“Introduction”
Hitoshi Oshitani (Professor from the Department of Virology, Tohoku University Graduate School of Medicine)
　Data from various countries have shown that the extent of damage caused by the COVID-19 pandemic varies greatly depending on socioeconomic status and race. In Japan, data showing COVID-19 health disparities by social class and nationality are not publicly available to prevent discrimination and prejudice. Even though some people are more vulnerable to infectious diseases than others, the unavailability of such data makes it impossible to create public health interventions for vulnerable populations.

　In addition, even though workers in the “nightlife district” are at high risk of COVID-19 infection, their actual condition remains unclear because the Japanese share an unspoken feeling that measures for them should not be discussed. Thus, the impact of this pandemic on the marginalized social classes and foreigners in Japan has not been discussed. If we do not discuss this issue, we will repeat the same mistakes in the next pandemic. We must once again focus on and think about this issue that society has been neglecting.

Topic ➀ "COVID-19 and Urban Health Disparities"
Tomoki Nakaya (Professor of Environmental Geography, Tohoku University Graduate School of Environmental Studies)
　Health inequity is a concept whereby socially disadvantaged people are at greater risk of poor health. The term itself was widely known before the COVID-19 pandemic. For example, it is empirically known that in major cities in the West, health disparities manifest depending on where people live.

　In Japan, there were data indicating that the higher the poverty level of a region, the higher the mortality risk. This is most likely due to the "amplification-of-deprivation hypothesis”; not only the economic status, but also the environmental characteristics of marginalized people’s residences negatively impact them. This creates the basis for chronic diseases, which ultimately leads to health disparities. Urban planning rooted in environmental health equity had already received interest before the pandemic.

　As the COVID-19 pandemic broke out and spread globally—especially in large cities—a series of reports from a variety of countries indicated that COVID-19 mortality rates were higher in low-income and marginalized neighborhoods. Such areas were also reported to have prevalent risk factors for COVID-19 mortality, such as obesity. Furthermore, these regions are home to a high distribution of ethnic minorities (who tend to be marginalized). In other words, health disparities that existed prior to the pandemic have perpetuated and amplified COVID-19 morbidity and mortality disparities. We can describe this as a "syndemic": a fusion of the two words “synergy” and “epidemic”.

　In Japan, the first wave in 2020 showed a inverse socioeconomic disparity trend, with more deaths among economically advantaged people. However, as the epidemic progressed, the direct relationship between lower socioeconomic status and COVID-19 deaths became more apparent, especially in Tokyo and Osaka where the number of COVID-19 deaths was particularly high. To date, studies on health disparities in Japan have only been conducted at the prefectural level, and unlike Western countries, there is insufficient data on COVID-19 health disparities by place of residence. This is likely due to the Japanese cultural tendency to avoid examining disparities among minority groups. However, from the perspective of environmental inequity, such as where outdoor spaces to exercise are more accessible in wealthier areas, the impact of environmental disparities on COVID-19 health disparities has been proposed.

　Higher rates of suicidal ideation in more urbanized and low-income areas suggest that COVID-19 has also worsened mental health disparities. These findings suggest that viewing geography as a social determinant of health is valid not only for COVID-19 mortality, but also for related issues, such as physical activity and mental health.

　During the COVID-19 pandemic, the relationship between health disparities and place of residence was not as pronounced in Japan as in Western countries. This could be because Japanese metropolitan cities are densely populated, have comprehensive public transportation, and do not have as extreme poverty rates compared to the West. Consequentially, urban design equity has received less attention in Japan than in the West, and geographically linked health disparities can be considered an "overlooked disparity" in Japan. Upon considering how we can create a pandemic-resilient society despite declining birthrate, aging population, and suburb decline, it will become increasingly important to discuss urbanism—which considers environmental equity.

Topic ➁ "Activities of Futerasu [風テラス]”
Kanako Sato (Director, NPO Futerasu [support group for women in the sex industry] / Psychiatric Social Workers)
　Many of those who work in the sex industry, especially those who are engaged in sex-related businesses under the Act on Control and Improvement of Amusement Business, face various problems. This includes barriers to employment due to disabilities, illnesses, presence of young children, or mental health deterioration due to human relation issues. All these result in insufficient income. The NPO Futerasu is working as a free daily life and legal consultation service for those working in the sex industry.

　The majority of our clients are in their 20’s and early 30’s living in large metropolitan areas, including Tokyo. Clients tend to work in delivery health services, "soap," and esthetic salons for men. They are mainly concerned about poverty, problems at their stores, and slander. Consultants rarely disclose all facts, and sometimes they themselves do not know what is troubling them. In most cases, we hold only one consultation, and it is not always clear what happens afterwards.

　In April 2020, when the first COVID-19 state of emergency was declared in Japan, the number of consultations spiked to three times more than average. Most of the consultations were related to poverty, such as "I don't even have enough money to live tomorrow," but we also consulted with clients on social isolation, disability, domestic violence, and abuse. This suggests that pre-pandemic problems have become noticeable, and people were forced to confront them. The so-called "nightlife districts" have been considered hot spots for COVID-19, and the people who work there were suffering on the brink of death.

　The issues consultees face are not unique to the sex industry but are both a radical manifestation of the state of society and a microcosm of society. The social bias towards sex work affects these women, and they find themselves in a situation where they "cannot and do not talk to anyone" about it. These women are socially isolated due to both the nature of their work and problems in their family relationships. They struggle to live and continue to suffer because they have no one to turn to. We at Futerasu have no option but to wait until a consultee comes asking for help. However, we continue to send out the message that we want people to take action and feel free to discuss with us.