Global Health in Japan: A Moral and Economic Dilemma

| February 1, 2012 | 0 Comments

After the Great East Japan Earthquake disrupted the lives of thousands of Japanese citizens in March 2011, it was expected that Japan’s foreign assistance would be significantly diminished in favor of domestic aid. Yet, Japan has continued to be involved in global health despite the tragedy. Japan’s commitment to global health illuminates how global health is seen by Japan as a critical moral and economic issue.

World leaders at the G8 Summit held in Tokyo, Japan (2008). At the summit, global health was identified by the Japanese Government as a major agenda item. (Courtesy of Eric Draper)

As an island with limited resources, Japan’s economy is heavily dependent on trade and globalization. Because of this, Japan’s foreign assistance—including global health aid—is often viewed through an economic lens. By providing global health aid, Japan is able to cement key relationships with its trade partners.

Japan’s perception of global health can be seen in its distribution of foreign aid. For example, in recent years, regions in the Middle East and Africa have been receiving the largest proportion of Japanese assistance: 26.2 percent and 22.5 percent of Japan’s Official Development Assistance (ODA), respectively.

Central to this shift is the goal to not only improve health in these regions, but also to form potential economic relationships. These countries are resource-abundant, and aid enhances economic development and Japanese access to those resources.

Specifically, there has been a sharp increase in global health assistance to Ethiopia, a country long associated with poverty. The strategic significance of assistance towards Ethiopia is outlined in Japan’s ODA proposal, which states that Ethiopia is economically important due to it accounting for 8 percent of Africa’s population and its “abundant potential for development.”

Dr. Kiyoshi Kurowaka, an advisor on global health to the Japanese government, provided his perspective on the economics of Japanese global health aid in a recent article. He explained that with global health support from Japan, developing countries become healthier.

Women wait in line for vaccinations given out by UNICEF in the Ethiopian village of Ereguda (2005). The Government of Japan has announced a nearly $16 million donation to UNICEF to improve global health in African countries such as Ethiopia. (Courtesy of The Gates Foundation)

These improvements will in turn enhance developing countries’ economies, and they will “recall how their donor country helped them.” Because Japan is heavily dependent on emerging countries’ economies, forming strong relationships with countries is essential to the survival of Japan.

Retaining and improving close relationships with countries is also a top priority. In previous years, Japan has concentrated a great deal of its global health aid to countries it already has economic ties to, specifically East and Southeast Asian countries, thus insuring a continuation of trade partnerships.

Indonesia serves as an instructive example: from 2005 to 2009, it received approximately 19.5 billion U.S. dollars in aid from Japan. Indonesia is a key recipient of global health aid due to its interdependent relationship with Japan in trade and investing. Specifically, Japan is dependent on Indonesia for natural resources, like oil, and as a market and manufacturing base.

Economic development in East and Southeast Asia is viewed as essential to the peace and prosperity of Japan. Since Japan’s economy is inseparable from East and Southeast Asia’s economies, economic development in these countries is directly related to Japan’s economic success.

The economic approach to global health is not unique to Japan. Many other countries have also approached global health as more than just a moral issue. One such example is the United States, which often addresses global health aid through a political, security and economic lens.

Various consequences arise because Japan’s global health aid is often influenced by economic concerns. One issue is that countries that are considered less economically important are sometimes overlooked. In terms of income group countries, only 16 percent of Japan’s ODA went to Less Developed Countries in recent years. The majority of Japan’s ODA went to Lower Middle Income Countries, due to a higher potential for developments in such countries.

Even further examination reveals that the actual percentage of ODA devoted towards improving health is very low. According to an article written recently in the Lancet, “Japan’s health ODA is set at only two percent of its total ODA, which is substantially lower than the average for OECD countries at 15 percent.”

Despite the low percentage devoted to global health aid, most Japanese feel it should be given top priority. In an interview with the HCGHR, Dr. Keizo Takemi, the former Vice Minister of Health in the Japanese government, stated that more than 70 percent who responded to a recent opinion poll for Japanese ODA believed health issues should be the highest priority for ODA.

Takemi further explained that most Japanese feel that it is their responsibility to improve global health care because of their own success with domestic health. In Japan, the average life expectancy is 86 for women and 78 for men– a very high number as compared to the world average of 67. Because of this success, Takemi claims, it is Japan’s responsibility to share their “experiences on how to achieve a healthy society at low cost with equity.”

This attitude of responsibility is reflected in Japan’s recent improvements in global health aid. From 1990 to 2005, Japan has increased its developmental assistance in global health from US $2.5 billion to US $14 billion. And recently, at the 2008 G8 Summit hosted by Japan, global health was identified as one of the nation’s top priorities and deserving of more attention.

Whether Japan’s involvement has been spurred by moral, economic or even security reasons, Japan has started to take on a strong leadership role in the global health community. With Japan’s help, real and sustainable gains will be made in global health.

Category: Panorama, Policy, Spring 2011

About the Author ()

Leave a Reply