Back to London, Part 2

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The final conference for the WHO Commission on the Social Determinants of Health was filled with wonderful sessions and panel discussions. It was the last formal gathering with the other Commissioners whom I’ve worked with for 3 years. The Commission’s final report is very unique. The WHO set up the special Commission to collect evidence of social determinants of health and recommend action, which is normally done by existing top-down orders of societies. So, the report’s recommendations will of course take time to put in place. Some of the recommended actions may simply be impossible. The greatest challenge is to implement what the Commission has identified. This is just a starting point.

In this "Hot, Flat, and Crowded" world, as Thomas Friedman puts in his new book, an unprecedented change is happening on a global scale. If humans cannot adapt, it will be too late. Different regions and countries are already being affected in ways that threaten to make the world unstable. Many people have been driven from their homes due to riots, strife and war. This is happening not only in Africa, but in areas of Pakistan, Palestine, Iraq and Kashmir. I fear that the situation may worsen over time. Poverty, lack of water, food and energy, and the movement of people will most certainly create further instability.

One piece of good news is that the United States seems to be on its way to regain trust and confidence of the international community by electing Senator Barack Obama as its next president. No one had imagined his victory even a year ago. However, Mr. Obama probably cannot afford to just focus on the rest of the world as he needs to fulfill his campaign promise to revive employment in the US.

In this global world, companies and non-government organizations will increasingly move beyond existing national frameworks and become more international. But politicians of democratic nations will basically remain local as they get their jobs by being elected in their countries.

I am posting some images from the conference. I hope you will enjoy the webcast and the website. You can listen to some amazing speeches by Hilary Benn (Photo 1&2) who I met at the May G8 Environment Ministers’ Meeting, Prof. Paul Hunt and former president of Ireland, Ms. Mary Robinson (Photo 3&4). I’m also in the Cafe Conversation on the afternoon of Day 2.

Dsc00241Photo1  UK Environment Secretary Hilary Benn

Dsc00275Photo2  With Secretary Benn （The red flower on his lapel is for Poppy Day to commemorate the war dead. I was wearing one too. ）

Dsc00276Photo3  Ms. Mary Robinson

Dsc00280Photo4  Ms. Mary Robinson and Conference MC, Mr. John Humphrys of BBC

On Friday, the second day of the conference, I skipped the final session and left for Heathrow Airport at 4:30 pm to fly to Dubai.

To London once again.

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After a meeting in Tokyo, I left Narita on November 4th, to London via Paris.  The travel was to attend the final meeting of Commission on Social Determinants of Health CSDH, WHO, where I served as one of the commissioners.  A report was neatly prepared by then.

Obama was elected for the next president at just about 5 am of November 5th local time, and I listened to his live speech on television at the lounge of Charles de Gaulle International Airport.  Wasn’t it a wonderful message?  Obviously the speech was a declaration of a strong will as the leader of America, perfectly aware of the attention that he attracted from the whole world.  "Google" the related sites, English sites, of course.

The fantastic thing about this meeting is that it is hosted by the Department of Health of Great Britain.  Approximately 500 people will gather from all over the world and not only the details will be broadcasted, but also the speeches and videos will be open to the public on internet.  Visit the web site in to get the idea of what has been discussed and feel the atmosphere.  My interview is uploaded, also.  I was a bit nervous, because it was <one to one> interview and I had no clue to what the overall program was like, or who came before and after me, or what the topics were, and also there was no rehearsal or editing, and lasted for 5-6 minutes.  It makes me sweat.

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Photo1:  Prime Minister Brown

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Photo2:  Minister Johnson

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Photo3:  Chairman Sir Marmot

The opening speech of 6th was delivered first by Prime Minister Gordon Brown and next was Minister of Department of Health, Alan Johnson.  Both speeches were impressive, as political leaders of Great Britain always are.  Responding to the report of this conference, the British government expressed their decision to develop specific policies and requested Professor Marmot, the Chair of WHO CSDH to organize a special committee for this objective.  They are very serious about what they are doing.  This is truly what I would call a government initiative.  Isn’t it admirable?   I envy it.

Japanese do not see the difference of the roles of bureaucrats, public officials, and politicians (I don’t know why but many of them are Niseis and Sanseis, i.e. successor of their fathers or grandfathers.  Even their electoral district is descendent, which is obviously not normal.  It might be that the candidates are unknown "outside their home district").  And also, English people perceive government as "Civil servants" while Japanese people see it as "Okami (people who reign)".  This difference is huge.  I feel embarrassed that without perceiving this basic difference in the societies of Britain and Japan, Japanese politicians, public officials, and specialists only quickly mock the system of Great Britain superficially, when problem arises and talk about "agency-nization," "privatization," "two major opposing political parties," "Thatcherism," and so on as if they are experts.  Actually, they don’t really know what they are talking about.

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Photo4:  Chair of the conference, BBC presenter and writer John Humphyrs, and Chair of CSDH

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Photo5:  A panel. On the left is chair, Editor of Lancet, Dr. Richard Horton

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Photo6:  At the reception. Asian network, mainly organized by Dr. Hashimoto of University of Tokyo. The 3rd person from the left is Dr. Kumaresan, president of WHO Kobe Center

By the way, the venue of the meeting was Queen Elizabeth II Conference Center, and the accommodation was Royal Horsegurads.  They are located only a few minutes away from each other by foot.  In between stands Prime Minister’s official residence Downing 10, Westminster Abbey, The houses of Parliament and Big Ben, and so on.  I have been to this place early in September, too.  This time, I had an opportunity to stop by at the residence of minister Nishigahiro.

G8 Summit Global Health Follow up Tokyo meeting

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2008 Toyako Summit had on its table agendas on energy, climate change, surging food prices, financial crisis, etc., all of which are major global problems that seemed to appear so suddenly.  However, I would like to point out that Japan played a significant role here even in this difficult time, especially in the area of global health where Japan followed up the promises between health care providing systems and G8, producing outcomes that were very highly evaluated by the world.

A follow up meeting was held on November 3 th and 4th in Tokyo under the auspice of JICE with the cooperation of Ministry of Foreign Affairs of Japan.  Participants were the world’s top members in this field, Dr. Margaret Chan, Director General of WHO (photo1, the last time I saw her was at Seattle in June), Dr. Tachi Yamada, president of the Global Health Program at the Bill & Melinda Gates Foundation (we were together at Fusionopolis 3 weeks ago), Dr. Julio Frenk, former Minister of Health of Mexico and Dean elect of the Harvard University School of Public Health (can you imagine such selection in Japanese university?), Dr. Richard Horton, Editor in Chief of The Lancet.

In addition, Dr. Miriam Were, the recipient of the "Hideyo Noguchi Africa Prize" announced at TICAD4 this May was present, also a happy reunion for both of us.  Large number of specialists gathered, not just from Japan but from all over the world.  Here, I would like to acknowledge their effort.

Rimg00192whodg2008113photo 1  From the left end, Ms. Ikegami of UNFPA Tokyo Office, Dr. Mari Simonen(deputy executive director of UNFPA), me, Dr. Margaret Chan(Director General of WHO), Dr. M Prakasamma(director of Academy for Nursing Studies and Women’s empowement Research Studies).

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photo 2, 3  Panel title. Myself as the chair, to left, Mr. Yamamoto, Ministry of foreign affairs and two officers of Ministry of Foreign Affairs who were assigned to the G8 of next fiscal year.

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In this meeting, Japanese government intends to summarize and stabilize plans that will be handed to Italy, the next host of the G8 Summit.  Former vice minister of the Ministry of Health, Labour and Welfare, currently Senior Fellow at Harvard University School of Public Health, Dr. Keizo Takemi is working to make this happen, which is truly wonderful.  Political activities carried out not only by government offices but also by many global NPOs and social movement groups, in which many of us participate, are part of the great social changes occurring in Japan as well as all parts of the world in this global era (refer to my speech at the G8 meeting of the ministers of environment).  Thanks to all who participated.  I was in the panel, too (photos 2, 3).  At the reception, Minister of Foreign Affairs, Mr. Nakasone delivered a welcome speech.

In the evening, besides other appointments, I had an opportunity to meet with Dean Olian of UCLA Management School (whom I saw last year, too), the Vice President, and Mr. Shibusawa (reference 1 ), a graduate of UCLA Management School and my friend (photo 4).

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photo 4  Dean Olian of UCLA Management School, Mr. Shibusawa, in the back row, Assistant Dean, Dr. Schakelford.

It was a busy day.

Hideyo Noguchi Africa Prize, our story to tell

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Dr. Hideyo Noguchi is one of the most known medical doctor and heroe of modern time Japan. But he is not known in the rest of the world though you can see his bust in the library of Rockefeller University, where he worked from its establishment in 1904, and made this new research institution known to the world in early 20 century. You also see him printed in Japanese 1,000 Yen note.

This May, Japanese government inaugurated Hideyo Noguchi Africa Prize and two laureates, Dr. Brian Greenwood of UK and Miriam Were of Kenya, were awarded the prize at the first evening, May 28th, 2008, of the 4th Tokyo International Conference of African Development as you may see I earlier columns of my blog.

Now our story appears in print. We hope you enjoy reading more or less a full story of the prize and share the spirit of Dr. Noguchi with your friends in and of Africa and throughout the world.

“Health care reform: Grasp reality and set up fundamental laws”

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Health care collapse. Medical reform. Doctor shortages. Exhaustion in the medical profession. All these words you hear a lot in Japan. It seems like there’s never a shortage of stories describing the critical state of the health care system. Although Health Minister Yoichi Masuzoe is showing political leadership to improve the situation, the problems are quite daunting. For the past 20 years I myself have been quite vocal about health policy issues in Japan and have been taking action in different areas. The health care system is one of the major challenges that Japanese politics needs to address. It is hard to imagine in a megacity like Tokyo that a pregnant woman recently could have died from brain hemorrhage after various hospitals, even a university hospital, turned her away.

My opinions were carried on the “My View” column of the Asahi Shimbun newspaper’s morning edition on October 30 under the title of “Health care reform: Grasp reality and set up fundamental laws.” As the title suggests, I think that, in the end, what is necessary is the introduction of fundamental laws. Considering the current political climate, I hope parties will draft their manifestos on health care reform, along with the pension issue, and make it into a priority policy that will be debated across party lines. In a society where safety is not ensured, you cannot expect action or vitality because people will be worried. The following are the main points I raised in the column, as I struggled to keep the text within the newspaper’s space constraints.

”Health care reform: Grasp reality and set up fundamental laws”

●Amid mounting calls to address the doctor shortages and problems with emergency medical services, Health Minister Masuzoe has started drafting a ministry policy guideline entitled “Vision to secure medical services of sense of security and hope.” Last month he convened an expert panel and released the mid-term plan, but I have doubts about it. It does not offer an analysis of the current situation, nor does it provide a long-term vision. The plan basically relies on a dramatic increase in the number of physicians. I would like to offer my frank advice from a standpoint of having worked in the medical field in both Japan and the United States for over 40 years and served as Special Advisor to the Abe Cabinet on health policy issues.

●The mid-term plan asserts that it “aims to increase the number of medical students by about 50 percent.” However, it does not explain how they will be trained or distributed (by geography or specialty). Simply increasing the number of doctors without considering social conditions will not solve problems. It is necessary to increase the number of doctors per citizen. At the same time, it is important to take a systematic approach.

●Firstly, the uneven geographical distribution of doctors needs to be addressed. Kyoto Prefecture has the highest number of doctors with 292; More than twice the number in the lowest prefecture of Saitama, which has 142. Although each hospital has a set number of posts for regular staff, there is no fixed number or framework by region or municipality. By adjusting the number of residents according to local needs, I believe geographical inequalities will diminish dramatically. If it is made mandatory for residents to work in areas without doctors for several months from the second year of their residency, it would provide them with diverse work experience as well as reduce doctor-less areas.

●The uneven distribution of doctors by specialty is also a widely recognized problem. There is a shortage in surgeons and obstetricians, while on the other hand psychiatrists and plastic surgeons are increasing. In order to provide adequate medical care to people, the medical training system needs to undergo a dramatic reform. The medical world itself should decide on the numbers for physicians by specialty and clarify the necessary qualifications. When I spent 15 years in a university hospital in the United States, doctors were also working as researchers and teachers. We learned from each other and built a strong sense of responsibility through a friendly rivalry. Japan should learn from such strict professional training methods and qualification standards in the US.

●There is also room to improve the institutions that provide medical care. Although Japanese hospitals have an extremely large number of beds compared to those in other developed countries, the facilities are not evenly distributed geographically. Many similar medical institutions are clustered together in a small area. By drafting medical plans by municipality, overlaps in services and facilities can be reduced to enable a better quality and balanced medical care. This will help increase the number of doctors per patient, and as a result create better working conditions for doctors. Such municipality-based planning should also work to prevent incidents like the recent case where numerous institutions rejected the admission of a pregnant woman. So it’s not only the number of doctors that needs to increase, but reform is necessary in the system and management of medical institutions.

●All the above is my private opinion. I believe that the mid-term plan does not recognize the current situation this way or offer specific methods for reform like this. The experts invited to the panel must have conveyed the pressing needs of those working in the field.

●What is important for Japanese people is not a simple increase in the number of doctors, but more high quality doctors. It is necessary to train physicians not only in their practice, but in a way that they can gain diverse work experience, a strong sense of responsibility, and a wide scope of judgment. In the Canadian and US “medical school” system, which has spread to Australia and South Korea, a college graduate without a bachelor degree in medicine can aspire to become a doctor by attending a 4-year graduate medical program. Now is a good time to promote this system in Japan.

●As there is great public attention in health care in Japan right now, it is the right time to begin setting up new fundamental laws that stipulate the basic principles, instead of haphazardly addressing problems as they arise.

That’s all I want to mention. I will continue to speak out about health care issues, not just from my own position but from a broader perspective, and will maintain the point of view of the public. I also intend to continue with my various activities at the Health Policy Institute Japan. I hope you will extend your kind support.

 

Alexandria Library, Global Health and Patient University

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Bibliotheca Alexandria is said to be the oldest library in the world (B.C. 300 to 400 era).  It was an open academy which gathered various acquaintances and scholars from across the world (of those days) and made them interact with each other (What an insight to recognize it’s true value!).  Having been reconstructed six years ago, it is now rapidly growing as digital library including wonderful activities.  Nowadays, young generation is making full use of it under the excellent leadership of Mr. Ismail Serageldin.

Lectures and panels were held at the United Nations University at Aoyama on October 4th in memory of the 1st anniversary of the set up of the library’s Japanese Web site.  Dr. Helal, Minister of Higher Education and Science of Egypt, Mr. Serageldin and the Ambassador His Excellency Abdelnasser were present for the ceremony.  Since I was acting as a director, I addressed the ceremony.  Dr. Takahashi, the first director had also participated in the panel.

In the afternoon, there was a follow up meeting of the Health Systems of Global Health, proposed by Japan in the Lake Toya G8 summit.  Excellent members gathered with Mr. Keizo Takemi as the head, and we will work to shape the system’s foundation before handing it over to Italy which will be acting as the host of G8 summit to be conducted next year.

In the midcourse, there was a session called "Patient University" (the link is in Japanese) organized by our NPO, Health Policy Institute, Japan, focusing on GE HealthCare and NGOs assisting the patients.  I also expressed my greetings and talked about "Why NGO has grown?"  Such a common process will support "civil activities."  Thank you all for your hard work.

It was a long Saturday.

‘SURVIVAL’, a new TV series on global health by BBC

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The British Embassy hosted a panel session and reception to introduce BBC program ‘SURVIVAL’  focusing on global health.  This is a set of eight (8) one hour documentaries on eight major global health issues, which include malaria, maternal health, child survival, HIV/tuberculosis, sleeping sickness.  The program will be on air in October thru November.  It is planned to produce a 50 minutes program edited from the set of these 8 series, which will become open to public access (guide to downloading and embeding documentary series).  The objective is to raise the public awareness on global health.  This is a collaborative project with Imperial College, Rockhopper and BBC supported by the Gates Foundation.

The evening began with a welcome opening speech by Ambassador Warren followed by 10-15 min each of 4 films.  I participated the panel moderated by Ms. Doden of NHK, a well known TV caster, with 3 women, each representing corporate (Ms. Chino of Itochu), NGO (Ms. Aoki of SHARE) and university (Prof. Ohnishi of Nagasaki University), and two ‘senior’ men (Mr. Tadashi Yamamoto of JCIE and myself) as panelists, seemingly an unusual 4:2 gender balance in Japan.  I enjoyed the film show and the panel very much.
(See photos of the event)

In the reception, two remarkable young man and woman showed up and told their own stories on Africa.  Power of Bicycle!

A man is Kohei Yamada, worked in Mali, Africa, as a member of JICA; he wrote a song ‘Love You’ in a local language a message to his friend who died of AIDS, which became number one hit in the chart.  In the reception he sang this song in local language with an African percussionist.  He continues his work on HIV/AIDS and Africa.  Visit his web site.

A woman is Mio Yamazaki, told her story with her slides of bicycling sub-Saharan Africa; while in College, she bicycled 6,000km around Japan, another 5,000km Africa.  What’s a girl she is!  She published a book on her African bicycle tour, organized NGO ‘Cow-Way’ for ‘social change by cycling’.

The youth power!  That’s what we need much more in Japan for CHANGE!

The evening was full of enthusiasm with a recognition of and sense of engagement to global health.  Thank you all for joining the evening and for the Ambassador Warren and the British Embassy to host this event.

Again from New Delhi

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Here I am in New Delhi for the second time in this year(Refer 1, 2 ).  Following last year, purpose of the visit is for the Health and Welfare Minister Advisory Council meeting lead by Jeffrey Sachs as before.  The meeting was held for 2 days.  On the second day, face to face discussion between us and Dr. Ramadoss, Minister of Health and Welfare, and advisory committee was held for about 3 hours.  The minister replied clearly to the comments and questions one by one.  I felt that he had a clear recognition and plans for the problems.  You can see the report contents on the website.

The results of health services in the regions of India (rural area and slum area) for these 3 years are emerging clearly.  Also, it is expected that the budget for the health service will be increased along with the economic growth.  Medical expenses in India are 1% of GDP.  It is extremely rare and it is an exceptional country.  I expect that the services will be improved even though there are lot of problems. But the success is still far away.  I think this medical policies for rural areas in India should be more referred to by developing countries. 

Dr. Hara at Health Policy Institute Japan, accompanied me as it was in last year.  We invited my friend Ashok Khosla, President of "Club of Rome" and Dr. Sunil Chacko (whom I introduced earlier) to dinner, and we had a wonderful time together (photo 1).  Also, it was a great pleasure to have an opportunity to meet Mr. Oscar Fernandes, the Minister of Labor through the introduction by Dr. Chacko and Dr. Mishra, Pro-Vice Chancellor of Indira Gandhi Naitonal Open University (photo 2).  It was 10 o’clock in the evening, yet still lots of people were waiting to see him and his work was not over yet at all.  He is such a person, they say.

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Photo1　Dr. Khosla (in the center) with Dr. Chacko and Dr. Hara

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Photo2　From the right with Dr. Mishra, Dr. Chacko and Minister Fernandos

To medical students from Asia: Cheers for young people and 3 speeches

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There is a gathering of medical students from Asia known as AMSC (Asian Medical Students Conference).  This conference is held annually, and I was invited for the last 3 years.  I enjoy this event every time.  I like to be a part of such conference of youth organizations since they are pillars of the future human resource.  This was the 29th year and the conference was held at Tokyo.  I talked in the closing ceremony.  I heared that about 400 students have participated.  The point of my speech was the tremendous change that had occurred in these 29 years and about the globalization era.  I also talked about on "3 speeches."

The 3 speeches were, the speech given by Steve Jobs at commencement ceremony of Stanford University in the year 2005 (I told the students that "I hope and look forward that this 1 week conference become a "dot" of your career."),  speech given by Bill Gates at commencement ceremony of Harvard University in 2007 (It was about recognition of and consciousness for "Inequality" in the world and society.) and the "Last Lecture" of Randy Pausch at Carnegie Mellon University (About the childhood "Dream."  Even if you face many problems, do not forget that you all had a "Dream" to become doctors.  Refer 1, 2 ).

You can have a look at these speeches on YouTube.  Each one of them is a wonderful speech.  The "Last Lecture" of Professor Pausch became a book and Japanese translation was published just a few days ago.

It must have been a lot of work for staff students who organized this conference.  It was really a wonderful conference.

MBA students in pharma-business from Philadelphia

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Philadelphia is my American home-town where I started my professional career in US at the University of Pennsylvania.

The University of Science in Philadelphia is unique and it offers various programs focusing on pharmaceutical and pharmacy sciences and businesses: it also offers courses for MBA program in this area.  The MBA program offers students a summer course to visit Japan and this year it includes a visit to GRIPS where I am a member of faculty.  I hosted a seminar taking an interactive dialogue style posing a wide range of subjects relevant to these future professionals in healthcare and global health issues.

Photos  Group photo and the session at GRIPS

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As I did for Harvard students of School of Public Health, I began asking them how many know and watched on the web of the commencement speeches of Steve Jobs at Stanford in 2005 and of Bill Gates at Harvard in 2006.  The background of about 10 students was quite diverse, which made the session a very interesting and rich.  I enjoyed very much the exchange.