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What place should Japan occupy in the world? This existential question has troubled Japan’s leaders for the past two decades. Military leadership is restricted by the Constitution. Economic might has lost its glimmer. Cultural influence, epitomized by “cool Japan,” has yet to take center stage.

So whither goes Japan? The answer does not lie in the aforementioned “projecting out” of Japan’s military, economic or cultural strengths. The world does not need another global power to project its strength. What it needs is solutions to intractable global issues. Japan as the catalyst for solving global issues — this is the vision that Japan should aspire to.

At the 2008 Toyako Group of Eight Summit, Japan proposed addressing the following global issues: global economy; climate change; African development; and global health. Much has been talked about the global economy, climate change and Africa. There is work to be done, and Japan should contribute. Yet, Japan’s strengths in global health are less known. For leaders in Japan, the neglect is an opportunity missed for Japan to play a pivotal leadership role in the global arena.

Every year around the world, 6 million people, or one person every 5 seconds dies of AIDs, tuberculosis and malaria. Half a million mothers die during pregnancy and delivery, and 10 million children under 5 pass away each year. These deaths — which are preventable — are highly concentrated in poor regions of sub-Sahara Africa where infant mortality is 50 times that of Japan, and maternal mortality more than 200 times higher.

To prevent these avoidable deaths and to contribute to improved development and human security are the goals of global health. Japan is particularly well-placed to lead: After all, Japan has the longest life expectancy and the lowest infant mortality in the G8.

Japan was the country that first put global health on the G8 agenda. At the 2000 Kyushu-Okinawa G8 Summit, Japan brought the world’s attention to infectious diseases around the world. The discussions led to the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has contributed to saving 2.5 million lives to date.

Since 2000, global health has had a continuous presence on the G8 agenda. Resources deployed in the field globally have increased dramatically from $6 billion in 2000 to $14 billion in 2005.

In 2008, as Japan took over the G8 presidency again, other global issues threatened to crowd out global health — financial crisis, economic downturn, food shortages, fuel prices, climate change negotiations, to name a few.

Still, Japan kept global health on the agenda, and pushed for an aggressive set of commitments by the G8 to invest $60 billion over the next five years to fight infectious diseases and strengthen health systems; distribute 100 million insecticide- embedded bed nets by 2010 in the fight against malaria; increase the number of health workers in Africa to the target of 2.3 per 1,000 inhabitants; and to put into place a review mechanism to monitor how past commitments are being implemented.

How was it possible for Japan to take leadership in global health at the G8? This is an important question to answer as Japan contemplates its ability to become a catalyst for solving global issues. Three things made such leadership possible:

Political leaders stepped up and owned the agenda. Foreign Minister Masahiko Koumura rallied the world for action on global health in the medical journal the Lancet almost a year before the summit. Then-Prime Minister Yasuo Fukuda announced global health as a G8 agenda at Davos in front of world leaders in January 2008. Former Prime Minister Junichiro Koizumi created the Hideyo Noguchi Africa Prize to be awarded to eminent global health researchers, and the prize was presented last May. Meanwhile, former Prime Minister Yoshiro Mori chaired the discussion with most African heads of state at the Tokyo International Conference on African Development.

Other stakeholders also contributed. For example, in business, Sumitomo Chemical, the producer of the innovative insecticide-embedded malaria bed nets central to the global fight against malaria, was one of the two companies named by Bill Gates as embodying “creative capitalism” to address critical global issues. In the nongovernment organization sector, more than 140 NGOs gathered to create G8 Summit NGO Forum whose special task-force on global health organized events to galvanize the public, led advocacy, and built up a global coalition to demand G8 action.

Academia, headed by the Science Council of Japan, partnered with other G8 plus Five national academies to produce the first-ever joint statement focused on global health. Broadcast and print media publicized the field, and international celebrities who came to Japan to push forth the agenda — such as rock star Bono and economist Jeffrey Sachs — received broad coverage. All sectors contributed their part.

Multi-stakeholder platforms were created to connect government, business, NGO, academia and media initiatives. One was the Global Health Summit co-organized by Health Policy Institute Japan and the World Bank six months before the G8 Summit to build national momentum for the G8.

Another was a cross-stakeholder working group organized by the Japan Center for International Exchange that identified better coordination among various disease-specific initiatives, and a renewed focus on strengthening the overall health system (as opposed to building disjointed and suboptimal systems for each disease-specific initiative), as a key issue to be addressed at Toyako.

What will happen to all this momentum in Japan since the 2008 G8 summit? To address this question, Japanese stakeholder leaders gathered Jan. 17 in Tokyo, and agreed that all stakeholders should continue their efforts even amid the economic difficulties. The importance of engaging with the world and, in particular, contributing to an effective transition to the next G8 president, Italy, was emphasized. For this purpose, Health Policy Institute Japan has co-organized, with Aspen Institute Italia in Rome, a Global Health Forum set for Friday. Gathering stakeholder leaders in Italy, it will continue the cross- stakeholder engagement that Japan started in 2008.

As the country that has achieved the longest life expectancy in the world, Japan has an obligation and an opportunity to help people around the world on their central concern: their life.

M. James Kondo is president of Health Policy Institute, Japan and associate professor of health policy at the University of Tokyo. E-mail: info@healthpolicy-institute.org

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