Health and Global Policy Institute (HGPI) launched the “Obesity Control Promotion Project” in 2022, with the aim to raise overall societal awareness of obesity and promote more effective and integrated measures.

In 2023, to deepen and implement the recommendations made in 2022, interviews were conducted with patients suffering from obesity and with medical professionals. Advisory board meetings were also held consisting of experts from industry, government, academia, and the private sector. Based on our understanding of the actual conditions and issues surrounding people living with obesity taken from the perspectives in the medical field and within society, we propose the following obesity countermeasures that are required in society and medical care.

Recommendations

1. Strengthen primary prevention of obesity and other lifestyle diseases by educating people about healthy lifestyles and creating a society with few health risks through collaboration among government agencies and the private sector.
2. Enact highly effective secondary prevention policies generated by promoting and enhancing health data in specific health checkups and specific health guidance.
3. Establish community healthcare provision and support systems that involve collaboration among industry, Government, academia, and civil society and that are tailored to individual challenges and needs to provide appropriate interventions to people who are overweight or obese.
4. Establish healthcare provision systems and pursue nationwide equity so multidisciplinary interventions can be delivered to people with severe obesity.
5. Generate evidence on the effectiveness of measures for controlling obesity and other chronic diseases to advance obesity policy and create better and more equitable healthcare provision systems.
6. Break away from the tendency to favor certain body shapes and sizes and the concept of personal responsibility for obesity, foster understanding of obesity as a medical condition, and eliminate stigma that prevents timely and appropriate medical interventions.

■ Local governments, experts, and people living with obesity who lent their cooperation in our interviews (Titles omitted; in Japanese syllabary order for each group)

Health and Welfare Policy Division, Department of Health and Welfare, Saga Prefecture
Health Education Division, Department of Education, Fukushima Prefecture
Health Promotion Division, Health and Welfare Department, Miyagi Prefecture
Health Promotion Division, Department of Children’s Health, Kushiro City, Hokkaido
Four people living with obesity

■ Advisory board members (Titles omitted; in Japanese syllabary order)

Takeshi (George) Imaoka (Associate vice President, Medical, Diabetes Products and Clinical Pharmacology Medical, Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K）
Tomonori Okamura (Professor, Department of Preventive Medicine and Public Health, School of Medicine, Keio University)
Yuko Oguma (Associate Professor, Sports Medicine Research Center, Graduate School of Health Management, Keio University)
Tetsuya Kakuma (Professor, Health Sciences Course, Department of Fundamental Nursing Sciences, School of Nursing, Faculty of Medicine, Oita University)
Iwao Kurose (Executive Director, Japan Medical Association)
Atsuhito Saiki (Professor, Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Graduate School of Medicine, Toho University)
Tomotaka Shingaki (Sr.Advisor-Medical, Diabetes products and clinical Pharmacology Medical, Japan Drug Development and Medical Affairs)
Hiroshi Sugii (Vice chair/ Member of the board, AVP CMRQ Development Region Japan, CMRQ Development Division, Novo Nordisk Pharma Ltd.)
Sayaka Tsuji (Obesity Treatment Coordinator, Toho University Medical Center Sakura Hospital)
Ichiro Tatsuno (Chairman, Japanese Society for Treatment of Obesity/ President, Chiba Prefectural University of Health Sciences)
Koutaro Yokote (President, Japan Society for the Study of Obesity/ Director General, Chiba University Hospital)

■ Sponsors (in Japanese syllabary order)

National Graduate Institute for Policy Studies (GRIPS) Global Health Innovation Policy Program (GHIPP)
Eli Lilly Japan K.K
Novo Nordisk Pharma Ltd.

Starting this year, Health and Global Policy Institute (HGPI) will be organizing breakfast study session for individual supporting members and those interested in health care policy from various fields.
The lecture for the second session will be given by Ms. Helen Tomlinson, Head of Talent (UK & Ireland) at The Adecco Group / Menopause Employment Champion, The Adecco Group.

Helen Tomlinson is Head of Talent and Inclusion (UK and Ireland) for the Adecco Group, the global leader in HR solutions, and the first “Menopause Champion” appointed by the UK government to promote the adoption and expansion of comprehensive corporate policies regarding menopause. The Adecco Group was the first private company in the UK to design and implement a menopause plan. Since then, Helen has supported companies of all sizes to create supportive environments, encourage open conversations, and help women thrive at work throughout their life stages. Helen will deliver a lecture titled, “– No Time To Step Back – how cultural workplace change can help women thrive and surpass their potential” based on her insights and experiences gained through her work. She will talk about menopausal measures receiving increased attention, and we hope this lecture will deepen the understanding of this subject for all attendees.

■ Speaker
Ms. Helen Tomlinson (Head of Talent (UK & Ireland) at The Adecco Group / Menopause Employment Champion, The Adecco Group)

■Date & Time
Thursday, April 11, 2024; 18:00‐19:15 (Doors open 17:40) JST

■ Format
In-person (No online streaming)

■Venue
Global Business Hub Tokyo
(Grand Cube 3F, Otemachi Financial City, 1-9-2, Otemachi, Chiyoda-ku, Tokyo, JAPAN 100-0004)

■ Language
English (No simultaneous interpretation)

■Capacity
50 (in case of a large number of applicants, a lottery will be held)

■Participation fee
・General: Advance Credit Card Payment 4,000 JPY, On-site Cashless Payment 4,400 JPY
・Students (Undergraduate Students Only): Advance Credit Card Payment 3,000 JPY, On-site Cashless Payment 3,300 JPY (Student ID Required)

* The event will be free for Individual Supporting Members. This event is for in-person only, but a video link to the symposium will be shared at a later date for individual supporting members only.
To donate as a Individual Supporting Member, please check this link

■ Profile
Helen Tomlinson
Helen Tomlinson is the UK Governments first-ever Menopause Champion. Working alongside the Department for Work and Pensions, Helen helps employers develop policies that empower women experiencing menopause to stay and progress in work. Applying the principles of Education & Allyship creating Cultural Change, Helen has built a clearly defined sector based strategy to support women across all aspects of intersectionality throughout their career from a women’s health perspective. Advocating for gender equity is the common thread throughout Helen’s 30-year career in the recruitment and employability sectors. In addition to her voluntary Menopause Champion role, Helen is Head of Talent & Inclusion (UK and Ireland) for the Adecco Group, the global leader in HR solutions. Her pioneering podcast on menopause and work inspired the Adecco Group to design and implement one of the UK’s first corporate menopause policies. Since then, Helen has supported companies of all sizes to create supportive environments, encourage open conversations, and help women thrive at work through menopause and beyond. With three decades of experience across commercial management, sales, and strategic HR planning, Helen helps organisations realise the business benefits of an enlightened approach – and drives positive, pragmatic change for employers and their people.

Please fill in the necessary information such as your name and email address by clicking the “Please register here” button. Registration will close on April 5.
Since this event will only be held in-person with limited seating, participants will be selected by lottery and will be informed of the result by the end of April 8.
After completing your registration, a confirmation e-mail will be sent automatically to your e-mail address. If you do not receive the email, please contact us via e-mail (info@hgpi.org) or by phone (03-4243-7156).

*If you would like to cancel your attendance, please inform us by 12:00 on Wednesday, April 10. Any cancellations made after this may incur participation fee.

For the 122nd HGPI Seminar, we hosted Professor Keiko Yamada, who serves as Associate Professor at Saitama Prefectural University and as Principal Investigator of the Project on Disseminating Medical Research Results in an Easy-to-Understand Manner. Professor Yamada spoke about the nature of health communication in an age of growing diversity in health information.

<POINTS>

• Even if two people are using the same words, the contexts for those words in real-world healthcare settings or in medical research differ from when they are used in general society. This means words can take on different meanings. The responsibility of bridging gaps in meaning falls to people serving in healthcare who can understand both sides.
• As previously noted, even when using the same words, health professionals and members of the general public sometimes have different intended meanings. Furthermore, Japan is a high-context society where people rely on unspoken understanding. These two elements make health information in Japan more complex. Having health professionals and members of the general public come closer to each other, reach a mutual understanding, and safely co-create information will be important in achieving smooth and effective communication between them. To help people reach that mutual understanding, Professor Yamada’s team has prepared guidelines on communication titled, “The Guidebook on Disseminating Medical Research Results in an Easy-to-Understand Manner”.

Differences in context between health professionals and the general public

Certain words that are used by the general public can take on different meanings when used by health professionals in health communication. For example, when using the term “standard treatment” in Japanese, health professionals are referring to treatments “that are based on scientific evidence and are the most effective option that is currently available.” When looking up “standard” in a Japanese dictionary, however, it is defined as “a benchmark or an example” or “common.” As we can see, there is a difference in how people usually perceive the term “standard” and how it is used in the term “standard treatment” in the context of medicine and healthcare in Japan. Focusing our attention on these differences, last year, we compiled guidelines on how to convey information on medical research findings in an easy-to-understand manner.

Medicine is a branch of science, and like most branches of science, specialists in this field use a context that has developed independently from the one used by the general public. As such, health communication requires that we keep those differences in mind as we work to build common understanding. In particular, when participation from citizens is necessary, steps must be taken to fully bridge the gaps in awareness toward the contexts used by health professionals and the general public before any final decisions are made. I believe that doing so will be the first step in achieving smooth health communication.

Communication grows complex when a medical context crosses with Japan’s high-context society, where unspoken understanding is common

“Context” is generally taken to mean something that refers to backgrounds, circumstances, or settings, but it also includes understandings or feelings that cannot be fully expressed in words. For example, when a married couple understands each other well, they are in a high-context state that allows them to communicate over their shared background or context. In this state, they can understand the other party’s intentions without the need for it to be put in explicit terms. The exact opposite situation – in which two people feel like they are communicating when they actually do not understand each other at all – can also occur. In high-context societies, there are times when information that is thought to be conveyed without making it explicit does not actually get across, and this can result in unpredictable events.

Japan is a high-context society where people find it relatively easy to convey ideas without having to rely on words. There are also predetermined formats that scientists and health professionals use to share information (such as when presenting research designs or evidence) that help to foster mutual understanding even when details are left out. As a result, extremely high context communication takes place in the worlds of science, medicine, and healthcare. The combination of society’s presumption that meaning can be conveyed without using words when health information is transmitted in Japan and the unique context used when specialists like scientists and health professionals transmit information may have resulted in a form of communication that is very complex and difficult to understand.

The characteristics of channels for obtaining health information have changed over time

Channels for obtaining health information are becoming more diverse and expansive. In the past, medical researchers bought articles and books to keep up-to-date on the latest information in health and medicine. Today, that information is very open and can be viewed by anyone over the internet. People also have increasing opportunities to share information using tools like social networks.

The utilization of personal health data outside of health facilities

In the past, most personal health data was held in medical records and was kept within health institutions. Today, however, as seen in the use of real-world data and personal health records (PHRs) outside of health institutions, personal health data is expanding in scope, and its use as a form of health and medical data is predicted to continue growing in the future. In response to this change, discussions on who owns the information held in electronic medical records are being held repeatedly. The current thinking is that the information in electronic medical records is the most personal form of information and that it belongs to the individual. However, electronic medical records are currently considered to be the property of health institutions which are also charged with managing and preserving them, so the nature of this information is highly unique. While the management of one’s own health information is gradually being passed off to the individual, there are high hurdles to allowing patients to hold and manage their own medical records, making it impractical. It is urgent that we establish a system that enables people to manage individual health data.

In recent years, the Government of Japan has been promoting the widespread adoption of PHRs. PHRs are a form of health data for storing information on an individual’s health and physical condition. They may seem like a relatively new topic of discussion, but Japan has one long-standing type of PHR that it can be proud of: the Maternal and Child Health (MCH) Handbook. While not digital, these handbooks are a representative example of a PHR that allows parents to track their child’s weight and health status and that provides a portable option for storing information on a child’s growth and vaccination history. Even after someone reaches adulthood, their MCH Handbook can serve as a record of their vaccination history and be used to track their health before birth and as an infant. The MCH Handbook provides one good example of people managing health information on their own and, in the near future, this sort of culture around self-management may become more common. The Government is also encouraging more widespread use of PHRs and is advancing efforts to more effectively manage and utilize health information.

Global growth in the health tech sector has been remarkable. Worldwide, the market for healthcare apps is estimated to be worth USD$10.4 billion while the mobile health market is estimated to be worth USD$74 billion. This sector also has an extremely high growth rate of about 20%. In Japan, the markets for wearable devices and digital technologies are expanding rapidly. Progress is being made in research on healthcare apps and the number of meta-analyses on their effectiveness is increasing. Using the results of these efforts, we are gradually building up knowledge regarding the usefulness of healthcare apps. Our knowledge in this area is predicted to continue growing in the future.

Unique aspects of health information and items to keep in mind when handling it

The essential purpose of medicine and healthcare is to address health issues, and while people tend to believe that the more information that is provided, the better, people on the receiving end of information have the unconscious tendency to pick up and discard information based on their current feelings or circumstances. The potential psychological impact of information on recipients must be taken into consideration when communicating health information. How people receive information and the psychological impact of that information varies from person to person, so particular care must be given to communication.

Furthermore, in healthcare, information and procedures can have a direct impact on human life, making it an area with an extremely narrow tolerance for trial and error. In this regard, healthcare is more demanding than other sectors. This makes accuracy a vital aspect when communicating health information.

Awareness toward science and medicine among Japanese people

In general, people in Japan think answers from science are guaranteed. When focusing on information accuracy, this firmly rooted preconception must be taken into account. As medicine is a branch of science, people tend to think of it as something that has already been perfected, and this leads people to believe that errors are unacceptable. In reality, based on the research that is conducted day by day, new knowledge and techniques are being discovered and updated over time. During the COVID-19 pandemic, for example, specialists shared their latest findings regularly in the media as they learned more about the virus. However, those specialists were criticized for presenting information that was different from what had been shared before. In this manner, people in Japan have the strong impression that medicine and healthcare are finished products. When transmitting information, steps must be taken to overcome this preconception in society’s subconscious.

Overview of “The Guidebook on Disseminating Medical Research Results in an Easy-to-Understand Manner”

Based on the idea that narrowing the gap between the contexts used by health professionals and by the general public even slightly and helping them know each other better will lead to better decision-making within health communication, our project developed a guidebook on providing easy-to-understand explanations on findings from medical research.
The guidebook is mainly for people responsible for transmitting health information and focuses on a formal writing style that is well-suited to press releases and other such publications. When creating the Guidebook, we incorporated various opinions from experts as well as members of the general public.

When creating the Guidebook, we sorted our questions into two categories: basic and advanced. The basic questions dealt mainly with language usage. The advanced problems, however, took into account more complex elements like the statistics and research designs used in medical research. To draft the basic questions, we created and analyzed corpora (large-scale linguistic text data) and performed a survey based on our findings. When drafting the advanced questions, we conducted a literature review of publications from Japan and overseas. Then, based on the findings of that review, members of our research group held discussions that incorporated multiple perspectives. Finally, all of our discussions were summarized and compiled into checklists and glossaries.

The checklist is divided into two sections: basic and practical. The basic section is for creating easy-to-understand documents and provides advice about writing style, readability, and overall visual clarity. In addition to medical research, the basic section is intended to be useful for scientific research and all varieties of reference materials. The practical section focuses on key points that are unique to medical research.

As for terminology, as described above, the Guidebook also includes explanations of terms selected according to the corpora (the database of language resources). Specifically, two corpora were created: one with articles for specialists in medical research and one with articles for the general public. After extracting nouns using morphological analysis, 33 word groups and 68 words were selected after being deemed important and worthy of explanation by multiple team members. Then, an online survey on understanding toward that terminology was conducted among 3,000 people (2,400 members of the general public and 600 specialists). Terminology explanations were compiled using all of the items listed above.

In the process of compiling the Guidebook, it became clear to us that the same sentences would be interpreted in different ways by health professionals and the general public. As mentioned above, these differences in perception occur due to the phrases being used in different contexts, and I think people who disseminate health information must first understand the contexts of both these parties before conducting research. I hope our Guidelines will assist them in doing that.

[Event Overview]

• Speaker: Prof. Keiko Yamada (Associate Professor, Saitama Prefectural University; Principal Investigator, Project on Disseminating Medical Research Results in an Easy-to-Understand Manner)
  
• Date & Time: Tuesday, December 19, 2023; from 18:30 to 20:00 JST
• Format: Online (Zoom Webinars)
• Language: Japanese
• Participation fee: Free
• Capacity: 500 participants

■ Speaker Profile:

Keiko Yamada (Associate Professor, Saitama Prefectural University; Principal Investigator, Project on Disseminating Medical Research Results in an Easy-to-Understand Manner)
Professor Keiko Yamada graduated from the University of Tokyo Graduate School of Medicine and Faculty of Medicine. After serving at departments of orthopedics and emergency medicine in Tokyo, Professor Yamada completed a Master of Medical Administration degree at Tokyo Medical and Dental University. She then moved abroad to study at the Dana-Farber/Harvard Cancer Center Health Communication Core. After returning to Japan, Professor Yamada served at the University of Tokyo Hospital Department of Orthopaedic Surgery and was appointed Visiting Researcher at the University of Tokyo Department of Medical Informatics and Economics. She then studied at Harvard T.H. Chan School of Public Health and served in the Department of Healthcare Information Management at the University of Tokyo Hospital before assuming her current position. Her specialties and qualifications include orthopedic surgeon, Doctor of Medicine, and Master of Public Health and Health Policy. She has been operating an online guide to women’s health called “All About” since 2001.

On January 15, 2024, the Health and Global Policy Institute (HGPI) Women’s Health Promotion Project held an advisory board meeting for the promotion of menopausal women’s wealth as a social issue to be considered by industry, government, academia, and the private sector. A policy proposal based on the meeting discussions will be released at a later date.

Since 2005, Health and Global Policy Institute has been focusing on sexual health and reproductive health issues though actionssuch as policy recommendations regarding the promotion of working women’s health and declining birthrates, developing health education programs for university students and companies, and the establishment of a midwife consultation platform for young people.

Recent years various initiatives related to women’s health have been launched and comprehensive policy promotion can be expected; however, there is still insufficient social understanding and policies on health issues of middle-aged and older women, especially menopausal symptoms. The “Basic Policy on Gender Equality and Empowerment of Women” announced in June 2023 includes a plan to increase the ratio of female executives in companies listed in the Prime market to 30% or more. The promotion of women’s participation in the workforce has often neglected women’s health, despite the fact that these two issues are inextricably linked. Therefore, addressing women’s health in their late 40s to early 50s, precisely the age group of potential executives and coincidentallyduring menopause, is essential. Further enhancement of societal awareness and support measures is necessary.

At this Advisory Board meeting, opinion leaders from industry, government, academia, and the private sector in the field gathered to discuss issues and solutions in three areas (the healthcare delivery system, medical human resources, and occupational health) based on HGPI’s prior research, company-specific initiatives, and interviews with working female professionals.

[Event Overview]
Date & time: Monday, January 15, 2024; from 14:00 to 16:00 JST
Format: Hybrid (Zoom conferencing system and in-person participation at the venue)

Advisory board members (title omitted; in Japanese syllabary order)

Mariko Ogawa (Associate Professor, Department of Obstetrics and Gynecology Ichikawa General Hospital Tokyo Dental College)
Megumi Kawashima (CEO / Occupational health physician, Keep Health, Inc.)
Kazue Kawamoto (Health Support Office, Human Resources Development Center, Lion Corporation)
Shigeyo Sasaki (Business Incubation Office, Strategy Management Department, Business Development Center, Lion Corporation)
Nobuharu Shirakoma (Senior Manager, Wellness Promotion Department, Japan Airlines Co, Ltd.)
Masakazu Terauchi (Professor, Chair of the Department of Women’s Health, Tokyo Medical and Dental University (TMDU))
Mayumi Nitta (Professor, Maternal Nursing/ Midwifery, Japanese Red Cross College of Nursing)
Yoshie Miwa (Chairman, Women’s Healthcare Awarenes & Menopause Network Society)
Akihiko Wakatsuki (Former President, The Japan Society for Menopause and Women’s Health, Senior Professor, Obstetrics and Gynecology, Aichi Medical University)

Observer

Mitsuha Aoyagi (Chief, Economic and Social Policy Office, List of Officials of Economic and Industrial Policy Bureau, Ministry of Economy, Trade and Industry)
Saki Muro (Deputy Director, Healthcare Industries Division, Commerce and Service Industry Policy Group, Ministry of Economy, Trade and Industry)

Sponsors (in Japanese syllabary order)

Astellas Pharma Inc.
National Graduate Institute for Policy Studies (GRIPS) Global Health Innovation Policy Program (GHIPP)
Fuji Pharma Co., Ltd.

For the 52nd Special Breakfast Meeting, we hosted Mr. Kurt Tong (Managing Director, The Asia Group). Based on his experience as a career diplomat and senior foreign affairs officer with the US Department of State for over 30 years and his current role as Managing Director of The Asia Group, Mr. Tong spoke about the intricate geopolitical dynamics between the US, China, and Japan at the intersection of regional security, health care, and economics.

Key points of the lecture:

• US and China are in a “quasi Cold War” with economic interdependence and military wariness. While cooperation is stagnant, neither desires open conflict. US-China relations declined in 2023 due to the balloon incident, Pelosi’s Taiwan visit, and trade restrictions. The upcoming Biden-Xi meeting will address sensitive topics like Taiwan.
• More economically dependent on China, Japan adopts a cautious approach compared to the US, including avoiding tariffs and Taiwan conflict.
• Frequent communication and minimal economic friction mark the strong US-Japan relationship, allowing for collaboration on various challenges.
• Japan’s system disincentivizes innovation and new entrants. Policy reforms are needed to revitalize the sector.
• Due to the complex geopolitical situation, US government intervention in Japan’s pharma industry is limited. Moreover, trade restrictions, unfair competition, and data flow issues pose challenges in the Chinese pharmaceutical space.

“Bad but stable” US-China Relations

The US and China exist in a tense “quasi Cold War” where economic interdependence is intertwined with military wariness. Neither desires open conflict, but cooperation remains stagnant. The US strategy bets on isolating China to hinder its growth, while China anticipates internal US strife leading to its decline. Japan’s “Free and Open Indo-Pacific(FOIP)” aims to establish a rules-based order for China to eventually accept. This approach is exemplified by significant trade ties like Apple and Tesla’s reliance on Chinese manufacturing, the contested South China Sea where US-China military exercises highlight friction, US tariffs and technology export restrictions as part of their strategy, and China’s retaliatory tariffs and anti-US propaganda campaigns showcasing their response.

Fall Marked by Missed US-China Opportunities

The first half of 2023 saw a decline in US-China relations, punctuated by the balloon incident and Pelosi’s visit to Taiwan. Efforts to repair this damaged relationship culminate in a November 2023 Biden-Xi meeting tackling sensitive topics like Taiwan, where compromise remains elusive. The decline was exacerbated by the US shooting down a Chinese “spy balloon” leading to China sanctioning US defense contractors. The upcoming Biden-Xi meeting at the Asia-Pacific Economic Cooperation (APEC) Leaders’ Summit in San Francisco will focus on economic issues, climate change, and Taiwan, highlighting the sensitivity of the latter topic where Taiwan, self-governed yet claimed by China, faces potential military unification threats.

Divergences on China in US-Japan Relationship

Compared to the US, Japan’s heavier economic dependence on China fosters a more cautious approach. This is evident in their over 20% trade dependence on China and their reluctance to join US tariffs on China. Japan’s policy consistency contrasts with US fluctuations due to political shifts, and their geographical proximity to Taiwan makes them acutely aware of potential conflict arising from that issue. Unlike the US sending warships near Taiwan, Japan has abstained, showcasing their contrasting policies.

US-Japan Ties Strengthen Amid Pressures

Excellent communication and minimal economic friction characterize US-Japan relations. Regular summits and cabinet-level meetings solidify strong communication, and a bilateral trade agreement reduces tariffs on numerous goods, minimizing economic friction. This strong relationship allows for collaboration on various challenges, including those posed by China, Russia, and the Middle East, exemplifying their joint efforts to counter China’s influence in the Indo-Pacific region.

TAG White Paper on Pharma Policy

The Asia Group’s White Paper on Pharma Policy identifies critical challenges hindering Japan’s pharmaceutical industry and proposes solutions to revitalize this sector. Additionally, the fee-for-service payment method and social security system, which offer little incentive for medical providers to improve efficiency in healthcare delivery and for individuals to engage in prevention, focus on controlling drug prices while also leading to the suppression of innovation and investment. This, coupled with two specific pricing policies – the “co-factor zero” rule and the Price Maintenance Premium system’s corporate status criteria – further disadvantages new entrants and foreign companies, restricting access to novel drugs. The paper urges the Japanese government to eliminate these “low-hanging fruit” policies to stimulate innovation and attract new players, ultimately benefiting patients. While acknowledging the complex geopolitical situation with China and limited potential for US government intervention, the paper suggests possible support from US industry and academia. However, it also anticipates increasing difficulties in the Chinese pharmaceutical space due to trade restrictions, unfair competition, and data flow issues. In essence, the paper calls for targeted policy reforms in Japan to foster a more vibrant and innovative pharmaceutical sector, while navigating the broader geopolitical landscape and its impact on the industry.

(Photographed by: Kazunori Izawa)

■Speaker Profile

Mr. Kurt Tong (Managing Partner, The Asia Group)
Mr. Kurt Tong is a Managing Partner and member of the Executive Committee at The Asia Group, where he leads consulting teams focused on Japan, China and Hong Kong, and on East Asia regional policy matters. He also leads the firm’s innovative thought leadership programs. A leading expert in diplomacy and economic affairs in East Asia, Mr. Tong brings thirty years of experience in the Department of State as a career Foreign Service Officer and member of the Senior Foreign Service.

*This forum will be held in Japanese only

The Health and Global Policy Institute (HGPI) Healthcare DX Project aims to achieve “A digital transformation (DX) in healthcare that generates benefits for both individuals and all of Japan by promoting the effective use of personal data for society.” The digitalization of society serves as the basis for healthcare DX and its greatest strength is that it allows for all forms of information to be converted into electronic data and shared over the cloud. The top priority when attempting to leverage this strength in the field of healthcare will be establishing an environment for collecting citizen and patient health data. However, efforts to accumulate data with the intent to share it can only advance when safety is guaranteed, and it will be difficult to gain cooperation from the public without benefits that make daily life feel more convenient for individuals. In addition to the public benefits that are currently outlined, it will also be important to highlight initiatives that will enable individuals to benefit from healthcare DX over the course of their own interactions with healthcare. As such, it is desirable that we pursue transformations that will benefit both individuals and the public. Emphasizing the perspectives of patients, affected parties, and citizens and making more efficient and accessible healthcare services by introducing such transformations will be key elements of future reforms that are created while keeping in mind our experiences with the Coronavirus Disease 2019 (COVID-19) pandemic as well as healthcare system sustainability and resilience.

To this end, the first step will be improving access to personal health data to encourage people to exercise proactive self-determination in addressing health-related issues. Doing so will enable citizens and patients to make decisions regarding their own health in a more conscious and autonomous manner. Second will be aiming to build a healthcare system in which citizens and patients can enjoy real benefits and are satisfied with services. This includes improving the quality of services, shortening wait times, and providing a wider variety of treatment options. Third will be making efforts to encourage innovation in the use of health data and responding appropriately to unfair discrimination and forms of use that are detrimental to individuals.

The Government of Japan has taken a number of steps to advance healthcare DX. These have included integrating My Number cards and health insurance cards, establishing a nationwide platform for healthcare information, standardizing data stored within electronic medical records, implementing DX in medical service fee revisions, and clarifying an administrative body to lead healthcare DX. These efforts will improve public health, provide higher quality healthcare, streamline operations at health institutions, ensure effective use of information systems personnel, and enable secondary use of health information. Achieving healthcare DX goals is likely to transform healthcare experiences for citizens and patients in various ways, such as popularizing online medical examinations, improving healthcare access, making medical information more transparent, enabling the provision of personalized treatment plans, and reinforcing public health risk management.

While broadening a deeper understanding toward the basic concepts of efforts from the Government’s Headquarters for Medical DX Promotion and examining its specific initiatives and future plans, this forum will feature a multi-stakeholder discussion that will identify concrete issues and next steps in response to expectations and concerns of patients, related parties, and citizens for healthcare DX that have been gathered over the course of HGPI activities.

[Event Overview]

• Date & Time: Thursday, February 22, 2024: from 16:00 to 18:00 JST (Open 15:30)
• Format: In-Person (no virtual attendance available)
• Venue: Global Business Hub Tokyo Field, Grand Cube 3F (Otemachi Financial City, 1-9-2, Otemachi, Chiyoda-ku, Tokyo)
• Language: Japanese
• Participation fee: Free
• Hosted by: Health and Global Policy Institute
• Supported by: National Graduate Institute for Policy Studies (GRIPS) Global Health Innovation Policy Program (GHIPP)
• Capacity: 100
  *Registration will close at 10:00, February 16. Participants will be selected by lot and will be informed of the result on February 19. We appreciate your understanding.
  **After your registration is completed, a confirmation e-mail will be sent automatically to your e-mail address.
  If you do not receive it, please send us an e-mail at info@hgpi.org.

[Program] (Titles omitted)

16:00-16:10 Opening remarks

Ryoji Noritake (CEO, Board Member, HGPI)

16:10-16:20 Message1: The Current State of and Future Outlook for Government Efforts
in Healthcare DX

Keizo Takemi (Minister of Health, Labour and Welfare)

16:20-16:30 Message2: Digital Transformation and the Positioning of Healthcare DX in Japan

Taro Kono (Minister for Digital Transformation; Minister of State for Regulatory Reform)

16:35-17:55 Panel discussion: Achieving the Healthcare DX Envisioned by Citizens

Panelists:
Mamoru Ichikawa (President, General Incorporated Association of Medical Journalism, Japan)
Hiroaki Kato (Specially–appointed Professor, Digital Hollywood University Graduate School / Clinical professor, Tokyo Medical and Dental University)
Yuko Kidoguchi (Vice President, Corporate Affairs, AstraZeneca Japan)
Tomohiro Sonoo (Chief Executive Officer (M.D.), TXP Medical Co. Ltd.)

Moderators:
Takanori Fujita (Research Fellow, HGPI; Project Associate Professor, School of Health Innovation, Kanagawa University of Human Services; Project Associate Professor, Department of Health Policy and Management, School of Medicine, Keio University)
Yusuke Tsugawa (Board Member, HGPI; Associate Professor of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA; Associate Professor, Health Policy and Management, Fielding School of Public Health, UCLA)

17:55-18:00 Closing remarks

Kiyoshi Kurokawa (Chairman, HGPI)

Health and Global Policy Institute (HGPI) held organizing breakfast study session for individual supporting members and those interested in health care policy from various fields.

The lecture for the first session, Ms. Naoko Iwanaga, a freelance medical journalist, provided a lecture titled “How to Communicate Medical Information and Make Choices?”

The lecture provided many insights from Ms. Iwanaga’s wide range of knowledge, including her motivation to become a medical journalist, her thoughts on web media cultivated throughout her career, and the value of accurate information and how to determine the value of accurate information.

In the Q&A session, in addition to questions received in advance and, there was a lively exchange of opinions.

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■ Profile
Naoko Iwanaga
After graduating from the University of Tokyo’s Faculty of Letters, Ms. Iwanaga joined the Yomiuri Shimbun in April 1998. After working as a reporter in the social affairs department and medical affairs departments, became editor-in-chief of yomiDr. in 2015. In May 2017, she joined BuzzFeed Japan and founded BuzzFeed JapanMedical, where she writes medical articles from a variety of perspectives. Since July 2023, he has been working as a freelance reporter, distributing medical articles in “The Newsletter of Naoko Iwanaga, Medical Reporter” and other publications on theLetter, a newsletter media platform provided by OutNow, Inc. Part-time customer service worker at an Italian restaurant in Tokyo since August 2022, in addition to her day job. She is the author of “Can Words Save Lives? Life and Death, from the Field of Care” (Shobunsha) and “Today, too, in the Light of the Restaurant” (East Press).

The Health and Global Policy Institute (HGPI) Health Information Project hosted a Global Sage Meeting entitled, “Co-creating Health Information Right.”

In the current era of advancing digitalization, when information regarding health and medicine is intertwined, we hosted a multi-disciplinary discussion that was rich in historical and cultural perspectives that examined the nature of accurate and reliable health information together with health sector representatives, patients and patient advocacy leaders, and experts in fields like history, philosophy, anthropology, and religion. Centered around the theme of “health information,” we exchanged broad views on the nature of health information that is needed today and will be needed in the near future, as well as on how to best prepare people for comprehending that information.

*For details, please see the PDF linked below.

[Event Overview]

• Date & Time: Friday, July 21, 2023; from 14:00 to 17:30 JST
• Venue: Event Space in Google
• Language: Japanese and English, with simultaneous interpretation
• Host: Health and Global Policy Institute
• Support: Moderna Japan Co., Ltd.
  　　　　YouTube

[Program] (title omitted, Japanese order)
14:00-14:10　Explanatory explanation
　Kai Shigeno (Senior Associate, Health and Global Policy Institute)
14:10-14:30 Keynote Lecture 1: Co-creating Health Information Right
　Takeo Nakayama (Professor, Department of Health Informatics, School of Public Health, Kyoto University)
14:30-14:50 Keynote Lecture 2: Information is a Determinant of Health
　Garth Graham (Head of YouTube Health)
14:55-15:35 Panel discussion 1: Defining “Accuracy” in the Context of Health Information
Panelists:
　Norio Ohmagari (Director, Disease Control and Prevention Center (DCC) of National Center for Global Health and Medicine (NCGM); Director and Chief, International Center for Infectious Diseases; Chief Medical Officer, Department of Infectious Diseases, Disease Control and Prevention Center of NCGM)
　Naomi Sakurai (President, Cancer Solutions Co., Ltd.)
　Rami Suzuki (President and Representative Director, Moderna Japan)
Moderator:
　Eri Yoshimura (Senior Manager, Health and Global Policy Institute)
15:35-16:20 Panel discussion 2: How We Should Consider Information Reliability and Validity
Panelists:
　Soichiro Toda (Project Researcher, Graduate School/Faculty of Arts and Letters, Tohoku University)
　Shoukei Matsumoto (Ancestroist; CEO & Co-Founder, Interbeing, Inc.; Young Global Leader, World Economic Forum)
Moderator:
　Ryoji Noritake (CEO, Board Member, Health and Global Policy Institute)
16:20-17:30 Networking

For the 50th Special Breakfast Meeting, we had the honor of hosting Mr. Hiroaki Tabata, a member of the House of Representatives and Director of the Liberal Democratic Party (LDP) Health, Labour and Welfare Division since August 2022. His lecture focused on the future of healthcare in Japan based on the Basic Policy on Economic and Fiscal Management and Reform 2023.

Key points of the lecture

• Trinity Labor Market Reform will be essential to complete labor market reforms, but there are significant obstacles to introducing them all at once in every industry and place of business. Instead, they must be introduced step-by-step in a combined manner that is tailored to each organization.
  
• The triple compensation revisions for long-term care, medical care, and welfare services for people with disabilities scheduled for FY2024, the legal revisions accompanying those revisions, and budgeting to secure financial resources for those revisions will be extremely important for building a sustainable social security system.
• Broad and frequent revisions to drug prices contribute to a weaker financial base for pharmaceutical companies and other companies. To reinforce drug discovery capabilities, it will be important to implement suitable assessments and for those assessments to also include patent periods. To ensure stable supplies of generic drugs, refinements to the structure of the industry must be made so it can develop and evolve.

■Overview of the Basic Policy on Economic and Fiscal Management and Reform 2023

The “Basic Policy on Economic and Fiscal Management and Reform 2023 – Accelerating New Capitalism by Expanding Investments in the Future and Achieving Structural Wage Increases” (hereinafter “the Basic Policy”) was approved by Cabinet Decision on June 16, 2023. It was approved alongside the “Grand Design and Action Plan for a New Form of Capitalism” and the “Regulatory Reform Implementation Plan.” The Basic Policy compiles key policies and sets the direction for the Government’s overall budgeting policy in the coming fiscal year. Discussions will be deepened based on what is included in the Basic Policy by the time budget estimate requests are issued at the end of August.

Discussions on the Basic Policy simmered to a conclusion as the Kishida administration entered its third year, and the final document reached 45 pages – nine more than last year. It consists of five chapters:

1. The basic approach to macroeconomic management
2. Accelerating a new form of capitalism
3. Responding to changes in the environment surrounding Japan
4. Medium- and long-term economic and fiscal management
5. Economic and fiscal management in the near future and ideas for compiling the FY2024 budget

This presentation will summarize Chapters 2 and 4 with a particular focus on the state of healthcare.

■Chapter 2: Accelerating a New Form of Capitalism – Trinity Labor Market Reform

I have held an interest in employment and labor policy throughout the course of my activities, and I feel a great sense of danger toward the facts that average wages for people in Japan have remained flat over the past three decades, and that wage growth in Japan has been slower than in Western countries. Unlike the early Heisei era, factors like the zero interest rate policy and rising insurance premiums and social security costs mean that disposable incomes are decreasing for the public, and this will require labor market reform. Trinity Labor Market Reform will be essential, but in practical terms, there are high hurdles to creating a free labor market for all industries and businesses of all sizes as well as to introducing job-based human resource management. It will be important to implement such reforms in phases, starting with fields that can adapt. Moving forward, we will establish legal frameworks to accompany these reforms and work to expand them. Given this context, the following three actions will be especially important for future reforms.

1. Support capacity building through re-skilling
   People in Japan tend to believe that they are done learning once they graduate university. We must expand a sense of value in which people appreciate updating themselves through continued learning and the joy of putting new knowledge to practical use.
2. Introduce a job-based compensation system that is tailored to the actual conditions at each company
   It is important that employees are evaluated based on their abilities and not on their age, and for systems that objectively reflect evaluations in compensation to be disseminated to medium-sized enterprises.
3. Facilitate labor migration to growth sectors
   Growth is being achieved at small- and medium-sized companies, which attract many mid-career workers with diverse backgrounds.

■Chapter 4: Medium- and Long-term Economic and Fiscal Management – Building a Sustainable Social Security System

General remarks on challenges facing healthcare and long-term care

The “Bill for the Establishment of the Institute for Health Security” – also known as the “Japanese CDC Bill” – was adopted during the current session of the Diet. It will merge the National Institute of Infectious Diseases and the National Center for Global Health and Medical Research into the “National Institute for Health Security.” Moving forward, we must establish budgetary measures and systems so this can be accomplished.

Other issues that must be addressed include restarting progress on Regional Medical Care Visions, which came to a halt due to the COVID-19 pandemic; as well as meeting demand for support for children and for perinatal care, which is facing trouble due to a decreasing number of healthcare institutions where babies can be delivered. As for the emergency medical system, in 2022, there was a significant increase in both emergency ambulances dispatched and people transported. There were 7,229,838 emergency ambulances dispatched, which was an increase of 1,036,257 dispatches or 16.7% over the previous year. The number of people transported was 6,216,909 people, which was an increase of 725,165 people or 13.2% over the previous year. These were the largest increases on record, and the burden of emergency care continues to grow. The Fire and Disaster Management Agency is taking measures to encourage people to make use of the Emergency Medical Service Center Project (#7119).

In Healthcare Digital Transformation (DX), there were errors when linking personal information to My Number cards during the online eligibility verification process, causing public trust in the My Number card system to waver. This was concerning and regrettable. Although the system was designed to prevent the possibility of human error, in the end, human errors did occur, and action must be taken to resolve them. While it was clearly stated that paper national health insurance cards will be abolished by fall 2024, citizens have various backgrounds and circumstances, and it will be more realistic to transition away from paper cards in phases. To extend healthy life expectancies, efforts to promote better health, prevent health problems, and prevent the severe exacerbation of existing health concerns must be strengthened; digital health must be connected to Healthcare DX; and, looking ahead to the third phase Data Health Plan, more energy must be devoted to analysis, including analysis that uses data as evidence.

On the topic of dentistry, the plan also emphasizes the importance of oral health, mentioning the growing recognition that the health of one’s teeth is linked to their overall health. As for cancer medicine, a Diet members’ bill for genomic cancer medicine was approved during the current Diet session and expectations are high for the field of genomic cancer medicine and the further expansion in cancer treatment. Many Diet members pointed out the need for measures for health concerns such as auditory disorders, intractable diseases, transplantation medicine, chronic kidney diseases, allergies, mental health, and nutrition, and I led many consultations and discussions in my capacity as Director of the Health, Labour and Welfare Division.

Reinforcing drug discovery capabilities

Drug prices are revised once every two years and these revisions have been growing in scope. This may be a factor causing financial pressure for pharmaceutical companies and companies related to pharmaceuticals and healthcare. Another significant issue is related to price maintenance during patent periods. Specifically, the mention of “further measures for NHI drug prices, including the appropriate evaluation of innovations at the time insurance coverage is granted” has become a source of division. There was also clear mention that drug lag and drug loss will be addressed, and that a response divided into short-, medium- and long-term issues will be mounted to fully reduce the number of unapproved drugs.

The Basic Policy says, “With the entire Government serving as a command tower, a comprehensive strategy will be formulated to promote investment in new modalities and drive international expansion.” The LDP Research Commission on Social Security System has already formed a project team for reinforcing and nurturing drug discovery capabilities which has recommended that the entire Government establish command tower functions for international expansion in this field. Rather than acting alone, it would be ideal for the Ministry of Health, Labour and Welfare (MHLW) to involve the Prime Minister’s Office and establish command tower functions outside of the MHLW and throughout the entire Government, as well as to collaborate on and orchestrate a vast movement for international expansion. The structure of copayments for products like long-listed drugs will be reviewed and examined to promote innovation within health insurance financing. Instead of expanding patient-selected extra medical services within the field of pharmaceuticals, all that was mentioned in the Basic Policy was, “Review and examine the structure of copayments.” This was likely done because “long-listed drugs” include a broad variety of drugs with different characteristics.

There are plans to amend laws related to the use of cannabis-derived medicines during the next extraordinary Diet session. The Basic Policy also mentions promoting over-the-counter (OTC) pharmaceuticals, self-medication, and the use of biosimilars, which carries implications for the promotion of imports and the reinforcement of domestic manufacturing. Efforts must be made to accelerate the approval process, although there are significant hurdles like reinforcing the system for regulatory approval to support the practical use of programmed medical devices. As the number of young people who can donate blood will continue to decrease due to population decline, from a medium- to long-term perspective, we must maintain a sense of caution regarding blood products. While promoting understanding toward blood donation, we must take various measures including those for domestic self-sufficiency, stable procurement, and encouraging the proper use of blood products.

Expenditures for and job placement in the healthcare and long-term care sectors

Chapter 4 of the Basic Policy states, “The next simultaneous revision of fees for healthcare, long-term care, and welfare services for persons with disabilities (the “Triple Revision”) will take into consideration rising prices, increasing wages, business conditions, the need to secure human resources in face of a shrinking workforce, and the impact of the financial burdens of patient and user copayments and insurance premiums and include the necessary measures to ensure patients and users can receive necessary services.” The Triple Revision in FY2024 is likely to include a revision of long-term care service fees as well as partial legal revisions. The challenge will be restoring financial resources for Long-Term Care Insurance in communities to sound health to respond to issues like increases in the numbers of citizens ages 75 years and over and senior citizens living with dementia. Since the existing Long-Term Care Insurance service fee system does not provide financial rewards for improvements in beneficiaries’ care levels (which range from one to five and depend on long-term care need), it is likely that many long-term care providers are continuing to provide care that corresponds to higher levels or are prioritizing people who require higher levels of care. It will be necessary to flesh out incentives for improvements made to long-term care levels. Also, after four to five years of broad-ranging discussions, a bill introduced by a Diet member called the Dementia Basic Act for an Inclusive Society (or the Dementia Basic Act) has been enacted. Among other advancements, building a long-term care support system based on the Dementia Basic Act will help create an environment in which many people can enjoy greater peace of mind when receiving long-term care and that will prevent people from being cut off from long-term care and becoming “long-term care refugees.”

Other emerging issues include personnel shortages among paramedics and long-term care providers, excessive referral fees charged by private for-profit long-term care companies, and high penalties fees for contract cancellations made after cooling-off periods. Public employment agencies like Hello Work must function more effectively and their robust activities must be made more visible. This is also an item that many legislators have voiced opinions on.

Steering fiscal management in a new direction

The direction of the Government’s fiscal management is set for one financial frame on a three-year cycle, so the current fiscal management approach follows that of the Basic Policy on Economic and Fiscal Management and Reform 2021. In 2021, growth in social security-related expenses was limited to the corresponding increase due to population aging. In a similar manner, the approach to budgeting was to reduce other budgets to secure financial resources to outpace population aging. The most frequently-selected target for reduction was pharmaceutical expenditures, which were reduced by as much as 160 billion yen. It was necessary to reverse this approach and I lobbied hard alongside many like-minded Diet members to see that happen. Although it was not mentioned in the Basic Policy, we were able to hold a fair and open discussion on this topic with the Deputy Director-General of the financial bureau, so it is likely to be reexamined during the budget compilation in December. As for additions to official prices during the Triple Revision, the budgeting policy ended up being different than last year.

Unnecessary expenditures must be curbed to generate finances to cover increases in social security spending. While maintaining an awareness toward willingness to invest and work in healthcare, long-term care, and drug discovery, we will send out political messages and advance the necessary discussions.

The need for measures to address inflation and rising prices

Recently, Japan has reversed from deflation to inflation, and we have now entered a phase in which prices are trending upward. The Kishida administration has requested the private sector to increase wages, and the Japan Business Federation has reported base salary wage increases of 3% or more in the spring labor offensive, centered around large corporations. On the other hand, those working at companies that are subject to official prices will end up being left out, so if the Government wants higher private sector wages, official prices must also be raised accordingly.

For dependents, there are what is known as “income barriers,” where real income decreases due to social security premiums that apply once their annual income exceeds 1.03 million yen and 1.3 million yen. Exceeding these barriers impacts employee pensions and other benefits, so this is a topic that requires cool-headed discussion, and the Government has declared it will work to review this system.

Increases in energy and electricity prices are particularly high at healthcare institutions and pharmaceutical companies, and this has become a source of pressure on their business operations. While it should be profits that drive wage increases through market mechanisms, diminishing returns mean companies currently have no choice but to use profits to stay in business, and this an alarming problem.

Generic drugs

Many people serving in real-world medical settings and dispensing pharmacies have voiced their concern regarding stable supplies of generic drugs. An expert panel at the MHLW has also offered recommendations on this issue, but there are structural problems like the ones below.

• The drug pricing system does not reflect prevailing market prices
• There is excessive price competition
• Negotiations with pharmacies and healthcare institutions are resulting in lower prices
• There are companies that lack the capacity for joint development and manufacturing

From the perspective of health financing, transitioning to an industrial structure that can maintain a stable supply of a broad range of generic drugs will be vital. This will require the following measures.

• Correct joint development mechanisms
• To further improve manufacturing capacity, consider evaluations that are tailored to it
• Starting with drugs of high medical necessity, assign price tiers to be reflected in the drug pricing system
• Strengthen the entire pharmaceutical supply chain

Antimicrobials have also been designated as key commodities, so proactive measures should also be taken for pharmaceuticals from an economic security perspective.

A lively exchange of opinions was held with members of the audience during the Q&A session after the lecture. Topics discussed included how to best structure the Government’s financial resources and challenges for retention rates in preventive healthcare.

(Photographed by: Kazunori Izawa)

■Profile

Mr. Hiroaki Tabata (Member, House of Representatives; Director, Health, Labour and Welfare Division, Liberal Democratic Party)

Mr. Tabata has served as Director of the House of Representatives Committee on Health, Labour and Welfare, State Minister for Internal Affairs and Communications, and Parliamentary Vice-Minister of the Minister of Health, Labour and Welfare, and as Director of the Health, Labor and Welfare Division of the Liberal Democratic Party since August 2022, he has been actively involved in policymaking in the ruling party, especially in the fields of health care and pharmaceuticals. Based on the lessons learned from COVID-19, Mr. Tabata will discuss the National Health Emergency Management Research Organization, the so-called Japanese version of the CDC, the rapid and stable supply of pharmaceuticals, and the domestic drug discovery ecosystem, as well as his thoughts on the prospects and the future of Japan from a broad perspective. He will also be discussing these perspectives with everyone in attendance.

Interview content

Self-introduction and current activities

Professor Hagiwara’s opinions on Mental Health 2020

Ensuring people with mental disorders are prepared for disasters is another important perspective for the future

Professor Natsuko Hagiwara (Chairperson, Japan NPO Center (JNPOC); Professor, Graduate School of Social Design Studies, Rikkyo University; Member, Advisory Board, HGPI Mental Health Policy Project)
“Enact citizen-driven policies so people with disabilities are supported by society as a whole”

• Self-introduction and current activities

Professor Hagiwara’s starting point was the “Citizen’s Research Contest”
One of the stated goals of Health and Global Policy Institute (HGPI) is to achieve “citizen-driven healthcare policy.” I served as program officer for a program that ran from 1989 to 1997 called “Let’s Take a Close Look at the Environment Around Us” and was part of the Toyota Foundation’s Citizens’ Research Competition (which was held from 1979 to 1997; hereafter the “Competition”). This was probably the first program in Japan that provided citizens with grants to conduct research on their surrounding environments.

But why did they place their focus on citizens? Mr. Yoshinori Yamaoka, who was serving as a program officer at the Toyota Foundation and is currently an advisor at the Japan NPO Center (JNPOC), was the one who devised and implemented the concept of “Citizens walking around and seeing with their own eyes, conducting surveys and research, and making policy proposals to solve community issues based on evidence.” It is no exaggeration to say this was a groundbreaking initiative for the period, because the research was conducted by citizens who had been living in the targeted regions and were therefore experts on local issues. Researchers may have the tendency to pursue research for the sake of accumulating achievements for themselves, but citizens feel responsible towards their communities. When research is conducted by local residents or people closely involved in a community, it is conducted with a strong sense of ownership. Citizens cannot conduct such research in an irresponsible manner. To share an example of research conducted in an irresponsible manner, we can look to the interviews conducted after the Great Hanshin-Awaji Earthquake. Researchers, experts, and journalists who came from outside the stricken area and interviewed locals in a mechanical manner, which ended up hurting the feelings of the disaster victims. I call such researchers, “Passer-by researchers.” I remember that based on lessons learned then, a notice was issued after the Great East Japan Earthquake reminding people not to engage in such behavior. (Note from HGPI: For more information on this issue, please see the March 28, 2013 proposal “Current Issues and the Future of Academic Investigation on the Great East Japan Earthquake” presented by the Science Council of Japan.) I learned through the Toyota Program that it is meaningless to distinguish between “experts” and “amateurs” when it comes to discovering and solving local issues.

I learned another important lesson during my activities for the Competition. When I spoke with a person with a severe disability who serves as the representative of a certain organization, they said, “Thinking of people with strollers and wheelchairs might give the impression that we should make the whole city barrier-free, but that’s not true. For the visually impaired, there is nothing scarier than a completely even street.” That made me realize something. What they were emphasizing was that it is no good for people with disabilities to only think of themselves, even if it is for others with the same disabilities.

As such, only those most affected know how many centimeters high a step should be or what kind of tactile paving is necessary. This is why it is important to continuously involve various people affected by disabilities in projects and discussions. I think the same could be said for policy proposals. It is important to have a process design that considers how to involve members of the public and those most affected.

So, I must conclude that my starting point was the Competition. I think it was there that I learned universal process design methods for allowing the various citizen stakeholders, who make up local communities, to interact and connect through surveys and research and to solve problems.

Professor Hagiwara utilizes her experience in Government as chair of the Toshima F1 Conference
I then became a university professor, and about six years later, I was invited by then Governor Shiro Asano of Miyagi Prefecture to serve as Deputy Director of the Miyagi Prefecture Environment & Living Department. I was only appointed for a two-year term, but I gained much from my experience in local government. For example, citizen-driven policy proposals are often made at the wrong timing because people do not understand how the government works. Consider the Toshima F1 Conference (hereinafter, the “F1 Conference”), which was launched to revitalize Toshima City, a city that was at risk of disappearing because of a decreasing population. One of the reasons the F1 Conference successfully raised approximately 880 billion yen was because it managed to submit its budget by autumn and made it to the Diet in time for February.

It is important that the policymaking process is accessible to a wide range of people. People with mental disabilities have their own unique perspectives, so I think the key issue is finding how to best gather the voices of many people. Someone must create a mechanism or system to make the current situation visible. After that is done, it will be important to determine when, how, and in what form to generate citizen involvement. Once members of the public have participated in an initiative, the next step is to get them to join in the planning process. This expands the project from one point to a line, and to then spread it out over an area. It is not only important to lend an ear to the voices of citizens, but to gradually make citizens’ opinions take form.

The F1 Conference uses the World Café method* to gather many opinions. Those opinions are then summarized and discussed together with representatives from the Government, at which point they are ordered by priority and synthesized into proposals. This method is now known as the “Toshima Style” and is being used to formulate policy. Toshima City has transformed into a city that is easy to live in for everyone.

*World Café method: A method in which a relaxing atmosphere, unlike a normal conference, is created to hold discussions focusing on a specific theme. Rather than disagreeing with each other’s opinions, participants strive to respect the opinions shared by others with the goal of making new discoveries. Continuous discussions are held with small groups of four to five people with members rotated in and out periodically.

Professor Hagiwara became aware of herself as a party affected by healthcare policy when her grandchild developed maple syrup urine disease
In June 2013, my grandchild was born with a congenital metabolic disorder called maple syrup urine disease, an intractable disease that affects just one in 640,000 people in Japan. Because their body is unable to break down essential amino acids, they are unable to consume proteins, including those from breast milk. Whey they were born, however, maple syrup urine disease had yet to be designated as an intractable disease. A signature campaign from a patient group and other efforts led to a law revision that designated maple syrup urine disease as an intractable disease in July 2015. (Information on maple syrup urine disease can be found in Japanese at MSUD-JAPAN.)

My daughter said that attending a patient meeting and seeing other people with maple syrup urine disease doing well gave her hope. This made me realize it is very important to see people engaging in mutual cooperation in everyday life.

Accepting the disease was tough, but we were open about it and actively sought advice from people like specialists we knew. I think it was wonderful to receive positive encouragement from the people around us.

It is important to accept the situation as it is while connecting with others
HGPI: Regardless of the disease, when someone is diagnosed with something, they worry and suffer. If they close their mind and avoid establishing relationships with the outside world, they will not be able to receive help from people around them. By overcoming this and opening up, you were able to connect with various people and gained their cooperation.

Hagiwara: If you view the disease as an obstacle, it becomes something you have to overcome. I think it is a question of if you can accept yourself just as you are. I think it is likely that education from an early age is also important. It is said that to connect with people, we must feel things like, “They are trying to understand me” and “They accept what I am telling them.” So, we must build relationships that make us feel this way. NPOs might be able to serve as mediators in that process.

• Professor Hagiwara’s opinions on Mental Health 2020

Continuously build connections with a bright outlook
Because my grandchild’s disease is called maple syrup urine disease, my daughter has been reaching out to companies and organizations that deal in maple syrup to ask for their cooperation. It went almost perfectly. We still keep in touch with the president of an import company who wrote us back because he received our letter. This experience provides an example of the way I would like to see mental health initiatives promoted – as cheerfully as possible. If they are too serious, it will be hard on the people involved.

The capacity to seek support and the ability to accept it
In Japan, people are taught from a young age not to be a bother to anyone, and we end up lacking the capacity to seek support. In other words, we do not have the ability to say, “Help me,” or ask for help. Rather than just saying, “I don’t need help, I’m okay,” it is important to be able to communicate to others about your problems and what you want them to do for you. It is also important to have the ability to accept support. In the field of disaster prevention, attention is growing on the importance of the ability to accept support among both communities and individuals who are the target of various support efforts. And to communicate with others, it is important to learn the art of communication. JNPOC and Dentsu, Inc. have been collaborating to host seminars for a program called “The Art of Communication.” This program aims to help NPOs improve their communication skills to expand their activities. We have been running it for about 16 years and we would love for it to serve as a good point of reference. (For more information, please see “The Art of Communication” at the JNPOC website here.)

• Ensuring people with mental disorders are prepared for disasters is another important perspective for the future

Support for caregivers
The Great East Japan Earthquake highlighted the problem of “hidden people with disabilities.” Some people had been hiding the existence of family members with disabilities. This meant that some people could not go to evacuation centers or that voluntary disaster prevention organizations could not confirm their status. I have also heard that few municipalities classify people with intractable diseases among those who require support.

When disaster strikes, people with mental disorders come to face even more difficult situations. Just as their conditions are worsening, it is likely that local NPOs and other organizations that had been providing them support are also suffering from lower capacity due to the disaster. This means we must consider forms of support that include both people with disabilities and their caregivers, including their families. In addition to support for people with mental disorders, I think we must make policy proposals for continuous support for caregivers during normal times.

Building environments in which people with disabilities are visible
Unlike many cases involving people with physical disabilities, unless the affected party speaks up or someone representing them speaks up for them, understanding when someone is affected by mental, internal, or developmental disabilities (which have been growing more common in recent years) can be difficult.

In particular, there are complex issues that come with developmental disabilities that cannot be taken together under the same umbrella, so I think people affected by them or other concerned parties must speak up. For example, a survey conducted by Rikkyo University, where I work, found that although online classes have become common at universities due to COVID-19, certain developmental disabilities like Autism Spectrum Disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD) have characteristics that make online classes unsuitable for people affected by those disorders.

Students attending my seminar course conducted a survey on employment support for students with developmental disabilities at universities as part of their master’s theses. They found that such students need more detailed, closer support that fits the characteristics of their disability. Unrelated to disabilities, values concerning work and work styles have been undergoing a dramatic shift in recent years. For example, in Japan, there has been a shift from “membership-type employment,” in which people seek to belong to an organization rather than to perform certain tasks, to “job-based employment,” in which employers rely on the expertise and characteristics of each member of the organization. These changes might, in a sense, lead to expanded employment opportunities for people with disabilities. Therefore, I think the practice of providing support for “job-based employment” will be expanded so people with disabilities can find jobs that make use of their individual characteristics and specialties.

Those most affected understand the importance of “strategic meddling”
To create an environment in which people with disabilities are visible, we need opportunities, frameworks, and mechanisms that allow people to recognize and accept each other and to have roles to play. As society grows more diverse, the need for such systems will continue to grow. To build a society of mutual support, I think some “meddling” is necessary. But because intervening too much can cause problems, I think it is also important to aim for a moderate degree of intervention and to engage in “strategic meddling.” It is difficult to know how much to intervene, but through my grandchild’s illness, I am in the process of acquiring that knowledge firsthand from the perspective of one of the parties most affected.

It is also important for people to manage risk with an awareness that they might find themselves in the same position at any time. As Ulrich Beck said, “individualization” is transforming companies and families and is forcing individuals to take on all sorts of risks. We have fallen into a situation where we cannot say, “Help me.” Therefore, it is important we create loose connections that allow us to call for help or provide help during emergencies. One example of how to create loose connections is Neighbors’ Day, which is said to have originated in an apartment in Paris. While Neighbors’ Day is a very simple celebration in which people bring their own food and drinks to gather and chat, it serves as a system for creating regular opportunities for residents to easily meet, interact, and connect with their neighbors to ultimately form a community safety net.

Supporting those our systems do not reach
When a system is created, there are always people who end up marginalized. Therefore, whenever we create a system, we must keep in mind that some will end up outside of its scope. This is why we must make systems better than the ones we have now. For example, some diseases are designated as intractable diseases while others are not. We need to think about how to provide support to those whose diseases are not designated intractable diseases.

For their entire lives, people with maple syrup urine disease must drink a special type of milk that does not contain essential amino acids. However, due to the small number of patients and the high cost of production, each can of the milk costs tens of thousands of yen, and the company that produces the milk does so as a form of contributing to society. Maple syrup urine disease is a specified chronic pediatric disease, so financial assistance was already available for children under age 18. Now that it has been designated as an intractable disease, financial assistance has finally become available for people after they turn 18. I think an issue we must address in the future is determining how to provide support to people with rare diseases that are not designated as intractable diseases.

The importance of enacting laws
The Equal Employment Opportunity Act took more than ten years to be enacted. I am a member of the generation that had to seek employment as a new graduate before it was enacted. Back then, women who were about to graduate from four-year universities were barely given opportunities to sit employment examinations, so I was happy when the law was created. While it is true that it is full of loopholes (called a “colander law” in Japanese) because it does not set any penalties, if we do not enact laws when we have the opportunity to do so, we will not make any progress. Once a law is in place, however, it can be amended to fit the situation. That is why it is important to make policy recommendations. We can gradually revise laws to make them a better fit for actual situations, and it is for that reason I believe enacting laws is highly significant.

(Interview held on December 4, 2020 at Professor Hagiwara’s office)

“Mental Health Policy in the Eyes of Those It Affects” Interview Series

Since its establishment in 2004, Health and Global Policy Institute (HGPI) has worked as a non-partisan think tank under the guiding principle of helping citizens shape health policies by generating policy options. Through conversations with multi-stakeholders including members of the public and parties most affected in Japan and abroad, HGPI amplifies the voices of citizens in proposals and statements in a global context to contribute to the realization of evidence-based health policies.

The knowledge provided to HGPI from people affected by mental disorders throughout our ongoing efforts for mental health in a project that began in 2019 led to the presentation of “Mental Health 2020 – Proposal for Tomorrow: Five Perspectives on Mental Health Policy” in July 2020. Moving forward, we will help empower people affected by mental disorders to independently engage in forming mental health policy and have their voices be heard by providing access to knowledge from organizations representing those most affected in other disease fields in Japan through collaborations with other HGPI projects and by creating opportunities for opinion exchanges and discussions with organizations representing people affected by mental disorders from abroad.

As part of this vision, we have started publishing a series of interviews featuring people affected by mental disorders. By incorporating their honest opinions in the aforementioned policy proposal and by disseminating their perspectives in both Japanese and English, we will contribute to the creation of mental health policy that further improve conditions and quality of life (QOL) for people affected by mental disorders in Japan.

■ Interview 1: Mr. Ken Udagawa (COmmunity Mental Health & welfare Bonding Organization Chairperson)
“Elucidate the physiology of recovery by improving longitudinal studies”

■ Interview 2: Mr. Yasuhiro Obata (Secretary General, The National Federation of Associations of Families with The Mental Illness in Japan (Minna-net))
“Placing Mental Health at the Center of National Policy for Harmony between the Healthcare System and Communities”

■ Interview 3: Mr. Kenjiro Horiai (YPS Yokohama Peer Staff Association)
“As Someone with a Mental Disorder, I Want to Help People Facing Similar Circumstances”

■ Interview 4: Mr. Keigo Kobayashi
“Gather and share examples of role models and establish a safety net so people with mental disorders can live every day with peace of mind”

Thank you for your continued support of Health and Global Policy Institute (HGPI).
In order to further strengthen and expand the future activities of HGPI, Dr. Yusuke Tsugawa (Assistant Professor, University of California, Los Angeles (UCLA)) , Prof. Satoko Hotta (Professor, Graduate School of Health Management, Keio University) , and Mr. Ryoji Noritake (President, HGPI) were appointed as Board Members at a meeting of the Board of Directors held on October 2, 2018. Mr. Noritake will also continue to contribute to HGPI as President.

In regards to this transition, Dr. Kiyoshi Kurokawa, Chairman of HGPI, remarked, “Looking to the future, it is my hope that HGPI continues to expand its range of activities, serving as a place where young minds full of energy and drive take action and spread their wings into the world. To that end, I would like to ask for everyone’s continued support.”

Thus with this renewed structure, HGPI looks forward to working even harder to develop and strengthen Japanese civil society. We would like to express our sincere appreciation for your continued support.

■Board of Directors (As of October 3)

• Kiyoshi Kurokawa(Chairman)
• Hiroaki Yoshida(Vice Chairman)
• Kohei Onozaki(Board Member)
• Yusuke Tsugawa(Board Member)
• Ryozo Nagai(Board Member)
• Ryoji Noritake(Board Member)
• Satoko Hotta(Board Member)
• Shinsuke Muto(Board Member)
• Tsuyoshi Dai(Auditor)
• Kenji Maekawa(Auditor)

* Names highlighted in underline represent new Board Members.
** With the exception of Ryoji Noritake, Board Members serve part-time and pro bono.

Health and Global Policy Institute (HGPI) is pleased to announce the 2018 Global Health Education Program (G-HEP), “Ageing and Health Innovation” co-organized by HGPI and the Faculty of Public Health of Mahidol University.

*Registration has closed.

Program Overview: G-HEP 2018
The G-HEP 2018 program aims to bring together students and young professionals from Japan and Thailand to share experience and knowledge on the common and unique health challenges faced by these two countries, with a special focus on ageing, and to propose innovative business/policy-centered solutions. Throughout the duration of the program, students will analyze major health issues, propose feasible and creative solutions, learn integrated approaches to ageing-related health challenges, build networks with foreign health experts, and think critically about their role and responsibility as future global health leaders.

Program activities will be conducted in English. Participants need not speak perfectly – we welcome applicants with a conversational level of English to apply!

Interested applicants, please submit the google application form from this link by Wednesday, June 27, 2018 at 17:00.

Program Details

• Dates
  August 25 – September 2, 2018
  9 days (1 day in Tokyo, Japan and 8 days in Bangkok, Thailand)
• Venue
  Tokyo: Global Business Hub TOKYO (HGPI’s office and conference space)
  Bangkok: Mahidol University and related facilities /site (ex. healthcare institutions)
• Program Contents
  • Lectures from global health professionals, and academia of Japan and Thailand
  • Fieldwork and site visits in Thailand
  • Discussion sessions among Thai and Japanese students
  • Final competition, providing innovative business/policy-centered solutions to overcome health challenges
• Program Schedule (TBD)
  

  Location	Day	Date	Contents
  Tokyo	1	August 25	Orientation, Ice-Breaker Session
  Bangkok and its suburbs	2	August 26	Flight to Thailand
  	3	August 27	Orientation, Lectures, Group Work, Welcome Dinner
  	4	August 28	Lectures, Group Work
  	5	August 29	Site Visits
  	6	August 30	Site Visits
  	7	August 31	Site Visits
  	8	September 1	Group Work
  	9	September 2	Final Presentation, Reception, Flight to Japan

  *Tentative plan
  1) Nakhon Ratchasima Province (approximately 3 hours away from Bangkok)
  2) Field visit on hospital and clinic related to ageing, non-communicable diseases and dementia
  3) Inspection on traditional medicine activities
  4) Exchange ideas with local community staff and regional community center on NCDs prevention
• Number of Participants from Japan
  Recruitment number:
  Maximum 15 young professionals (also students from Thailand will be participating)
  
• Application Eligibility
  Young professionals or university and graduate level students in the fields of medicine, public policy, international affairs, public health, international health and other fields with an interest in global health are welcome to apply.
  *As the program will be conducted in English, English conversation and listening skills are required.
  *Past participants of Global Health Summer Program (GHSP) and G-HEP programs are NOT eligible to apply.
• Selection Criteria
  Participants will be selected based on their levels of English language proficiency and the answers (in English or Japanese) to the short essay questions provided on the application form. 
• Application Process and Selection Announcement*
  The application deadline is Wednesday, June 27, 2018 at 17:00. To apply, from the google application form (in either English or Japanese, but preferably in English).
  Successful applicants will be notified by email on Friday, June 29, 2018.
  *We extended application deadline.
• Participation Fee
  The participation fee is JPY 85,000. For successful applicants, the fee is due by the end of July, 2018 (Date to be notified by email). Please note that cancellation fee applies after the selection announcement on Thursday, June 28, 2018.
• The participation fee includes:
  
  • Round-trip airfare to/from Tokyo, Japan – Bangkok, Thailand
  • Fieldwork costs (hotel, in-country transportation, meals*)
    *Including the reception and welcoming dinners on the first and last night in Bangkok, and hotel breakfasts only.
• The participation fee does NOT cover:
  
  • Travel insurance
  • VISA application
  • Domestic transportation to/from Airport
  • Transportation within Tokyo for Day1
  • Meals while in Tokyo, except Day1 lunch
  • Meals while in Bangkok, except breakfast, welcome dinner, and reception
  • Souvenirs and personal spending in Tokyo and Bangkok
• Travel Insurance 
  All program participants will be required to obtain travel insurance. The average cost for international travel insurance is below JPY 10,000. Recommended travel insurance company will be announced to the participants later.
• Visa Application 
  To enter Thailand, a traveler needs to acquire a Visa depending on his/her nationality. A successful applicant is responsible for the Visa application procedures. Please note that this process may take more than a month. Holders of a Japanese passport do not need a Visa for this program. 
• Assistance for Travel/Accommodation Cost*
  For those outside of Tokyo, Kanagawa, Chiba, and Saitama Prefectures: There are funds available to assist with travel to/from Tokyo and accommodations at a designated location in Tokyo. If this applies to you, please indicate your current location and level of need on the application form. Please note that this assistance is applicable only to those outside of Tokyo, Kanagawa, Chiba, and Saitama Prefectures.

Co-organizers
Health and Global Policy Institute (HGPI)
Faculty of Public Health of Mahidol University
Kanagawa University of Human Services
National Graduate Institute for Policy Studies (GRIPS)

Contact
Health and Global Policy Institute
info@hgpi.org (Sugawara, Aoun)