Lecture 11
Converting Prevention into Social Value: Cancer Prevention, Patient Navigation, and Corporate Innovation in Asia

AHMAD Syarif Ramlan has over seven years of experience in occupational health, leading the Social Health Section at PERKESO, the mission of which is to advance workplace safety, health, and well-being. Passionate about fostering impactful programs like Workplace Health Promotion (WHP) advocacy and Zero Sugar campaigns, he is dedicated to creating environments that prioritize employee health. Aligned with PERKESO's vision, he brings a collaborative mindset and a commitment to innovative health solutions that empower organizations and employees alike. At PERKESO, he oversee initiatives like the SEHATi Management Unit and Active@Work, contributing to the improvement of workplace health through seminars, health screenings, and medical surveillance programs. Working alongside a team of skilled professionals, he focuses on delivering impactful results by combining expertise in occupational health and project management with a shared passion for employee well-being.

Daisuke KATO holds a Master's degree in Biotechnology from Osaka University. He began his career at Astellas Pharma, initially working in a department focused on investigating the efficacy and safety of post-marketed pharmaceutical products. He then transitioned to the Marketing Division, where he was responsible for developing market strategies for urology products. Following this, in the Medical Affairs Division, he formulated post-marketing information creation strategies for urology products. During this time, he also led numerous research initiatives, including Phase 4 studies, Post Marketing Surveillances, and database researches, presenting his findings in academic papers and conferences. Subsequently, he moved to the Corporate Strategy Division, gaining experience in corporate governance, including involvement with the Executive Committee and Board of Directors. Currently, he leads a corporate value visualization project within the Sustainability Division. His recent achievements, particularly in monetizing previously unquantifiable non-financial initiatives and demonstrating the correlation between financial and non-financial performance, have been featured in publications like Harvard Business Review and Nikkei BP.

(1) Framing of the issue of converting prevention into social value  

Norie KAWAHARA opened the eleventh and final lecture of the Spring 2026 semester of the Surviving Cancer in Asia: Cross-boundary Cancer Studies lecture series by introducing the week’s theme, Converting Prevention into Social Value: Cancer Prevention, Patient Navigation, and Corporate Innovation in Asia.

She offered a single frame for listening to the two keynote presentations that would follow. Prevention, she observed, is important but characteristically invisible: when it succeeds, nothing dramatic happens, and it is precisely this absence of drama that makes prevention difficult to locate, to evaluate, and to translate into policy. Awareness, moreover, is only the doorway to prevention rather than its destination — a person may learn about cancer and still not attend screening; a person may be screened and still not reach diagnosis; a diagnosis may be made and treatment still delayed. If social value is to be demonstrated, she argued, the task is to identify precisely where along this pathway people fall away.

She previewed the two complementary vantage points that the lecture would bring to bear on that pathway: AHMAD Syarif Ramlan of PERKESO would provide the government and social security lens, examining how prevention becomes a policy tool; and Daisuke KATO of Astellas Pharma would follow with the corporate and sustainability lens, examining how prevention can be translated into visible monetary value. Taken together, she suggested, the two talks converge on a single shared question: what evidence can move a decision? 

The BEAUTY Project, entering its fifth year

Before turning to the two keynote presentations, Dr. Kawahara revisited a project referenced repeatedly across the semester and in previous lecture series: BEAUTY (Bringing Education And Understanding To You). Now in its fifth year, the project has entered a new phase, BEAUTY Plus. It began in Malaysia in 2022 with the support of Astellas Pharma, as part of the company’s sustainability activities, together with the Asia Cancer Forum and the National Cancer Society of Malaysia (NCSM).

The project’s premise, she explained, is that knowledge of the importance of cancer screening does not by itself change behavior. Some people fear the result of a test; some cannot take time away from work; others prioritize the care of children or parents; and still others are deterred by cost, transport, or simple uncertainty about where to go. The operative question for BEAUTY was accordingly not only how to teach prevention but how to embed prevention within everyday life.

The BEAUTY model does not wait for people to present themselves at a hospital. It begins instead in places people already trust and visit on a regular basis — beauty salons and barbershops, and now also workplaces. In the community setting, salon owners and salon workers become health change agents; in the workplace setting, human resources and occupational safety officers assume that role, sharing educational materials, initiating conversations, encouraging screening, and connecting people onward to follow-up care. In this way, Dr. Kawahara suggested, BEAUTY converts prevention from a medical message into a social pathway.

This, she argued, is precisely why BEAUTY offers a concrete case for the lecture’s central question of social value. That value is not adequately captured by counting leaflets distributed; the more meaningful measure is whether awareness becomes screening, whether screening becomes earlier action, and whether earlier action in turn protects families, workplaces, and health systems. Social value, on this reading, may take the form of reduced fear, earlier diagnosis, lighter burdens on families, protected employment, and stronger prevention systems overall — and it was with the question of how to convert these largely invisible changes into demonstrable social value that she opened the floor to the two keynote speakers.

Dr. Kawahara went on to introduce the three discussants who would join the panel following the two presentations. She noted that the resulting discussion would connect directly to a policy initiative planned for Malaysia in September, and that, as their final assignment, students would be asked to prepare a policy brief on this theme.   

Prevention, she cautioned, should not be discussed simply as something self-evidently good; the more demanding task is to ask what kind of value prevention creates, who benefits from that value, how it can be demonstrated, and what systems and incentives are required to make it sustainable.

(2) Converting Prevention into Social Value 

AHMAD Syarif Ramlan opened with his central question: how prevention can be converted into social value, drawing from PERKESO’s own experience of running prevention programs to mitigate and control health risk among Malaysia’s insured workforce.

An overview of PERKESO

PERKESO — Pertubuhan Keselamatan Sosial, the Social Security Organisation of Malaysia — is the statutory body charged with administering the country’s social security net for employers and employees. Its mandate derives from the Employees’ Social Security Act, established in 1969, under which PERKESO was given legal authority to collect and pool contributions from workers across Malaysia’s private sector. No tax revenue is injected into the fund: it is financed solely through the low, mandatory contributions of employers and employees, and used to share collectively the risk of workplace accident, disability, and death. Because the Act confers a legal mandate to collect contributions from all covered members, PERKESO bears a corresponding obligation to administer benefits justly and equitably across its membership.

From compensator to preventer

For some thirty to forty years, PERKESO functioned principally as a compensator, administering the benefits mandated under its founding Act. Yet the Act itself, from its inception, had also empowered PERKESO to initiate and establish preventive measures in the interest of the fund’s long-term sustainability — a provision that went largely unused for decades. More recently, PERKESO has adopted a more proactive posture, embracing the Vision Zero philosophy and extending into Workplace Health Promotion. Prevention now stands alongside enforcement, rehabilitation, and compensation as one of PERKESO’s four core pillars.

The invalidity and NCD trend

The urgency behind this shift is legible in PERKESO’s own claims data. Invalidity pensioners — workers formally certified unable to continue contributing to the fund or to the workforce more broadly — have risen steadily since 2009, when annual invalidity and survivors’ pension cases stood at 18,594; by 2025 the figure had reached 65,321. A parallel series tracks the share of these cases attributable to non-communicable diseases (NCDs): from 58 percent of cases in 2009, the NCD share fell to a low of 36 percent in 2021 before climbing back to 50 percent by 2025 — meaning that, on PERKESO’s own recent figures, one in two of the workers deemed invalid in 2025 had reached that state through NCD-related complications. Twelve percent of these NCD-related invalidity and survivors’ pension cases in 2025 were specifically attributable to cancer. (See Figure 1) 

Fig. 1 Changes in recipients of invalidity and survivors’ pension

Extending the safety net: the Universal Coverage Matrix

PERKESO’s protection was, for most of its history, confined to formally employed workers with employers — the population covered by the original 1969 Act. Self-employed workers, domestic workers, and foreign workers accordingly fell outside its protection, as, for many years, did housewives, whose unpaid domestic and caregiving labor was not classified as formal employment despite its evident contribution to household and community sustenance. Extending coverage to each of these groups required a dedicated legislative act for each new category of worker; the most recent extension, covering housewives, was introduced through Act 838 in 2022. 

The Health Screening Programme and SEHATi

PERKESO’s principal prevention vehicle is its Health Screening Programme (HSP), introduced in 2013 as a one-time, free health screening offered to eligible contributing workers aged 40 to 59. The program’s delivery mechanism has evolved considerably since then: from a paper voucher system at launch, to a voucher-less system, and — since 2023 — to SEHATi, PERKESO’s digital health application, which functions as an electronic health diary for contributors and integrates the HSP alongside work-injury benefit access. The 2023 relaunch, combined with a period of national budget support, drove a marked acceleration in uptake: within two years, PERKESO had screened close to the number of workers it had accumulated over the preceding decade.

Screening has since been extended specifically to cancers affecting women, through mammography and Pap smear testing, aimed respectively at the early detection of breast and cervical cancer. Between 2025 and June 2026, PERKESO conducted 1,068 mammograms and screened 4,947 women through Pap smear testing; cumulatively since 2013, more than 190,000 Pap smears have been performed, with the great majority of results — 96.18 percent — returning as normal. Of the women screened by mammogram in this period, some 17.8 percent required additional imaging, and around 2.4 percent returned findings classified as suspicious or highly suggestive of malignancy, underscoring the referral capacity that such screening requires downstream.

In parallel, HSP screening has tracked a wider set of non-communicable risk factors. Across recent HSP cycles, drawing on a sample of 302,654 workers, hypercholesterolemia was found in approximately 59 to 60 percent of those screened, with comparable elevated-risk shares recorded for body-mass index, blood pressure, and diabetes markers. Since 2013, PERKESO has screened close to 914,000 workers in total, yet, as Dr. Ahmad Syarif noted, the underlying trend in these risk parameters has not meaningfully improved, which would suggest that the existing approach requires new strategy, new methods, and new collaboration. (See Figure 2) 

Fig. 2 Overview of the outcomes of HSP 

That need for a new approach was thrown into sharper relief by a funding setback in 2025: PERKESO was unable to secure a national budget allocation for that year’s HSP cycle and was obliged to fund the program entirely from its own resources. The screening parameters and the program’s ambitions were scaled back accordingly — from a target in the order of 300,000 screenings to a more realistic figure nearer 50,000, ultimately screening close to that reduced number over the year. Somewhat basic screening parameters, in Dr. Ahmad Syarif’s assessment, further limited the program’s ability to attract participation.

Reaching the employer, not only the employee

Facing these resource constraints, PERKESO has increasingly directed its prevention efforts toward employers rather than employees directly, on the premise that employers hold both the authority and — under the Occupational Safety and Health Act — the social mandate to look after their workers’ health. This shift has produced several linked initiatives, run at no cost to participants and funded from PERKESO’s own budget.

Workplace Wellbeing Seminars, conducted nationwide across PERKESO’s state offices as one-day sessions, engaged 321 employer representatives across 14 series in 2025. The Tolak Gula (sugar reduction) initiative sought explicitly to move beyond the logic of a conventional campaign — which, in Dr. Ahmad Syarif’s phrase, tends to have a “half-life and a due date” — toward an embedded way of working within the workplace. 

In practice, this meant reconfiguring the default environment: pantries and cafeterias eliminating sugared drinks as standard, healthier catering protocols for corporate meetings, and a realignment of corporate gifts and souvenirs toward healthier options, delivered through 24 dedicated briefings to corporate leadership. Twenty-four major employers had, by the end of 2025, successfully overhauled their workplace environments along these lines. A further series of eight WHP webinars, spanning topics from cancer prevention to sleep performance, drew 5,480 views across the year.

The initiative that has generated the greatest engagement, however, is Activ@Work — a three-month, gamified step-count competition run between participating employers. Structured to widen participation across firms of different sizes (bands of under 200, under 500, under 1,000, and over 1,000 employees), the challenge collected 10.5 billion steps in 2025 across 343 participating employers and 21,268 employees, an increase of 1.5 billion steps over 2024 and, according to Dr. Ahmad Syarif, a new record for an initiative of this kind across his seven to eight years of experience with such programs. 

In 2025, PERKESO layered bonus points onto the competition for employers that had also implemented Tolak Gula or mental-health and occupational-safety programming, further boosting engagement. Having previously been concentrated in the private sector — PERKESO’s primary source of contributions — Activ@Work opened to the government sector in 2026, with registrations for the year already double those of the previous cycle by the time of the lecture. Dr. Ahmad Syarif framed the competitive, gamified structure of the challenge as building employers’ reputation as healthy brands, while noting that the principal beneficiaries remain the employees themselves.

Return to Work: keeping cancer patients in employment

A newer albeit still modest initiative addresses cancer specifically within PERKESO’s broader Return to Work program. Between 2024 and 2026, PERKESO identified 193 cancer patients through the initiative, of whom 63 percent were successfully returned to employment. Dr. Ahmad Syarif characterized this as a small number relative to the scale of the underlying need, and identified the prevention of cancer patients’ slippage out of employment as an area PERKESO intends to expand.

(3) Monetary Valuation of the Social Impact Generated by Cancer Awareness Campaigns

Daisuke KATO opened by noting that his talk would examine both the cancer awareness activities that Astellas supports and the methodology by which the company places a monetary value on the social impact those activities create.

Astellas and its oncology footprint

Astellas Pharma, he explained, is a pharmaceutical company oriented toward first-in-class and best-in-class medicines — treatments that establish a new standard of care for a given disease.

In fiscal year 2024, the company recorded its highest revenue and profit in its history, at ¥1,912.3 billion in revenue and ¥392.4 billion in core operating profit, a 20.5 percent margin, driven substantially by five strategic brands: PADCEV for urothelial cancer (¥164.1 billion), IZERVAY for age-related macular degeneration (¥58.3 billion), XOSPATA for acute myeloid leukemia (¥68.0 billion), VEOZAH for menopausal vasomotor symptoms (¥33.8 billion), and VYLOY for gastric cancer (¥12.2 billion).   

Oncology occupies a particular focus within this portfolio: beginning with XTANDI for prostate cancer in 2009, Astellas’ oncology pipeline has extended through XOSPATA (2018), the first-in-class urothelial cancer therapy PADCEV (2019), and the novel gastric cancer treatment VYLOY (2024), with seven new molecular entities currently in clinic and a further pipeline of emerging assets extending toward 2035.

Mr. Kato situated his own role within this organization briefly: having joined Astellas in 2002, he moved through Medical Affairs, Product Marketing, and Corporate Strategy before joining the Sustainability Department in 2022, where his responsibility is to render visible the value and good work that financial figures alone do not capture, translated into a form that can be measured and communicated to stakeholders. The monetary valuation methodology he presented is, he noted, a central part of that work, and remains a field still very much under development.

Three lenses on pharmaceutical contribution

Mr. Kato framed the lecture’s core question — how a pharmaceutical company assesses its own contribution to improving access to health — through three simultaneous points of view. The first is that of a for-profit company whose core business is the manufacture and sale of medicine, ordinarily judged by product sales and profit. The second is that of a company existing, in part, to address social problems through the life sciences, typically assessed by its contribution to society but described more often in words than in numbers. The third is that of an entity accountable to the shareholders who invest in it, obliged to demonstrate an efficient return on that investment. Mr. Kato asked students to hold all three perspectives in mind across the remainder of the lecture.

The scope of Access to Health

Astellas frames its Access to Health activity as three concentric circles. 

At the center sits the company’s core business: the delivery of its principal anti-cancer medicines to patients through ordinary commercial channels. A second circle, immediately outside the first, concerns expanding access to treatment even ahead of, or beyond, normal commercial channels — through early access requests, post-trial access, patient access initiatives, and the International Pharmacy Program (IPP), including in countries where a given product is not yet commercially available, delivered through Astellas’ sustainability activities without reference to profit. A third, outer circle concerns support for third parties engaged in awareness, education, and diagnosis that lead onward to quality care.

Measured in raw numbers, these three circles are already substantial. Astellas’ core business reached more than 172 million patients across 103 countries in the results reported for the first half of FY2024. Under the second circle, early access requests had been cumulatively approved for 1,614 patients across 43 countries; post-trial access reached 696 oncology patients across 39 countries; patient access initiatives ran to 29 programs across 17 countries; and the International Pharmacy Program had, since its inception in May 2021, brought PADCEV to 153 patients across 20 countries. Under the third circle, four global health-system-strengthening programs, working through NGOs and NPOs, had directly benefited 18,584 people according to the most recent impact reports; over 100 patient advocacy and patient-organization programs had been supported, reaching an expected 20 million or more individuals; 105 education grants had reached 158,000 healthcare-professional learners; and, since 2018, the independently governed Astellas Global Health Foundation had supported 21 charitable initiatives, with an expected reach of more than 32 million lives (See Figure 3).

Fig. 3 Overview of Access to Health metrics 

Yet, Mr. Kato observed, even figures of this scale do not by themselves answer the question posed by his three opening lenses — for-profit performance, social contribution, and shareholder accountability all remain difficult to read directly off a count of patients or programs. It was this gap that prompted Astellas to attempt a conversion of activity into monetary value, and Kato turned to one specific program — among four comparable health-system-strengthening initiatives Astellas supports in Malaysia, Mexico, Peru, and the Dominican Republic — to demonstrate the method: the BEAUTY & Health Program in Malaysia.

BEAUTY & Health as a case study

The starting point, Mr. Kato explained, was a well-documented deficiency in Malaysia’s cancer outcomes: national registry data show that around two-thirds of colorectal cancer patients — some 75 percent, distributed across Stage III (35.5 percent) and Stage IV (39.4 percent) — are diagnosed only at a late stage, against just 6.5 percent diagnosed at Stage I and 18.6 percent at Stage II. Against this backdrop, Astellas donated a total of ¥150 million (approximately US$1.0 million) to NCSM and the Asia Cancer Forum, the bodies operating the BEAUTY & Health program, to fund community cancer-awareness sessions and cancer screening delivered at venues people already frequent, such as department-store event spaces, alongside the construction of a cancer-education database to assess and manage the health risks of program registrants.

Converting activity into a logic model

To answer the two questions Mr. Kato posed at the outset of this section of the lecture — whether the activity is genuinely useful to society, and whether it justifies Astellas’ investment — the BEAUTY & Health program was first mapped as a logic model running from input through to social impact. An input of US$1.0 million funds a set of activities: cancer-awareness sessions, the maintenance of a cancer-patient registry, screening, and referral to specialists. These activities generate outputs — a confirmed diagnosis, cancer staging, treatment initiated at a given stage, and, ultimately, cure — which in turn generate outcomes across three time horizons: earlier cancer detection in the short term, better treatment outcomes in the medium term, and improved prognosis in the long term. The open question at the end of this chain was how to express the resulting social impact, if at all, in monetary terms.

Breaking social impact into a monetizable structure

Astellas’ method splits social impact along two axes. Down one side sit five categories of value: medical, psychological, economic (further split into income effects and expenditure effects), scientific, and environmental. Across the top sit four categories of beneficiary: patients directly affected, patients indirectly affected, families and healthcare providers, and society, industry, and the environment more broadly. Each intersection of a value category and a beneficiary category defines a specific, nameable impact item — for instance, increased access to optimal treatment as a direct medical value accruing to patients, or improved work productivity as an indirect economic value accruing to patients. For the BEAUTY & Health program, ten such impact items were identified across the medical, psychological, and economic categories; scientific and environmental value were not calculated, on the assessment that the program carries no significant impact in either domain.

Building the valuation formulas

Each impact item was then converted into a calculation formula. The largest single item — increased access to optimal treatment — multiplies three quantities: the monetary value of one year of life (drawing on the US$50,000 willingness-to-pay threshold per life-year gained used in a Ministry of Health Malaysia economic evaluation of colonoscopy-based colorectal screening), the survival time associated with each stage of cancer (drawn from Overall Survival data published by Malaysia’s National Cancer Institute), and the modelled change in the number of patients at each cancer stage attributable to earlier detection. The logic, in short, is that earlier detection shifts patients toward earlier stages, where survival time — and therefore the value of the life-years preserved — is materially greater.

A second major item, the impact on patients’ work productivity, was itself decomposed into three components, each addressing a distinct channel of income protection: avoiding income losses from unemployment (drawing on Multinational Supportive Cancer Care Association data on the cost of lost productivity), avoiding productivity losses while still working (the same cost basis, applied to reduced output rather than job loss), and avoiding loss of income from premature death — calculated from average annual income in Malaysia, the years of life lost avoided through earlier treatment (based on Malaysia’s retirement age of 60 and Ministry of Health age distributions by cancer stage), and the modelled change in the number of premature deaths at each stage, the last drawn from an Astellas-commissioned analysis referencing Malaysian research on colorectal cancer among younger adults.

Results: a $4.6 million social impact

Applying these formulas to a modelled scenario — the BEAUTY & Health program’s education and outreach reaching approximately 1 million Malaysian residents, resulting in 150 colorectal cancer patients diagnosed and treated earlier, and a corresponding shift in the share of patients detected at Stage III or IV from 75 percent to 55 percent — Astellas calculated a total social impact of US$4,562,470 (¥684,370,557) against the US$1.0 million invested (See Figure 4).

Fig. 4 Estimated impact of the BEAUTY and Health Programme

Of this total, medical value accounted for the largest share, at US$2,799,770 (61.4 percent), followed by psychological value at US$1,328,700 (29.1 percent) — a psychological contribution Mr. Kato flagged as larger than might be expected — with the income and expenditure components of economic value contributing US$359,355 (7.9 percent) and US$74,645 (1.6 percent) respectively. 

Viewed by beneficiary rather than by value type, direct impact on patients accounted for 60.7 percent of the total (US$2,768,125) and indirect impact on patients for a further 36.3 percent (US$1,657,926); families, healthcare providers, and the wider social, industrial, and environmental category together accounted for the remaining 3.0 percent. In other words, on Astellas’ own accounting, almost the entirety of the program’s monetized social impact accrues to patients themselves, whether directly or indirectly.

Per-patient value and return on investment

Recast on a per-patient basis, the program’s colorectal cancer patients gained an average of US$29,507 (approximately ¥4,426,000) each, of which 97 percent derives from the program’s primary and secondary impact on patients directly. This breaks down into US$18,454 per person from the life-years gained through earlier treatment, US$8,858 per person representing the value of hope for improved survival associated with earlier treatment, US$1,987 per person from improved work productivity through shorter treatment periods and social reintegration, and US$208 per person from reduced treatment-related costs.

Expressed as a return on investment, the US$1.0 million Astellas contributed generated US$4.6 million in modelled social impact — a social return on investment (SROI) of 4.6 times. Returning to his three opening lenses, Mr. Kato closed by reading this single set of results through each in turn: from the for-profit perspective, the program generates US$4.6 million of social impact from a modest input; from the social-problem-solving perspective, it delivers some US$30,000 of impact per patient; and from the shareholder-accountability perspective, it returns 4.6 times the capital invested. A company’s sustainability initiatives, he concluded, need to be evaluated from several such perspectives simultaneously, since no single lens fully captures their value.

(4) Assignment 

Students were presented with a final assignment to compile a policy brief that makes the social value of cancer prevention visible, drawing explicitly on the concepts, methods, and perspectives each student’s own field.  (See Appendix for full details of the final assignment.) 

(5) Discussion

Tony HILL (Asia Cancer Forum) opened the discussion by noting the range of perspectives assembled on the panel — private sector, pharmaceutical industry, academia, and the implementing arm of government — and put the first question to Mr. Kato: whether the scale of Astellas’ modelled results, a fourfold-plus return on a modest input, had come as a surprise.

Mr. Kato responded that the 4.6-times return was itself derived from assumption-based modelling rather than observed outcomes, and that Astellas’ next step would be to calculate the same valuation using actual program data, so that assumption and outcome could eventually be compared directly.

Turning next to Mr. Takuma WADA, Tony invited him to introduce PMCare and to reflect on how figures of this kind register within a private managed-care organization.

Mr. Wada described PMCare as a subsidiary of Sumitomo Corporation operating as a managed-care organization in Malaysia, holding an estimated 40 to 50 percent market share and sitting at the intersection of payers and medical providers. He reported that PMCare, in its daily interactions with corporate clients and insurers, faces its own difficulty in visualizing the value of preventive care, and situated Mr. Kato’s presentation against the backdrop of medical cost inflation in Malaysia running at around 15 to 16 percent a year — a trend that leaves payers focused principally on containing cost even as PMCare tries to make the case for prevention’s longer-term value.

Tony connected this to a theme Dr. Syahid had raised in an earlier lecture in the series — a focus on “return on health” and on corporate health responsibility, as distinct from conventional corporate social responsibility — and invited him to extend that argument into the present discussion of social value.

Dr. AHMAD Syahid situated his remarks within KPJ Healthcare Group, Malaysia’s largest private healthcare provider by hospital count, spanning thirty hospitals from mid-tier to top-tier facilities, with KPJ Healthcare University functioning as its academic arm. He described a deliberate institutional effort to look beyond hospital operations toward the broader transition from sick care to healthcare — a shift that, in his account, asks patients to take on more of the responsibility for their own health, financial security, and family security, rather than assuming that medical advances will simply be there when needed, given the rising cost of care even where subsidized or insured. His concept of “return on health,” modelled explicitly on the more familiar return on investment, aims to popularize this framing in Malaysia, and he located the workplace — following on from points made earlier in the series about barbershops and salons — as one of the more promising sites for building it, since it is where most people spend the greater part of their waking lives.

Tony then turned to Dr. Murallitharan Munisamy, inviting his reflections on the social value of prevention and on the BEAUTY & Health program, which NCSM has supported through implementation since its inception.

Dr. Muralli opened by describing the value of hearing both PERKESO and Astellas speak to prevention from what he characterized as genuinely complementary angles — one social-security-based, one corporate-sustainability-based — combining to offer a fuller account of what prevention means in both social and economic terms. 

He singled out for particular praise Dr. Syarif’s attempt to quantify what prevention actually costs, observing that even an institution as well placed as PERKESO struggles to build a continuous case for sustaining prevention investment year on year — not, in his assessment, through any fault of PERKESO, but because many policymakers continue to regard prevention as a significant resource expense rather than as an investment.

He illustrated the point with a development from the preceding fortnight: PERKESO’s move to extend accident coverage to protect workers around the clock, including outside the workplace, had been rolled back from a mandatory to a voluntary enrolment scheme following what he described as poorly informed social media pushback. 

Dr. Muralli reported having presented to Malaysia’s Ministry of Finance in a closed-door civil-society meeting earlier that same week to argue against the rollback, and returned to Mr. Kato’s monetary valuation work as one of the more promising available responses to this climate — a way of expressing what a dollar of prevention returns in monetary and human terms. 

Even so, he cautioned that the dollars-and-cents framing, while apparently the only language some policymakers respond to, does not by itself change the underlying reality: prevention continues to be treated by many decision-makers as a spending line rather than an investment, and that mindset, more than any shortage of data, remains the central obstacle confronting everyone on the panel.

Tony returned to Dr. Ahmad Syarif with a related question, asking him to reflect further on the resource constraints PERKESO faces in sustaining prevention and screening against a backdrop of rising NCD-linked invalidity and pension costs, and amid both positive campaigns such as Activ@Work and, at times, negative pushback online.

Dr. Ahmad Syarif situated his response within the wider occupational safety and health literature, noting research suggesting that a dollar invested in prevention returns roughly double in safety terms, and citing research from the International Social Security Association (ISSA) — of which PERKESO’s own chief executive currently serves as president — indicating an even larger, triple return specifically in the health domain, a figure that, set against Mr. Kato’s own 4.6-times result, he read as evidence of a broadly consistent, and strikingly favorable, pattern across independent methodologies. 

He acknowledged the continuing difficulty of settling on a single agreed method for calculating such returns, echoed Dr. Muralli’s call to keep making the case for prevention despite tight budgets, and set out PERKESO’s own legal hierarchy of obligations — rehabilitation, return to work, and income replacement chief among them — as constraints that shape, without foreclosing, its prevention efforts. 

He described PERKESO as actively reconsidering the HSP’s future design, weighing continued universal free screening against more targeted approaches such as tumor-marker testing, itself presently unaffordable within available funding, and reaffirmed PERKESO’s openness to further collaboration with Astellas, the Asia Cancer Forum, KPJ, and NCSM, already a close and longstanding partner.

Tony asked Mr. Wada whether, in his experience running managed care for Malaysian employers, employees tended to welcome screening or whether some reluctance persisted.

Mr. Wada reported a gradual increase in awareness among PMCare’s self-funded and insured corporate clients, with roughly half now proceeding to screening once offered; PMCare itself runs dedicated three- to six-month preventive-care awareness periods tracking core risk indicators such as BMI and blood pressure. He described a recent engagement with a holding company of around ten subsidiaries and roughly 1,000 participating employees, in which PMCare shared aggregated screening results with each subsidiary’s HR team, allowing a degree of friendly competition between them as an incentive to improve — and expressed hope that better visualization of preventive care’s value, along the lines Kato had presented, could accelerate this kind of uptake and, over time, help contain costs.

Tony broadened the discussion by asking whether the competitive, ranking-based model used in both Activ@Work and KPJ’s own initiatives could realistically extend to micro, small, and medium-sized enterprises (MSMEs), rather than remaining the preserve of larger companies.

Dr. Ahmad Syarif explained that Activ@Work already segments participating employers into bands by headcount — under 200, under 500, under 1,000, and over 1,000 employees — specifically to widen participation across companies of different sizes, offered free of charge; while historically concentrated among private-sector contributors, the competition has since opened to government employers, whose 2026 registrations were already running close to those of the private sector.

Dr. Ahmad Syahid added a complementary perspective from two vantage points at once: as part of KPJ, a large organization that sponsors roughly RM1,000 per employee per year toward screening of their choosing, and as the owner of a separate sixteen-employee micro-enterprise, where he personally sponsors staff screening out of pocket. In his assessment, awareness-raising and the introduction of tax incentives for MSMEs — which he suggested could meaningfully encourage smaller employers to send staff for screening — stood out as the two most important levers for extending this model down to the smallest firms.

Tony posed a closing question to the panel: looking ahead to the roughly three-hour discussion planned in a workshop session at APOCP 2026 in Kuching at the end of September 2026, what did panelists most wish to see carried forward into that session?

Dr. Muralli noted that the question had never really been one of further discussion, but rather of the urgency of moving to implementation. He traced BEAUTY’s own origin to perhaps no more than two informal conversations — one, as he recalled it, on the footpath outside the Kuala Lumpur City Centre, the other in Kazakhstan — roughly five years before the present lecture. 

From that modest beginning, he noted, BEAUTY has since contributed substantially to preventive efforts in Malaysia, not least through the library, data system, and patient registry the project built along the way, which was subsequently repurposed to support the successful HPV vaccination of 300,000 people — a return he described as one that sells BEAUTY a thousand times over. 

Today, he noted, that same registry holds close to 700,000 people who have passed through some form of screening or preventive intervention, the cumulative product of approximately four hours of initial conversation with Astellas colleagues.

Looking forward, Dr. Muralli noted that his central message to the Kuching gathering was that the field should move decisively past discussion toward small, deliberately scaled “phase-one” interventions — a term he preferred over “pilot,” on the grounds that pilots too often die a horrible death once their pilot phase concludes, whereas early-phase interventions are conceived from the outset for judicious scale-up. 

He stressed that prevention needs to be fueled by financing, and the panel’s central mission going forward is not further to diagnose the problem but to put in place concrete solutions to fix health financing, particularly on its preventive side.

Returning to Mr. Kato and Astellas, Tony picked up directly on Dr. Muralli’s point about financing, describing the BEAUTY & Health monetary valuation work — a single dollar of input yielding $4.6 million in modelled impact — as a genuinely persuasive basis for exactly the kind of investment case Dr. Muralli had called for, and asked Mr. Kato whether he agreed.

Mr. Kato acknowledged that the scale of the impact was large, but cautioned that going forward Astellas’ responsibility to its shareholders and other stakeholders would require it to demonstrate such impact quantitatively rather than qualitatively. He expressed the hope that figures of this kind could indeed prove persuasive to a wider audience.

Dr. Kawahara closed the session by expressing her sincere hope that the five guests joining the lecture would continue their dialogue together, carrying today’s ideas forward into future research, policy, and practice. She recalled that, since 2011, the lecture series has explored the proposition that cancer functions as a mirror of society, and described the course as more than an academic offering — an incubator, in her words, for implementation research, in which ideas can be developed, tested in society, and transformed into action, with the BEAUTY Project standing as one clear example of that process at work. 

To the students, she expressed her anticipation for their final policy briefs and voiced her hope that the briefs students would write might help shape a better future for Asia.

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Appendix: Final Assignment for Spring Semester 2026 Lecture Series 

Final Assignment

Making the Social Value of Cancer Prevention Visible

Presenting a New Perspective on the Culture of Prevention from Your Academic Field

Toward the Asia Well-being Survey and Prevention Culture Index

Graduate School of Arts and Sciences, The University of Tokyo

Course Instructor: Project Associate Professor Norie Kawahara

Submission deadline: 10 August 2026, 23:59 Japan Standard Time

Throughout this course, cancer has been used as a symbolic mirror of society: a shared setting in which knowledge from medicine, engineering, life sciences, information science, the social sciences, economics, culture, embodiment, social protection, and international cooperation can be brought together.

Many of the values protected through prevention appear as outcomes that did not occur: an illness that did not develop, employment or education that was not interrupted, or burdens that were not imposed on families and communities. Consequently, the social value of prevention is often difficult to capture through existing indicators such as treatment volumes and healthcare expenditure, and may therefore remain absent from public and institutional decision-making.

For the final assignment, students are asked to draw on their own academic or professional field to identify what society should observe in order to understand a culture of prevention, what remains invisible in existing indicators, and how that value might be made visible through a Policy Brief.

You are not expected to produce a completed index, measurement scale, or advanced statistical model. Nor are you required to propose a medical intervention for cancer prevention. Instead, you should treat cancer as a shared setting in which institutions, culture, economics, technology, the environment, the body, information, employment, families, communities, and international relations intersect, and consider what perspective your field can contribute.

The values, observational perspectives, visualization methods, proposed indicators, and identified blind spots presented in the Policy Briefs will serve as potential elements for the future development of the Asia Well-being Survey and the Prevention Culture Index.

2. Assignment

Prepare a Policy Brief that makes the social value of cancer prevention visible, drawing explicitly on the concepts, methods, and perspectives of your own field.

This is not a summary of the lectures. Your brief should integrate the following elements into one clearly focused and coherent argument.

Required Elements of the Policy Brief

1. The social value protected through prevention

Clearly identify whose value is protected through prevention and what that value consists of. The value need not be limited to health or survival. It may include continuity of everyday life, employment, education, dignity, social participation, family relationships, community sustainability, the environment, access to information, social trust, or equity.

2. What should be observed in order to understand a culture of prevention

Propose one phenomenon, condition, practice, or relationship that should be observed when assessing whether a culture of prevention is embedded in a society, community, organization, or institution. Consider not only individual knowledge and behavior, but also the roles of workplaces, schools, families, companies, governments, professionals, and communities.

3. What remains invisible in existing indicators

Identify one value, experience, population, timescale, or cultural context that is not adequately captured by existing statistics, surveys, or evaluation methods. Explain not only what is missing, but also why it has been overlooked.

4. A method for making the value visible

Explain what should be examined, from whom information should be obtained, and how the proposed value or phenomenon could be made visible. Your proposal does not need to take the form of a numerical indicator. Appropriate approaches may include survey questions, qualitative research, behavioral or environmental data, institutional assessment, narratives, comparative research, mapping, network analysis, or the systematic accumulation of cases.

5. Implications for policy or practice

Explain whose decisions or actions should change once the value has been made visible. Identify a specific decision-maker or target audience and present one feasible recommendation directed to a government body, company, educational institution, healthcare organization, professional association, community organization, international organization, or other relevant actor.

3. Submission Requirements

• Language: English

• Format: Policy Brief

• Length: 800–1,000 words, within a maximum of two pages

• References should be listed separately and are excluded from the word count.

• A maximum of one figure or table may be included.

• The brief must draw explicitly on at least two lectures or concepts presented in the course.

• The brief must use at least two external academic or policy sources.

• The intended audience or decision-maker must be clearly identified.

• The brief must have a clear English title that communicates its principal argument.

• Include your name, affiliation, academic field or research area, and email address.

• Submission deadline: 10 August 2026, 23:59 Japan Standard Time

4. Assessment Criteria

Assessment will not be based on whether the brief contains a completed index or an advanced statistical model. The following criteria will be emphasized:

• Originality of the perspective grounded in the student’s academic field

• Clarity in defining the value protected through prevention and the people whose value is concerned

• Critical understanding of the blind spots of existing indicators and evaluation methods

• Logical justification for the proposed method of visualization

• Clear identification of the intended audience and relevant decision-maker

• Specificity and feasibility of the policy or practice recommendation

• Potential contribution to future research, policy development, and interdisciplinary discussion

5. Use of the Policy Briefs after Submission

Each submitted Policy Brief will receive individual feedback from researchers. All students who submit the assignment will also receive a Certificate of Participation and a participation award.

With the author’s consent, submitted Policy Briefs will be presented at a visualization session during APOCP 2026, Cancer Intelligence for Action, to be held in Kuching, Malaysia, from 28 to 30 September 2026. The briefs will be organized into a single matrix structured around:

Academic field × Value protected × Method of visualization

Outstanding Policy Briefs will be individually featured or presented during the session.

No Policy Brief will be publicly presented or otherwise used without the prior consent of its author.

The course series will resume in October 2026, and students enrolled in the present course may enroll again.

6. Intended Outcome

This assignment does not seek a single correct answer or a completed index.

Each student is asked to identify one value that has remained insufficiently visible from the perspective of their own field and to propose a way for society to recognize, discuss, and use that value in decision-making.

When each person makes one previously invisible value visible, those contributions can collectively transform the value of prevention into a public value that can be shared, debated, and negotiated.