{"id":35875,"date":"2015-12-22T13:03:18","date_gmt":"2015-12-22T12:03:18","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=35875"},"modified":"2015-12-22T13:03:18","modified_gmt":"2015-12-22T12:03:18","slug":"gavin-yamey-can-japan-rouse-the-g7-nations-to-action-on-universal-health-coverage","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/12\/22\/gavin-yamey-can-japan-rouse-the-g7-nations-to-action-on-universal-health-coverage\/","title":{"rendered":"Gavin Yamey: Can Japan rouse the G7 nations to action on universal health coverage?"},"content":{"rendered":"

\"Gavin_Yamey3\"<\/a>In Tokyo last week, at a workshop to prepare for the May 2016 G7 summit in Ise Shima<\/a>, I arrived early at the hotel\u2019s conference room; I was giving a presentation later that day and wanted to pre-load my slides. The hotel staff were setting up the room, placing print copies of the day\u2019s meeting agenda at each place setting at each table. To ensure precision in their task, two women were using a length of string that they pulled taut along each table and that they used to confirm an exactly equal spacing between the print-outs. It was an impressive display of dedication, focus, and seriousness of purpose. A perfect metaphor for how Japan is approaching its role of G7 chair.<\/p>\n

The day before the workshop, Japan hosted an extraordinarily high level one-day international conference<\/a> on \u201cUniversal Health Coverage (UHC) in the New Development Era.\u201d In a sign of Japan\u2019s determination to use its political capital to put global health high on the 2016 G7 agenda, Prime Minister Shinz\u014d Abe himself kicked off the day, echoing the messages of his editorial in last week\u2019s<\/a> Lancet<\/em>, called \u201cJapan\u2019s vision for a peaceful and healthier world.\u201d<\/p>\n

\u201cOne of the overarching goals of my tenure as Prime Minister,\u201d said Abe, \u201chas been to make a proactive contribution to peace based on the principles of international cooperation.\u201d These principles, he said, are to contribute to \u201cworld peace and prosperity,\u201d including through global health, \u201cbased on the concept of human security.\u201d Japan will use its G7 chair status, said Abe, to push for UHC\u2014particularly for building \u201cresilient, sustainable, inclusive health systems that can deliver basic services to all\u201d and to strengthen global outbreak responses. Japan\u2019s own history of UHC has delivered<\/a> the world\u2019s longest life expectancy, some of the world\u2019s best health outcomes, and a reduction in health inequalities, so it is clearly leading by example.<\/p>\n

As I argued recently in The BMJ<\/em><\/a>, with my colleagues Sabine Campe and Sara Fewer, Japan\u2019s track record in hosting G7 meetings has been impressive. The 2000 summit in Okinawa, for example, which focused on achieving measurable progress on HIV\/AIDS, tuberculosis, and malaria, led to the formation of the Global Fund<\/a>, which has signed grants<\/a> worth over $US 33 billion. Is a repeat performance likely, given that the focus this time is on the \u201cfuzzier\u201d concept of UHC rather than targeting specific diseases?<\/p>\n

It\u2019s a question that I think was at the heart of the debates at both the conference and the workshop. What the G7 summits do well is to give a global health issue legitimacy, attention, and\u2014sometimes\u2014funding. The goal needs to be clear, understandable, and focused, and the issue needs to play well to the citizens of the G7 nations, given that the heads of state always have one eye on the electoral prize. The \u201cbig three\u201d killers (AIDS, TB, malaria) fit the bill. But it isn\u2019t clear that UHC will be as rousing a concept.<\/p>\n

One way to make UHC compelling\u2014an avenue suggested by Abe and echoed by other speakers, especially David Heymann<\/a>, Head of the Chatham House Centre on Global Health Security\u2014could be to link UHC to the worldwide concern about pandemics in the wake of the Ebola crisis. Heymann, who led the global response to SARS when he was Executive Director of the WHO Communicable Diseases Cluster, argued that the G7\u2019s focus should be on \u201cpersonal human security,\u201d which includes UHC and access to medicines and vaccines. \u201cSmallpox eradication, a global public good, was only possible,\u201d he said, \u201cbecause individual protection was possible, and polio eradication is only possible with a personal vaccination.\u201d Collective security, exemplified by the International Health Regulations<\/a>, has been easy to understand, said Heymann, but is impossible to achieve without human security.<\/p>\n

Security quickly became the buzz word of the conference, a way of talking about UHC that builds on post-Ebola concerns. But this framing is a double edged sword\u2014it certainly captures attention (and plays well to the media and the electorate) but it also carries risks.<\/p>\n

The \u201csecuritization\u201d of health makes many of us uncomfortable, as it conflates public health\u2014with its core principles<\/a> of justice, equity, and a focus on the poor\u2014with military and intelligence concerns. We saw this kind of fusion of two worlds when the CIA used a vaccine programme<\/a>\u00a0as a way to gain information about Osama bin Laden\u2019s whereabouts, which had appalling consequences<\/a>, such as an increase in public mistrust of vaccines and physical attacks on vaccination workers.<\/p>\n

Perhaps the addition of the words \u201chuman\u201d or \u201chealth\u201d ahead of \u201csecurity\u201d will make all the difference in preventing such conflation, especially if the agenda that ensues is about people rather than (geo)politics. That\u2019s certainly the argument behind a recent policy paper<\/a> in The Lancet<\/em> on the lessons from Ebola, which argued that health security \u201ccomes from personal access to safe and effective health services, products, and technologies\u201d and \u201cwhat matters is the centrality of people\u2014not borders, not economies, and not even international relations.\u201d<\/p>\n

So you should expect to be hearing rather a lot about health security over the coming year\u2014particularly in The Lancet<\/em>, which just deemed it to be<\/a> \u201cthe big idea of our time\u201d and \u201cthe defining challenge of 2016.\u201d<\/p>\n

Gavin Yamey<\/strong> is a professor of the Practice of Global Health and Public Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, USA.<\/em><\/p>\n

Competing interests:<\/strong> My travel costs to Tokyo were covered by the meeting organizers (Japan Center for International Exchange; Ministry of Foreign Affairs of Japan; Ministry of Finance of Japan; Ministry of Health, Labour and Welfare of Japan, and Japan International Cooperation Agency). I have received grant funding from the Global Fund (to conduct analytic work related to the Affordable Medicines Facility-malaria and to integrating HIV\/AIDS, TB, and malaria with maternal and child health services) and travel expenses from Chatham House (to participate in a workshop on \u201crethinking the global health system\u201d).<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

In Tokyo last week, at a workshop to prepare for the May 2016 G7 summit in Ise Shima, I arrived early at the hotel\u2019s conference room; I was giving a […]<\/p>\n

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