Global health is standing at a crossroads. The past decade has been a glorious period for global health because aid to the health sector has surged, and newly formed public-private partnerships have increased the effectiveness of development assistance.¹ Japan has played a significant part, for example by leading discussions at the G8 Kyushu-Okinawa Summit in 2000 and by helping in the establishment of the Global Fun d to Fight AIDS, Tuberculosis and Malaria. However, countries now face changing disease structures, and non-communicable diseases are a global threat.² If the world follows the existing disease-focused vertical pathway for development assistance in the coming years, the disparity between resource allocation and actual disease burdens will widen. The disease-specific approach is straightforward, but the importance of tackling health in general is clear.³

At the G8 Hokkaido Toyako Summit in 2008, Japan proposed a comprehensive approach to health, inclusive of health system strengthening, to complement a vertical approach.⁴ A working group led by Keizo Takemi supported the work of the G8 Health Experts Group by recommending actions.⁵ Unfortunately, because of the financial crisis that began in 2008, there have been difficulties in sustaining the amount of aid for health.⁶

We should now pursue universal health coverage (UHC) to solve existing global health challenges and to embark on the post-2015 development agenda. UHC would help us to reach three goals. The first of these goals is to improve the health of countries' entire populations,⁷ including the most vulnerable people, women in particular.⁸ The existing Millennium Development Goals (MDGs) stop short of addressing widening domestic inequalities, and it is crucial to close the gap in access to health services between wealthy and poor people. The second goal is to ensure health service provision for all people, shifting from a disease-oriented to a people-centred approach.⁹ UHC can meet the wide-ranging health needs of every person. These two goals are interrelated and together help to achieve human security through protection and empowerment of individuals. The third goal is to enable countries to look at their own challenges and implement health policies that fill diversified needs with a limited budget.¹⁰ UHC can be a powerful way to reinforce country owner ship and setting of priorities in search of value for money.¹¹

This new pathway for global health is still at an early stage and needs strong political leadership, which is why I launched the Strategy on Global Health Diplomacy in May, 2013.¹² With this strategy, I first and foremost spare no efforts to incorporate UHC as a crucial element of the post-2015 development agenda. UHC is gaining a footing in the global health dialogue. The Foreign Policy and Global Health initiative led a resolution on UHC, which was adopted at the 67th UN General Assembly.¹³ I agreed with President François Hollande of France, who leads this initiative, to promote UHC.¹⁴

Second, I will reinforce Japan's assistance to developing countries to work with them to achieve UHC. Promotion of UHC does not mean a reduction of aid in the health sector or ignorance of the unfinished work of the MDGs. With regard to Africa, our work on MDGs opens the door towards UHC. At the 5th Tokyo International Conference on African Development (TICAD V) held in June, 2013, I called for the promotion of UHC¹⁵ and committed US$500 million of financial assistance in health, including capacity building of a 120000-strong health workforce.¹⁶

To turn our attention to Asia, Japan and the Association of Southeast Asian Nations (ASEAN) are celebrating the 40th year of ASEAN-Japan friendship and cooperation this year. As a microcosm of diversifying challenges of global health, ASEAN presents an opportunity for all the stakeholders in health to work together for the health of all the people of the region.¹⁷ I look forward to further reinforcing Japan's cooperation with ASEAN nations, particularly on how to effectively promote UHC.

Japan's strategy on global health diplomacy corresponds to the changing strategic environment. The 21st century calls for major powers to show leader ship in resolving common challenges of the international community, in addition to the leadership of 20th-century-style power politics.¹⁸ This dynamism is described as the age of smart power.¹⁹ Japan has the capacity and determination to undertake this new form of leadership.

Japan's success in achieving universal health insurance has improved equity in our health system, expanded coverage for our citizens, and controlled health-care costs.²⁰ Our experience shows how investment in UHC brings good returns. Investment in UHC could also help the redistribution of incomes according to the developmental stage of individual countries, and in turn aid the stabilisation of societies. On the basis of the achievements in UHC, Japan is now advancing its strategy toward a society of good health and longevity. Public long-term care insurance was initiated to help the elderly to live more independent lives in the community,²¹ and participation of older people in social activities has been reinforced. I encourage research and development through increased and consistent public investment and deregulation when necessary, while simultaneously developing industry for good health and longevity. These public and private efforts to achieve a greater increase in healthy life expectancy, which outweighs the increase in life expectancy, will lead to the successful handling of a test case of the most rapidly ageing society in the world.²² The emerging challenge of a globally ageing population should never be ignored when we look to the era of sustainable development post-2015.

More and more poor people are suffering from double disease burdens of non-communicable and communicable diseases, and technology is contributing to addressing these global health needs.²³ In April, 2013, the Global Health Innovative Technology Fund, a new model of funding for global health research and development, was established in Tokyo.²⁴ Technology should benefit the health of all people. My government stands ready to work with the private sector and help other countries to solve these global health challenges to contribute to the sustainable growth of the global economy.

Japan is at a crossroads - in 2012, we were asked whether Japan was determined to continue to be a tier-one nation.²⁵ Now I am ready to give a firm answer: of course we are. As a responsible and mature nation, Japan is willing to contribute to resolving the challenges that countries have in common, drawing on its own experiences. Global health diplomacy is the very strategy that embodies our vision and aspiration.

Shinzo Abe
Prime Minister of Japan

I declare that I have no conflicts of interest.

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