Environmental Sciences & Natural Resources - Juniper Publishers
In the latter part of the twentieth century there
was, in some developed markets, a reevaluation of the basic definition
of healthcare. This led to a fundamental shift from a treatment
orientation to a prophylactic stance and expanding self-medication.
Social cost drivers were part of this transformation as well as an
increasing recognition of the impact and importance of lifestyle-related
disease. This led to a broader and more dynamic view of health that
needed improved health literacy so that individuals could make informed
lifestyle choices.
Attitude naturally drives behavior and the seminal
work that established the ‘Positive Health’ initiative offers a coherent
framework to effect healthy lifestyle behaviour. Social media, and
social sharing of healthy lifestyle can act as both a catalyst for, and
an accelerator to, the take-up of new such choices. Understanding what
is important to people enables policy makers and educators to engage
with communities in a relevant meaningful and effective manner. The
narratives that are shaping our digital lives can be the basis of
behavioural shifts that can enhance people’s QOL.
During a period of unprecedented and rapid changes in
people lives, caused by the covid-19 pandemic, this research, in Japan
and the UK, tracks some of the narratives that can enhance a ‘Positive
Health’ narrative. To ‘engage with engagement’ it is not simply having
the appropriate content, but it is also critical to convey the
appropriate tone. This is dramatically illustrated by the emotional
dynamics at a time of perceived vulnerability / uncertainty during 2020
global pandemic.
Keywords: Narratives; Positive health; Self-medication; Affect; QOL; Informed choice; Social; Sharing; Empowerment
A core tenet of The University of Tokyo’s LifeStyle
by Design research initiative is the increasing need to empower the
individual to make an informed choice about their own healthy life
options. To execute this policy demands greater health literacy amongst
the population. As self-medication and healthy lifestyle choices become
increasingly important social sharing of new ideas and practices can
readily go viral [1]. This will have the potential to drive major
attitudinal and behavioral shifts that enhance ‘healthspan’, rather than
just longevity.
Taking a LifeStyle by Design stance will improve an
individual’s QOL and potentially transformative and pervasive for
public and private sector stakeholders, alike. It is widely accepted
that roughly 60percent of mortality and 80percent of the global disease
burden are a function of just four LifeStyle choices- lack of exercise;
poor nutrition; smoking and alcohol abuse.
As countries try to balance their social health
costs, especially in ageing demographies, the increasing need for
self-medication necessitates that policy align with the attitudinal
shift from a treatment to a prophylactic priority in healthcare. As
such, the longstanding (from 1948; [2]) World Health Organisation’s
(WHO) definition of healthcare:
‘Health is a state of complete physical, mental
and social well-being and not merely the absence of disease or
infirmity’ is at odds with empowering the individual to make personal
and potentially ambiguous choices regarding their own health
The covid-19 pandemic has magnified the importance of
science and technology innovation to create a new and sustainable
society. It has also illustrated that any communications must be
inclusive and understood and embraced by multiple constituencies
to have a coherent effect. The diffusion of new ideas is greatly
enhanced by the almost ubiquitous participation in social. Indeed,
narratives and social media are integral parts of today’s connected
world. Critically, trust is paramount as it is amplified in a social
setting and more than ever people find trusted voices in their
networks.
State-of-the-art communication science, driven by AI, can
classify the utility of different narratives. They should be viewed
as complex, organic structures, with unique behaviours and
characteristics. Most of today’s, digital conversations, [82 percent
[1]] can be viewed as Transient and have no impact. Practically
it is also possible to identify Timeless and Transformational
narratives that can effect change, implement policy, and create
sustainable value. Significantly, this allows one to identify, at
any time, what is important to people, so that one can readily
participate with topical conversations in a relevant and credible
manner; to ‘engage with engagement’. It is more effective and
efficient to be part of the on-going story rather than to try to
intrude from outside, which has historically been the traditional
mass communication norm.
LifeStyle by Design proposes to leverage social media to
ensure the effective and efficient delivery of the appropriate
narratives, in context, to different constituencies. It is anticipated
that this will help create Community Value. We began in mid-2019
to benchmark twenty key narratives [1] in the UK and Japan, to
draw scalable communication implications for policymakers
and public and private institutions, alike. The original premise
was to understand what people wanted and that would enable
innovation to magnify and annex on-going trends. Beyond
creating a benchmark of attitudes and behavior, to monitor the
mood of society, it was also intended to be comparative in nature
focusing on both Japan and the UK, to help affect policy or monitor
any subsequent action plan. Naturally one can hypothesise
material differences in the nature of the narratives associated
with LifeStyle heath choices and self-medication, not only because
of cultural differences, but also due to differences in primary
healthcare provision between the two countries. For example, the
primacy of the General Practitioner as the interface for the patient
/ family in the UK.
Traditional consumer / market research is by its’ very nature
akin to looking in the rear-view mirror while driving. A different
approach adopted for LifeStyle by Design to explicitly extract
insights from on-going global narratives. To do this we chose
Significance System’s proven and proprietary platform earth.ai,
which analyses millions of behavioural interactions with content,
to model human interaction, and to provide an objective read on
engagement, media power, and the authentic, emotional drivers
of (new) behaviour. It can sense and quantify over 400 named
emotional states, in response to any story. The process considers
all open data online as contending for consideration. Significance
Systems follow a computational-reductionist approach applying
multiple layers of processing to identify and extract humanmeaningful
social-signaling structure within the petabytes of
raw topical data available to the first stages of our process. This
process dramatically reduces the volume of data to which they
then apply computationally intensive processes such as detailed
grammatical analysis. The textual content is interpreted within an
affect model. As such the understanding of the emotional depth
of the narrative, allows for better understanding and connection
with people.
The core premise, explore LifeStyle by Design innovation
opportunities, is that social sharing can be more authentic, and
trustable than traditional forms of mass communications and can
drive real world outcomes, it is now possible, with big-data based
communications insight, to;
a) Objectively explore these narratives to understand the
drivers and dynamics of changing behavior and consensus;
b) Probe what people value and feel are more important;
c) Establish how new solutions can be effectively
introduced to create new and better behaviours.
To ‘engage with engagement’ it is not simply having the
appropriate content, but it is also critical to convey the appropriate
tone. This is dramatically illustrated by the emotional dynamics at
a time of perceived vulnerability / uncertainty during 2020 global
pandemic, when it is evident that, with conflicting policy options,
unclear and sometimes contradictory messages only exacerbated
the difficult situation. Figure 1 shows the affect associated with
covid-19 from March 2020 when the country went into the first
lockdown through to mid-January 2021.
Affect is a rich measure of the emotional tone of the narrative. It
is felt emotion which is a powerful descriptor of future behaviour.
Below the horizontal we see negative emotions dominating
the positive senses (above the vertical). Initial panic (red) was
replaced by fear, grief, despair and resignation, and material
periods of confusion and anger. People’s resilience (above the
vertical) came through with a greater sense of belonging helping
to maintain hope and create optimism. One clear learning in
coping with the pandemic has been the need to have a positive
outlook, to obviate the heightened negativity. Anxiety and anger
has been exacerbated by confusing, contradictory messages from
local and central government officials. The Guardian [3] links this
confusion, with lockdown rules changing on average less than
every 5 days on average, for the 10 months since March 2020.
In line with this, in name and reality, the seminal work
[4] that resulted in the ‘Positive Health’ initiative is reflective
of a prophylactic stance regarding health. Critically, it offers a
potential, patient-centric, framework of health [5] in which social
sharing can enhance its take-up and diffusion. This represents a
major transformation from the WHO’s definition of health.
The dynamic concept of health as espoused by Positive Health
offers a broad perception of health (Table 1) that can readily
facilitate prioritizing macro policy decisions. That said, it helps
support the individuals’ own direction and is wholly consistent
with the broader challenges outlined in ‘The 100 Year Life’ [6]. In
practice, it can be readily used for a subjective assessment of one’s
state. Critically it facilitates the patient taking the lead and setting
their own actions, to reflect what is important to them. Huber [5]
devised a simple ‘spider chart’ to visualize the results, at any given
time. The basis of the spider chart are the 6 main dimensions
summarized in Table 1.
The sense of supporting the individuals own direction is,
Hasegawa [7] notes, like the Japanese notion of ikigai. She speaks
to the shift in emphasis of Positive Health from ‘restoring to
normal’ to ‘support ability to adapt’. Although there is no direct
translation of ikigai in English it connotes sense of purpose in
life or happiness in living and the secret has been the focus of
international best seller by Garcia & Miralles [8]. Empowering the
individual to the take the lead naturally requires a change in the
role of the healthcare professional, but it can be envisaged it will
reduce the need for care.
The benchmark primary research began in June 2019, with a
first wave of the LifeStyle by Design narratives in Japan and the
UK; followed by a second wave in December 2019; with a special
third wave, April 2020, when the UK was in lockdown and Japan
had the national emergency in place. Subsequent waves included
in this paper were in June and December 2020. This is the basis
of what is referred to as the LifeStyle by Design, Virtual, Living
Lab [9].
The vast majority of narratives, are Transient (82%). Such
narratives will fall away without significant investment. These
are poor choices for communications, since as issues, they are
not expected to persist or grow. Strategically, such narratives
are often easy to ‘own’, but they must be driven, or connected
to greater relevance and/or differentiation, to have any longterm
value. Tribal (11%) narratives are characterised by intense
debate, being driven by personal experiences or commercial
perspectives, bringing divergent POVs. The vast majority of
this debate, therefore has no impact. Although it is easy to be
a participant, it is far more difficult to be a player or leader in
such narratives.Those narratives that have the greatest potential
utility are Transformational and Timeless. Transformational (2%)
narratives are characterised by intensely, engaged experiences
with strong timeless themes. These narratives are fast-changing,
yet potentially result in lasting transformation of the world.
Timeless (5%) narratives are expected to persist or grow.
They are characterised by long-term, deep engagement These
narratives are good choices for communication activities. If one
considers the narratives of the top 100 brands / companies then
their effective communications strategies are focused. One sees
Timeless engagement representing at least 90 percent of the
narratives [10].
In tracking narratives that can shape our world, we recognize
explicitly that:
a) popular stories affect individual and community
behavior.
b) improve decision-making comes by knowing and
addressing what people feel is important.
c) relevant and timely communications, in context, can
stimulate change in perception and behaviour.
d) not just content but tone is important has been
exemplified by changing affect during covid-19 (Figure 1).
To leverage the strong story, it is now possible to go beyond
traditional media planning considerations and focus on the strong
narrative. Simply
a) Know what to say;
b) How to say it;
c) Who to say it to;
d) Where to say it.
For this paper, a subset of the 20 narratives [1] being
benchmarked, in Japan and the UK, is considered. These are
skewed towards the notion of ‘Positive Health’:
a) My Community (私のコミュニティ).
b) Personal Activity (個人的な活動).
c) Wellness (健康) #3.
d) My Resilience (私の回復力).
e) Motivation (動機).
f) Personal Optimism(個人楽観主義).
To develop the narrative Landscapes, we look at all online
sources, in Japan and the UK respectively, up to the date of the
research wave. There is no time window. So, depending on the
specific narrative, which self organises, it could be dominated by
recent content ... or not. The period of study, June2019 to December
2020, saw unprecedented and dramatic changes in people’s
behaviour, with covid-19 becoming a social media virus as well as
a biospheric virus. Already social and political commentators are
referring to the tectonic shift created by the pandemic in terms of
different era BC, DC and AC [Before- During- and After Covid-19]
[11]. During this tumultuous period, with minds altered, opinions
changed, and attitudes adjusted, it is not surprising that some of
the narratives themselves took on different characteristics (Table
2).
Some differences are evident in both the classification of
the narratives chosen above, between Japan and the UK, and the
extent to which a particular narrative has been stable over the
study period. Of all the narratives benchmarked it is evident that at
present there is higher average engagement for the narratives in the
UK [1]. For the UK, with the exception ‘Personal Optimism’, all the
other narratives studied are Timeless and therefore of potentially
value to effect change. In the case of Personal Optimism it begin
as Transient, perhaps because of the uncertainty around Brexit
in June 2019; became Tribal after the conservative government
majority in the election in December 2020, but by mid-2020 was
Transient it was only in early December that the first vaccine was
approved in the UK. [The UK was the first country in the world to
approve the Pfizer/BioNTech vaccine].
With relatively weaker levels of engagement in Japan,
only “My Community’, ‘Personal Activity’ and ‘Wellness’ are
broadly Timeless in Japan, and the remainder (‘My Resilience’,
‘Motivation’, ‘Personal Optimism’) are Transient. A priori the
Timeless narratives currently have the most potential to affect
attitudes and behavioural shifts. That is not to say that during
the study period the affect around these narratives remained
constant. One practical advantage of this Virtual Living Lab is
that the research waves can be as regular as necessary; our Japan
and the UK comparative benchmark has 2 waves a year; while the
information on the affect associated with covid-19 in the UK, is
tracked daily.
In June 2019 ‘My Community’ in Japan is Timeless but has poor
definition (weak content efficiency) (Figure 2). Content Efficiency
is a measure of the extent to which the existing narrative content
is significant. High content efficiency means that much existing
content is significant, whereas a low score means there is a gap
between the needs of the narrative, and the currently-created
content. Affect Orientation (Figure 3) is a measure of the degree
to which the narrative stimulates an emotional response: active or
passive, positive or negative. Most narratives are simply neutral,
and do not provoke any emotional response. ‘My Community’
which is driven by an active, negative engagement, will polarise
opinion. Although it has the power to grow, to maximise longterm
power, it must transform from destructive and oppositional,
to being viewed in positive and creative way. The analyses
shows that YouTube is the media with most power around the
‘My Community’ narrative. Figure 4 shows how this has been
transformed during the pandemic so that the ‘My Community’
narrative projects a sense of delight being both active and positive.
Understanding of the emotional resonance of the narrative,
assists in the development of strategy for both content creation
and curation that can effectively disperse new ideas. Affect is a
rich measure of the emotional tone of the significant content.
Understanding of the emotional drivers empower you to better
understand, and respond appropriately to, the emotional impact
of the narrative. This is portrayed in Figure 5 for ‘My Community’
in Japan in June 2019.
In Figure 5, positive emotions are highlighted in green,
whereas negative emotions are red. If there is a clear tonality to
the emotions expressed, such as expectation or apprehension,
these are shown in purple.The intensity of the colour indicates
the intensity of each emotion. The width of each arc reflects the
degree to which the named emotion contributes to the overall
emotional response. Broad emotions, such as fear and love, are
closer to the centre of the chart. The more subtle emotions, which
contribute to those broad emotions, are shown in the concentric
rings further out. Moving out from the centre, each ring shows
a further level of detail. From June 2019 to December 2020 the
affect around ‘My Community’ becomes noticeably more positive,
although expectations and hope are somewhat weaker (Figure
6). The dislike coming from jealousy and envy that was evident at
the start of the study (Figure 3), has disappeared as the sense of
community became a more practical support, through closeness,
during the unprecedented changes, such as teleworking, caused
by the pandemic.
In broad terms a similar pattern can be seen over time in
the UK with “My Community’ becoming more important to
the resilience of the nation during the pandemic. In June 2019,
the Affect Orientation was more active and negative than in
Japan (Figure 3), indicative of the disgust and opposition being
stimulated by the Brexit debate. By June 2020, there is evidence of
a sense of satisfaction and content, as well as pride providing hope
to overcome the defeatism that drives, resignation and despair
(Figure 7), as the Affective Orientation has become positive, but
neither active nor positive.
With enforced isolation the pandemic has triggered reflection,
soul-searching and friendship has been redefined and taken on
new forms Not surprisingly, the affect around the Family, is both
active and positive and despite being surprised and astonished by
the situation there is a sense of calmness, love and joy in the family
unit. Covid-19 is first a human tragedy, and we are witnessing
universal human values of love, purpose, and connectivity uniting
us. We can see that reflected in the broader narratives tracked,
in the UK, by LifeStyle by Design’s Virtual Living Lab, where in
December 2020 ‘Personal Friendship’, ‘Personal Bonding’, and
“Personal Satisfaction’ are all Transformational. As we look to the
future, we should support the things that bind us together, and
invest in our communities at scale. We can imagine that role of
convenience stores, especially in Japan, will have the potential
to become more integral to daily ‘community’ living, community
health, and contactless experiences; less about casual shopping
but more mainstream as people are now concerned about dining
out and queueing in supermarkets. Ito-Yokado have recently
announced they will start a nationwide mobile supermarket
channel in 2022 to help ‘stay-at-home’ consumers have access to
daily perishables.
Our study period has seen abrupt and fundamental changes in
‘Personal Activity’. In June 2019 the affect orientation of ‘Personal
Activity’ had active, but negative engagement, which can polarize
opinion. The strongest impact on topical engagement was found
at http://news4vip.livedoor.biz. By December 2020 the affect
orientation of the ‘Personal Activity’ narrative had changed to be
active and positive and therefore had created some momentum
with its positive engagement. The most powerful content driving
the narrative was found at Yahoo Japan. During the same period
a similar trend could be seen in the UK. One sees similar shifts
in emotional cues from negative to positive, but they have also
become weaker, perhaps reflective of the increasing lack of ‘real’
control people have over their time.
At the heart of LifeStyle by Design’s interest in ‘Positive Health
[7] is the notion of Wellness. In both countries Wellness is a
Timeless narrative which suggests that it has long term and deep
engagement potential and can be driven by a small number of key
players, leaders, who are considered experts and authorities. The
affect orientation of Wellness is positive and active, while most
narratives are simply neutral and do not provoke any emotional
response. Therefore, if one magnifies the enthusiasm, optimism
and energy of this narrative then it can grow further and be adapted
to drive meaningful behavior. However, in the UK it is relatively
well defined compared to Japan. In both countries YouTube has
a significance influence as the media that drives the category but
in Japan it is also evident that local culture (cf. manga), and social
media play an important role. A visual exploration of the content
shows very little difference between Japan and the UK.
In the UK, in December 2019, Wellness is driven by four
principal topics and themes which were interrelated and
personal: Global Wellness Institute, body, wellness and weight.
One year later in December 2020, the key topics have materially
changed to ones which have a macro and public policy skew:
health, investment, workplace and care. These are shown in
matrix (Figure 8) It shows the topics which are driving emotional
engagement, and the tone of the associations between them. Green
indicates a positive association, and in this instance, there are no
negative associations. White means a neutral connection, and
blue, an association driven by anticipation and expectation.This
matrix gives you an ‘at-a-glance’ view of the overall complexity,
engagement, and tone of the narrative.
In Japan in December 2019, there were a wider number
of different topics and themes (Figure 9), compared to the UK,
driving emotional engagement. Many of these interrelationships
were positive (as indicated by green), but (lack of) exercise and
health have a negative association (red). However, the situation
had changed materially one year on, in a similar way to the UK
by becoming significantly less personal. The key topics with this
narrative included management, Tokyo Stock Exchange, personal
perspectives and work, Ministry, health, collaboration and
perspective. The association between each of these key topics had,
after almost a year of the pandemic, all become negative!
For many observers around the world [12], including Japan
[13] there has been a heightening of mental health concerns
during the pandemic. Fujieda city in Shizuoka took an unusual
step for their senior residents (living alone or in care homes)
as they would be unable to receive visits from family/friends.
The municipality made robotic companions (PaPeRo from NEC
Corporation) available for rent. Speech recognition enables
PaPeRo to have conversations, and other functions enable the
elderly to keep in touch with family/friends electronically.
Significantly, it can be also used for health monitoring by tracking
the senior’s activity.
Of all the narratives tracked in the LifeStyle by Design’s
Virtual Living Lab, ‘Motivation‘ in the UK has consistently been
the strongest Timeless narrative tracked, as shown in the UK
narrative landscape, for December 2020 (Figure 10). This may
be a reflection of cultural differences between Japan and the UK,
where individuality and short-termism are relatively important in
the latter [14].
‘Motivation’ has consistently been driven by active, positive
engagement and, as such, has momentum. Powered by enthusiasm
and energy, they exhibit growth and adaptation, and drive
behaviour. The positive emotions associated with ‘Motivation”
are about satisfaction and a sense of content, but there are
some fear and dislike that has to be acknowledged and resolved.
Indeed, an American worldwide employment website owned
by the Japanese Recruit Co., in September 2020, produced some
especially powerful content [15] that provided practical examples
of different types of motivation in the workplace.
Health has moved to the top of everyone’s agenda as the
pandemic has fundamentally, and permanently, changed how
people live, work and what is important to them. In terms of
technology transformation, covid-19 has in many regards fastforwarded
our futures. In particular digitisation, data analytics
will increase predictive analysis to be used to personalize
healthcare and there will be greater consumerisation of the
(contactless) patient experience, only further heightening healthy
lifestyle choices.
This reframing of healthcare for society demands an improved
level of health literacy amongst the population and this can be
assisted by, as well as personal adoption of ‘Positive Health’
tracking help behavioural shifts towards, and maintenance
of, health lifestyle behaviour. covid-19 has been attitudinal
transformational, an equaliser, in that people are now talking more
about mental health and seeking treatment when they would not
have done before. There is need to create a momentum, and public
and private institutions will need to accelerate digital investments
and participation in ecosytems, where aligning with Lifestyle
narratives is likely to become more influential and impactful.
The imperative to communicate and really connect is to
ensure that the complex is simplified. Since most narratives are
Transient this is also indicative that not all screen time / social
media is productive time. Creating healthy, productive social
media user experiences has become topical given the increasing
reliance of social media and social sharing due to social distancing.
It is driving start-up investment [16] and generating dialogue
between entrepreneurs and social media specialists who believe
they can create better media options, that clarify content. Some
recent, social issue research [17] has identified latent desires
and conflicts, through data mining, in a way that can provide
greater societal understanding of subcultures, current issues and
potential avenues to better governance. That said, our approach
of engaging with engagement is more singular and focuses to
help attitudinal and behavioral LifeStyle change. Empowering
the individual through stories that go viral will have the impact
outlined in Narrative Economics [18].
As people evolve from DC to AC, they are looking forward
to experimenting with newer activities [18]. The pandemic
has brought forward people’s expectations in technology and
innovation, as well as a desire to streamline their lives. Companies
that recognize the new nature of convenience and community will
embrace mobility, contactless experiences, and social sharing to
create dynamic, future-forward behaviours.
With many different people/institutions naturally trying
to provide help and advice; the imperative is to focus on what
is important to people, now. Their health literacy is inadequate
for the demands of self-medication, never mind in the new
reality created by covid-19. Trust is an imperative but that can
be gained by talking and fueling the stories that are important.
The pandemic has sparked innovation, whether a start-up or an
established cross-border, MNC, today’s digital ecosystems enable
you to focus the right message, to the right people, and in the right
context. Listening is so underrated, but with a focus on objectively
understanding and leveraging important stories, public policy
and commercial enterprise, leaders, alike can affect change for the
good. Engaging with engagement can move people, and can move
markets, that will enhance people’s health and QOL. The critical
characteristic to enhance QOL is a positive attitude and a sense of
personal empowerment [19].
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