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Japan: universal health care at 50 years
Editorial
Japan marked the 50th anniversary of universal health care on April 1, 2011. During this relatively short period of time, Japan quickly became a world leader in several health metrics, including longevity. To celebrate and consider Japan’s achievements in health, The Lancet today publishes a Series on universal health care at 50 years in Japan. Six theme papers and eight Comments by Japanese academics with international collaborators document the post-war evolution of health care in Japan—particularly the country’s increased participation in global health. In describing Japan’s actions and providing an opportunity to translate that experience to other settings, the theme papers resemble finely crafted netsuke (fasteners): both functional and provoking reflection. At the centre of Japan’s approach has been the constitutionally enshrined objective of universality in health care, translated into practice by universal access. Equality is emphasised in society at large, with the result that Japan has performed well on social determinants of health. However, the financial and social underpinnings of health care in Japan are now under threat from economic stagnation, which has widened social divisions. As inequalities increase, social determinants of health will likely deteriorate, leading to poorer population health and greater demand for services. Combined with rising health-care costs and an ageing population, Japanese doctors—like those elsewhere—worry about the sustainability of universal access under such pressures. The Japanese health system was tested on March 11, 2011, by the Great East Japan Earthquake and events that followed. The magnitude 9·0 earthquake and ensuing 40 m high tsunami caused extensive damage to infrastructure, health-care facilities, and a nuclear power plant. The subsequent leak of radiation complicated efforts to deliver care and secure public health. In the midst of winter, against an unpredictable risk of aftershocks and nuclear contamination, the Japanese people showed a dignity and solidarity that commanded international respect. The perseverance of medical teams under harsh conditions with little equipment showed that the heart of the health-care system is determined by the dedication of its personnel, as it had been for the past 50 years. Dedication and leadership describe the two Series champions, Keizo Takemi from the Japan Center for International Exchange and Kenji Shibuya from the www.thelancet.com Vol 378 September 17, 2011
University of Tokyo, who supported their colleagues to meet manuscript deadlines despite pressures placed on medical staff in the months after the earthquake. Their unswerving commitment to describe the successes, predicaments, and future of universal access, while working hard to improve health outcomes in Japan and to share expertise with developing countries, sets the tone for this Series. A central message of Japan’s experience is that many challenges are common across health systems—and thus there is a need to identify and share what we know. For instance, all countries, at whatever stage of development, have ageing populations. In Japan, this situation has arisen particularly rapidly, with the number of people older than 65 years having quadrupled during the past 60 years to 23% of the population. Japan sets an example of healthy ageing and shows that in addition to medical concerns, longevity has social implications that need to be debated and addressed. Another lesson is that effective medical care can be delivered without waiting lists at a comparatively low cost of 8·5% of gross domestic product. But there is room for improvement. The two final theme papers challenge the Japanese Government to revise the health agenda at home and abroad by providing, among other changes, improved preventive care for chronic disease and bold leadership for health in developing countries and among its neighbours in Asia. Both goals are important and progress will be monitored by The Lancet. Central to the sustainability of a health-care system is the quality and commitment of its youngest members. One less publicised legacy of the Great East Japan Earthquake was that it was young people, skilled in social media, who coordinated assistance for 180 000 stranded commuters in Tokyo during the hours after the earthquake, and who—months later— continue to provide free medical services in the areas hardest hit by the tsunami. Thus, it would be wrong for a Series that is dominated by longevity in a country steeped in tradition not to ascribe appropriate credit to the young generations of health workers in Japan. These people, who have already shown resourcefulness and dedication, are well qualified to meet the challenge of sustainability and quality of care for universal access in the future. ■ The Lancet
David McLain/Aurora/SpecialistStock
Japan: universal health care at 50 years
Published Online September 1, 2011 DOI:10.1016/S01406736(11)61223-3 See Comment page 1051 See Perspectives pages 1064 and 1065 See Series page 1094 and 1106 See Online/Comment DOI:10.1016/S01406736(11)61221-X, DOI:10.1016/S01406736(11)61220-8, DOI:10.1016/S01406736(11)61148-3, DOI:10.1016/S01406736(11)61130-6, DOI:10.1016/S01406736(11)61189-6, DOI:10.1016/S01406736(11)60820-9, and DOI:10.1016/S01406736(11)61187-2 See Online/Series DOI:10.1016/S01406736(11)60987-2, DOI:10.1016/S01406736(11)61176-8, DOI:10.1016/S01406736(11)61048-9, and DOI:10.1016/S01406736(11)61098-2
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Japan marked the 50th anniversary of universal health care on April 1, 2011. During this relatively short period of time, Japan quickly became a world leader in several health metrics, including longevity. To celebrate and consider Japan’s achievements in health, The Lancet today publishes a Series on universal health care at 50 years in Japan. Six theme papers and eight Comments by Japanese academics with international collaborators document the post-war evolution of health care in Japan—particularly the country’s increased participation in global health. In describing Japan’s actions and providing an opportunity to translate that experience to other settings, the theme papers resemble finely crafted netsuke (fasteners): both functional and provoking reflection. At the centre of Japan’s approach has been the constitutionally enshrined objective of universality in health care, translated into practice by universal access. Equality is emphasised in society at large, with the result that Japan has performed well on social determinants of health. However, the financial and social underpinnings of health care in Japan are now under threat from economic stagnation, which has widened social divisions. As inequalities increase, social determinants of health will likely deteriorate, leading to poorer population health and greater demand for services. Combined with rising health-care costs and an ageing population, Japanese doctors—like those elsewhere—worry about the sustainability of universal access under such pressures. The Japanese health system was tested on March 11, 2011, by the Great East Japan Earthquake and events that followed. The magnitude 9·0 earthquake and ensuing 40 m high tsunami caused extensive damage to infrastructure, health-care facilities, and a nuclear power plant. The subsequent leak of radiation complicated efforts to deliver care and secure public health. In the midst of winter, against an unpredictable risk of aftershocks and nuclear contamination, the Japanese people showed a dignity and solidarity that commanded international respect. The perseverance of medical teams under harsh conditions with little equipment showed that the heart of the health-care system is determined by the dedication of its personnel, as it had been for the past 50 years. Dedication and leadership describe the two Series champions, Keizo Takemi from the Japan Center for International Exchange and Kenji Shibuya from the www.thelancet.com Vol 378 September 17, 2011
University of Tokyo, who supported their colleagues to meet manuscript deadlines despite pressures placed on medical staff in the months after the earthquake. Their unswerving commitment to describe the successes, predicaments, and future of universal access, while working hard to improve health outcomes in Japan and to share expertise with developing countries, sets the tone for this Series. A central message of Japan’s experience is that many challenges are common across health systems—and thus there is a need to identify and share what we know. For instance, all countries, at whatever stage of development, have ageing populations. In Japan, this situation has arisen particularly rapidly, with the number of people older than 65 years having quadrupled during the past 60 years to 23% of the population. Japan sets an example of healthy ageing and shows that in addition to medical concerns, longevity has social implications that need to be debated and addressed. Another lesson is that effective medical care can be delivered without waiting lists at a comparatively low cost of 8·5% of gross domestic product. But there is room for improvement. The two final theme papers challenge the Japanese Government to revise the health agenda at home and abroad by providing, among other changes, improved preventive care for chronic disease and bold leadership for health in developing countries and among its neighbours in Asia. Both goals are important and progress will be monitored by The Lancet. Central to the sustainability of a health-care system is the quality and commitment of its youngest members. One less publicised legacy of the Great East Japan Earthquake was that it was young people, skilled in social media, who coordinated assistance for 180 000 stranded commuters in Tokyo during the hours after the earthquake, and who—months later— continue to provide free medical services in the areas hardest hit by the tsunami. Thus, it would be wrong for a Series that is dominated by longevity in a country steeped in tradition not to ascribe appropriate credit to the young generations of health workers in Japan. These people, who have already shown resourcefulness and dedication, are well qualified to meet the challenge of sustainability and quality of care for universal access in the future. ■ The Lancet
David McLain/Aurora/SpecialistStock
Japan: universal health care at 50 years
Published Online September 1, 2011 DOI:10.1016/S01406736(11)61223-3 See Comment page 1051 See Perspectives pages 1064 and 1065 See Series page 1094 and 1106 See Online/Comment DOI:10.1016/S01406736(11)61221-X, DOI:10.1016/S01406736(11)61220-8, DOI:10.1016/S01406736(11)61148-3, DOI:10.1016/S01406736(11)61130-6, DOI:10.1016/S01406736(11)61189-6, DOI:10.1016/S01406736(11)60820-9, and DOI:10.1016/S01406736(11)61187-2 See Online/Series DOI:10.1016/S01406736(11)60987-2, DOI:10.1016/S01406736(11)61176-8, DOI:10.1016/S01406736(11)61048-9, and DOI:10.1016/S01406736(11)61098-2
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