From Dubai-Part 1: Summit on the Global Agenda

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After a six-and-a-half hour flight from London, I arrived at Dubai Airport on the morning of Nov. 8 without enough sleep. I checked into my hotel Jumeirah Al Qasr and went to the conference venue early. I was in Dubai for the first “Summit on the Global Agenda” convened by the World Economic Forum. It’s a huge brainstorming meeting on the global agenda. If you check out the conference website you can see that 8 large themes are broken down into 68 global challenges. A working council for each issue held a series of discussions, each lasting for about three hours. I am a member of the councils for “Innovation” and for “Global Health.” I mainly focused on attending sessions at the “Innovation” council. I reunited with many friends. Mr. John Gage who was also at the STS Forum in Kyoto in October and Davos conference in January was on the same council. I also ran into Mr. Tim Brown of the IEDO, whom I recently introduced in this blog, for the fifth time this year. He was participating in discussions at the council for “Design.” The sessions can be quite draining as they require debating skills and concentration. If you read the columns on the blog of Dr. Yoko Ishikura who was also at the conference you can probably see what I mean by “draining.”

In the evening, a 40-minute bus ride took us to a reception in the desert. Here are some images from it.

Dsc00288Photo1:　The University of Tokyo President Hiroshi Komiyama(on a day trip to Dubai), Prof. Akihiko Tanaka, Prof. Motoshige Ito, Prof. Hiroko Akiyama

Dsc00290Photo2:　With JICA President Sadako Ogata and Ambassador of Japan to the US Ichiro Fujisaki and Mrs. Fujisaki.

Dsc00295Photo3:　Horse riding demonstration

Having been engaging in intense debates at conferences one after another, in Tokyo, London and then Dubai, I felt a bit tired.

But then I learned that JICA President Sadako Ogata had left Dubai on Nov. 6 to attend the opening event of a new terminal at Afghanistan’s Kabul International Airport on behalf of the Japanese prime minister, and then made a quick return to Dubai for this conference. I’ve got to tip my hat to her. She even attended the evening reception in the desert with us.

Wherever Ms. Ogata goes people always gather around her. You can tell that they sincerely admire and respect her.

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.

 

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.

Speeches, “strength” and ideas of leaders

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At last, Obama is elected the next President of America. Great!

A person with such background becoming president indicates the inner strength of American society – its power and commitment to take up the responsibility to react to the changing global world and expectations of the world. Didn’t this moment create a sense of envy in us? In every corner of the world, people are talking about it with excitement and emotion. I am also one of those who felt that this election was a great historic event which proved the inner strength of America. Japan, on the other hand, though economically ranking 2nd in the world, can not “change” in the least. Comparison is easy, isn’t it?

Even in U.S., he is called an “orator” (great public speaker). Some people say that he is such a presidential candidate ever since JFK. Of course, great speech is not all. He is also surrounded by brilliant people and supporters, started with the civil activities and overcame many adverse circumstances. This indicates inner strength. He is not a common person. I think people who have never experienced “adversity” in their life can not cope with any “disastrous situation” that might happen in the future. It is as mentioned in the book ‘Yubi ippon no shunen ga syoubu wo kimeru (Obsession of one finger decides the game)’ written by Mr.Tayama Kazuhiko. There is hardly any exception if you examine history.

For the process and significance of messages of leaders, collection of speeches of “JFK” and “Winston Churchill” are good references.

Ted Sorenson, author of the former book ‘Let the Word Go Forth,’ (Whom I unexpectedly met last year) was a speech writer of JFK at the age of 31. His “Foreword” of the book is excellent. We can learn much from it about the ideas, significance, and background of speeches by JFK, the incomparable politician. I recommend this book to you as a good reference.

The latter is “Never Give In” authored by a grandchild of Churchill, whose name is same i.e. Winston Churchill (just the middlename is different). This book is also helpful to understand the speeches of politicians, their thoughts, drafts, and style of communication to people.

After reading these books, one will think that top politicians are too much “at ease” in a closed country like Japan. Like it or not Japan cannot survive in the world all by itself. I must say that Japan has no such competent, substantial speeches of a “Leader” with the strength to inspire citizens so far. At any rate, it is hardly possible to win confidence as a politician if a speech means merely reading a draft given from government officers. Today in this Global era, even if you speak in Japanese, what you have said will be known throughout the world in no time. And as those spoken words spread, they will eventually create trust on politicians and ultimately trust upon a nation. Nevertheless, same can be said for the business leaders, scholars and government officials as well. And all of them put together will sum up to what you would call “Dignity” or “the Style” of the nation.

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.

 

Mr. Miki Watanabe, Education and Special zone for Agriculture

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Mr. Miki Watanabe, President of Watami Co. Ltd., is a very enthusiastic and a dashing entrepreneur and chief executive, who is turning excellent passions and dreams into a reality.  He authored many books as well.  Search at "amazon" for these books.  Caring about the education, he is rapidly expanding activities such as education assistance to many children not only in Japan but as well as in Cambodia (recently in Nepal too).  It is really admirable.

As the price of crude oil is increasing (at present the price is temporarily stabilized but, eventually to what extent will it rise?), there is already shortage of food worldwide (moreover, there is a sign of condition to be worse due to changing climate, scarcity of water etc.) and so the present condition where millions of people are starving to death (also called as "2C+3F" －Climate Change and Fuel, Food, Feed－) is hardly expected to improve.  I would say that agriculture must be promoted as a growing Industry from a long term point of view since agriculture technology of Japan is excellent.  Many worldwide brands will emerge from this sector not to mention the obvious improvement of  the food self sufficiency ratio.  Moreover, since non-edible parts of agricultural products may be widely used as reclyclable energy, research and development in this field is already becoming competitive worldwide.

I speak whenever there is an apportunity, as does Mr. Watanabe.  In May this year, for example, I had an opportunity to speak about agricultural policies at a committee meeting of Liberal Democratic Party that was attended by Mr. Koichi Kato as the chairman, Mr. Motegi, Secretary General, and Mr. Yatsu, Member of the House and former Minister of Agriculture, Forestry and Fisheries.

Mr. Watanabe uses Special zones for Agriculture also (it is difficult to use in reality, why is it so?), and as I was hoping to talk with him about this, he kindly set up an opportunity for me.  A one page summary of this dialogue is scheduled to be released soon.  Some parts of the talk is posted in his blog (in Japanese).

From Singapore, The opening ceremony of Fusionopolis

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After my visit at Seoul, I came to Singapore to participate in the opening ceremony of Fusionopolis.  Attended by many scientists in Singapore and around the world, Director Lim of A*STAR made a welcome speech.  Then, a powerful message from the Prime Minister Lee Hsien Loong, followed by fascinating high tech holographic demonstration, musical performance by researcher group, and a reception.  I had the honor of being introduced to the Prime Minister Lee at the reception hall and talking with him.  He explained how his government is committed to making Fusionopolis a center full of energy that attracts scientists and youth around the world.  By the way, the architecture of Fusionopolis was designed by Dr. Kisho Kurokawa, a well known Japanese architect.

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photo  Prime Minister Lee at the Opening.

On the next day, I attended the board meeting of A*STAR.  Then, in the evening of the day after, had dinner with Professor Ito (ref. 1 ), a very active scientist at A*STAR as well as former director of Institute for Virus Research, Kyoto University, and Mr. Kakihara, the manager of Riken Singapore office.

Anyway, I would like all of you to know how sad I am not to see Japanese researchers, especially young generations, participating in such places to mix with other researchers for training and competition as Samurais did for fencing in their era.  Shouldn’t Riken stop making excuses and send more scientists to Fusionopolis?  I dare say that Riken is just wasting their money if they don’t.  As I always say, I do not want to hear excuses for not doing.  Remember the Japanese old sayings such as "Young ones head to wilderness (Wakamono wa koya wo mezasu)" or "If you love your child, let him/her travel (Kawaii ko niwa tabio saseyo)."  They have universality and implications.

I expect everyone to do better.