From Rome, Drafting Global Health Agenda of G8 Summit

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On 11th, I went to Paris by the usual Air France last flight departing at 21:55.  I have been on this flight so many times for these 3-4 years.  You are able to work full day before going to Narita so it is convenient for flying to Europe.  London, for instance, it may even be possible to make it for a morning meeting if connection is good because you will arrive by 9:30 or so.

I arrived at Rome via Paris at 9:00 on 12th.  The hotel was elegant St. Regis Hotel I joined with Mr. Banno who arrived from New York and together we prepared for the next day’s “Global Health Forum”.  This Forum is held under the auspices of our Health Policy Institute and Aspen Institute Italia .  Other institutions such as Rockefeller Foundation, etc. are also giving support.

We are trying for the first time to reflect the process of "Global Health Summit; Toward TICAD, G8 and Beyond" (which we have organized last year) to the G8 Summit which will take place in Italy this year.  For this purpose, we held a preliminary meeting last December (Ref.1, 2).  Next day, the 13th, the meeting started at last.  Venue is within this gorgeous hotel.  The opening was "Welcome Speech" by Professor Petroni of Aspen Institute Italia, the joint organizer, and myself.  In the end of my speech, I mentioned that the Global Fund was founded through the active work of Japan and Italy at 2000, 2001 Summit, and that the host of 2001 Genoa Summit was current Prime Minister Berlusconi .

Participants were seated in circle around television screens for discussion.  I will show you more photos once they are ready.

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Photo2, 3:  The conference

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Photo4:  Mr. Massolo, the Sherpa and Dr. Chan of WHO.

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Photo5:  Minister Tremonti.

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Photo6:  From right, Minister of Health, Dr. Hatem El Gabaly, WHO Executive Director, Global Health Workforce Alliance Dr. Sheikh, Executive Secretary of GAVI Alliance Dr. Julian Lob-Levyt, ActionAid International delegate Dr. Noerine Kaleeba(Dr. Kaleeba is from Uganda).

Many important people such as WHO Director General Dr. Margaret Chan, Aspen Institute Italia President and current Minister of Finance, Dr. Tremonti, Sherpa of Summit in Italy, Dr. Massolo gathered for this meeting.  Mr. Keizo Takemi was also present.  As we were acquainted with each other through participation in Toyako Summit, I informed him about the outcomes we’ve achieved so far.  The members of this meeting were just outstanding.  Everyone participated actively in enthusiastic discussions.  At a time of such economic disaster, wouldn’t it be great if we could contribute to this year’s G8 Summit in Italy, however small the contribution is?  It would also be good for the presence of Japan in global society.

On this very same day, our article “Italian G8 Summit: a critical juncture for global health” was published in The Lancet, February 14th, 2009; volume 373, number 9663, p.526-7.  We wrote this mainly from “Japan’s experience on Global Health”. Most contents of The Lancet are free for access On-line for any users with registration.  I strongly recommend you to register.  Here, I will provide links to the On-line version and PDF for your reference.

G7 Finance Ministers' meeting will start from tomorrow in Rome so tonight there will be a reception, I hear.  Next week H8 meeting for discussion on health issues among G8 relations will take place as well as G8 Sherpa meeting.  Naturally, people involved are moving very busily.

In the evening, Dr. Peter Singer (Univ. Toronto) (Ref.1, 2) , Dr. Rajeev Venkayya of Gates Foundation, Mr. Banno and I went to a nice restaurant well known around here.

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Photo7: From right、Myself, Dr. Peter Singer(Univ. Toronto) , Dr. Rajeev Venkayya at Gates Foundation, Mr. Banno.

Dr. Vankayya said he had seen me more than a decade ago when I was Professor of Medicine at Todai.  I started Chief Resident Exchange Program with University of Michigan then, and he was one of the visitors to Todai under this Program.  What a coincidence!

 

National Vision, New Energy and Agricultural Policy

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Since the start of New Year, I’ve been posting number of columns in my blog concerning national vision of Japan.

Starting from January 1st, they continue to 7th, 20th , and 21st.  In the posting of 13th , I also touched upon the policy of Obama administration.

Today, I would like to report to you that an article on my lecture which I delivered in December and January appeared in The Asahi Shinbun newspaper of January 22nd.  Judging from the fact that the articles commenting on those lectures are getting longer and longer, I feel that people are gradually getting the picture of my “Story” which I have been telling. 

I really appreciate those comments on articles and other media when I think of current dynamic change in global society, disastrous situation Japan is facing, beginning of the new administration led by president Obama, movement of Japan, United States, and the world.

Now, how do we move from here? What is the next step? Please join in and take actions.

A new national vision

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On January 1st, I posted a column titled “National vision of Japan- in start of the New Year”.  There, I mentioned about my two lectures on December 8th and 11th, which touched upon a national vision which I would propose, from my own point of view, “to become an exporting country of food and clean energy by 2003”.

“The Nihon Butsuryu Shinbun (Japan Physical Distribution Newspaper)” January 1st edition, printed an abstract of my lecture on January 11th which appeared under the title of “Let’s become a net-exporting country of food and energy”.  (Since I haven’t read this draft prior to printing, I made some minor changes in particles and words.)

●“Introduction” Professor Kiyoshi Kurokawa at the National Graduate Institute of Policy Studies (GRIPS) gave a key note lecture on December 11th at “Eco products 2008” held in Tokyo (by the auspices of Japan Environmental Management Association of Industry, and Nikkei Newspaper).  He pointed out straightforwardly issues of Japan and energy problems to survive this global age.

■Monozukuri (item making) in Japan is vertical in structure from the beginning to the end.   The cell phone sales in the world is 3 million per day, and 40% of the share is taken by Nokia, followed by Motorola, Samsung (15% each), and Sony Ericsson of Japan (9%) finally appears at the 4th place.  But recently Sony is overtaken by LG of Korea, so the sales are not good at all even though Japan is standing as a Monozukuri country.  The good news however is that 65% of components are still made in Japan.  It’s because of the quality.  If we are to survive by making components, we must be like Intel.  Japan is patiently working to fill the 2nd, 3rd, and 4th contracts, but isn’t this because Japanese people do not know how to make stories, lack imagination, or world view?

●Countless useful technologies are at hand

■In energy problems also, the key is how to utilize the strength which Japan already have.  Water, forests, hot springs etc are natural resources that exist from the beginning.  Of course, we do have some weak points such as earthquakes… Why not use those natural resources as energy?  Take electricity for example ? is the current apportion of thermal power 65%, water power 10%, and atomic power 25% good enough?  Don’t we want to impress the world by coming up with some good idea?

■Atomic power might be good for the time being, but even in a huge country like America, they are having difficulty in getting the laws passed for disposal of the nuclear wastes.  People are so sensitive about those things.  Scientists say that with the technology today it is unthinkable that accidents will occur, but who can be so sure?  How about the possibility of terrorism?  (I added this.)  I would like to stress that Japan has so many technologies for not using nuclear power although we have ability to shift nuclear technologies to overseas.  For example, we already know that just 2% of the solar energy falling to the earth is enough to manage the energy needs of the whole world.

■I hear that some companies are fighting against the shift of current light to LED and other less power consuming devices, but I suspect that they are manufacturers who don’t produce LEDs and so on.  Similar problems exist also in aluminum sash industry, and I think Japan is the biggest consumer of aluminum sashes among the developed countries.  It is ridiculous to use aluminum for windows if you want to insulate heat because the material transmits heat so quickly.  Vinyl chloride or wood is much better.  Is it again just because of the opposition from the aluminum industry?  World is changing, so we’d better not make ourselves fall behind.

●“Let young people draw pictures for the future”

■I suggest that Japan set a goal to be a net-exporter of food and clean energy and this is possible, from my point of view, by 2030 if we really try.  Draft a 10 year plan, list missions for each 5 years and make a road map.  Have people evaluate the achievement constantly.  I don’t care who will work on the plans – government offices, think tanks, or whatever, but people over age 45 should stay out of this because it is a picture for the future. (people laugh)

■We have come to a year of turning point.  It is 150 years from the publication of “On the Origin of Species” by Darwin.  The most important message in this book is that in the long history of survival, it is not the strongest, not the wisest, but the one which has adapted most to the changes in environment of that age that has survived.  Today, environment has changed drastically.  Are we, the Japanese, going to keep on walking behind others?

Above are my points.  What do you think?

Ridiculous? Then, I suggest that you read the last 5 lines of my column of January 1st.

Emperor as a scientist

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Today, 23rd of December is a holiday for celebrating the 75th birthday of our Emperor, Akihito.

In my recent column, I’ve introduced you the extraordinary speech our Emperor has given at the Linnean Society of London in celebration of the 300th anniversary of the birth of Carl Von Linne and asked you to “read it by all means…”.

In the New Year special edition of Asahi Weekly magazine (Jan.2 and 9th editions combined) now on sale at bookstores, appears an interview of Dr. Toshitaka Hidaka, ethologist, and Mitsumasa Anno, artist, in which they comment on this Emperor’s address.

Those two giants of Japanese culture commented very much like I did about this wonderful speech of the Emperor.  I was so delighted that although my previous introduction of this speech to the public was by a sheer chance of being invited to Kobe symposium on preservation of bioresources, I had to ask all of you again to “read it by all means”.

My article on “Mainichi Forum” December 2008 edition

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The following article of mine was carried on the December 2008 edition of “Mainichi Forum” in the section titled “Views”.

A “Community PTA Anyone Can Participate” at elementary school can improve regional unity ? Academics and college students should volunteer

Family health is important for individual health, while community health is necessary for family health. This is the basic idea I have strongly advocated as the chairman of the government’s New Health Frontier Strategy Conference when we compiled a report called the “New Health Frontier Strategy” last April.

The report identifies among its top priorities health of children, women, and the working-age population and increasing the healthy life expectancy of the elderly. What I stressed in particular is to review the role of family and strengthen regional communities in order to promote health with a focus on preventive measures. Increased urbanization, nuclearization of families, the declining birth rate and the advance of women’s role in society is making it increasingly difficult to pass knowledge and skills forward to the next generation in domestic life and child rearing, as well as culture and tradition. The weakened family is now on the brink of collapse. As a result, some young parents don’t know what to do when their child’s temperature suddenly goes up and rush to emergency rooms. The fundamental problem is that basic skills to raise children are not being passed on due to the collapse of family.

Just as a firm root and trunk are necessary for strong branches and leaves to grow on a tree, vibrant families and regional communities are important to be at the foundation of sound individual health policies. Discussions that lack such a broad vision will result in lousy policies.

In urban society, it is important for regional communities to complement weaknesses in families. In Japanese communities, however, a sense of unity is unfortunately diminishing both in cities and rural areas. A disconnected community puts people at big risk if anything should happen. On the other hand, a unified community creates a greater chance for neighbors to notice when something is wrong with an elderly person living alone. There is also more cooperation when disasters strike. Developing a strong community is essential in nurturing family bonds.

In Europe people have traditionally gathered at public spaces in their districts or local churches where they share their beliefs. We, however, don’t have such places in Japan today. So, I would like to propose the use of the 22,000 elementary schools around the country as community gathering places. Schools are usually located in areas that are relatively easy for anyone to reach because children as young as first graders commute. They can serve as centers of community where elders, young people and mothers in the area can congregate at their free time. This can take off heavy responsibilities placed on teachers, giving them more time to focus on teaching classes because the people who have gathered can look after the children too. Schools will in essence have a running “Community PTA Anyone Can Participate”. If a child becomes sick the mother can seek advice from other mothers on what to do, or may be able to find somebody they met there to look after the child. Naturally people may talk about their doctors of preference, and this will result in local physicians becoming part of the community too. Local governments can provide mini-bus services going around the district picking people up and delivering them to school. They should also support voluntary community activities that continue on the weekends.

Inside this community, many adults will be looking after the children’s well-being and food. Some elderly people may even scold kids at school for not eating breakfast in the morning. Having this kind of relationship with other community members is important for young boys and girls, especially since there’s a recent increase in children who have never been scolded before. Even outside of school, there will naturally be more people calling out to the kids on the streets. This will help improve their attitudes and behavior because they will be conscious that others are watching them. Parents can feel safe to leave their children at school until around 6 pm, knowing that they will have a wide variety of things to do such as study, read, exercise and play under the supervision of many adults. It will also give teachers more time to focus on their work and may improve their relations with parents.

A sense of unity can contribute to preventive care

Women(and men) who have grown up in nuclear families don’t have much contact with their siblings or grandparents and hardly have any experience in holding babies or lulling them to sleep until they get married and have children themselves. These women can receive support and a sense of security from the community, as many people will try to help them on a daily basis when they see that they are pregnant. This will contribute to developing a brighter society. Separately, people in the community can help each other by casually sharing episodes like how they quit smoking or overcame the Metabolic Syndrome through exercising. In this way, adequate preventive care will be promoted in the community not through a top-down government policy, but through a sense of togetherness.

There are nearly 500 public health offices nationwide, but a sense of unity seems to develop more in areas where their staff or nurses actively reach out to the community. So, it is important for members of these facilities to interact with local residents on a daily basis.

Another point I have advocated is for university faculty and staff members and graduate and college students to volunteer at local elementary, junior high or high schools for about 20 hours a year (including weekends). By teaching alongside school teachers, graduate students and university faculty can develop confidence in their specialty areas while learning how to teach children. Another incentive for graduate and college students to volunteer would be to offer them teaching certificates. Many students may develop a desire to become teachers after volunteering at the schools. The education arena could change dramatically if a system is implemented to hire such people as teachers, even if they are in their 30s. Such flexible work styles and career paths would also strengthen the school-based regional community. Centers of community like those at elementary schools can also be set up at junior high and high schools, kindergartens, facilities for the elderly, and hospitals. Local governments should support such programs that will help form communities that anyone can participate.

There is a movement that is likely to positively influence the formation of regional communities. It is called social entrepreneurship and is spreading around the world. One example in Japan is a non-profit organization called Florence that supports working women. It is a day-care center specifically for sick children and operates on a membership fee which amounts to several hundred dollars a year. The center has a registered person from the local community look after a child who falls sick or, in some cases, dispatches a local doctor to their homes. This bottom-up style of management is a “social business,” and the founder is called a “social entrepreneur.”

Communities are not imposed from above by local governments, but we create them. In Japan we need to form local communities where people of different generations can interact, or else the lack of connection in both urban and rural areas could lead to the country’s collapse. So, it is “Back to Basics” in both public health and medical care. I would like to emphasize again that all health policies should be based on underlying principles that will create community health and revitalize family strength.

Is income disparity leading to mortality disparity?

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Inequality between rich and poor is increasing even in Japan and large number of unnatural accident is reported. People cannot depict a bright future, I suppose. Citizens are feeling insecure and living self-destructive life. This attitude spreads to families and then to children. Tragic news we hear so often these days are probably not irrelevant to this. Humans are social being and cannot live alone.

Under normal circumstances, everyone live life in their own way, but when something wrong happens weak people easily become victims as they are not flexible. During these 10 years, a notable increase is observed in suicides in Japan (Approximately 30%, the increase is mostly in men in 40s and 50s. What may be the reason? ). Collapse of medical system, unbelievably irresponsible “mismanaged” pension schemes and rise in irregular employment etc. —Japan politics and government’s failure in coping with the changes in global world is responsible for this. Victims of poverty will increase, I must say.

Medical care and education are social infrastructures that must be supported by government.  Current inadequacy of the support is resulting in inequality in the society that will be carried over for generations forming the major cause of social instability.

People from the low income group tend to refrain from taking medical treatments even if their health condition is poor. Social system of Japan structured in the period of economic growth is not working well now as there are problems such as increase in the self-payment burden, uncertainty of income, and household problems. Politics, government and society are not functioning for the reformation. Historically speaking, the people in “government, industry, bureaucracy” with vested interest formed a strong structure during the several decades in the latter half of 20th century and this is now working as hindrance to reformation. Firm collaboration mechanism is built among politics, government office, and the industrial world. At the time of economic growth, re-distribution of wealth to the society was functioning in its own way by the system of so-called "Iron triangle" in Japan. The basic systems indispensable to society such as education, pension, and healthcare were also functioning in a satisfactory manner. However, today, those people having traditional predominant rights are simply not coping with changes in the world environment which Japan is surrounded with.

“People from low income group die early” is a phenomenon that is often reported. This is basic human-rights issue and is the large core message of Commission Report of WHO, a conference held at London about which I have recently reported twice. For the OECD nations like Japan, disparity etc. are both domestic issues and political problems. This means it will depend on whom you select in the election. (Even if you disagree, this is the foundation of democratic

There is an article in Asahi Shimbun about recent performance of Professor Katsunori Kondo on economic disparity, health disparity, and “Life span disparity”. My comments were also published. Of course, I had a lot more to say but the space was limited. Similar behavior of people is observed in the research of our think-tank Health Policy Institute, Japan.

 

WHO commission, WHO Kobe Center and Global health

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I am attending the WHO Commission for Social Determinents of Health(CSDH) held at WHO Kobe Center from the 16th. Kobe Center serves as one of the hub of CSDH and 16 Commissioners are participating this time. As I have reported in my blog about the CSDH that started in March, 2005 (BeijingVanacouverGenevaNairobi etc.) this is the 10th and will be the last conference and the final report is due in June.

Thanks to Dr.Iwao, former Chief of Ministry of Health, Labor and Welfare who headed the WHO Kobe Center until December 2007, just until 2 weeks ago, for this meeting in Kobe. I’m happy that this was Dr. Kumaresan’s first big task after he newly took office in January. Former Director Dr. Iwao, new Director Dr. Kumaresan, the Governor of Hyogo Prefecture and the Mayor of Kobe attended the reception held at the night of 16th. And today, January 17th marks the 13th year of the Kobe earthquake. WHO Kobe Center was established the following year after suffering from the damage.

This is the last conference of CSDH and will be the only one held in Japan. This year, Japan will host conferences that will attract the world’s attention like the TICAD and G8 summit. Also, it is the mid year of the United Nation’s MDG(Millennium Development Goals). “Global Health” is one of the major global agenda. Last November, Minister of Foreign Affairs, Mr. Koumura addressed its importance in his speech and the content was published in Lancet.

This year, Japan will attract a lot of attention from the world which will also mean that it is a year of heavy responsibility as well. Nevertheless, stock prices are dropping in the year-end through the new year and sentiments are inward-focused in a stagnant mood as usual, don’t you think?  To cope with this environment, Prime Minister Fukuda will attend the World Economic Forum in Davos in the end of this month and make a speech. There will be a policy speech tomorrow (18th),  and the Davos Meeting speech will follow,  so the staff at the Prime Minister’s office will be very busy. 

With the understanding said above, we asked the Commissioners of CSDH to come to Tokyo in the morning of the 15th to pay a courtesy call to Prime Minister Fukuda and Minister of Foreign Affairs Mr.Koumura. In the afternoon, we held a global conference on “Global Health as Global Agenda” with the presence of Mr. Masuzoe, Minister of Health, Labor and Welfare. 

It was our attempt to urge the domestically focused Japanese to look at more global issues. It turned out to be very successful with about 200 enthusiastic participants. Keynote speeches and the panels were all wonderful. The Commissioners were also very happy about it. As being a member of the Commissioner myself, I was also very satisfied. Thanks to you all who have participated, the success is to your credit.

Nikkei Discussion with President Yonekura of Sumitomo Chemical and Professor Jeffrey Sachs

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Discussion with President Yonekura of Sumitomo Chemical and Professor Jeffrey Sachs, who visied Japan in March is published on THE NIKKEI WEEKLY(Vol 45, No.2, 287/May 28, 2007)

"Extreme poverty can be ended, not in the time of our grandchildren, but our time."

Source: THE NIKKEI WEEKLY(Vol 45, No.2, 287/May 28, 2007)