News Release

The future for Japanese health: human-security based reforms, more power for local government, improving quality, emphasis on global health, and effectively dealing with the Fukushima aftermath

Peer-Reviewed Publication

The Lancet_DELETED

Japan's premier health accomplishment in the past 50 years is the achievement of good population health at low cost with increased equity between different population groups, but the future of this universal health coverage is now under threat from demographic, economic and political factors. The tsunami and nuclear crisis earlier this year heaped further pressure on Japan's ability to provide quality health care for all its people. To maintain and build on the 50 years of universal health coverage into the next 50 years, Japan must implement human-security based reforms, provide more power and responsibility for health care to local governments, improve the quality of care, and boost its commitment to global health. The final paper in The Lancet Japan Series is by Professor Kenji Shibuya, Department of Global Health Policy, University of Tokyo, Japan, and colleagues.

Japan's situation of low economic growth rate and unstable political climate creates a particularly difficult situation for addressing the problems of universal coverage and undertaking structural reform. For example, the need for new drug and device regulatory and approval procedures: new drugs appear in Japan an average of almost four years after their first entry into world markets. New devices and vaccines also lag behind.

Added to this, the tsunami disaster ruthlessly exposed the underlying structural problems in the health system, and made the three challenges (demographic, economic, and political) much more difficult to resolve fiscally. Management of chronic illnesses in disaster areas remains a critical health priority for both evacuees and non-evacuees, problems aggravated by the lack of exercise and high salt intake among evacuees in shelters. Mental health problems have emerged widely among the people affected, their family members, and the health and aid workers. The local economy has also been destroyed throughout the region. The radiation-related effects from the doomed Fukushima nuclear power plant are as yet unknown, and credible public information remains lacking.

Human-security based reforms must maintain the basic structure of compulsory enrolment in the social health insurance plan, based on the underlying value attached to equity in Japanese society; and also use good-quality research and scientific evidence to frame key choices in local, national, and global decision making. Health-care resources and funding responsibility should be transferred to prefectural government. Fragmented agencies should be consolidated into new institutions (eg, Japanese version of the Institute of Medicine, Centers for Disease Control and Prevention, and National Institutes of Health). Training and monitoring of subspecialties must be broadened to improve physician quality, and stringent benchmarking introduced. Finally, the country must provide opportunities for domestic and global health experts to interact, and mobilise Japan's accumulated knowledge, especially of the universal coverage, ageing and long-term care, and health and wellbeing for the past 50 years in the global health context

The authors conclude: "We propose that Japan should act as a platform for research and development of health systems and innovations, drawing lessons from all over the world about universal coverage, equity and healthy ageing in the context of human security, humanitarian responses to disasters, and health effects of radiation exposure. We believe this Lancet Series initiates a new era in which these hurdles can be overcome, and that broader lessons can be learned from Japan's successes and problems of the past 50 years."

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Professor Kenji Shibuya, Department of Global Health Policy, University of Tokyo, Japan. T) +81 3 5841 3688 E) shibuyak@m.u-tokyo.ac.jp


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