[Title] Address by Mr. Masahiko Koumura, Minister for Foreign Affairs of Japan Global Health and Japan's Foreign Policy - From Okinawa to Toyako -

Ladies and Gentlemen,

Next year, Japan will play host to two major international conferences, the Fourth Tokyo International Conference on African Development (TICAD IV) and the G8 Hokkaido Toyako Summit. At this significant diplomatic juncture, Japan will take up and call for a stronger engagement of the international community in Global Health - an issue that humanity cannot evade in its progress towards the future. I would like to share my views on what the international community should strive for in the field of Global Health and the role of Japan's diplomacy.

(From Okinawa to Toyako)

In the year 2000, during the G8 Kyushu Okinawa Summit, Japan launched the 'Okinawa Infectious Diseases Initiative' and appealed for international collaboration. This led to the establishment of the Global Fund addressing the three major infectious diseases, namely, AIDS, tuberculosis and malaria. The United Nations Millennium Summit in 2000, laid the foundation for the Millennium Development Goals (MDGs) including health goals to be achieved by 2015. That same year, a historical statement was issued announcing the eradication of polio in the Western Pacific region.

Seven years have passed. International awareness on the need to take action against infectious diseases has increased since then. The Global Fund to Fight AIDS, Tuberculosis and Malaria now saves 3,000 lives each day; it has saved 1.5 million so far. And yet, a total of 6 million people still die from these three diseases every year. At the same time, we still face serious challenges in maternal, newborn and child health. In sub-Saharan Africa, 166 out of 1,000 children die before their 5th birthday; that is 20 times the number than in the developed world. Risk of pregnancy- and childbirth- related deaths is one out of 16, which is 200 times higher for women in sub-Saharan Africa than for those in developed countries. At this rate, I must say we are likely to miss the Millennium Development Goals.

Next year we reach the mid-point for the achievement of Millennium Development Goals by the year 2015. At TICAD IV, Japan intends to take up the issue of health in Africa, and at the G8 Summit, the wider issue of Global Health. The objective will be to develop a set of common framework for action shared by the international community. I am inviting all key stakeholders including national governments, international organizations, the business community, academia and civil society to take part in developing this framework for action to respond to the issues I will present today.

(Striking a Balance between Two Directions - a Disease-specific Approach and a Comprehensive Approach including Health System Strengthening -)

Where should the international community go from here? Here I underline the notion of 'Human Security', a concept that is so relevant to cooperation in the 21st century. That is to say, it is of vital importance that we not only focus on the health of individuals and protect them, but also strive to empower individuals and communities through health system strengthening.

Until now, international efforts in the health sector has largely centered on measures against infectious diseases as a pressing issue. From now on, it is essential to promote a comprehensive approach to strike at the root of the problem including through the promotion of research and development and strengthening of health systems including human resource development and retention. Disturbingly, sub-Saharan Africa holds 11 percent of world's population and 25 percent of disease-related burden, but the region has only 3 percent of health workers in the world. The importance of human resource development and retention on a considerable scale is self-evident. The 'disease-specific approach' and the 'comprehensive approach' complement each other. Striking a good balance between them will be at the core of international framework for action that we aim to develop at Toyako.

(A Proposal based on Japan's Own Experience)

The effectiveness of integrating two intersecting approaches has been empirically proven by Japan's own experiences. Post-war Japan focused on promoting maternal and child health and tackled infectious diseases such as tuberculosis at the same time. Maternal and Child Health Handbooks contributed to enhancing the basic health knowledge of mothers and its dissemination along with the development of community health systems led to a significant decline in maternal mortality ratio and infant mortality rate. Combating infectious diseases were not solely the work of hospitals, doctors and nurses. A holistic approach was taken that included the spread of vaccinations and regular health check-ups at health centres and schools, provision of nutritional education and school lunches, which together led to concrete results. Efforts in these two areas eventually led to the overall improvement of Japanese people's health.

Japan has shared its experience with developing countries, for example, through dissemination of Maternal and Child Health Handbook in Indonesia. It began when one Indonesian doctor happened to come across this Handbook during his training organized by Japan International Cooperation Agency (JICA). This empowerment tool for mothers traveled beyond the seas and has been reaching several other countries in Asia and the rest of the world, even Palestine.

(A Cross-sectoral Approach and International Collaboration)

The proposed framework for action cannot be formulated by health experts alone. We need experts from various fields to be involved in this process.

One vital aspect of health is 'water'. In a developed country like Japan, 99 percent of people have access to safe drinking water. In sub-Saharan Africa, that rate drops to a mere 56 percent. If you look at access to adequate sanitation facilities including toilets, you will find that 99 percent of the developed world is covered, whereas only 37 percent of sub-Saharan Africa is.

Development and retention of human resources is important for running health systems. Basic education and gender equality are essential, because they provide the underpinnings for it. The development of road networks is also very relevant. We may have to transport patients quickly, medical doctors and nurses may have to rush to a scene with medical supplies. Unless roads and bridges work, medical services do not reach people. We also need means of communication that are readily available. In recent years, as global warming progresses, various effects of climate change have been noted including expansion of malaria-affected areas.

The proposed framework for action cannot be promoted by the Japanese Government alone. It is imperative that diverse stakeholders collaborate further.

Developing countries including those in Africa must have ownership of the health agenda. The 'Hideyo Noguchi Africa Prize' will be supporting various efforts in this regard in Africa, and will be presented for the first time at the TICAD IV.

Major developed countries including the G8 and international organizations need to show clear political will to support the efforts of developing countries as their partners. In this respect, I welcome the health initiatives announced by UK, Norway, Germany and Canada this year. I also welcome other countries who are emerging as new providers of aid through south-south cooperation to join our effort. It is equally important to mobilize NGOs carrying out grass-roots activities on the ground. We would also like other stakeholders such as the business sector, private foundations and knowledgeable people to come on board with their diverse expertise and resources.

The TICAD IV and G8 Summit next year will be excellent opportunities for the international community to strengthen their collaboration and build a framework based on a participatory approach suited to the 21st century. Japan, as G8 chair and host to TICAD will aim to achieve this.

The theme of today's symposium: the 'People-Centered Health Care' is perfectly in line with the concept of 'human security' that I spoke about. I conclude my speech by returning to the central premise that what matters most is 'people'. Not only in the field of health or development, but in all fields of international collaboration, 'people' are what we should focus our attention on.

Thank you very much for your kind attention.