance with their
personal religious convictions. These basic principles, reinforced by
several pieces of legislation, create the foundation under national law for a
right to reproductive health, including access to contraception. [p. 9]

The report suggests that “The Manila City government should revoke Executive Order No. 003” as well as various further plans. [p. 11]

While many people look at issues such as these primarily in terms of individual rights and their effect on individuals and families, it is critical to consider the broader picture as well.

The Philippines today has a population of just under 90 million, a staggering number of whom live in poverty. I can attest from my own visit to the country that the cities are clogged with slums, illegal shanty-towns line the rivers and fill public parks, and the ratio of the population with no gainful employment appears to be easily several times that of anyplace else I have ever been. I have even heard that the unemployment rate in Metro Manila may be almost 50%.

Without high quality and aggressive family planning, that 90 million could nearly double in a generation- and the country’s scarce economic resources would be stretched even thinner. Could the unemployment rate rise even above 50%? Will The Philippines be plunged into a Malthusian crisis like Bangladesh or parts of Africa? Lack of birth control is hardly the only factor that has made Manila, and many other third-world regions, into dystopias, but it is one.