Mainstreaming universal health, with Japan at the helm as a long-lived nation

Japan's early adoption of Universal Health Coverage (UHC) has attracted worldwide attention, as it is the country with the longest healthy life expectancy in the world.

One of the reasons for this is that for more than half a century Japan has maintained a health insurance system that all permanent residents of Japan for more than three months are required to join, allowing people living in Japan to access appropriate healthcare services at a cost they can afford. This is characterized by a free-access system that allows patients to choose any healthcare provider, from small clinics to large hospitals with the latest medical facilities, and all medical services are provided at a uniform price anywhere in Japan.

In addition, the Japanese government has increased the number of medical schools, especially in rural areas, in order to increase the number of physicians under the One Prefecture, One Medical School policy approved by the Cabinet in 1973. This has also contributed to the high quality of healthcare services in the country.

With such a history and system of insured health care, Japan issued the Basic Policy for Peace and Health in 2015, and based on its own experience, has shown a commitment to strengthen the necessary support for mainstreaming universal health coverage in the international community.

At the G7 Ise-Shima Summit and G7 Kobe Health Ministers' Meeting held in 2016, Japan became the first G7 country to set the promotion of UHC as a major theme at the summit-level meeting. Japan expressed its commitment to play a leading role in international discussions by supporting the establishment of universal health coverage in Africa, Asia, and other regions in cooperation with the international community and organizations.

Subsequently, in 2017, Japan co-hosted the high-level forum on UHC with the World Bank, the World Health Organization (WHO), and the United Nations Children's Fund (UNICEF). Government leaders from over 30 countries, as well as representatives and experts from international organizations, gathered to discuss how to promote universal health coverage in their countries, and adopted the Tokyo Declaration on UHC, which includes a commitment to accelerate efforts to achieve UHC by 2030.

In May 2022, the Kishida administration set forth its new Global Health Strategy based on the experience of responding to the spread of COVID-19. Placing the achievement of more resilient, equitable and sustainable UHC at the centre of Japan's international cooperation in the health sector, the strategy provides guidelines for efforts to build a global health architecture and strengthen health systems to prepare for future public health crises, including pandemics.

Ajinomoto, a Japanese food company, has been developing a project to improve infant nutrition in Ghana since 2009, working with Japan International Cooperation Agency (JICA) to promote baby nutritional supplements to reduce infant mortality due to malnutrition.

In addition, LEBER, Inc. has developed a healthcare app that can connect doctors and users anytime, anywhere, to solve the problems of people living in areas where access to healthcare is difficult. The app enables 24/7 remote doctor consultation via smartphone. With one of the largest networks of doctors in Japan, the app also functions as a physical condition management tool as well as a doctor consultation platform.

Universal health coverage is attracting attention as an excellent approach, but the key issue is how to maintain and operate the system once it has been realized. Securing an operating budget and training human resources with expertise are essential to making UHC sustainable.

Even in Japan, a leading universal health coverage country, there is a growing view that the current health insurance system is at risk of collapsing in the future due to increasing medical costs associated with the rapid aging of the population and sluggish income growth caused by slow economic growth. If Japan is to further develop its healthcare functions, there is an urgent need to rebuild a sustainable healthcare system that can respond to changes in the demographic structure. To address this challenge, the Ministry of Health, Labour and Welfare has launched Health Care 2035 to discuss a paradigm shift in Japan’s healthcare, with the aim to achieve this by 2035.

It will soon be three years since the first outbreak of COVID-19. The virus has repeatedly mutated, with numerous infectious outbreaks and convergence cycles that have taken a long-term toll on the economies of countries and peoples around the world. We have become acutely aware that health issues are closely linked to economic and social issues, and the importance of Sustainable Development Goal number 3 – good health and well-being – has also been highlighted once again.

What is noteworthy about Goal 3, which is comprised of 13 targets, is that the achievement of UHC is stated as being related to all of the targets and as the foundation of the entire goal. The need for universal health coverage has become even more urgent, not only to correct the world's increasingly pronounced health disparities, but as a foundation for economic and social stability and global health security.

Developed countries have extended assistance to people in developing countries to ensure that they have access to adequate healthcare services. On the other hand, the pandemic has also pushed the healthcare systems of developed countries to the brink of collapse. In 2023, the G7 summit is scheduled to take place in Hiroshima. In conjunction with the summit, Health Ministers' Meeting will be held in Nagasaki in May. As the chair, Japan is expected to lead the discussion on overcoming this crises and rebuilding cooperation among countries.