Former Japanese Parliamentarian and Current HSPH Fellow Offers Recommendations to G8 about Strengthening Health Systems

To make big changes in the world, a politician usually starts by winning an election. The reverse holds true for former Japanese Senator Keizo Takemi. He failed in his bid for a third term in his country’s parliament two years ago. Yet, the legislature’s loss has been global health’s gain.

Within months, Takemi joined HSPH as a research fellow. Drawing on the expertise of his Harvard colleagues and his own extensive network, Takemi has helped lead Japan’s promising effort within the G8, a group of global political leaders, to strengthen health systems in developing countries.

“He has been introducing some of the latest academic thinking at Harvard on health systems into official statements and, we hope, official actions at the G8,” said Michael Reich, a professor in the HSPH Department of Global Health and Population. “This is an unusual example about how to go from research to action and from research to policy.”

Last July, the annual G8 summit was held in Toyako, Japan. At the behest of the Japanese government, Takemi headed a “Working Group on Challenges in Global Health and Japan’s Contribution,” better known as the Takemi Working Group, to keep global health high on the G8 agenda. The working group identified areas for discussion about improving health systems.

Carrying momentum from the 2008 summit, the Takemi Working Group was charged with developing recommendations for specific international action on three high-priority health-system components (people, money, and data). Those recommendations were given to the Japanese government, who will present them to the hosts of the 2009 G8 summit — Italy.

“Our job is to contribute to a smooth transition from Japan to Italy,” Takemi said. “The Toyako framework for action can be respected as the basis of new developments at the Italian G8 summit.”

Takemi and Reich published, "G8 and strengthening of health systems: follow-up to the Toyako summit," in the February 7 issue of The Lancet. The overview includes descriptions of the three policy papers on themes that were emphasized in the Toyako Framework for Action on Global Health: health workforce, health finance, and health information summaries. All three papers stress the need for the G8 to address the quality of resource use and the quantity of resource provision, write Takemi and Reich. The full overview and the related policy papers are available online.

In a commentary published online on January 15 in The Lancet, HSPH Dean Julio Frenk wrote: “The current economic crisis is placing additional strains on a world that is already overburdened by its inability to meet the basic needs of billions of its inhabitants. Yet we also have before us the unique opportunity represented by strong interest in health systems.”

The growing interest in health systems and the rise of the G8’s role in global health mark a major change in the agenda and power of global politics, observe Takemi and Reich.

In the last two years, Takemi’s travels have included meetings and discussions at the top levels of Japanese government, international non-governmental organizations, academia, and private foundations. Early on, he reflected, the hardest part was explaining the importance of health-systems strengthening to policymakers.

“For example, when we talk about a health system, what does that mean?” Takemi said. “It’s easier to understand the seriousness of an individual disease.”

“I utilized the appeal of Harvard as a pillar of academic research in the global community to persuade policymakers how health systems are important,” Takemi said.

In their Lancet overview, Reich and Takemi write: “The global health agenda is shifting from an emphasis on disease-specific approaches to a focus on strengthening of health systems." They continue: "We believe that a better balance needs to be struck between the two approaches, so that efforts at fighting specific diseases and strengthening health systems can support each other effectively.”

Global health governance has become a crowded arena. The World Health Organization (WHO) used to be the sole international health agency. Not anymore. Last July, ten days after the G8 meeting, a group of global health leaders met for the first time, calling themselves the Health 8 or H8. The group included WHO, the World Bank, GAVI (a consortium of organizations to promote immunization and vaccination), the Global Fund, UNICEF, UNFPA, UNAIDS, and the Bill & Melinda Gates Foundation. Public-private partnership has become the new mantra.

Strengthening health systems will require collaboration between G8, H8, and national institutions in donor and recipient countries, Takemi and Reich say. “The G8 does not have the capacity to become a global health apex institution, but the G8's special leverage can help drive health-system strengthening forward in new ways,” they write.

If the name Takemi sounds familiar to HSPH members, there may be several reasons why. The Takemi Program in International Health at the School has hosted more than 250 mid-career professionals, mostly from developing countries, since it was established in 1983. It was named for Taro Takemi, a physician-scientist who served for more than 25 years as the president of the Japan Medical Association and is the father of Keizo, now a Takemi fellow. For long-time news junkies, Keizo Takemi also has been an anchor on CNN Day Watch in Japan. Reich is the Taro Takemi Professor of International Health Policy and directs the Takemi program.

Japan’s annual budget for official development assistance is now second only to the World Bank, according to Takemi, thanks in part to a restructuring of Japan’s foreign aid institutions that he facilitated when he was in the Japanese parliament. The country’s current strategies for health assistance relate to a concept of health security, including human protection and empowerment, as a priority of its foreign policy.

The authors of the three policy reports published in the web appendices of the Takemi and Reich Lancet overview also have HSPH connections. Masamine Jimba (co-author, health workforce) is a former Takemi fellow. Ravi Rannan-Eliya (author, health financing) and Kenji Shibuya (author, health information) both received their doctorates in population and international health from HSPH.

-- Carol Cruzan Morton