Lecture 8
My Journey with Global Health and the Takemi Program

(1) Introduction to the lecture

Norie KAWAHARA opened the eighth lecture of the Spring 2026 semester of the Surviving Cancer in Asia: Cross-boundary Cancer Studies lecture series by situating the lecture within the larger arc of the course to date. 

She recalled that the course had not approached global health as a medical issue alone, but had rather sought to train students to see it as a matter of institutions, public finance, political choice, international cooperation, and social trust. Prevention is not a narrow technical intervention but one of the ways a society protects life, expands human possibility, and shapes its own future.

The lecture series’ field of vision had progressively widened over the course of the past few weeks, from disease to systems, from systems to society, and from society to the regional and global order within which health is governed. As that horizon widened, one question had become unavoidable: if a society holds good values and even strong evidence, how do these actually become policy, budgets, institutions, political priorities, and international frameworks? 

It is the answer to this question that the eighth lecture seeks to explore. Professor Takemi’s work helps make clear how major ideas in global health are translated into action, namely how concepts such as human security, universal health coverage, and health systems strengthening move beyond the level of ideals to enter negotiation, agenda-setting, institutional design, and public decision-making.

Dr. Kawahara characterized the lecture not as a departure from the course's main flow but as one of its central turning points: the moment at which reflection meets implementation and vision is tested in the language of policy. Prof. Takemi’s lecture would connect through to the sessions that follow, including case studies from Malaysia, in which the course would move from asking why prevention matters to asking how it is implemented, sustained, and defended within real institutions and societies. She asked students to listen to the lecture not only for information but for details about methodology, namely how values are translated into institutions, how evidence is translated into budgets, and how an ideal future is translated into practical policy.

Dr. Kawahara introduced Prof. Takemi as one of Japan’s most distinguished leaders in global health, citing his major contributions both in Japan and internationally and his experience at the highest levels of policy formation and global health governance. She noted that Prof. Takemi is the figure best placed to help the class consider how ideas are carried forward into public action.

(2) My Journey with Global Health and the Takemi Program

Keizo TAKEMI opened by situating his career against the intellectual legacy of his father, Taro Takemi, and the concept of Seizon no Riho, or the Logic of Survival, an analytical framework from which he drew three enduring lessons that have shaped his engagement with global health throughout his career.

As a physician, his father had approached human behavior primarily through a biological lens, an orientation Prof. Takemi in turn applied to his own political analysis.   

From this foundation he outlined three ways of conceiving the future: (1) a natural future, in which existing social systems and conditions are assumed to persist unchanged; (2) a socio-biological future, shaped by the socialization of human biological characteristics, of which demographic analysis is a typical example; and (3) a creative future, forged from new values and ethical frameworks and realized through deliberate and creative policy interventions, guided by a vision of an ideal future. 

Of the three, the creative future was presented by Prof. Takemi as the most consequential, since it enables a future-back-casting approach: an ideal future is first envisioned, and the policy challenges required to reach it are then identified and addressed.

The Takemi Program and Early Lessons

This thinking behind Seizon no Riho originated with Dr. Taro Takemi, who established the Takemi Program in International Health at the Harvard School of Public Health in 1983, three months before his death. Of his four children, it was only Prof. Takemi who chose to carry the program forward, assuming responsibility for its fundraising and for organizing its international symposia together with Dr. Lincoln Chen, the first Takemi Professor, and Dr. Michael Reich, the program’s secretary general. 

The first Takemi Symposium, held in Tokyo in 1984, addressed health problems that extend beyond national boundaries; the second, held in Boston in 1986, examined the relationship between health, nutrition, and economic crisis in the developing world. That symposium documented how the conditionalities attached to International Monetary Fund and World Bank lending, at a time when many low- and middle-income governments faced severe budget deficits, often led policymakers to cut social welfare budgets sharply, so that essential services failed to reach those most in need and avoidable deaths resulted. Accordingly the symposium presented an early critique of the social costs of structural adjustment that anticipated much of Prof. Takemi’s later work.

From the Asian Financial Crisis to Human Security

Elected to the House of Councillors in 1995, Prof. Takemi subsequently served as a close aide in the cabinet of Prime Minister Keizo Obuchi. When the Asian financial crisis of 1997–98 led President Suharto of Indonesia to resist the conditionalities attached to IMF and World Bank support, Prime Minister Obuchi persuaded him to accept them, while Japan separately committed to maintaining the supply of thirty-six essential drugs to Indonesia and to financing their purchase. Even as the health budget contracted, essential services continued to reach the population and avoidable deaths were averted, an experience that became Prof. Takemi’s first direct engagement with global health as a policymaker.

This period coincided with a broader search, as the wartime generation passed away, for a future-oriented foundation for Japanese pacifism. The 1994 Human Development Report by Dr. Amartya Sen and Dr. Mahbub ul Haq introduced the concept of human security, and Prof. Takemi recognized that this report represented the maturation of human security from an academic concept into a comprehensive policy framework with tangible impacts on human wellbeing worldwide. 

Prof. Takemi proposed to Prime Minister Obuchi the creation of a UN commission on human security. Following Obuchi’s sudden death and Prime Minister Yoshiro Mori’s succession, UN Secretary-General Kofi Annan convened the Commission on Human Security, co-chaired by Dr. Amartya Sen and Ms. Sadako Ogata, on whose secretariat Prof. Takemi served. 

The commission’s 2002 report, Human Security Now, drew in part on an exchange in which Prof. Takemi had asked Dr. Sen how health should be positioned within the human security framework. Dr. Sen replied that the purpose of human security is to expand the alternatives available for a meaningful life. Health alone cannot supply that meaning, but its loss forecloses other alternatives, such as education, employment, and vocational training, simultaneously. 

Health, on this reasoning, belongs at the core of human security, a lesson Prof. Takemi subsequently made central to Japan’s future-oriented conception of pacifism.

Toward the G8 Toyako Summit and the Diagonal Approach

An electoral defeat in 2007 led Dr. Reich, by then the second Takemi Professor, to invite Prof. Takemi to spend two years as a Takemi Fellow at the Harvard School of Public Health. The timing coincided with preparations for the 2008 G8 Toyako Summit, for which Prime Minister Yasuo Fukuda appointed Prof. Takemi head of the agenda-setting task force, supported by US$2 million in funding from the Gates Foundation. 

Global health at the time was divided between a vertical approach, concentrated on individual diseases such as HIV/AIDS, tuberculosis, malaria, and polio, and a horizontal approach centered on health systems. The vertical approach continued to dominate financing even after the Millennium Development Goals were adopted in 2000, three of which concerned health.

Finding that the G8 Sherpa process had little familiarity with the health systems approach, Prof. Takemi convened a Harvard task force comprised of Dr. Michael Reich, Dr. William Hsiao, and Dr. Marc Roberts, which met periodically to prepare a proposal for the summit. It was this period that enabled Prof. Takemi to serve as a catalyst for transferring concepts from academic discussions to global policy formulation through sophisticated public-private collaboration mechanisms. 

It was Dr. Reich who led the resulting Lancet article, Global Action on Health Systems: A Proposal for the Toyako G8 Summit, for which Prof. Takemi was also a co-author. Drawing on what Prof. Takemi credited to Harvard’s Dr. Julio Frenk as a diagonal approach, the proposal sought to combine vertical and horizontal strategies around three principles: 1) local empowerment and ownership, 2) the use of existing mechanisms such as the Global Fund and the GAVI Alliance rather than new financing vehicles, and 3) enhanced learning through investment in research and shared learning, together with three building blocks drawn from the WHO’s own health-systems framework: human resources, financing, and information. The proposal proved influential in mainstreaming the health systems approach within global health policy.

Universal Health Coverage as Goal

Attention then turned to Japan’s own experience. Japan had achieved universal health coverage (UHC) in 1961, just before the onset of rapid economic growth and at a per capita income of only 4,100 US dollars. Prof. Takemi noted that its redistributive function, responsible for some seventy percent of the government’s reallocation of resources from rich to poor, had allowed Japan to expand its middle class without a widening of inequality during that growth, thereby underpinning the Liberal Democratic Party’s long political dominance during the postwar period. At the suggestion of Dr. Lincoln Chen, Prof. Takemi had worked with Lancet editor Richard Horton to publish a series marking the fiftieth anniversary of Japan’s UHC in 2011.

Around the same time, in the context of preparations for what would become the Sustainable Development Goals, Prof. Takemi proposed to Prime Minister Shinzo Abe that UHC, already defined by the WHO as affordable access to appropriate care including preventive services, be established not merely as an instrument of health systems reform but as its explicit goal. The prime minister agreed, publishing an article under his own name, Japan’s Vision for a Peaceful and Healthier World in the Lancet (Figure 1), and hosting UHC forums at the Japan Society in New York around the UN General Assembly in 2014 and 2015 that brought together the leadership of the World Bank, WHO, UNICEF, and other UN agencies. This groundwork culminated in the inclusion of UHC among the 169 targets of the 2015 Sustainable Development Goals, and in the first UHC Forum held in Tokyo, which brought the new UN Secretary-General to Japan on his first visit.

Institutionalizing Global Health Governance

Prof. Takemi next identified health financing as the decisive lever, or control knob, for the design of health systems, and he explained how he had proposed to Prime Minister Abe and Finance Minister Taro Aso a joint session of finance and health ministers at the 2019 G20 summit in Osaka, a practice subsequently continued by successive G20 hosts including Saudi Arabia and Italy. As Minister of Health, Labour and Welfare under the Kishida cabinet in 2023–24, he pursued the institutionalization of this agenda further, securing agreement from WHO Director-General Tedros Adhanom Ghebreyesus and, subsequently, World Bank President Ajay Banga to establish a UHC Knowledge Hub hosted in Tokyo.

Formally established in December 2025 and operational from February 2026, the UHC Knowledge Hub is a joint undertaking of the Government of Japan, the WHO, and the World Bank, providing training and capacity-building alongside advocacy and convening functions in support of domestic health-financing capacity in low- and middle-income countries (Figure 2).

Its first cohort comprises eight member states, and its first High-Level Forum was held in Tokyo in December 2025. A more recent conversation with President Banga, in mid-2026, led to agreement on a Global Health Leaders Group, intended to bring new proposals on the governance of global health financing to a planned UN high-level panel on UHC in 2027.

Concluding Reflections

Prof. Takemi closed by situating this agenda within a global health environment he described as increasingly disordered, citing the withdrawal of the United States from the WHO and the erosion of the organization’s institutional authority as reasons for the heightened importance of a deliberately architected global health governance, a role he hoped the Global Health Leaders Group could help fulfill.

Prof. Takemi attributed his own ability to advance this agenda over four decades chiefly to personal trust and friendship accumulated with counterparts across national boundaries, rather than to institutions alone. He closed by encouraging students to think ambitiously, adopt a wide field of vision, and locate their own role at each stage of their lives.

(3) Student Assignment

Students were given the following assignment.

How Can the Social Value of Prevention Be Communicated, Institutionalized, and Implemented? 

This assignment is not intended simply to assess your understanding of Professor Takemi's lecture. 

In the coming weeks, the course will explore a series of real-world implementation cases, including cancer prevention initiatives in Malaysia, exercise as secondary prevention for cancer survivors, well-being surveys, and the evaluation of the BEAUTY Project. 

Before engaging with these cases, however, you are encouraged to develop a broader policy perspective. 

Prevention does not become reality simply because it is beneficial. It requires individuals who can envision a desirable future, design appropriate institutions, mobilize sustainable financial resources, and articulate its value convincingly to society. 

Drawing upon Professor Takemi's concept of the “Creative Future,” consider how prevention can be transformed from an ideal into an effective and sustainable public policy. 

Furthermore, prepare yourself to approach the Malaysian implementation cases not merely as examples of best practice, but as opportunities to examine and refine your own research question or working hypothesis. 

You may choose one of the following questions, or formulate your own. 

• How can preventive interventions reach people who do not participate in cancer screening? 

• How can exercise be sustained as an effective strategy for preventing cancer recurrence among cancer survivors? 

• How can the value of prevention be evaluated through well-being indicators rather than conventional health outcomes alone? 

(4) Discussion

For the discussion session, Dr. Kawahara was joined by Dr. Shinjiro NOZAKI, Compliance and Risk Management Officer, Office of the Regional Director, World Health Organization, Western-Pacific Region. 

Dr. Kawahara opened the discussion by observing that global health, as presented in the lecture, is not confined to medicine but connects politics, finance, international cooperation, and interpersonal trust in the pursuit of social change, and by noting her particular interest in the idea of a creative future achieved through deliberate choice rather than prediction of the future. She asked Dr. Nozaki how far WHO policy design in practice begins from a desired future state.

Dr. Nozaki described backcasting as central to the planning of the WHO in the Western Pacific Region: rather than addressing only the problems immediately at hand, as in the twentieth century, planners now begin by imagining health conditions twenty or thirty years ahead and work backward to define what must be achieved in the near and medium term to achieve that ultimate goal 20 or 30 years in the future. 

Dr. Kawahara asked how the WHO measures the success of UHC as a tool for social stability rather than as a health system alone. Dr. Nozaki recalled that the organization’s engagement with the UHC concept has a comparatively short history: having proposed in 2014 that WHO build a dedicated program around it, he was told by then Director-General Margaret Chan that UHC was essentially a Japanese request centered on health financing. He had argued in response that every country would eventually require it, and that the WHO’s own conception extends well beyond financing to broader social dimensions. He illustrated the point with his experience advising the Thai government: rather than replicate Japan’s premium-based insurance system, which would be impractical given that roughly three-quarters of the Thai workforce is informally employed, Thailand built universal access to care through its national hospitals without requiring cash payment, an approach that Dr. Nozaki characterized as universal health access rather than universal health financing.

Dr. Kawahara asked where, given that the WHO Western Pacific Region spans both aging societies such as Japan and ostensibly younger ASEAN countries, Japan’s leadership is strongest. Dr. Nozaki first cautioned against the premise that only Japan’s society is aging, noting that Thailand, Vietnam, and Indonesia are already experiencing aging of their societies, and most low- and middle-income countries in the region are expected to become aging societies by the middle of the century, making preparation a near-universal rather than a Japan-specific concern. He characterized Japan’s claim to leadership as sometimes accurate and sometimes not, but noted that Japan’s sequence of institution-building, from universal health insurance to long-term care insurance to community-based integrated care, illustrates a pathway other Asian countries might study and adapt without needing to copy Japan’s system outright. 

A student asked what skills and experience would best prepare young researchers and medical students to influence international health policy through work with the WHO. Dr. Nozaki first noted the WHO’s present financial constraints, including a roughly US$1.5 billion deficit arising from unpaid US assessed contributions and consequent staff reductions, before affirming his confidence in the WHO’s future as the sole UN public health agency. He observed that the scope of public health has broadened since the twentieth century, when communicable disease control was paramount, to encompass noncommunicable disease, climate change, and equity alongside UHC, and encouraged students to consider how their own expertise, whether in law, climate science, or another field, might intersect with the WHO’s evolving needs. Passion, he suggested, matters more than any specific skill or language, and the formal requirements (Master of Public Health degree and at least two years of relevant work experience) are, in his view, sufficient preparation in themselves.

Dr. Kawahara closed the session by connecting the lecture to the theme of translation. She noted that a sound idea does not by itself become policy, nor does strong evidence by itself move budgets, and the task is to determine to whom, in what language, and as what kind of value prevention should be explained. She characterized the lecture’s contribution as situating prevention within a wider policy vision encompassing UHC, human security and the creative future. She tasked students with the challenge of connecting policy imagination to implementation by defining, measuring, and justifying the social value of prevention.