Lecture 1
Universal Health Coverage in Asia and Investment in Prevention: Assessing the Social Value of Prevention

Shinjiro NOZAKI

Compliance and Risk Management Officer, Office of the Regional Director,
World Health Organization Regional Office for Western Pacific

(1) Introduction to the lecture

Norie KAWAHARA welcomed students to the spring 2026 semester lecture series Surviving Cancer in Asia: Cross-boundary Cancer Studies, the theme for which is “The Social Value of Prevention: Reimagining the Foundations of Future Society.” She noted that the Cross-boundary Cancer Studies course grows from a long-running project, “Surviving Cancer in Asia,” which treats “cancer as a mirror”, reflecting Asia's diverse cultures and social systems. This idea was first developed and discussed by the late Dr. Hideyuki Akaza.  

Since 2011, Dr. Kawahara has been teaching courses on cancer issue in Asia within the University of Tokyo's Interdisciplinary Collaboration Program. Cancer could be viewed as a device that reflects society. When we look at cancer care, we can ask simple but powerful questions. Who is being forced to bear the risks of cancer? Who has reliable access to treatment? And who is being left behind when it comes to care? These questions lead us beyond medicine. They point to social systems, institutions, resources, and inequality. 

This lecture course sits within Interdisciplinary Cancer Research in Asia. the aim is to address cancer-related issues by integrating multiple academic fields. The inaugural lecture of 2011 was titled “A mirror reflecting the nature of life: On cancer care in Asia,” and was delivered by Hideyuki Akaza. 

All the students auditing this lecture series represent the next generation of society. The social insurance costs that will accrue in that generation are therefore the students’ own issue. Prevention is not just a narrow medical topic. It is a question about the future of society (Figure 1). 

Dr. Kawahara noted that there are four structural layers to the course. First, redefining value: What counts as a value and for whom? Second, evaluation: How do we measure benefits and trade-offs? Third, implementation: How do we embed prevention in systems and everyday practice? Fourth, diversity: How do culture and context change what works? The first three lectures of the series will cover the “Foundations of Value.” Moving into May 2026, the second part of the lecture series will cover “Evaluation and Comparison” asking how we can compare the value of prevention across the setting and countries? Part three covers “Systems and Implementation,” in which speakers will focus on how prevention can be embedded in real institutions. Part four will discuss “Diversity and Politics/Economics.” 

Dr. Kawahara explained that all sessions are conducted fully online. Although real-time participation is strongly recommended, recorded on-demand viewing is also available. Second, learning support. A lecture summary will be posted on the website one week after each session, to be used for review and for deeper understanding. With regard to assessment, a short report will be required to be submitted after every lecture. Students will then submit a final report in the form of a policy proposal. This final report is the primary component of the final grade. Consistent participation and timely submission will help students to build a well-developed proposal.  

Before introducing the first lecturer, Dr. Kawahara shared what she considers to be the core concept for the course: 

Dr. Kawahara noted that under this concept, the Asia Cancer Forum has been advancing activities since last year towards the realization of designation as a WHO Collaborating Center. 

Dr. Kawahara noted that it was therefore highly fitting for the first speaker of the Spring 2026 lecture course to be Dr. Shinjiro Nozaki. The central concept of this year's lecture course is deeply inspired by what Dr. Kawahara has learned from Dr. Nozaki. For many years, he has worked at the very heart of global health at WHO, helping to move many important agendas into reality. The lecture will be invaluable for students to hear about the reality of global health practice from someone who has been directly shaping it.

(2) Universal Health Coverage in Asia and Investment in Prevention:
Assessing the Social Value of Prevention

Shinjiro NOZAKI explained that his main function at the World Health Organization (WHO) at the present moment is Compliance and Risk Management Officer. He explained that the lecture would introduce his experience in global health and consider how best to think about the future of global health. One of the key messages would be prevention, which is one of the important items to consider for the future of the global health arena. Recently the WHO has established the WHO Tokyo Office, also named the UHC Knowledge Hub. On 6 December 2025 a high-level launch ceremony was held, and Dr. Nozaki was appointed Acting Head of the UHC Knowledge Hub in Tokyo. His main job is still with the WHO Western Pacific Regional Office in Manila, Philippines, but half of his time is now spent in Tokyo setting up the UHC Knowledge Hub. Today’s lecture would introduce some of the components of the UHC Knowledge Hub, with the lecture title “Universal Health Coverage in Asia and Investment in Prevention: Assessing the Social Value of Prevention.”

Introduction to the work of the WHO 

The WHO was founded in 1948 as a United Nations agency that connects nations, partners and people to promote health, keep the world safe and serve the vulnerable, so that everyone everywhere can attain the highest level of health. WHO is one of the UN agencies, but it does not sit directly under the UN Secretary General; rather it is a specialized agency, which means it has its own separate governance mechanism.   

While the United Nations holds its General Assembly in September each year, WHO separately holds its own World Health Assembly. WHO has 194 member states, slightly more than the United Nations’ 193, and has six regions with more than 8,000 professionals across the world. WHO also works with more than 800 WHO collaborating centers, and Dr. Kawahara is currently planning to work together with WHO to have her own organization (Asia Cancer Forum) designated as a WHO Collaborating Center in the near future.

Regarding WHO’s core functions, the popular image of WHO is of an organization that sends medical teams onto the ground during pandemics to support affected people. In reality WHO’s main function is totally different. WHO can be thought of as a union of the ministries of health around the world. Its main function is therefore “normative” — providing policy, setting standards, providing leadership, and offering health research support to member state ministries of health. 

For example, when the Ebola outbreak occurred in West Africa in 2014, the US Centers for Disease Control and Prevention and Médecins Sans Frontières sent medical teams to the affected countries, but WHO’s own role was to support member states by providing standards, policies, guidelines and evidence derived from health research. Some countries and international organizations have complained that WHO is always behind the scenes, and not standing on the ground as frontline workers. WHO's mandate, however, is to support health ministries through its normative function. After the Ebola outbreak, in response to such complaints and guidance from member states, WHO has begun to change its approach gradually, adding field work to support vulnerable populations alongside its normative functions, but its main function remains normative.

WHO operates on three levels. The headquarters in Geneva houses more than one-third of the 8,000 staff — about 3,000 people — who work mainly on normative, standard-setting work, providing policy, evidence and standards. Country offices represent “the face of the organization,” delivering frontline technical support to countries, although in principle the main frontline technical function belongs to health ministries. In some countries, particularly in Africa, WHO itself has to take on frontline roles because of a lack of human resources and budget. For example, in Nigeria, WHO has more than 650 staff in one country office, most of them working on polio immunization activities. By contrast, in the entire Western Pacific Region WHO has just 650 staff spread across the whole region. Country office functions therefore differ significantly depending on the national or regional context. The regional offices sit between headquarters and country offices, translating normative functions into field-level action and supporting country offices, for example by sending experts to support frontline technical work at country level.

In terms of the location of WHO offices, WHO headquarters is located in Geneva, Switzerland. In Washington D.C. is the AMRO/PAHO, the regional office for the Americas and the Pan American Health Organization, which was actually established before WHO, prior to World War II, and that is why in the Americas the regional office retains the PAHO name alongside its AMRO function. The European regional office is in Copenhagen, Denmark; AFRO, the African regional office, is in Brazzaville, Republic of the Congo; EMRO, the Eastern Mediterranean regional office, is in Cairo, Egypt; SEARO, the South-East Asia regional office, is in New Delhi, India; and the Western Pacific regional office (WPRO) is in Manila, Philippines. The Western Pacific Region previously had 37 countries and areas, but last year Indonesia moved from SEARO to WPRO, taking the number to 38. However, in January 2025 the United States officially withdrew from WHO, and the region therefore now has 37 countries and areas once again (Figure 2) 

The region encompasses nearly two billion people — roughly one quarter of the world's population — and is enormously diverse. Some countries are very small, such as Niue in the Pacific with only around 2,000 people, while others are very large, such as Australia and China, the latter with 1.5 billion people. The region also spans high-income countries such as Japan, Korea, China, Australia, New Zealand, Singapore and Malaysia, and low- and middle-income developing states.

In terms of the WHO leadership structure, Dr. Tedros Adhanom Ghebreyesus is the WHO Director-General, and Dr. Saia Ma'u Piukala is the Regional Director for the Western Pacific. A distinctive feature of WHO is that the Director-General is elected by the 194 member states, and similarly Regional Directors are elected by the member states within their respective regions (in the Western Pacific Region's case, the 37 member states). This is unique among UN agencies, and means that Regional Directors hold considerable independent power — the Director-General cannot select them. This uniqueness was demonstrated during COVID-19 in 2020, when WHO headquarters initially sent out the message that mask wearing was not necessary or effective against COVID-19 infection. The Regional Director for the Western Pacific disagreed with that position and publicly stated that masks should be worn and that mask wearing was very effective for prevention of infection. 

Across the world there are also 149 country offices, each led by a WHO Representative. WHO's separate governance platform is also distinctive — the World Health Assembly is held each May with all 194 member states attending, as well as Regional Committees held annually in each region.

WHO's current priorities are set out in its medium-term plan, the Fourteenth General Programme of Work (GPW 14), covering 2025 to 2028 (Figure 3). 

Through the 20th century WHO mainly worked on the prevention and control of communicable diseases. In the 21st century, however, a much broader set of issues have emerged, including climate change, social determinants of health, health system capacities, universal health coverage (UHC), financial protection, inequity, and gender inequality. With increasing climate-change-related disasters, WHO must now do more in these areas, while continuing its work on health emergencies, particularly in relation to pandemics caused by emerging and re-emerging communicable diseases.

Through the 20th century WHO mainly worked on the prevention and control of communicable diseases. In the 21st century, however, a much broader set of issues have emerged, including climate change, social determinants of health, health system capacities, universal health coverage (UHC), financial protection, inequity, and gender inequality. With increasing climate-change-related disasters, WHO must now do more in these areas, while continuing its work on health emergencies, particularly in relation to pandemics caused by emerging and re-emerging communicable diseases.

History and Future of Global Health

Dr. Nozaki identified 11 major events in the history of global health: the formation of WHO in 1948; the Declaration of Alma-Ata in 1978; smallpox eradication in 1980; the HIV/AIDS pandemic of the 1980s–1990s; the G8 Denver Summit in 1997; the G8 Kyushu-Okinawa Summit in 2000; the UN Millennium Development Goals (MDGs) of 2000–2015; the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002; the SARS outbreak of 2002–2003; the adoption of the UN Sustainable Development Goals (SDGs), including UHC, from 2015; and the COVID-19 outbreak of 2020–2022.

The WHO Constitution adopted in 1948 declared that the States Parties to the Constitution affirm, in conformity with the Charter of the United Nations, that certain principles are basic to the happiness, harmonious relations and security of all peoples. The Constitution defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, and it declares that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being. 

The foundations of the concept of UHC can be traced to 1978, when the International Conference on Primary Health Care was held in Alma-Ata, in what was then the USSR. The USSR collapsed on 26 December 1991, and 15 newly independent states were established from the former Soviet Union. The 1978 Alma-Ata Declaration, so-called primary health care declaration, built on the WHO definition of health and highlighted health system development and the overall social and economic development of the community as core elements for primary health care. This forms the conceptual foundation for UHC.

The Alma-Ata Declaration was revisited in 2018 at the Global Conference on Primary Health Care held in Astana, the new capital of Kazakhstan. The resulting Astana Declaration reaffirmed the primary health care concept as a fundamental basis for achieving UHC. It highlighted the need for governments and societies to prioritize primary health care and health services, the importance of enabling and health-conducive environments, and the need for engagement not only by governments but also by partners and stakeholders in advancing primary health care towards UHC and the SDGs.

The UN Millennium Development Goals, which ran from 2000 to 2015, were set up very simply, in contrast to the formulation process for the SDGs that succeeded them. The SDGs took almost two years to develop, reflecting the much broader range of stakeholders involved, while the MDGs were established relatively quickly. There were only eight MDGs, of which Goals 4, 5 and 6 were health-related: reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other diseases. These targets were very simple and very clear — for example, Goal 4 sought to reduce the under-five child mortality rate between 2000 and 2015 by a specified proportion, Goal 5 sought a comparable reduction in maternal mortality, and Goal 6 sought reductions in the prevalence of HIV/AIDS, TB and malaria. By comparison, the SDGs are much broader, encompassing 17 goals; even within Goal 3 (good health and well-being) alone there are almost 20 indicators.

The political context of global health changed sharply at the end of the 20th century. At the 1997 G8 Denver Summit in the United States, Japanese Prime Minister Ryutaro Hashimoto raised the issue of tropical diseases. At G7/G8 summits global leaders usually discussed only security and economic issues, but Prime Minister Hashimoto's intervention placed global health on the political agenda for the first time and became a game-changer. From the Denver Summit onwards, political leaders began paying attention to global health issues, and global health became a global agenda item. Prior to this, there were only a very small number of UN agencies working on global health, such as UNICEF and WHO; since then, many more UN agencies, international organizations and stakeholders have become involved, including Gavi and the Global Fund.

Three years later, at the G8 Kyushu-Okinawa Summit in 2000, the G8 leaders adopted the Okinawa Infectious Disease Control Initiative. This initiative was a key trigger for dramatic increases in global health funding — the total global health investment budget grew more than tenfold between 2000 and 2010 — and also brought many more stakeholders and partners into the global health arena. The Kyushu-Okinawa Summit is therefore a significant milestone in the expansion of global health funding and participation.

Moving into more recent years, COVID-19 came as a great surprise to WHO. The coronavirus belongs to the same family as the SARS virus, and when SARS emerged in 2002–2003 it disappeared within half a year as summer arrived. WHO expected COVID-19 to behave similarly, perhaps like influenza, and to disappear once summer came. This expectation proved entirely wrong: COVID-19 continued for more than two years and stopped almost all human activity, including economic and social activity. The pandemic also highlighted the disproportionate impact on vulnerable communities — overcrowded housing, indigenous communities, migrant workers, closed facilities, residential facilities — many of which are the same communities affected by climate change. The impact of COVID-19 was not only felt in low- and middle-income countries; Europe and the United States also experienced huge impacts, in part because they had reduced their primary health care services, having previously prioritized other areas. This experience reinforces the importance of supporting vulnerable populations and of strong primary health care systems.

Aging as the Biggest Threat to UHC

Today, aging presents the biggest threat to achieving UHC. Aging itself is not a problem, but it is a trigger for population decline, economic slowdown, and increasing medical expenditure. Japan is the leading aging country in the world, and in the near future most other countries will follow Japan's experience in this regard. Globally, the aging population totaled 761 million in 2021 but is expected to reach 1.6 billion by 2050. The proportion of older people in the global population will rise from around 1 in 10 to about 1 in 6. According to WHO and UN estimates. 

Aging will intensify worldwide, but at very different speeds across regions. In the most advanced aging regions — East Asia, Europe, and North America — by 2050 approximately one in four people may be aged 65 or older. In rapidly aging transition regions — Latin America, Southeast Asia, South Asia — aging is accelerating very quickly, often faster than in today's developed countries historically. Sub-Saharan Africa will remain relatively young in 2050, but the number of older people in the region will grow very sharply. The issue of aging is therefore not confined to high-income countries but is a global concern.

Among the top 15 countries ranked by aging in 2050, the first group are “super-aged societies” — Japan, South Korea, Italy, Spain and Greece. The second group, “deep aging societies,” includes China, where the aging rate will be around 28–31% by 2050. Even though China's percentage is lower, its absolute numbers of elderly will be massive because of its population size. Attention should also be paid to rapidly aging middle-income countries such as Vietnam and Brazil, which are transitioning rapidly to aging or aged societies. Even the young populations of today, such as those in sub-Saharan Africa, will follow this trajectory over time, and could become super-aged societies in the longer term. Countries in all of these categories can and should prepare now.

In the context of this aging world, there are three key factors for achieving UHC. First, rebuilding the primary health care system; second, recognizing that prevention is better than cure; and third, creating a new culture of well-being.

To illustrate these themes Dr. Nozaki shared a personal story about his mother, who is 92 years old. She has dementia and no longer recognizes him as her son. When he visits her care facility, she always welcomes him warmly, saying she does not know who he is but thanking him for visiting and talking to her. While his brother feels this is a sad situation because she has forgotten her family, Dr. Nozaki considers her still very healthy physically, apart from the dementia. Most importantly, she is financially sustainable on her own. She receives a pension of 90,000 Japanese yen and pays 80,000 yen to the care facility. This sustainability is made possible by Japan's long-term health insurance system. The idea that a 92-year-old woman can be financially sustainable to the end of her life is still a very rare case in the world. This outcome is made possible by the combination in Japan of health insurance, long-term care insurance, and local community support systems for aging populations.

Since many other countries will follow this aging trajectory, the question arises: how can governments support such aging populations, as Japan has done? Many Japanese people equate UHC with universal health insurance coverage, however, such a concept may be difficult to replicate in other countries. In many Asian countries it is very difficult to establish universal health insurance coverage, and so alternative systems must be considered. The three key factors — rebuilding primary health care, prioritizing prevention over cure, and creating a new culture of well-being (including concepts such as healthy aging) — offer a framework for realizing UHC in contexts where a traditional insurance-based approach is not feasible. Prevention is especially critical in the context of aging, because without it medical expenditure in aging countries will rise drastically.

Dr. Nozaki closed his lecture with the following four questions as the assignment for students.

(3) Assignment

Students are requested to ponder the following questions: 

• Is the hypothesis that achieving UHC is the ultimate goal of global health correct?

• What will be the biggest obstacle to achieving UHC in the future? Are there obstacles other than aging? 

• Some say that countries should simply follow Japan’s model – do you think that is feasible? 

• What is the message from President Trump and why did most of the COVID-19 deaths occur in the United States?

With regard to (4) above, Dr. Nozaki noted asked students to consider whether President Trump's complaints about WHO are justified or not? From WHO's perspective the situation is very serious because of the US withdrawal from the WHO and the loss of roughly US$1.5 billion in income, but can WHO simply ignore the message from Mr. Trump, or is there something to learn? What should WHO change, and what must it do in the future to achieve its mandate? 

(4) Discussion

Dr. Kawahara thanked Dr. Nozaki for a most insightful lecture that made clear that UHC should be understood not simply as a medical matter but as a question of patient justice, policy design, and the long-term sustainability of society. She noted that Asia is aging at very different speeds, with some countries aging before true economic prosperity has been achieved, and that the story of Dr. Nozaki's mother was very moving. She asked how UHC and prevention could be improved in societies that must build healthcare systems, long-term care systems, and social prevention systems all at once.

Dr. Nozaki answered by recounting his experience in Thailand in 2001–2002, when he worked as a JICA expert to try to establish a health insurance coverage system in Thailand. Thailand has become one of the most rapidly aging societies in Asia. In 2001 the National Health Security Office (NHSO) was established as a social-care-system establishment agency. The NHSO had originally been conceived as a health-insurance-coverage mechanism. The first Secretary General of the NHSO, Dr. Sanguan, brought Dr. Nozaki to meet then-Prime Minister Thaksin. Prime Minister Thaksin asked Dr. Nozaki whether it would be possible to install a national health insurance coverage system in Thailand. Dr. Nozaki immediately responded that it would be impossible, which upset the Prime Minister. He explained that 75% of Thailand's population worked in the informal sector, meaning farmers, who did not have enough cash income to pay premiums — premiums have to be paid in cash, not in rice or vegetables. An alternative approach was therefore necessary.

Dr. Nozaki recounted how he had advised Prime Minister Thaksin that UHC does not mean only universal health insurance coverage, and that universal health accessibility was a key concept to consider. Fortunately, Thailand's national hospital system was already covering much of the population's fundamental health service delivery, and informal-sector workers were going to national hospitals rather than private ones. The national hospitals were at that time providing fundamental basic services free of charge. Dr. Nozaki therefore proposed that the Thai government make use of this existing system. At the time the government of Thailand was allocating just 4.5% of national expenditure to the health system, including funding for national hospitals. Dr. Nozaki proposed increasing this share to nearly 20% over ten years, explaining that national hospital service delivery could then cover most diseases and most health needs. 

He also proposed a capitation system, whereby a unit cost per person per year for medical expenditure would be identified, and national budget would then be allocated to district hospitals according to the number of registered patients or population. Alongside this, an advocacy campaign was rolled out encouraging everyone to go to national hospitals for health problems, with the message that most problems could be solved at national hospital level. A yellow card, known as the “golden card,” was issued to everyone as a registration card. People understood that national hospitals would provide basic health services free of charge. Prime Minister Thaksin, being a businessman, then added a distinctive touch by proposing that patients pay 30 baht (about one dollar) per visit. Dr. Nozaki pointed out that this could not meaningfully be called a copayment because the amount was very small relative to actual medical costs, but that it was a very good advocacy device. The so-called “30 Baht Policy” became a major game-changer for universal health accessibility in Asia.

The broader lesson is that most countries cannot simply copy the Japanese or European health insurance model, and so alternative policy approaches must be considered. Thailand's 2001–2002 experience is a case in point: because Thailand did not have the money to establish a full health insurance system, it instead combined a taxpayer-funded system with a health insurance system. Seventy-five percent of the population — farmers in the informal sector — were covered by the taxpayer-funded component, while 25%, working in large cities such as Bangkok or Chiang Mai, were covered by health insurance. The 30-Baht Policy is therefore, in effect, a hybrid system. Subsequently, as Thailand has shifted into the era of non-communicable diseases, which are more costly than communicable disease control, the country has not been able to cover all NCD-related expenses and has therefore invested in community advocacy for healthy aging and well-being campaigns to prevent illness among older people. 

This preventive approach is one of the most important tools for managing the costs of an aging and super-aged society. This is Thailand's story for UHC and for prevention in the context of aging populations.

A student thanked Dr. Nozaki and noted that over the past few years global health has been somehow shaken, particularly since President Trump regained power. Previously global health was led by Europe and the United States, and the student asked whether global health was now shifting towards Asia.

Dr. Nozaki responded that this was a difficult question to answer. WHO is currently facing many difficulties because of the US withdrawal, which is costing WHO US$1.5 billion in income every year. At WHO headquarters in Geneva, more than 500 or 600 positions are being cut. The impact extends beyond human resources to activity costs, because the US has also stopped funding not only through WHO but also through US agency activities, for example in African countries, where some national vaccination and communicable disease control programs are totally reliant on US support. As a consequence, the global effort to eradicate polio — the next target after the smallpox eradication declaration of 1980 — is in a very serious situation, and the polio eradication schedule and plan will have to be reconsidered.

A student from Afghanistan noted that his country still has polio cases, and that cases have been increasing recently in Afghanistan and Pakistan, with some environmental cases also reported in Palestine and one in Germany. He then asked about criticisms of WHO's structure that he had heard at the Japan Association for Global Health conference the previous year. These criticisms centered on the structure whereby regional directors are selected by the countries of their region rather than in coordination with the Director-General in Geneva, raising the question of whether regional offices operate in harmony with the main office.

Dr. Nozaki responded that there are substantial differences among the regional offices. The Americas regional office is very rich, and the Western Pacific regional office is also well-resourced thanks to the presence of donor countries such as Japan, Korea, China, Singapore, Australia and New Zealand. By contrast, EMRO, AFRO and SEARO lack major donor countries and therefore rely heavily on WHO headquarters. This creates difficulties in expanding their own regional approaches with member states. It would be advisable to consider local and regional contexts more carefully in the global health development approach. In the Western Pacific Region the fact that funding is relatively secure allowed the region to maintain its own initiative — as with the COVID-19 mask-wearing example, when the Western Pacific Regional Director pushed back against the Director-General's initial message. This kind of balance between headquarters and regional offices is needed, but in practice it is largely controlled by budget. In the current difficult financial situation, this provides a good opportunity to consider new approaches to resource mobilization in the regions.

Dr. Nozaki added that the UHC Knowledge Hub (the WHO Tokyo Office) will launch a capacity-building program for low- and middle-income countries, mainly in Asia and Africa, but it is not a training program in the conventional sense. Rather it is a program to consider future policy options. As Thailand's experience illustrates, countries should not simply copy Japan's system but should develop their own approach to UHC that fits their country and regional context. To do this, it is helpful to draw not only on the experience of high-income countries but also on that of middle-income countries, whose experiences can serve as very useful examples for other low- and middle-income countries that will face aging or aged societies in the near future. That is the current focus of the UHC Knowledge Hub in Tokyo. 

Mr. Ikram Abdul Latif, the local coordinator in Malaysia for the lecture series, noted that he was a beneficiary of the “Look East” policy established by former Prime Minister Dr. Mahathir in 1982, and was sent to Japan to study. He observed that Thailand’s situation is similar to that of Malaysia, but Malaysia is now facing rising healthcare costs, which are affecting the sustainability of health insurance. Mr. Ikram noted his own personal health insurance premiums have risen by about 50% in the past year. He asked what kind of prevention measures Malaysia should prioritize, and what practical steps could be implemented immediately.

Dr. Nozaki proposed that Malaysia should review its current medical expenditure allocation, identifying which population groups are absorbing how much medical expenditure. From there it becomes possible to consider which groups can be covered by health insurance and which vulnerable populations cannot, allowing for targeted reallocation of the budget. It is important to categorize target populations and to consider multiple approaches rather than a single one. Malaysia's aging rate is not currently very high, but preparations should be made now for the future aging of the population, including considerations about how much budget will need to be allocated, and what prevention and mitigation measures for healthy aging can be introduced right away. It is particularly valuable to embed these ideas in the education system from childhood, for example by advocating for good nutritional education.

Dr. Nozaki also shared his concerns from living in the Philippines, where he has been shocked by a new trend among young people towards fast food and snacks, and a preference for meat-heavy meals even when eating out. Partly as a consequence, life expectancy in the Philippines stands at around 70–72 years, and many people, even workers who perform well, pass away within two or three years of retirement. To avoid a similar trajectory, the education system needs to include advocacy for healthy food habits and healthy nutrition content. Preventive approaches through education are very important in reducing future rates of non-communicable diseases and cancer.

Mr. Ikram agreed particularly with Dr. Nozaki's point about long-term nutritional education in Malaysia, observing that this has been discussed for several years in Malaysia but has not been easy to implement due to a variety of causes.

Dr. Kawahara thanked Dr. Nozaki and all students and introduced the lecture series teaching assistant, Ms. Kou, before closing the lecture.