Current Issues in Social Medicine and Public Health from the Viewpoint of Early-career Researchers: Summary of Opinions at the Social Medicine Young Retreat

The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of research, practice, social contribution, and education in social medicine and public health, which relate to the core mission of universities. Early-career researchers and professionals play an important role in these domains, but little is known about the challenges and issues they encountered or recognized during this pandemic. Therefore, we summarized the opinions of 37 participants (30 early-career researchers and seven senior researchers) on this issue from discussions at the Social Medicine Young Retreat, 2019, of the Japanese Medical Science Federation. The retreat was initially planned to be held during March 5-6, 2020 in Yamanashi but was changed to be held virtually on March 5, 2021. Early-career researchers participated in group discussions on how social medicine should transform itself to serve the public during the COVID-19 pandemic. Afterward, each group provided opinions on challenges and issues in social medicine. For example, participants perceived difficulties in implementing research in a timely way and the lack of multidisciplinary collaboration. They recognized challenges in continuing practice because of the limited evidence on COVID-19. On social contribution, they described difficulties in communicating risk as professionals. They also noted issues arising from online teaching and learning. One group suggested that the essence of social medicine did not need to be changed, but methodologies should be updated to tackle multiple existing challenges. These opinions may not cover all issues but could help establish a better relationship between medicine and society in a bottom-up manner. The continuous promotion of interdisciplinary collaboration in social medicine (and basic and clinical medicine) would provide ideas to solve these issues at scale. Organizational support is warranted to ensure sustainability and scalability of these actions.


Appendix Table of Contents
Supplementary text. Additional evidence relevant to issues raised by early career researchers Figure S1. Top page of special website for Social Medicine Young Retreat 2019

Supplementary text
Scientific evidence relevant to issues raised by early career researchers is provided below as supplementary information.

Research
• The difficulty in data sharing was mentioned during the early phase of the pandemic (e.g., number of COVID-19 cases among healthcare workers) (1) . To promote research on the impact of health-related policies, sharing data on policies is important (2) .
• A Japanese survey showed that 83% of 66 post-doctoral researchers in health sciences perceived the influence of COVID-19 on their research activities in 2020 (3) .
• COVID-19-related restrictions were associated with a decrease in research motivation and anxiety about future research activities, especially among young researchers (4) .
• Science Council of Japan and Japan Science and Technology Agency, which plays an important role in Japan's Science and Technology Basic Plan, also summarized issues and solutions (5,6) .

Practice
• In legal medicine, challenges in infection control related to forensic autopsies (7) . A report during the COVID-19 pandemic also pointed out the importance of good infection control measures for autopsies (8) . Other reports during the COVID-19 pandemic also pointed out the importance of good infection control measures for autopsies (9,10) .
• While guidelines on implementing practice during the pandemic have been published and updated (11) , a report described a disparity in implementation of infection control by company size in occupational settings (12) . Evidence for implementation of practice is needed (13) . 3 • Some practitioners felt hard to find and digest an enormous volume of information on COVID-19 (14) .
• A survey in Japan showed that total claimed charges decreased during the early phase of the pandemic (15) . Surveys in Japan showed a 30% drop in the total number of individuals who participated in cancer screening in 2020 and 9.2% drop in the number of people with newly diagnosed cancer between 2019 and 2020 (16,17) . A recent cohort study also found fewer new diagnose of early-stage gastrointestinal cancer during the COVID-19 pandemic (18) .
• Japanese studies have shown that income level is not clearly associated with healthcare utilization, diabetes care and telemedicine use (19)(20)(21) , although these findings may have been influenced by selection bias and timing of exposure assessment.
• Physician shortage in local areas has been a long-standing problem in Japan (22)(23)(24) and their working hours will be limited by law in Japan (25) . To maintain the quality of medical services, information and communication technology might be helpful, especially in rural areas (26) .
• A recent Japanese survey showed that 54.1% of 37 occupational health practitioners experienced problems when using an online meeting service for interviews (27) . Another Japanese survey found that disparities in telemedicine use had widened across generations during the pandemic (28) .
• Working from home or teleworking has been recommended in Japan for infection control since the early phase of the pandemic (11,29) . Evidence on the effect of working from home on behavioral, health, and economic outcomes is limited in Japan (30)(31)(32)(33)(34)(35) . Similarly, health management for individuals working from home and effective vaccination procedure in remote settings were raised as challenges (36,37) .
• The importance of the flexible operation of administrative systems at various levels during 4 the pandemic was emphasized by participants. Examples include governmental response to COVID-19 (38) , research funding (39) , approval for COVID-19 vaccines and treatments (40,41) , public healthcare systems (42) , healthcare at hospitals and clinics (43) , community activities by volunteers (44) and education at universities (39) .

Social contribution
• Experts should respond to inappropriate information circulating on social media (45) . A recent report in Japan showed that the younger generation was more unsure about and unwilling to have COVID-19 vaccinations than older generations (46) .
• Lessons from the history of Hansen's disease are raised in relation to bioethical problems and violation of any human rights (47,48) .
• Development of resources for risk communication was recommended by Japanese government (49) , while only limited opportunities are available for researchers to receive training or education. Evaluation of researchers' performance in social contribution is unclear for early career researchers, who are often in a precarious employment position (50) .
The roles of experts and governments in risk communication were a major issue during the early phase of the pandemic (51) .

Education
• Live streaming for remote teaching was used in only 25.5% of universities in Japan in 2016, but used at most Japanese universities during the pandemic (39,52) .
• A copyright exemption in teaching was announced by the government (53) . The extent of instruction to teachers about copyright and personal information protection issues might have varied by institution (54)(55)(56)(57) .
• Problems related to online learning have been pointed out in Japan by researchers in medical education since the early phase of the pandemic (58,59) . These findings on education during the pandemic will be important in improving the quality (60) .
• Increased suicide rates among undergraduate students were observed during the pandemic (61) . First-year university students in 2020 had higher academic distress than the previous year's students (62) .
• The disparity in the information environment was identified during the very early phases of the pandemic (63) while online learning has been introduced everywhere. It seems likely that online learning will remain a feature of universities even after the end of the pandemic (64) .
proposal of building a research platform for infectious disease to make the nation resilient to infectious disease. 2020. Available from: https://www.jst.go.jp/crds/report/CRDS-FY2020-RR-05.html. Japanese.