Offline: Japan's daring gamble in an age of apprehension

Abstract

How do you persuade a President or Prime Minister to take health seriously? The most common approach is one we use in The Lancet every week. We try to explain the burden of disease, disability, and risk facing people today and in the future. We hope to move the hearts and minds of policy makers by appealing to their sense of outrage. How can they bear the fact that so much unnecessary suffering exists among the populations to whom they are directly responsible? We try to publish research that offers solutions to these burdens. We believe that if we make our arguments convincing—by inviting scientists and physicians with interesting ideas and, better still, reliable evidence to write for us—we can persuade even the most hardened sceptic. One advantage we have is that the public cares about their health and so the quality of their health system. Voters punish politicians who are indifferent to the health of their people (there are intriguing exceptions, and they deserve separate study). Our approach sometimes works, albeit very slowly. Evidence from research does gradually seep through the thick, dark regulatory layers of licensing, health technology assessment, procurement, supply, and delivery. Accumulated data do eventually reshape practice through guideline committees, professional associations, and ministries of health. But it is a glacial process. There is another way. The best examples come from economists. The World Development Report 1993, Investing in Health, assembled evidence to prove that a country could make enormous economic gains by improving its health policies. The 2001 Commission on Macroeconomics and Health showed that tackling a small number of poverty-related diseases could bring substantial macroeconomic dividends to a country. And The Lancet's own Global Health 2035 report proved not only that it was possible to end preventable mortality within a generation, but also that in doing so the effect on a nation's economic performance was amplified in extraordinary ways. For health advocates, these instrumental arguments leave a bitter taste. We wish we could persuade political decision makers that health matters because of its intrinsic value to human beings. But given that countries have ministries of finance, whose job it is to say no, emphasising the pure merits of medicine often fails to win complex and competitive budgetary arguments. By (frustrating) contrast, using disease as a way to prove that the health sector is a wealth-creator as well as a health-creator can sometimes unfurl even the tightest of Treasury fists. The Government of Japan, which hosts the 2016 G7 Summit in Ise-Shima in May, is now preparing a third, even more daring argument. Last month, Prime Minister Shinzo Abe (along with Jim Kim, Margaret Chan, and Bill Gates) opened a conference in Tokyo on universal health coverage in the new development era. It was the main preparatory meeting to get the argument right for global health at the G7 Summit. Prime Minister Abe claimed that health mattered not only because of its inherent value, but also because of its contribution to peace. He framed health as a security issue. Indeed, Japan's distinctive contribution to global health has long been to link health with security—specifically, human security. And, in our current times, with good reason. As Presidents and Prime Ministers contemplate priorities for the coming year, a long list of concerns is likely to be topped by national security—the threat of terrorism, politically inspired violence, and even the risk of outright war. They will wish to build confidence among people that their nations are safe and secure. How? By investing in national defence, of course. But also by prioritising security in a broader sense—the security of the person as an indispensable prerequisite for national security. And here health occupies a special place. The G7 could make a huge contribution to its growing security agenda by adding a human dimension, and by delivering that dimension through advocacy for universal health coverage. What chance does this strategy of persuasion have? According to a recent survey of the Japanese public, the kanji symbol, an, which means safety or peace, is the most accurate measure of public mood today. If safety is the top priority for citizens of G7 countries, perhaps human security and its instrument, universal health coverage, could command the ardent support of Heads of State. Japan's compelling approach to global health is a calculated gamble. It deserves to win in this age of apprehension.