Japan's universal and equitable health system, now in place for 50 years, has put the country in a position to become a leader in global health. Yet governmental fragmentation, a weak civil society, and lack of transparency and assessment have made Japan's development assistance for health (DAH) budget low compared with many high-income countries. Now, 6 months after the Fukushima tsunami disaster in which the world has shown its generosity to Japan, the country must take centre stage in global health to help other countries. This fifth paper in The Lancet Japan Series is by Professor Kenji Shibuya, Department of Global Health Policy, University of Tokyo, Japan, and colleagues.
Although more than 70% of Japanese people rate health as the most important priority for the country's foreign aid budget, just 2% of the budget is spent specifically on DAH. Furthermore, in the group of G7 countries, Japan spends the lowest proportion of its gross national income (0.013%) on DAH, languishing well behind the top 2 countries (USA, 0.082% and UK 0.064%). It is also the only OECD country to oversee a continual decline from year to year in its DAH budget, whereas countries like the UK and France have substantially raised their budgets since the Millennium Development Goals were introduced in 2000.
The authors say that Japan's health expertise in achieving some of the world's best health outcomes, universal coverage, and high-quality long-term care is underused in tackling global health challenges. They say: "Japan has the potential to make substantial contributions to the health of the world as many countries move toward universal coverage and as Japan itself faces the challenge of maintaining its own health system…As a citizen of our increasingly interconnected and interdependent world, Japan should be actively sharing these accumulated insights with the international community and using them to strengthen national health around the world in pursuit of progress in global health." They add that the country should also be more engaged in helping developing Asian countries achieve universal coverage and meet the MDGs.
Japan can overcome obstacles to effectively share and transfer its diverse national health expertise in pursuit of global health by establishing a high-level governmental global health committee, increasing its financial commitment to global health, promoting innovative initiatives in the non-governmental sector, increasing Japan's research capacity, and developing Japanese global health leadership.
The authors say that because of the tsunami, "Never has there been a time in Japan when understanding the need for worldwide solidarity has been so important." Promising signs of change are occurring, with an outpouring of passionate Japanese youth determined to help those severely affected by the disasters.
The authors conclude that Japan, and all countries, have amassed countless insights in their pursuit of their nations' own health which have yet to be globally pooled. They say: "This is unacceptable. Collectively, this wealth of knowledge represents an almost boundless, but as yet untapped, source of potential lessons for a world that urgently needs them. The time to act is now."
Professor Kenji Shibuya, Department of Global Health Policy, University of Tokyo, Japan. T) +81 3 5841 3688 E) shibuyak@m.u-tokyo.ac.jp
Journal
The Lancet