Japan's strategy for global health diplomacy: why it matters.

Global health is standing at a crossroads. The past decade has been a glorious period for global health because aid to the health sector has surged, and newly formed public–private partnerships have increased the effectiveness of development assistance. Japan has played a significant part, for example by leading discussions at the G8 Kyushu-Okinawa Summit in 2000 and by helping in the establishment of the Global Fun d to Fight AIDS, Tuberculosis and Malaria. However, countries now face changing disease structures, and noncommunicable diseases are a global threat. If the world follows the existing disease-focused vertical pathway for development assistance in the coming years, the disparity between resource allocation and actual disease burdens will widen. The disease-specific approach is straightforward, but the importance of tackling health in general is clear. At the G8 Hokkaido Toyako Summit in 2008, Japan proposed a comprehensive approach to health, inclusive of health system strengthening, to complement a vertical approach. A working group led by Keizo Takemi supported the work of the G8 Health Experts Group by recommending actions. Unfortunately, because of the financial crisis that began in 2008, there have been difficulties in sustaining the amount of aid for health. We should now pursue universal health coverage (UHC) to solve existing global health challenges and to embark on the post-2015 development agenda. UHC would help us to reach three goals. The first of these goals is to improve the health of countries’ entire populations, includ ing the most vulnerable people, women in particu lar. The existing Millennium Development Goals (MDGs) stop short of addressing widening domestic inequalities, and it is crucial to close the gap in access to health services between wealthy and poor people. The second goal is to ensure health service provision for all people, shifting from a diseaseoriented to a people-centred approach. UHC can meet the wide-ranging health needs of every person. These two goals are interrelated and together help to achieve human security through protection and em powerment of individuals. The third goal is to enable countries to look at their own challenges and implement health policies that fill diversified needs with a limited budget. UHC can be a powerful way to reinforce country owner ship and setting of priorities in search of value for money. This new pathway for global health is still at an early stage and needs strong political leadership, which is why I launched the Strategy on Global Health Diplomacy in May, 2013. With this strategy, I first and foremost spare no efforts to incorporate UHC as a crucial element of the post-2015 development agenda. UHC is gaining a footing in the global health dialogue. The Foreign Policy and Global Health initiative led a resolution on UHC, which was adopted at the 67th UN General Assembly. I agreed with President François Hollande of France, who leads this initiative, to promote UHC. Second, I will reinforce Japan’s assistance to develop ing countries to work with them to achieve UHC. Promotion of UHC does not mean a reduction of aid in the health sector or ignorance of the unfinished work of the MDGs. With regard to Africa, our work on MDGs opens the door towards UHC. At the 5th Tokyo International Conference on African Development (TICAD V) held in June, 2013, I called for the promotion of UHC and committed US$500 million of financial assistance in health, including capacity building of a 120 000-strong health workforce. To turn our attention to Asia, Japan and the Asso ciation of Southeast Asian Nations (ASEAN) are celebrating the 40th year of ASEAN–Japan friendship and cooperation this year. As a microcosm of diversi fying challenges of global health, ASEAN presents an opportunity for all the stakeholders in health to work together for the health