Analysing the behavioural responses to COVID-19 among the residents of Kobe, Japan

During the early stages of the pandemic, many people globally did not get the healthcare they needed because of fear of COVID-19 infection, imposed restrictions on movement, or unaffordability of care. In Japan, studies have shown that it was common for people to adopt unhealthy lifestyles related to their diet, physical activity, or social activity, thereby increasing their risks for poor health outcomes. However, there is still a lack of research into the health impact of the behavioral changes caused by the COVID-19 pandemic, both globally and in Japan.

To describe the behavioural changes among the population 20 years and older, in Kobe City, Hyogo Prefecture, Japan, before and after the COVID-19 pandemic, and the effects of these behavioral changes on the health of this population. 

• Cross-sectional and longitudinal analysis of Kobe City’s administrative data on medical care, long-term care and public health services use and population health and lifestyle surveys for the years 2016 to 2023.
• Study outcomes include health-promoting/risk behaviours, health status, physical function, loneliness/social isolation, oral health, health care use and eligibility for long-term care services. Sociodemographic variables associated with those outcomes as well as area-based inequalities were analyzed.
• Study samples included:
  • approximately 400,000 adults, 20 and older, who were registered in the city’s integrated health care data system between 1 April 2016 and 31 March 2023;
  • older people, 65 and older, who participated in one or more waves of a panel survey on health and lifestyle behaviors conducted jointly by Kobe City and JAGES in 2016 (n=12,107), 2019 (n=10,668) and 2022 (n=11,070); and
  • working-age adults, ages 20-64, who responded to one or more waves of a panel survey on health and lifestyle behaviors conducted jointly by Kobe City and JAGES in 2018 (n=5,609) and 2023 (n=5,345).

This study identified possible impacts of the COVID-19 pandemic on the behavior and health of an urban population. By combining government health care data and population-based survey data, the study revealed factors that contributed to both vulnerability and resilience in local communities.

• Behavioral Changes: Both younger and older people showed a decline in social participation and interpersonal communication comparing before and after the COVID-19 pandemic. However, as an exception, older people’s participation in kayoinoba (community-based gathering places designed to promote social interaction among older people to prevent frailty and functional decline) and income-generating activities increased during the same period. Community-based programs such as kayoinoba may have mitigated negative impacts of the pandemic among older people.
• Health Outcomes: Increased prevalence of depression and insomnia were observed among working-age adults, while frailty and hypertension increased among older people, suggesting that the pandemic may have had different mental and physical effects depending on age.
• Preventive Care: Attendance rates for health check-ups/screenings dropped sharply during the pandemic, especially among socially isolated and low-income individuals.
• Health Inequalities: Health and social disparities were identified between different areas of Kobe City, underscoring the need to conduct health equity assessments and develop policies and interventions that target the more challenged areas.

These findings suggest that Kobe City has the potential to serve as a model for a data-driven and community-centered city that is resilient to future health crises.

This project contributes directly to WHO’s ongoing global efforts related to the Decade of Healthy Ageing (2021–2030) and the WHO Fourteenth General Programme of Work (GPW 14), both of which emphasize all people’s right to health and the importance of creating resilient health systems capable of protecting populations during emergencies.

Findings from the study indicate that it is critical to have an integrated approach to support social participation and health care to maintain people’s wellbeing during public health crises. These research outcomes reinforce WHO’s global agenda on:

• Strengthening community resilience and promoting Healthy Ageing by enabling social participation and reducing isolation.
• Improving health equity through local data systems that identify vulnerable populations and guide targeted responses.
• Building pandemic preparedness at the city/subnational level through interoperable health and social care data systems.
• Supporting whole-of-society approaches, responding to WHO’s call for multisectoral collaboration between local governments, academia, and communities.

This case study offers a globally applicable lesson on operationalizing WHO’s frameworks for resilient cities by demonstrating that long-term investment in community-building activities (i.e. strengthening social participation) before a crisis may have the pay-off of enhancing public health response capacity.

For Kobe City, the study provides actionable evidence to enhance local public health strategies and strengthen preparedness for future health emergencies. The findings suggest the following policy directions:

• Expand and sustain community-based initiatives, such as kayoinoba, to reduce social isolation, frailty, and health disparities.
• Ensure continuity of prevention services (e.g. health check-ups/screenings) during crises through outreach and digital technologies.
• Address residential area-level inequalities by prioritizing resource allocations and delivering tailored interventions in disadvantaged areas.
• Strengthen data integration and governance to enable timely, evidence-based decision-making across health and social care systems.

By reflecting these suggestions in ongoing urban health and healthy ageing strategies, Kobe City can continue to exemplify a “learning city” approach—translating evidence into sustainable, equitable, and resilient health systems.

Journal articles and other publications from this project are expected in (or after) 2026.