When the Spanish flu flared up just over a century ago, it claimed at least 50 million lives worldwide at a time when influenza vaccines were undeveloped and other treatments were ineffective. Society fragmented as people lost trust in government institutions and national health care services, which were just as ineffectual. The disease also killed a disproportionate number of young adults, which further shredded the world’s economy and social fabric.
Despite a far stronger health care environment and better immunization protocols, the COVID-19 pandemic similarly disrupted global society, killing close to 7 million people and infecting over 764 million, forcing governments, businesses and individuals to take radical measures to blunt its impact. While COVID-19 is on the wane, calls for governments to better shield their citizens from similar health care catastrophes are loud, clear and persistent.
Health is an essential element of people’s lives, social stability and economic development. Japan has a robust health care system and the life spans to prove it, boasting one of the longest overall life expectancies on the planet at 84.3 years. Many called on Japan to address other issues besides the Ukraine conflict at the G7 Summit in Hiroshima, and Japan readily agreed to make health care a priority. Japan had already laid the groundwork for an update on global health in August 2022 with the formation of a task force. During the last ministerial meeting of the COVID-19 Global Action Plan initiative in February — which involved the United States and more than 30 other countries, the European Union and various organizations — Japan formally announced this facet.
Leading by necessity
Japan is a logical choice for this spearhead role. The country’s robust health care system is inclusive and has a strong preventive care element. Since the 1950s, for instance, the Japanese government has promoted X-ray exams, made tuberculosis treatments free and expanded insurance coverage to preventive medications, such as hypertension drugs. Other examples of preventive care include free screening tests and prenatal and postnatal programs that include health and dental checkups.
Having health insurance in Japan is mandatory, and what people pay for coverage is typically based on income. Their contributions subsidize the system, which in turn subsidizes treatment, generally at a rate of 70%. Since spreading the burden minimizes medical costs, being driven into poverty by a medical condition or emergency is rare.
The government created an essential grid for health care in 1973 that may have potential in other countries facing similar imbalances in regional medical services. That’s when the Cabinet launched its “one prefecture, one medical school” policy to increase the number of medical schools and boost the number of physicians.
A similar policy specifically addressed a common geographic imbalance: a lack of rural physicians. Newly minted doctors would avoid less-populated rural areas, leaving them without proper medical care. Graduates from prefectural medical schools typically must commit to practicing for nine years in such regions. On completing that, their tuition is forgiven.
A rapidly graying population with all its attendant health care issues also makes Japan a test bed of sorts for new ways of handling elder care and end-of-life issues. For example, Japan has been dedicated to developing care robots for over two decades, including the technologies needed to handle both the physical and mental aspects of the job to offset the high numbers of elderly and the shortage of people available to care for them.
Some robots are tasked with physical care, such as mobility and exercise, physically lifting patients and monitoring their condition. Others are meant to be companions and therapists that stave off dementia and maintain cognitive levels.
According to the MIT Technology Review, however, robotic caregivers and helpers tend to create more work for their human counterparts. They also reduce vital human interactions and relationships. Even so, according to Yano Research Institute, funding for care robots in Japan is still growing. In fiscal 2021, this market was valued at ¥2.18 billion and is expected to be worth ¥3.63 billion by 2025.
The number of Japanese over 65 reached a record high of 36.2 million in 2022, representing 29% of Japan’s population of 124.9 million. According to the National Institute of Population and Social Security Research, that ratio is expected to rise to 35% by 2040. The country is also predicted to have a shortfall of 1 million medical and welfare workers by the same year.
Of course, Japan has the option of bringing in health care workers from abroad, and has deployed high-profile policies and recruiting and training programs for that. For example, Japan has brought in care workers through economic partnership agreements with nations such as the Philippines, Vietnam and Indonesia since 2008. With the EPAs facilitating their entry and training, care workers who obtain certification under the program may stay and work in Japan indefinitely. More recently, in April 2019, the government established a new Specified Skilled Worker visa category for qualified workers, including nursing professionals and those in other related services, regardless of nationality.
Working conditions for those brought in under the former initiative had been poor, unfortunately, leading to many returning home. A beneficial byproduct, however, is that they are bringing their expertise gleaned in elder care to systems that largely lack that knowledge.
Taking the initiative
Japan has reached out internationally as well to build momentum for global health through meetings and summits. The Japan International Cooperation Agency has supported developing countries through financial contributions to international organizations and the development of skilled workers through technical and financial cooperation.
When COVID-19 began spreading in 2020, for example, JICA launched the Initiative for Global Health and Medicine, helping to strengthen therapeutic and diagnostic systems through the expansion of hospitals. Around 200 million people in 22 countries have benefited so far. JICA has also provided over 2,500 medical personnel in 11 countries with remote training in intensive care. In addition, as of May 2022, Japan has sent approximately $5 billion to developing countries to fight the pandemic.
Even before the COVID-19 pandemic, Japan was leading the fight for universal health coverage (UHC). Since the 2000s, in fact, it has consistently made the concept of “human security” an essential pillar of its foreign policy. Since health is an integral element in human security to protect individuals, Japan is working on global health as a facet of diplomacy.
For example, infectious disease control was designated a major theme during the Kyushu-Okinawa G8 Summit in 2000, and the Global Fund to Fight AIDS, Tuberculosis and Malaria was established in response to this gathering. As of January 2022, Japan’s cumulative contribution to the fund totaled approximately $4.24 billion. By the end of 2021, the number of deaths from AIDS, tuberculosis and malaria in the countries in which the fund invested in had been cut in half, saving 50 million lives and increasing overall life expectancy. In 2015, to contribute to true UHC by applying the knowledge gained in Japan to global health issues, Japan formulated the Basic Design for Peace and Health, a global health strategy.
Japan also became the first G7 nation to make UHC a major theme at a summit-level meeting, at the 2016 Ise-Shima G7 Summit and the G7 Kobe Health Ministers’ Meeting. The country committed itself to making UHC a reality in Africa, Asia and other regions alongside the international community and various organizations.
A year later, Japan also cohosted UHC Forum 2017 with organizations such as the World Bank, the World Health Organization, and the United Nations Children’s Fund. The leaders of more than 30 countries, along with representatives and experts from international organizations, met to discuss UHC in their countries. As a group, they adopted the Tokyo Declaration on Universal Health Coverage, which includes a commitment to accelerate efforts to achieve UHC by 2030.
That declaration included zeroing in on target 3.8 of the U.N.’s sustainable development goals, which seeks to “achieve universal health coverage, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” The core goals are to ensure that people avoid financial hardship when accessing services, to protect them from public health crises, such as outbreaks, and to respond rapidly to those and other health emergencies.
Life after COVID-19
When COVID-19 came along, the urgency in all of this intensified. Writing in the online edition of the weekly medical journal The Lancet in January, Prime Minister Fumio Kishida focused on shoring up the glaring gaps in global health architecture that the disease exposed. One imperative is to strengthen pandemic prevention, preparedness and response (PPR). Another is to create more resilient and sustainable health systems that lead to UHC. He believes the concept of human security — which focuses on the importance of global solidarity — is the key to addressing this challenge.
Kishida laid out several strategic issues in his article. For example, he cited a need to strengthen global health architecture as a key goal. At present, there is an unfortunate lack of cooperation and information-sharing among relevant international organizations. There are also limitations on large-scale and rapid fund mobilization during the spread of infectious diseases. That was one of the underlying rationales for hosting the first G20 Joint Finance and Health Ministers’ Meeting in 2019 under the Japanese presidency. Monitoring and reporting on infectious diseases are also spotty, national health systems are weak and there’s a lack of support for developing countries.
Kishida also stressed the importance of developing a WHO convention, agreement or other international instrument on PPR, along with amending the organization’s International Health Regulations. He added that as one of the world’s rapidly graying societies, Japan bears a special responsibility to spotlight demographic challenges.
According to Kishida, the world also needs a more enabling ecosystem to make rapid research and development on medical countermeasures possible. He said Japan will follow up on the U.K.’s 100 Days Mission to develop and deploy safe, effective diagnostics, therapeutics and vaccines on a global scale within the first 100 days of a pandemic. That includes accelerating the development of research and development for PPR, and ensuring equitable access to vaccines, diagnostics and therapeutics under the overall umbrella of UHC.
Further reflecting Japan’s commitment on this issue, the Japanese government launched its Global Health Strategy in May 2022. Once again, human security was made a core pillar in this quest. The policy goals set are to make global health architecture more resilient, strengthen PPR to overcome health crises and pursue UHC in a more resilient, equitable and sustainable way. The keys to all that will require better detection, maintaining surge capacity, closing gaps in access to services, and making health care systems more adaptable to demographic changes, climate change and more.
More work to do
In his Lancet article, Kishida stated that driving innovation in health technologies — including the digital domain — is vital. On the basis of an assessment of global experiences during the COVID-19 pandemic, the G7 should explore ways to ensure equitable access to new technologies for future threats.
In this area, however, Japan still has work to do as a model and leader. For example, according to a December 2020 white paper from the American Chamber of Commerce in Japan, while many forms of digital data exist in Japan, prior consent is a vital one that is not often obtained. Even if the government possesses the data, it is still difficult to use because of considerations of individual dignity.
Another factor limiting the transition to a more data-friendly health care system is that Japan is not ready to switch to electronic health records because “data silos” prevent health care providers, patients and medical researchers from accessing key data. The ACCJ white paper also referenced 2016 data from the Organisation for Economic Co-operation and Development showing that Japan ranks low in technical and operational readiness and data governance readiness to develop national information from electronic health records.
And yet Japan has many answers for a world that can’t afford to be blindsided again by pandemics or other health crises, and is motivated to share them. As Kishida urged in his Lancet piece, the global surveillance network should be transformed into an effective early warning system for health threats. All people must have equitable access to new health care technologies, with the aim of leaving no one behind.
The expectation is that Japan’s hard-won experience and knowledge will lead the world to UHC. The G7 Summit in Hiroshima will provide a solid platform for moving ahead on that and other health issues to ensure the world is a healthy place for all of us.