Perspectives
Profile
Kenji Shibuya: promoting global health in Japan
Kenji Shibuya’s work to foster Japan’s role in global health
is not a huge surprise. His father was a professor in public
health, so the young Shibuya was exposed to many aspects
of medicine from an early age. And as a medical student at
the University of Tokyo, he was inspired by the work of then
UN High Commissioner for Refugees Sadako Ogata. “This
appointment was big news and made Japanese students
want to get involved in the global agenda”, he recalls. After
qualifying, Shibuya avoided the career path of so many of
his contemporaries—a lifelong career in Tokyo University
Hospital. He chose, instead, to train at a rural hospital, an
experience that revealed “how the Japanese health system,
while strong, was not efficient or equitable in all locations”.
Mulling over his next career move, and inspired by the
World Bank’s World Development Report 1993: Investing in
Health, he went to the USA to work at Harvard University with
the report’s author Christopher Murray, who now directs the
Institute for Health Metrics and Evaluation at the University
of Washington. Their small team set about collecting all
the information they could on disease burden and health
systems, an arduous manual exercise at the time. This work
on improving data for the burden of disease, mortality, and
disability remains standard practice today. Murray then went
to WHO, and encouraged Shibuya to join him in Geneva.
Shibuya spent much of his time at WHO making sure
WHO’s databases were “evidence based, consistent, and
relevant for policy”. Health statistics was one of the key policy
debates and sources of controversy at the time, as the level
of development assistance for health was skyrocketing. He
helped build momentum in health metrics and evaluation
during this time and enjoyed success in establishing the
role of evidence in WHO policy-making. Having achieved
all he felt he could at WHO, Shibuya consulted his friend
and mentor Tachi Yamada about his next move. Yamada,
who was at the time president of global health at the Bill &
Melinda Gates Foundation, advised Shibuya to return home
and to do all he could to promote global health in Japan.
A watershed moment came in 2008 when Japan hosted
the G8 Summit in Toyako. Shibuya was asked to write a
strategic policy paper on health systems, and it was the
first time Japan had helped to lead a global health initiative.
“Kenji has been at the forefront of measuring progress in
global health using hard data and reliable and confirmable
information from the field”, says Yamada. “He championed
these views during his stint at WHO and his voice as well as
that of many others contributed to this landmark paper.
He has been a most important role model and leader in the
fledgling field of global health in Japan.”
The Japanese Government has since increased its support
for strengthening health systems in developing countries,
www.thelancet.com Published online August 30, 2011 DOI:10.1016/S0140-6736(11)61388-3
in line with the recommendations of that paper. Recently,
it encouraged increased donations to charities and non-
governmental organisations (NGOs) by waiving tax on
pledges for disaster relief. Shibuya hopes to see this cultural
and policy change extended to other global health activities.
“The country has received much sympathy from the world
following the recent disaster in Tohoku. This generosity,
together with innovations and new public movements,
particularly among the younger generation here, will make
it much easier to promote global health to the Japanese
people. I want them to see that disasters like the tsunami can
Published Online
happen anywhere in this interconnected world, and we must August 30, 2011
be ready to help. All nations are feeling uncertainty about DOI:10.1016/S0140-
health, about terrorism, about natural disasters.” Key to 6736(11)61388-3
boosting Japan’s global health ambitions are “transparency
about how much money is going where and a focus on
Japan’s comparative advantages, such as technology and
the provision of universal health care at low cost”, Shibuya
says. Currently, only 2% of Japan’s overseas development
assistance goes to health, although about 70% of Japanese
people think that health should be the primary target.
More recently, Shibuya has established the Japan Institute
for Global Health (JIGH) and wants it to reach out to many
sectors, including academics, Members of Parliament, NGOs,
industry, and the media, as well as working with the Japan
Center for International Exchange. He has also set up the
Global Health Leadership Program at the University of Tokyo,
which offers graduate students the training in leadership
and innovation in global health that he believes is most
lacking in the Japanese education system. While students
gain inspiration from lectures by such figures as Yamada and
Lobsang Sangay, Tibet’s new Prime Minister, Shibuya also
ensures they experience health care on the ground: “every
weekend I take them to Fukushima to support small villages
that have been affected by the nuclear accident, and to
provide health check-ups and consultations”, he explains.
The Lancet’s Japan Series comes at an important time for the
country, thinks Shibuya. He hopes it will help Japan address
how it would like its health system to develop. “The questions
about what we want have never been asked publicly, the
system has just evolved”, he observes. To move forward
“Japanese health requires leadership from both politicians
and doctors alike”, he says, and aims to instil exactly that
with the work of JIGH and the leadership programme. Small
wonder then with all these projects in hand that he has little
free time, but, when time permits, fly-fishing, walks with his
two dogs (a Westie and a French Bulldog), and an occasional
karaoke with students are his favourite ways to unwind.
Tony Kirby
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