Lecture No.5
UHC and Finance:
Developing Human Resources for Sustainable Health Financing

Keizo TAKEMI is senior fellow of Japan Center for International Exchange (JCIE) and has been serving as chair of JCIE’s Executive Committee on Global Health and Human Security—a public-private global health policy platform founded in 2007—and chair of the Asian Population and Development Association (APDA). He served as Minister of Health, Labour and Welfare from September 2023 to September 2024 and served five terms as a Liberal Democratic Party (LDP) member of the House of Councillors. Prof. Takemi has been involved in various global initiatives including the UN Commission on Information and Accountability for Women’s and Children’s Health, the Global Health Workforce Alliance (GHWA), the WHO Expert Working Group on R&D Financing, and the international organizing committee of the Prince Mahidol Award Conference (PMAC). In 2016, he was appointed to the UN High Level Commission on Health Employment and Economic Growth, and in 2018, to the UHC Financing Advisory Committee for the G20 2019. He served as Senior Vice Minister for Health, Labour and Welfare, and State Secretary for Foreign Affairs, where he led the initiative to establish the UN Trust Fund for Human Security. In recognition of his contributions to the field over the past decade, he was appointed WHO Goodwill Ambassador for Universal Health Coverage (UHC) from 2019–2022, and was named to the advisory board of the International Committee of the Red Cross (ICRC) in July 2025. From October 2025, Professor Takemi has also served as Visiting Professor at Nagasaki University, is the co-author of Global Action for Health System Strengthening: Policy Recommendations to the G8 (2009), and has written numerous articles for various publications.

First, prioritization of prevention as an essential component of UHC. Second, primary healthcare as the foundation of UHC. Third, saving lives by increasing equitable, universal access to quality and affordable essential medicines and products. Fourth, increasing sustainable financing for health and improving efficiency in investments. Fifth, enabling community engagement and empowerment in universal health coverage design, development, and accountability. These approaches are essential for every Asian country.

To achieve these processes and take care of people's health conditions, the Sustainable Development Goals can serve as targets. Achieving UHC is an efficient policy concept that can integrate different approaches to health conditions. UHC can therefore be utilized as a target and goal for health systems approaches. While vertical approaches like polio eradication and stopping tuberculosis can easily set goals, health system strengthening requires the identification of goals. UHC can serve as the goal of health systems approaches and can be an efficient approach to integrate different approaches for health. Therefore, there was strong advocacy that UHC should be part of the SDGs. As a result of this encouragement to the United Nations, SDG3 finally adopted UHC as one of its goals.

When considering how to achieve UHC, Prof. Takemi noted that based on his own experience as Japan’s Minister of Health, Labour and Welfare, governance is key to strengthening the health system. Health financing is a fundamental building block of the health system, along with service delivery by medical suppliers. The purpose includes equity, quality, responsiveness, efficiency, and resilience.

Collaborative networks for sharing knowledge and research in Asia

Recognizing the rapidly aging societies in Asia and that the elderly populations in Asian countries will become the largest in the world, there is a need for close collaboration regarding aging populations. Many Asian countries already have their own approaches to elderly care. Analysis of different types of elderly care services is what led to the establishment of the Healthy Aging Prize for Asian Innovation (HAPI). This international award honors innovative initiatives that address aging challenges and contribute to realizing a healthy and long-living society. The prize is organized by the Japan Center for International Exchange (JCIE) and the Economic Research Institute for ASEAN and East Asia (ERIA) as part of the Asian Health and Wellbeing Initiative (AHWIN), a project led and financed by the Japanese government.

This prize serves as a symbol of how Asia can consolidate collaboration and identify how to work closely and efficiently together, determining what services are required for aging populations, including super-aging. The prize evaluates innovation technologies, community-based initiatives, and support for self-reliance through neutral committees that assess applications from Asian countries. 

  Another example of a collaborative initiative involving multiple countries in Asia is the ATLAS (Asian Clinical Trials Network for Cancers) Project. Prof. Takemi noted that when serving as health minister, a proposal was made to create more efficient networks for clinical trials for cancer-related pharmaceutical development. The result was ATLAS, an initiative led by the National Cancer Center Hospital to establish a regional clinical trial network for cancer across Asia. 

Launched in September 2020 with support from the Japan Agency for Medical Research and Development (AMED), ATLAS aims to accelerate international collaboration in pharmaceutical and medical device development. If clinical trial networks can be efficiently designed, each Asian country can join the early stages of research and development for pharmaceutical development, improving the quality of pharmaceutical development itself.

ATLAS is built upon three key initiatives. First, conducting multinational clinical trials aimed at regulatory approval and practical implementation of pharmaceuticals and medical devices. Second, providing Asian-originated educational content through both online and onsite formats. Third, establishing a permanent international research group consisting of leading investors from across Asia.

A further initiative is the Academic Research Organization (ARO) Alliance for Southeast Asia and East Asia (ARISE) project. While ATLAS focuses on non-communicable diseases, specifically cancer, ARISE addresses communicable diseases. ARISE was launched by the National Center for Global Health and Medicine of Japan in 2021. This center became part of the Japan Institute of Health Security (JIHS) after the COVID-19 pandemic. Therefore, JIHS is now in charge of this network for clinical trials, specifically for communicable diseases. There is a need to develop more efficient processes for collaboration in clinical trial research, especially for infectious diseases. Much has been learned through the initial stages of ARISE regarding regulatory systems and collaboration for infectious diseases.

Japan’s national vision for active aging and global health

Prof. Takemi noted that during his tenure as health minister two key vision papers were published. The first is the Strategy for Future Society for Active Aging, a national vision to promote active, health lives amid Japan’s super-aged society. This vision aims to extend healthy life expectancy and reduce the gap between health span and lifespan. It encourages innovation in prevention, early intervention, and personalized care, and integrates health policy with economic revitalization and workforce sustainability.

The second vision paper is the Global Health Vision, which is closely related to the first paper. Most departments of health tend to be domestically oriented rather than global. However, even with many geopolitical conflicts ongoing worldwide, globalization cannot be stopped, especially in terms of innovation. Globalization is key to the development process, particularly in health research and pharmaceuticals, appoint that is aptly illustrated by the development of RNA messenger-type vaccines. In fact, the global pharmaceutical ecosystem emerged through the COVID-19 pandemic. Not only vaccine development but many other types of pharmaceutical development have become cases of globalized ecosystems for pharmaceutical development. Therefore, when Japan undertakes internal reforms for healthcare services, it must simultaneously and inevitably take into account the global context. A global health vision is needed not only for global health but also for domestic health reform.

Many lessons were learned from the COVID-19 pandemic. The most serious issue was that Japan did not have a Center for Disease Control. There was only the National Institute of Infectious Diseases, which was solely a research body, not a Center for Disease Control. Therefore, a decision was made to establish a Japanese-type Center for Disease Control by merging the National Center for Global Health and Medicine, the largest hospital, with the National Institute of Infectious Diseases. These two bodies were merged to create the Japan Institute of Health Security (JIHS). System strengthening and digital transformation are now ongoing at the newly inaugurated organization. While continuously strengthening the health system, it is necessary to simultaneously take care of future risks from infectious diseases, and the creation of JIHS is one such development. Healthcare DX 2030 is another initiative, where infectious disease and comprehensive health data being integrated into the digital transformation agenda to ensure robust and responsible information infrastructure. 

Other initiatives in Japan include the enhancement of research and development and manufacturing capacity, including domestic vaccine production capabilities and positioning Japan as a global drug discovery hub. 

In summing up, Prof. Takemi noted that health issues in Asia originate with the rapid demographic change being experienced by Asian countries. Rapid aging will cause widening health gaps among Asian countries and among Asian peoples. Consideration must therefore be given to how to avoid increasing gaps in health between Asian peoples. As the most mature and advanced aging country, Japan should be responsible for committing to technological transfer for healthcare services and supporting Asian countries to develop their own preparation for aging societies. Japanese people, along with Asian peoples, can jointly create healthier societies in Asia as a whole.

(3) Discussion 

Dr. Kawahara asked whether increasing public investment in health is becoming more difficult in the current political context.

Prof. Takemi responded that many domestic reasons prevent countries from efficiently building health systems to achieve universal health coverage. Many low and middle-income countries (LMICs) rely heavily on global financing and lack independence. Support is needed to widen their fiscal space and strengthen sustainability of UHC. He noted that while serving as health minister, he developed training programs for government officials in health financing. Through discussions with WHO and the World Bank, the Knowledge Hub for UHC Finance was established, which is scheduled to launch on December 6, 2025 in Tokyo. The Prince Mahidol Conference in Thailand also has similar initiatives. These networks collaborate to overcome domestic challenges in achieving UHC.

Prof. Takemi noted that domestic obstacles can be overcome by policymakers who utilize global context and services for domestic reforms. The catalyst for such initiatives is primarily government officials, led by government policy, with providers mostly from the private sector, coordinating different players under the banner of UHC.

Tony HILL (Asia Cancer Forum) asked about the various mechanisms to scale up innovative ideas, such as those emerging from the Healthy Aging Prize for Asian Innovation (HAPI). 

Prof. Takemi responded that COVID-19 had considerable impact on designing health systems. Japan could not develop its own vaccines and relied on other countries. As a key decision-maker, Prof. Takemi was involved in purchasing vaccines while considering how LMICs could access vaccines without competitive pressures. Consultations with the global health community led to the realization of the COVAS facility. During his time as health minister, Prof. Takemi noted how he had worked to create pillars for domestic reform for the next pandemic. Everyone recognizes that Japan must collaborate with Asian partners and therefore national reforms and global collaboration became closely related, which provided the impetus for the formulation of the two vision papers he had mentioned in his lecture.

Regarding the question about whether Japan’s MHLW has become more international in the process of creating such globally oriented policies, Prof. Takemi noted that younger and middle-level bureaucrats fully embraced his top-down leadership and recognize the need for more dynamic decision-making in a global context. 

A student asked why the scope of ATLAS and ARISE focus on Southeast Asia rather than all of Asia.

Prof. Takemi responded that geographical conditions are factors when widening networks for clinical trials and regulatory systems. When harmonizing regulatory systems, partner countries should have similar standards. ASEAN countries have many first-class cancer hospitals that can easily partner with the National Cancer Center of Japan, based on scientific and geographical reasons.

However, networks must be widened beyond Southeast Asia. Some countries may not have large cancer hospitals but still have cancer patients. Key persons can learn diagnostics and treatment, then return to their countries to open hospitals and clinics, becoming partners beyond national boundaries.

This year, a full scholarship program for medical school in Japan was started for foreign students. Twelve foreign students were accepted for the six-year scholarship. From April, these students will begin coursework under full scholarships from the Japanese government. Such approaches are required for future partnerships beyond national boundaries.

A student asked about policies for controlling commercial determinants for cancer.

Prof. Takemi noted that when discussing pharmaceutical development, the private sector and venture businesses are essential. When designing health systems and UHC, careful consideration must be given to the role of the private sector and commercial mechanisms. Market mechanisms can be part of health systems as catalysts for service delivery.

The government's role is to design how players in different sectors can collaborate under public-private partnerships. Market mechanisms and business must be considered as partners. How countries design health systems depends on individual circumstances. Flexibility and inclusiveness are required for realizing health system strengthening to achieve UHC.

A student asked under what circumstances UHC could be considered to have been fully achieved and which country is closest to this achievement.

Prof. Takemi responded that the definition of UHC is that all people can access health services, including preventive services, at affordable cost. Japan achieved UHC in 1961 when the universal health insurance system was established, meaning that every Japanese person could access healthcare services of similar quality. Japan achieved this goal when annual per capita income was still only around US$4,300. Many Asian countries now exceed US$5,000 annually in per capita income but have not achieved UHC. When UHC was adopted as SDG3, many decision-makers in LMICs claimed they had already achieved it. Therefore, careful analysis of the content and details of services and access process is necessary. The key concept of equity is an important value in developing UHC.

(4) Assignment  

Students were given the following assignment: 

Objective

The purpose of this individual assignment is to critically engage with key themes from the lecture—population ageing, the rise of non communicable diseases (NCDs), and the UHC Knowledge Hub—by interpreting them through the lens of your own disciplinary background. 

Task description 

1. Select your disciplinary background
   Identify one primary disciplinary background on which you draw in your studies

2. Select one lecture topic
   Choose one topic from the lecture slides that you found particularly engaging. 

3. Apply one theory, concept, or method from your discipline
   Bring one specific theory, concept, or methodological approach from your field and use it to re interpret or re frame the selected topic. In your essay, explain how this disciplinary lens sheds new light on the topic.

4. Concluding reflection
   Conclude with two to three sentences explicitly articulating how your discipline can contribute to:
   - sustainable universal health coverage (UHC), and
   - addressing the challenges of an ageing society.